Epidemiology of asbestosis in the Netherlands: a 10-year cohort analysis

Our plain-English summary of Epidemiology of asbestosis in the Netherlands: a 10-year cohort analysis, by I. Smesseim, H. Schouwink, J.C. Grutters, et al (ERJ Open Research, 2026).

The study

• Authors: I. Smesseim, H. Schouwink, J.C. Grutters, H. Kromhout, D. Heederik, J.A. Burgers
• Journal: ERJ Open Research
• Published: 2026;12(4)
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Asbestosis is a progressive interstitial lung disease caused by inhalation of asbestos fibres. Although asbestos use was banned in the Netherlands in 1993, new cases continue to be diagnosed. Since 2014, a national compensation system has enabled systematic assessment of asbestosis incidence and outcomes. This population-based study examined national trends in asbestosis incidence from 2014-2024 and evaluated survival and prognostic factors.

Methods: We conducted a retrospective national cohort study including all adults (≥18 years) diagnosed with asbestosis between 2014-2024 according to Dutch Health Council criteria used for compensation. Diagnoses were established by consensus of three independent pulmonologists based on radiological evidence of diffuse pulmonary fibrosis, ≥5 fibre-years of exposure, and lung function impairment according to American Medical Association (AMA) criteria. Demographic data, lung function, work history and overall survival were collected. Incidence per 100 000 persons per year was calculated.

Results: Of 1004 applicants, 476 (47.4%) met criteria for asbestosis. Median age at diagnosis was 77 years, and 98.9% were male. Annual incidence ranged from 0.115 to 0.347 per 100 000, with no significant temporal trend (Spearman rho 0.41; p=0.214). AMA class 4 was most common (44.5%) and strongly associated with mortality (hazard ratio 2.52, 95% CI 1.81-3.49). Older age also predicted poorer survival. Median survival ranged from 25.5 months (AMA 4) to 83.4 months (AMA 0-2). Time-dependent modelling showed increasing hazard over time for AMA class 4.

Conclusions: More than two decades after the asbestos ban, asbestosis incidence remains stable. AMA class and age are key predictors of survival.

Copyright ©The authors 2026.

In plain English

This retrospective national cohort study used Dutch compensation records to measure asbestosis diagnoses from 2014 to 2024 and patient survival. Of 1004 applicants, 476 (47.4%) met the Dutch Health Council criteria, as judged by three pulmonologists. The criteria were diffuse lung fibrosis, at least 5 fibre-years of asbestos exposure starting at least 15 years before symptoms, and lung function loss graded by the American Medical Association (AMA) system. Patients' median age was 77, and 98.9% were men. Yearly incidence ranged from 0.115 to 0.347 per 100 000 people, with no statistically significant trend. The 212 patients (44.5%) in AMA class 4, the most severe impairment, had a higher hazard of death than those in classes 0–2 (hazard ratio 2.52, 95% CI 1.81–3.49). Their median survival was 25.5 months, against 83.4 months for classes 0–2. Older age was also linked to shorter survival. Sex and smoking status were not significantly linked. The authors concluded that incidence remained stable more than two decades after the 1993 ban. They cautioned that their figures describe compensated asbestosis only, not all cases.

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: Retrospective national cohort study based on applications to the Dutch asbestosis compensation program
• Who was studied: 1004 people who applied to the Institute for Asbestos Victims for asbestosis compensation in the Netherlands between 1 January 2014 and 1 January 2025. Of these, 476 (47.4%) met the criteria and were analysed. Median age at diagnosis was 77 years and 98.9% were male.
• Exposure: Occupational asbestos exposure of at least 5 fibre-years, beginning at least 15 years before typical symptoms, was required for inclusion. Median total work-years was 45.0 (IQR 38.0–48.0). The article does not specify fiber types.
• Main results:
  • Among confirmed asbestosis cases, annual incidence ranged from 0.115 to 0.347 per 100 000. There was no statistically significant trend over 2014–2024 (Spearman rho 0.41; p=0.214).
  • Overall incidence of asbestosis in the Netherlands over 2014–2024 was 0.241 cases per 100 000 persons per year.
  • Of the 476 patients, 44.5% (212) had AMA class 4 (severe) lung function loss at diagnosis.
  • Only 54 of 476 patients (11.3%) had undergone a lung biopsy.
  • AMA class 4 patients had a higher hazard of death than AMA class 0–2 patients: HR 2.52 (95% CI 1.81–3.49; p less than 0.001).
  • Older age was associated with a higher hazard of death. The article reports HR 2.35 per year (95% CI 1.90–2.91; p less than 0.001).
  • Sex and smoking status were not statistically significantly associated with survival (p=0.499 and p=0.324).
  • Median overall survival by AMA class was:
• 83.4 months (IQR 39.1–163.5) for class 0–2
• 54.8 months (25.4–94.7) for class 3
• 25.5 months (9.8–57.3) for class 4
  • In a time-dependent model, the hazard for AMA class 4 increased over time (HR 1.067 per square-root-of-time unit; p=0.005). The result for AMA class 3 was not statistically significant (HR 1.035; p=0.197).
• The authors' conclusion: The authors concluded that, more than two decades after the asbestos ban, asbestosis incidence remained stable, and that AMA class and age are key predictors of survival.
• Limitations the authors state:
  • Only people who applied for compensation and met the eligibility criteria were captured. The authors say the results reflect compensated asbestosis, not true population incidence.
  • This may have introduced selection bias in both the incidence and the survival estimates.
  • Higher incidence in the early years may reflect applications from people with pre-existing fibrosis after the program began, rather than new cases.
  • The retrospective design led to incomplete clinical data for some patients.
  • Diagnosis under the Dutch Health Council criteria is susceptible to variability between observers.
  • Generalisability outside the Netherlands is limited, for example because fibre-year thresholds may differ internationally.
  • Smoking status was unknown for 30.2% of patients, so residual confounding by smoking cannot be excluded.
  • Comorbidity data were not available, so survival analyses could not be adjusted for them.

Topics

Medical terms in this study, explained in our Lexicon: Epidemiology, Interstitial Lung Disease, Cohort Study, Pulmonary Fibrosis, Occupational History, Overall Survival, Hazard Ratio, Median Overall Survival.

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