Burden of Mesothelioma in China, 1990-2023: Trends, Decomposition, and Projections Until 2045

Our plain-English summary of Burden of Mesothelioma in China, 1990-2023: Trends, Decomposition, and Projections Until 2045, by K. Hu, Q. Ye, R. Zhao, et al (Cancers, 2026).

The study

• Authors: K. Hu, Q. Ye, R. Zhao, C. Ma, X. Zhang, T. Xie, C. Shao, C. Ding, J. Zhao, H. Ding
• Journal: Cancers
• Published: 2026;18(15)
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma is a rare but highly aggressive malignancy strongly associated with asbestos exposure. Owing to its long latency and poor prognosis, its burden requires systematic evaluation. Methods: Data on prevalence, incidence, deaths, disability-adjusted life years (DALYs), and age-standardized rates were extracted from the Global Burden of Disease Study 2023. The estimated annual percentage change, Joinpoint regression, Das Gupta decomposition, and Nordpred forecasting were used to assess temporal trends, identify turning points, quantify demographic and epidemiological contributions, and project future burden through 2045. Results: From 1990 to 2023, the absolute burden of mesothelioma in China increased substantially. Prevalent cases rose by 189%, incident cases by 150%, DALYs by 98%, and deaths by 142%. Males consistently showed a higher burden than females, and the burden was concentrated mainly among middle-aged and older adults. The age-standardized prevalence rate and age-standardized incidence rate increased, whereas the age-standardized DALY rate and age-standardized mortality rate remained stable or declined slightly. Decomposition analysis indicated that population growth and aging were the principal drivers of increased DALYs and deaths, while epidemiological change contributed negatively. Projections suggested that deaths may continue to increase through 2045, despite declining age-standardized fatal burden. Conclusions: This is the first update of the burden of mesothelioma in China over the past thirty-four years. The absolute burden of mesothelioma in China, as estimated by the GBD study, increased markedly, largely driven by demographic changes. Strengthening asbestos exposure surveillance, diagnostic standardization, and cancer registration systems would enable burden estimates to be derived from directly observed and certified data rather than relying primarily on model-based assumptions, while potentially identifying previously unrecognized sources of asbestos exposure.

In plain English

This study analysed modelled estimates of mesothelioma (ICD-10 code C45) in China from the Global Burden of Disease Study 2023. It did not study individual patients and had no detailed asbestos exposure data. Between 1990 and 2023, estimated prevalent cases rose from 1607.49 (95% uncertainty interval 1219.50 to 2116.23) to 4640.31 (3545.91 to 6025.91), a 189% increase. Incident cases rose by 150%, deaths by 142%, and disability-adjusted life years (DALYs, a measure of healthy life lost) by 98%. The age-standardized prevalence and incidence rates rose slightly. The estimated annual percentage change was minus 0.21% (95% CI minus 0.38% to minus 0.03%) for the age-standardized DALY rate. It was minus 0.03% (95% CI minus 0.20% to 0.14%, an interval including zero) for the age-standardized death rate. Rates were higher in males than females in most age groups. A decomposition analysis attributed the rise in deaths and DALYs mainly to population aging and growth. Projections suggested deaths may keep rising to 2045. The authors concluded that demographic change was the main driver. They cautioned that rising rates may partly reflect better diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive epidemiological trend analysis of modelled Global Burden of Disease (GBD) 2023 estimates, using estimated annual percentage change, joinpoint regression, Das Gupta decomposition and Nordpred projections
• Who was studied: The whole population of China, 1990 to 2023, as estimated by GBD 2023; mesothelioma defined by ICD-10 code C45 (all sites combined)
• Exposure: Asbestos exposure was not measured. The GBD data used contain no detailed information on asbestos exposure or occupational history. The outcome studied was overall mesothelioma burden.
• Main results:
  • Estimated prevalent cases in China (both sexes) rose from 1607.49 (95% UI 1219.50 to 2116.23) in 1990 to 4640.31 (95% UI 3545.91 to 6025.91) in 2023, a 189% increase
  • Incident cases increased by 150% from 1990 to 2023 (160% in males, 135% in females)
  • Deaths increased by 142% from 1990 to 2023 (141% in males, 142% in females)
  • DALYs increased by 98% from 1990 to 2023 (108% in males)
  • Estimated annual percentage changes (both sexes, percent per year) were: age-standardized DALY rate −0.21% (95% CI −0.38% to −0.03%); age-standardized prevalence rate 0.83% (95% CI 0.65% to 1.01%); age-standardized incidence rate 0.20% (95% CI 0.02% to 0.37%); age-standardized mortality rate −0.03% (95% CI −0.20% to 0.14%, an interval that includes zero)
  • In 2023, rates were markedly higher in males than females across most age groups
  • Joinpoint analysis found the fastest increases in age-standardized prevalence, incidence and DALY rates during 2004 to 2009 (annual percent changes 4.68, 3.59 and 2.94)
  • Decomposition of the DALY increase: epidemiological change −5646.96 (−15.21%), population aging 21,021.92 (56.61%), population growth 21,757.03 (58.59%)
  • Decomposition of the increase in deaths: epidemiological change −119.66 (−7.37%), population aging 1002.59 (61.74%), population growth 740.93 (45.63%)
  • Projections for 2024 to 2045: DALYs relatively stable and deaths rising. Deaths are projected to reach 1979 in males (age-standardized mortality rate 0.13 per 100,000) and 1316 in females by 2045.
• The authors' conclusion: The authors concluded that the absolute burden of mesothelioma in China increased markedly from 1990 to 2023, while age-standardized fatal burden remained stable or declined slightly. They named population aging and growth as the main drivers of increasing deaths and DALYs. They stated that their policy recommendations are not conclusions derived directly from the analysis.
• Limitations the authors state:
  • The analysis used GBD modelled estimates rather than individual-level registry or hospital data, and may be affected by data availability, coding accuracy, disease misclassification and model assumptions
  • There was no information on occupational history, tumor site, histological subtype, stage, treatment or survival, which limits causal interpretation
  • Rising age-standardized incidence and prevalence rates may partly reflect improved diagnosis and more complete cancer registration rather than a true increase
  • Decomposition analysis cannot identify the specific mechanisms behind epidemiological change
  • Projections are scenario-based forecasts built on current trends, not precise estimates
  • Data quality varies by region within China, which may affect the precision of national estimates

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Asbestos Exposure, Latency, Prognosis, Incidence.

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