Effect of Asbestos Consumption on Malignant Pleural Mesothelioma in Italy: Forecasts of Mortality up to 2040.

Enrico Oddone,Dario Consonni,Antonio Gasparrini,Francesco Barone-Adesi,Alessandro Marinaccio,Jordy Bollon,Corrado Magnani,Consuelo Rubina Nava

doi:10.3390/cancers13133338

Abstract

Simple SummaryAsbestos consumption figures could be used to construct epidemiological models to forecast the pleural mesothelioma mortality, although they are not frequently taken into consideration in this kind of analysis. Our purpose is to predict the future burden of pleural mesothelioma deaths in Italy until 2039 and to describe the exposure–response curve considering time lasted from the exposure start. Our results could be of interest to plan future needs of the Italian health system and to provide evidence on the consequences of asbestos exposures useful for countries in which this material is, at present, still used for productive activities.Statistical models used to forecast malignant pleural mesothelioma (MPM) trends often do not take into account historical asbestos consumption, possibly resulting in less accurate predictions of the future MPM death toll. We used the distributed lag non-linear model (DLNM) approach to predict future MPM cases in Italy until 2040, based on past asbestos consumption figures. Analyses were conducted using data on male MPM deaths (1970–2014) and annual asbestos consumption using data on domestic production, importation, and exportation. According to our model, the peak of MPM deaths is expected to occur in 2021 (1122 expected cases), with a subsequent decrease in mortality (344 MPM deaths in 2039). The exposure–response curve shows that relative risk (RR) of MPM increased almost linearly for lower levels of exposure but flattened at higher levels. The lag-specific RR grew until 30 years since exposure and decreased thereafter, suggesting that the most relevant contributions to the risk come from exposures which occurred 20–40 years before death. Our results show that the Italian MPM epidemic is approaching its peak and underline that the association between temporal trends of MPM and time since exposure to asbestos is not monotonic, suggesting a lesser role of remote exposures in the development of MPM than previously assumed.

Highlights

Asbestos exposure, both in occupational and environmental settings, is estimated to annually cause around 255,000 deaths worldwide and an impressive amount in social costs and human suffering [1,2,3]
Analyses were conducted using data from the Italian National Statistical Institute (ISTAT) on male malignant pleural mesothelioma (MPM) deaths that occurred in the period 1970–2014
We explored different age ranges during which asbestos exposure likely occurred (15–65, 15–70, 20–65, and 20–70 years), and we considered exposed in each yearly period only the subjects in these age ranges

Summary

Introduction

Both in occupational and environmental settings, is estimated to annually cause around 255,000 deaths worldwide and an impressive amount in social costs and human suffering [1,2,3]. A large proportion of such deaths are due to Malignant Pleural Mesothelioma (MPM), a type of cancer that is almost exclusively caused by asbestos exposure [4]. Was one of the most important producers and users of asbestos worldwide. National consumption of asbestos exceeded 100,000 tons in 1970 and further increased in the following years to reach 180,000 tons in 1980 [7,8]. Its largest use was in asbestos-cement production, followed by fire-proofing and thermal insulation in shipbuilding and railway carriages [9]. In 1992, a national ban forbade asbestos production, import, export, and trading in Italy. It has been calculated that at the beginning of the 2000s, there were still more than 70,000 workers in Italy that were exposed to asbestos, mainly in the construction and in the asbestos-removal sectors [11]

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