title: The next mesothelioma wave: mortality trends and forecast to 2030 in Brazil.
abstract: BACKGROUND
  There are limited data on mesothelioma mortality in industrializing countries, where, at present, most of the asbestos consumption occurs.
  
  
  OBJECTIVE
  To analyze temporal trends and to calculate mortality rates from mesothelioma and cancer of the pleura in Brazil from 2000 to 2012 and to estimate future mortality rates.
  
  
  METHODS
  We retrieved records of deaths from mesothelioma (ICD-10C45) and cancer of the pleura (ICD-10C38.4) from 2000 to 2012 in adults aged 30 years and over. Crude and age-standardized mortality rates (ASMR) were calculated. Rate ratios of mean crude mortality for selected municipalities were compared to the Brazilian rate. A regression was carried out of the annual number of deaths against asbestos consumption using a Generalized Additive Model (GAM). The best model was chosen to estimate the future burden and peak period of deaths.
  
  
  RESULTS
  There were 929C45 and 1379 C38.4 deaths. The ratio of men to women for C45 was 1.4. A positive trend in C45 numbers was observed in Brazil (p=0.0012), particularly in São Paulo (p=0.0004) where ASMRs presented an increasing linear trend (p=0.0344). Selected municipalities harboring asbestos manipulation presented 3.7-11 fold rate ratios of C45 compared to Brazil. GAM presented best fits for latencies of 34 years or more. It is estimated that the peak incidence of C45 mortality will occur between 2021 and 2026.
  
  
  CONCLUSIONS
  The observed ASMRs and the gender ratio close to 1 suggest underreporting. Even so, deaths are increasing and mesothelioma clusters were identified. Compared to industrialized countries Brazil displays a 15-20 year lag in estimated peak mesothelioma mortality which is consistent with the lag of asbestos peak consumption in the country.
authors: Division of Medicine, FUNDACENTRO, São Paulo, Brazil. Electronic address: eduardo@fundacentro.gov.br.
authors: Eduardo
authors: E
authors: Algranti
authors: Division of Educative Actions, FUNDACENTRO, São Paulo, Brazil.
authors: Cézar Akiyoshi
authors: CA
authors: Saito
authors: Workers' Health Service, Hospital das Clinicas, Federal University of Minas Gerais, Brazil.
authors: Ana Paula Scalia
authors: AP
authors: Carneiro
authors: Workers' Health Service, Hospital das Clinicas, Federal University of Minas Gerais, Brazil.
authors: Bruno
authors: B
authors: Moreira
authors: Division of Medicine, FUNDACENTRO, São Paulo, Brazil.
authors: Elizabete Medina Coeli
authors: EM
authors: Mendonça
authors: Division of Statistics and Epidemiology, FUNDACENTRO, São Paulo, Brazil.
authors: Marco Antonio
authors: MA
authors: Bussacos
mesh_terms: D000328:Adult; D001194:Asbestos / Q000009:adverse effects; D001938:Brazil / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D000067896:Industrial Development / Q000639:trends; D008297:Male; D008495:Medical Oncology / Q000639:trends*; D008654:Mesothelioma / Q000401:mortality*; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000401:mortality*
chemical_list: D001194:Asbestos
keywords: Asbestos; Brazil; Mesothelioma; Mortality