title: Regional variations in German mesothelioma mortality rates: 2000–2010.
abstract: OBJECTIVE
  Germany has one of the highest age-adjusted mesothelioma mortality rates worldwide. As mesothelioma occurs ≥ 30 years after asbestos exposure, contemporary rates likely reflect exposures in the 1960-1970s. During this period, political division between West and East Germany led to differences regarding the import and consumption of asbestos. It is unclear whether mesothelioma rates also differ between these formerly separate countries which are now served by similar health and mortality reporting systems, thereby facilitating regional comparisons.
  
  
  METHODS
  We examined regional, temporal, and sex variations in mesothelioma mortality rates in Germany in 2000-2010, collapsing the federal states into West Germany, East Germany, and Berlin. We calculated truncated (≥ 40 years) age-standardized mesothelioma mortality rates (ASRs(40+)) per 100,000 person-years, estimated sex-stratified mortality rate ratios (MRRs) (95 % confidence intervals (CIs)), adjusted for age and calendar year from Poisson models, and fitted age-period-cohort models.
  
  
  RESULTS
  There were 12,854 mesothelioma deaths at ages ≥ 40 years in Germany during 2000-2010. ASRs(40+) were higher in West (males 4.4; females 0.8) than East (males 1.7; females 0.6) Germany. MRRs for West versus East Germany were 2.68 (95 % CI 2.48-2.88) among males and 1.42 (95 % CI 1.27-1.59) among females. In both regions, mortality rates increased for birth cohorts until the mid 1940s and subsequently declined. The country's peak mesothelioma burden is predicted to occur by 2020.
  
  
  CONCLUSIONS
  Geographical differences in mesothelioma mortality rates are consistent with heterogeneous historical asbestos exposures. Differences may exist for other asbestos-related cancers and should be investigated in analytic studies with individual asbestos exposure information.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Schonfeld
authors.forename: Valerie
authors.initials: V
authors.lastname: McCormack
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Rutherford
authors.forename: Joachim
authors.initials: J
authors.lastname: Schüz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000506:poisoning; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D005859:Germany, East / Q000453:epidemiology; D005860:Germany, West / Q000453:epidemiology; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000401:mortality*; D008875:Middle Aged
chemical_list: D001194:Asbestos