Global burden of lung cancer attributable to occupational asbestos exposure: 1990 to 2021

Our plain-English summary of Global burden of lung cancer attributable to occupational asbestos exposure: 1990 to 2021, by Q. Huang, Y. Cheng, R. Lei, et al (Environmental Health, 2025).

The study

• Authors: Q. Huang, Y. Cheng, R. Lei, Z. Chen, W. Gu, K. Hemminki, T. Chen
• Journal: Environmental Health
• Published: 2025;24(1):84
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Asbestos is a well-established occupational carcinogen, with strong evidence linking its exposure to lung cancer. Despite increasing awareness of its health risks, asbestos continues to be used in many countries. We aimed to evaluate the global burden of lung cancer attributable to occupational asbestos exposure and to analyze its epidemiological patterns across time and by regions, sex, and age.

Methods: We utilized lung cancer data from the Global Burden of Disease (GBD) 2021 database, including information on new cases, deaths, and disability-adjusted life-years (DALYs), along with their age-standardized rates by gender and age groups. Temporal trends were examined using Joinpoint regression models with 95% confidence intervals (CIs). The timeline data on global asbestos bans were retrieved from the International Ban Asbestos Secretariat.

Results: We observed, approximately 25 years after the complete ban on asbestos use, a declining trend for lung cancer incidence, as well as for mortality and DALYs due to asbestos exposure. In 2021, occupational asbestos exposure accounted for 9.4% of global lung cancer deaths and 7.2% of DALYs. Between 1990 and 2021, the number of asbestos-related lung cancer deaths increased from 0.13 million to 0.19 million, while DALYs rose from 2.58 million to 3.34 million. The highest deaths and DALYs were observed in regions with high Socio-demographic Index (SDI), though the most rapid increases occurred in lower SDI regions. Over time, lung cancer burden shifted towards older populations, especially those aged over 70.

Conclusions: We found, for the first time, that a complete ban on asbestos with a lag time of 25 years could effectively reduce lung cancer incidence along with asbestos-related deaths and DALYs. These findings underscore the urgent need for a complete ban on asbestos (especially chrysotile).

© 2025. The Author(s).

In plain English

The authors analyzed Global Burden of Disease (GBD) 2021 estimates of lung cancer attributed to occupational asbestos exposure worldwide from 1990 to 2021. They also described trends in 50 countries with a complete asbestos ban, using ban dates from the International Ban Asbestos Secretariat. In those countries, total new lung cancer cases (not only asbestos-related ones), and lung cancer deaths and disability-adjusted life-years (DALYs) attributed to asbestos, began to decline about 25 years after a complete ban. Worldwide in 2021, occupational asbestos exposure accounted for 9.4% of lung cancer deaths and 7.2% of lung cancer DALYs. Asbestos-attributed deaths rose from 0.13 million in 1990 to 0.19 million in 2021, while age-standardized rates fell. High socio-demographic index regions had 62.6% of these deaths in 2021. Age-standardized rates fell among men, while the death rate among women rose. The authors called for a complete ban on asbestos worldwide. They noted that smoking and air pollution may have affected the incidence trends.

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 published Global Burden of Disease 2021 estimates, with descriptive trend analysis around asbestos ban dates, Joinpoint regression, and estimated annual percentage changes (EAPC)
• Who was studied: Global, regional and national GBD 2021 lung cancer estimates for 1990 to 2021, for people aged 20 and over in three age groups (20 to 49, 50 to 69, over 69). The ban-trend analysis covered 50 countries with a complete asbestos ban. The USA was excluded from that analysis.
• Exposure: Occupational asbestos exposure as modeled in GBD 2021. The article does not break this down by fiber type, product or job. Complete national asbestos bans were taken from International Ban Asbestos Secretariat timelines.
• Main results:
  • In the 50 ban countries, total new lung cancer cases and the age-standardized incidence rate (all lung cancer, not only asbestos-attributed) started to decline after 25 years of a complete ban
  • In the ban countries, asbestos-attributed lung cancer deaths, DALYs and their age-standardized rates declined starting about 25 years after a complete ban
  • Iceland, the first country with a comprehensive ban, saw a notable decline in new lung cancer cases and the age-standardized incidence rate 27 years after the ban
  • Worldwide in 2021, occupational asbestos exposure accounted for 9.4% of lung cancer deaths and 7.2% of lung cancer DALYs
  • Worldwide, asbestos-attributed lung cancer deaths rose from 0.13 million in 1990 to 0.19 million in 2021, and DALYs rose from 2.58 million to 3.34 million
  • Worldwide, the age-standardized mortality rate and age-standardized DALY rate in 2021 were 2.28 and 39.07, a significant decrease from 1990, with EAPCs of minus 1.17 and minus 1.63
  • In 2021, High SDI regions accounted for 62.6% of global asbestos-attributed lung cancer deaths and 58.5% of DALYs
  • Deaths and DALYs rose in all SDI regions, but only the age-standardized rates in High and High-middle SDI regions decreased significantly
  • Australasia had the highest proportion of lung cancer deaths (30.6%) and DALYs (25.8%) attributable to occupational asbestos exposure among geographic regions
  • The United States, China and Japan together accounted for about 40% of global asbestos-attributed lung cancer deaths and DALYs in 2021
  • Georgia had the fastest-growing age-standardized mortality and DALY rates, with EAPCs of 13.72 (95% CI 11.56 to 15.91) and 13.76 (95% CI 11.59 to 15.98)
  • Globally, the age-standardized mortality and DALY rates among males fell significantly. Among females, the mortality rate rose and the DALY rate stayed stable.
  • Male mortality and DALY rates were consistently higher than female rates from 1990 to 2021, especially at ages 75 and over
  • The share of asbestos-attributed deaths and DALYs among people over 70 increased from 1990 to 2021 in both sexes
• The authors' conclusion: The authors concluded that lung cancer incidence and asbestos-related lung cancer deaths and DALYs began to decline about 25 years after complete asbestos bans. They called for a complete worldwide ban, particularly in regions with low SDI levels, and in their abstract especially of chrysotile.
• Limitations the authors state:
  • GBD 2021 data come from different sites, and the data may be incompatible despite model corrections
  • The relative risks used by GBD come mainly from studies in high-income countries and may not fit other regions
  • There are no data on environmental or domestic asbestos exposure
  • Confounding factors such as declining smoking and rising air pollution must be considered when interpreting the incidence trends after bans
  • Smoking and air pollution latency make it hard to attribute lung cancer incidence to specific causes
  • The estimates may underestimate or overestimate the true asbestos-related lung cancer burden

Topics

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

Medical terms in this study, explained in our Lexicon: Lung Cancer, Asbestos Exposure, confidence interval, Chrysotile.

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