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Manufacturers who were aware of the dangers of asbestos continued to use asbestos in manufacturing and construction. They ignored safer alternatives to make a profit for their own benefit. Manufacturers first began using asbestos in their buildings, for its absorption, strength and resistance to heat, electrical and chemical damage. If you are a victim of asbestos you have a right to file a lawsuit to the manufacturer. They are at fault for the damage and the pain you are suffering. The courts have recognized this, making it possible for victims, and the families of victims, to recover compensation for their suffering.
Contact an Attorney Who Can Help
If doctors have diagnosed you or a loved one with asbestosis, lung cancer or mesothelioma, call Long Island law firm at (631) 543-3663. There is no charge for a case evaluation. Our attorneys have handled over 1,200 asbestos cases and over 100 lung cancer cases.In response to the health risks posed by asbestos exposure, some countries have imposed strict regulations and adopted bans, whereas other countries have intervened less and continue to use varying quantities of asbestos.Objectives
This study was designed to assess, on a global scale, national experiences of recent mortality from pleural mesothelioma, historical trends in asbestos use, adoption of bans, and their possible interrelationshipsMethodsFor 31 countries with available data, we analyzed recent pleural mesothelioma (International Classification of Diseases, 10th Revision) mortality rates (MRs) using age-adjusted period MRs (deaths/million/year) from 1996 to 2005. We calculated annual percent changes (APCs) in age-adjusted MRs to characterize trends during the period. We characterized historical patterns of asbestos use by per capita asbestos use (kilograms per capita/year) and the status of national bans.Results
Period MRs increased with statistical significance in five countries, with marginal significance in two countries, and were equivocal in 24 countries (five countries in Northern and Western Europe recorded negative APC values). Countries adopting asbestos bans reduced use rates about twice as fast as those not adopting bans. Turning points in use preceded bans. Change in asbestos use during 1970–1985 was a significant predictor of APC in mortality for pleural mesothelioma, with an adjusted R2 value of 0.47 (p < 0.0001).Conclusions
The observed disparities in global mesothelioma trends likely relate to country-to-country disparities in asbestos use trends.Keywords: asbestos, asbestos-related diseases, ban, epidemiology, lung cancer, mesothelioma, mortality, occupational cancer, pleural mesothelioma
The world is steadily retreating from dependence on asbestos. In 2006 the International Labour Organization (ILO 2006) and World Health Organization (WHO 2006a) jointly declared that the most efficient way to eliminate asbestos-related diseases is to stop using all types of asbestos. Nevertheless, current use varies widely. Some countries have imposed strict regulations to limit exposure, others have adopted bans, and yet others have intervened less and have continued to use varying quantities of asbestos. The global burden of asbestos diseases over time will be uneven, reflecting the extent and patterns of asbestos use.
Globally, each year, an estimated 125 million people are occupationally exposed to asbestos, and 90,000 die from asbestos diseases (WHO 2006a). Around the time of peak use in the mid-1970s, approximately 25 countries produced asbestos and 85 countries manufactured asbestos products (Virta 2005). In 1983, Iceland became the first country to ban asbestos, reflecting increasing recognition, predominantly in Western countries, of health risks associated with asbestos exposure. Subsequently, 40 or more countries have adopted bans (WHO 2006a).Among the asbestos diseases, mesothelioma is the most sensitive and specific indicator of the disease burden in the population (Weill et al. 2004). The annual incidence of mesothelioma has been estimated at 10,000 cases in Western Europe, North America, Japan, and Australia combined (Anonymous 1997). Peto et al. (1995, 1999) predicted a dramatic increase in future mesothelioma deaths in the United Kingdom and Europe. Several statistical projections have been made since then, suggesting that deaths from mesothelioma will increase in many countries.
We recently reported that per capita asbestos use is a useful surrogate for the general asbestos exposure level of a population and may be used for estimation of health effects (Lin et al. 2007). Information is limited at the global level concerning the relationship between mesothelioma trends and trends in asbestos use, and the status of bans. Our aim in the present study was to assess, on a global scale, national experiences of recent mortality from mesothelioma, historical trends in asbestos use, adoption of bans, and their possible interrelationships. We focused specifically on pleural mesothelioma in men because a high proportion of such cases arise from asbestos exposure.Go to:
Materials and Methods
Indicators of mortality
The primary source of information on mortality was the WHO database (WHO 2006b). It registers the number of deaths by country according to the International Classification of Diseases (ICD). Several countries shifted from coding based on the ICD 9th Revision (ICD-9) to that based on the 10th Revision (ICD-10) (WHO 1992) during our 1996–2005 study period [year of change ranged from 1996 to 2002, with a median of 1998 in the countries studied; Supplemental Material, Table 1 (http://www.ehponline.org/members/2008/11272/suppl.pdf)]. Notably, the disease category of mesothelioma was initially introduced into ICD-10 codes comprising subcategories of pleural (C45.0), peritoneal (C45.1), pericardial (C45.2), other sites (C45.7), and unspecified (C45.9). In our study, we defined pleural mesothelioma as a composite of mesothelioma of the pleura (C45.0) and unspecified mesothelioma (C45.9) because in certain countries, including the United States, most mesothelioma was coded as C45.9 instead of C45.0. From the database, we obtained the annual numbers of male deaths for each country, based on 5-year age intervals.
Recent trend in mortality from pleural mesotheliomaa in men.
We obtained national population data from the WHO (2006b), the U.S. Census Bureau (2006), the United Nations (2006), and Lahmeyer (2007), prioritized for use in that order. For each country, we calculated age-adjusted annual mortality rates (annual MRs; deaths/million/year) by dividing the number of male deaths in each year by the size of the corresponding male national population, which we age-standardized to the world standard population of the year 2000 (Ahmad et al. 2000). We similarly calculated period MRs by dividing the average annual number of male deaths from 1996 to 2005 by the average sizes of male national populations, also age-standardized.
To characterize the trend of mortality, we estimated the annual percent change (APC) of annual MRs using the Joinpoint software (version 3.0, U.S. National Cancer Institute, Bethesda, MD, USA). Briefly, the method fits a least-squares regression line to the natural logarithm of the rates using calendar year as a regressor variable. That is, y = bx + c, where y is the ln(rate), x is the calendar year, and c is the intercept. Hence, APC = 100 × (eb – 1) (Jemal et al. 2000; Lasithiotakis et al. 2006; Ries et al. 1997). In addition, we calculated p-values for APC = 0 and 95% confidence intervals (CIs) of APCs. Testing the hypothesis that APC = 0 is equivalent to testing the hypothesis that the regression slope parameter is equal to zero (Ries et al. 1997). We assumed a linear change of trends in log rates over time. Because trends pertained to a 10-year period, we limited analyses to countries with at least 4 years of pleural mesothelioma data under ICD-10 codes (the range was 4–9 years, with a median of 6 years).Indicators of asbestos use
We extracted data on new use of asbestos by country from a U.S. Geological Survey (USGS) report (Virta 2006). We defined “use” as production plus import minus export (Virta 2006). We considered negative values of use (caused by storage and the like) uninformative and excluded them from further analyses. To characterize trends, we divided use numbers by sizes of national populations for the corresponding year or period (to give use per capita, expressed as kilograms per capita/year) (Lin et al. 2007). The USGS database provides data only sparsely in 10-year intervals up to 1960, 5-year intervals from 1970–1995, and annually for 1996–2003. We classified use of ≥ 3.0 kg per capita/year as high and ≥ 4.0 as very high, and change in use during a particular period (Δ, kilograms per capita/year) as the difference between average use during the earlier and latter subperiods (halves) of the entire period (e.g., for the period 1960–1985, change is the difference between the average use of 1960 and 1970 and the average use of 1975 and the average use of 1980, and 1985; for the period 1970–1985, change is the difference between the average use of 1970 and 1975 and the average use of 1980 and 1985). We calculated Δ values for all possible combinations of available data. We retrieved national ban status from the database compiled by Kazan-Allen (2005, 2006) and verified it by separate reports. To describe historical trends in asbestos use and relationships with banning status, we grouped countries according to their national ban status into early-ban (adopted by 1995), late-ban (1996–2006), and no-ban groups.
Statistical analysisWe adapted geographic grouping of countries from the U.N. Statistics Division (United Nations 2006). We performed statistical analyses using Joinpoint, SPSS version 12.0 (SPSS Inc., Chicago, IL, USA), and Excel 2003 (Microsoft Corp., Redmond, WA, USA). When we used Joinpoint, we assumed a linear change (or 0 joinpoint) during the observed period, with a maximum length of 10 years. We deemed p < 0.05 statistically significant and 0.05 < p < 0.10 marginally significant. We use the terms “increase” (denoted as ↑) or “decrease” (↓) when APC was marginally or statistically significant, and “equivocal” (↔) when APC and its significance level were neither statistically nor marginally significant.When we evaluated trends in asbestos use by groups of countries, we weighted means by the size of national populations of the corresponding periods. We analyzed data from the United States separately because of the known high degree of historical asbestos use. We regressed recent changes in pleural mesothelioma mortality (APC values) against historical changes in use of asbestos (Δ values for various periods). We weighted each regression model by the sizes of male national populations in the corresponding per
Results
Trends in mortality
Table 1 shows the period MRs and APCs in mortality for pleural mesothelioma and male population by country. Mortality from pleural mesothelioma was highest in United Kingdom (31.1 deaths/million/year), with a global median of 7.8 deaths/million/year. Trends of mortality were as follows: statistically significant increases in five countries, marginally significant increases in two countries, and equivocal results in 24 countries. Global median APC was 4.5%/year, and negative values of APC were recorded in five countries of Northern and Western Europe. We observed increasing trends more often in countries with above-median period MR values than in those with below-median values (26.7%, or 4 of 15, vs. 20.0%, or 3 of 15).
Regionally, countries of Northern and Western Europe and Oceania showed high and stable MRs; those of Eastern and Southern Europe, South America, and Asia showed low and increasing rates.
Trends in asbestos use
Asbestos use peaks were higher and occurred earlier in the countries of Northern and Western Europe, Oceania, and the Americas (excluding South America) (Table 2). Very high (≥ 4.0 kg per capita/year) asbestos use was recorded in Australia, Canada, and several countries of Northern and Western Europe.

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