Deaths burden of laryngeal cancer attributable to occupational exposure in the male working age population: findings from global burden of disease study 2021

Our plain-English summary of Deaths burden of laryngeal cancer attributable to occupational exposure in the male working age population: findings from global burden of disease study 2021, by D. Wang, S. Yang, W. Yu, et al (Frontiers in Public Health, 2025).

The study

• Authors: D. Wang, S. Yang, W. Yu, Z. Tang, Q. Wang, M. Fang, C. Li
• Journal: Frontiers in Public Health
• Published: 2025;13:1605654
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Laryngeal cancer (LC) is a major health threat to the male working-age population, with occupational exposures (asbestos and sulfuric acid) being key risk factors. However, the deaths burden of LC attributable to occupational exposure in this population remains unclear. This study analyzes the deaths burden from 1990 to 2021 using Global Burden of Disease (GBD) data, providing insights for optimizing prevention strategies.

Methods: Data from GBD 2021 database were used to calculate age-standardized death rates (ASDR) and estimated annual percent changes (EAPC). Decomposition analysis and Bayesian age-period-cohort (BAPC) models were applied to assess trends, drivers, and predict future trends to 2040. Frontier analysis exploring the relationship between SDI and ASDR for 204 countries and territories.

Results: Globally, deaths burden of LC attributable to occupational exposures exhibited divergent trends from 1990 to 2021. Asbestos-related deaths decreased by 22% (533.6 cases in 2021; ASDR 0.02/100,000, 95% CI 0.01-0.04), with an EAPC of -3.23% (95% CI -3.32 to -3.14). Sulfuric acid-associated mortality increased by 16.19% (2,131.2 cases; ASDR 0.09/100,000, 95% CI 0.04-0.16), though with an EAPC decline of -1.90% (-1.98 to -1.82), suggesting improving age-standardized rates. Regional disparities were striking: High-SDI regions showed elevated asbestos burdens (Western Europe ASDR 0.06 vs. global 0.02), while middle-SDI regions dominated sulfuric acid mortality (South Asia ASDR 0.18 vs. global 0.09). Decomposition analysis revealed distinct drivers - asbestos burden growth (415% from epidemiological factors) reflected latency effects of historical exposures, whereas sulfuric acid increases stemmed from population expansion (336%) and aging (148%). Projections to 2040 indicate continued divergence: asbestos-related deaths are predicted to decline to 372.8 cases (ASDR 0.011/100,000), while sulfuric acid-associated mortality may rise to 2,543.8 cases (ASDR 0.078/100,000), with middle/low-SDI regions accounting for 78% of sulfuric acid burden.

Conclusion: Laryngeal cancer burden attributable to occupational exposure shows a contrasting trend with asbestos-related deaths appearing to decrease while sulfuric acid-related cases are rising. High-SDI regions face legacy asbestos risks, while middle and low-SDI regions are increasingly exposed to sulfuric acid. Targeted prevention strategies are needed, high-SDI regions should focus on asbestos risk management, and middle/low-SDI regions need to strengthen industrial protections, promote alternative materials, and enhance screening.

Copyright © 2025 Wang, Yang, Yu, Tang, Wang, Fang and Li.

In plain English

This study analysed Global Burden of Disease 2021 estimates of laryngeal (voice box) cancer deaths attributed to workplace asbestos or sulfuric acid exposure among men aged 15 to 64 in 204 countries and territories, 1990 to 2021. These are modelled estimates. Worldwide, 533.63 asbestos-attributed deaths were estimated for 2021 (95% CI 280.15 to 842.41), 22% fewer than in 1990. The age-standardized death rate was 0.02 per 100,000 (95% CI 0.01 to 0.04); its average annual change was −3.23% (95% CI −3.32 to −3.14). Southern Sub-Saharan Africa had the highest 2021 regional asbestos rate (0.12; 95% CI 0.06 to 0.19); Lesotho had the highest national rate (0.43). Sulfuric acid-attributed deaths rose 16.19% from 1990, to 2131.15 in 2021 (95% CI 899.19 to 3825.72). Asbestos-attributed deaths were projected to fall to 372.78 by 2040. The authors concluded that high-SDI (more developed) regions still face a substantial asbestos burden from historical exposure. They noted underreporting in low-income countries, incomplete control for smoking and alcohol, and yes/no exposure classification. The article's explanation of the asbestos trend contradicts its reported decline.

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: Secondary analysis of Global Burden of Disease (GBD) 2021 modelled estimates. Methods were trend analysis (estimated annual percentage change), decomposition analysis, Bayesian age-period-cohort projection to 2040, and frontier analysis against the Sociodemographic Index (SDI).
• Who was studied: Men of working age (15 to 64 years) in 204 countries and territories, grouped into 21 GBD regions and five SDI levels, 1990 to 2021.
• Exposure: Occupational exposure to asbestos (fiber type not specified) and occupational exposure to sulfuric acid, as attributed by GBD models. The authors state that exposure was classified as present or absent, with no exposure levels.
• Main results:
  • Globally, laryngeal cancer deaths attributed to occupational asbestos exposure among working-age men were 533.63 in 2021 (95% CI 280.15 to 842.41), a 22% decrease from 1990.
  • The global asbestos-attributed age-standardized death rate was 0.02 per 100,000 in 2021 (95% CI 0.01 to 0.04, per Table 1). The average annual change since 1990 was −3.23% (95% CI −3.32 to −3.14, per Table 1).
  • Among SDI groups in 2021, the High-middle SDI region had the most asbestos-attributed deaths (147.25) and the Low SDI region the fewest (26.24). The highest asbestos-attributed rates were in the High and High-middle SDI regions.
  • The Low-middle SDI region was the only SDI group with an increasing asbestos-attributed rate from 1990 to 2021 (0.27% per year).
  • In 2021 the highest regional asbestos-attributed rates were in Southern Sub-Saharan Africa (0.12; 95% CI 0.06 to 0.19, per Table 1), Central Europe (0.07) and Tropical Latin America (0.07).
  • Nationally in 2021, Lesotho had the highest asbestos-attributed rate (0.43 per 100,000), followed by Monaco (0.20) and Eswatini (0.19). No intervals are given for these figures.
  • Across regions, higher SDI was generally associated with a higher asbestos-attributed rate.
  • The decomposition of asbestos-attributed deaths is printed as epidemiological changes 415.13%, population growth −216.16% and aging −98.96%. The text describes this as an 'increase', which conflicts with the reported 22% decline in deaths.
  • Projections: asbestos-attributed deaths were projected to fall to 372.78 by 2040, with the rate falling to 0.011 per 100,000.
  • Sulfuric acid-attributed laryngeal cancer deaths among working-age men were 2131.15 in 2021 (95% CI 899.19 to 3825.72), a 16.19% increase from 1990.
  • Sulfuric acid-attributed deaths were projected to rise to 2,543.78 by 2040, while the rate was projected to fall to 0.078 per 100,000.
• The authors' conclusion: The authors concluded that asbestos-related laryngeal cancer deaths in working-age men are decreasing while sulfuric acid-related deaths are rising. They concluded that high-SDI regions still carry a substantial asbestos burden from historical exposure, which they attributed mainly to delayed carcinogenic effects.
• Limitations the authors state:
  • Underreporting of data in low-income countries.
  • Only 1990 to 2021 data were covered, missing earlier high-exposure populations.
  • Smoking and alcohol were not fully controlled for.
  • Exposure was classified only as present or absent, so exposure levels could not be assessed.
  • Exposure settings were not distinguished, so key risk contexts may have been missed.
  • Confidence intervals for the death rates were wide, and occupational exposure misclassification may bias the estimates.
  • The decomposition assumes demographic and epidemiological factors act independently, which may oversimplify interactions.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Throat and laryngeal cancer.

Medical terms in this study, explained in our Lexicon: Laryngeal Cancer, Occupational Exposure, Latency.

Related studies

• Global, regional and national mortality burden of laryngeal cancer attributable to occupational exposure to sulfuric acid and asbestos: 1990-2021 and projections to 2040 — X. Gong, Y. Xu, et al. (2025)
• Global, regional and country-specific burden of larynx cancer due to occupational exposure to asbestos: a systematic analysis of the Global Burden of Disease Study 2021 — S. Zhang, D. Du, et al. (2025)
• The global burden and associated factors of ovarian cancer in 1990-2019: findings from the Global Burden of Disease Study 2019 — S. Zhang, C. Cheng, et al. (2022)
• The global burden of cancers attributable to occupational factors, 1990-2021 — B. Zou, P. Wu, et al. (2025)
• Global burden of mesothelioma attributable to occupational asbestos exposure in 204 countries and territories: 1990-2019 — Z. Chen, Y. Cai, et al. (2024)
• Global and regional burden of disease and injury in 2016 arising from occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 — GBD 2016 Occupational Risk Factors Collaborators (2020)

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