Projecting future mortality risk of pleural mesothelioma in Italy (2020-2034): Bayesian age-period-cohort analysis over 40 years of death registration

Our plain-English summary of Projecting future mortality risk of pleural mesothelioma in Italy (2020-2034): Bayesian age-period-cohort analysis over 40 years of death registration, by A. Sartore, G. Stoppa, G. Minelli, et al (Frontiers in Public Health, 2025).

The study

• Authors: A. Sartore, G. Stoppa, G. Minelli, C. Mensi, D. Consonni, V. Manno, A. Marinaccio, L. Fazzo, A. Biggeri, D. Catelan
• Journal: Frontiers in Public Health
• Published: 2025;13:1741506
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Italy, a major former producer, banned asbestos in 1992. A high incidence of mesothelioma, one of the asbestos legacies, is still observed due to the long latency and exposure from residual asbestos-containing materials. Future mortality forecasts at both national and subnational levels are still lacking. This work aims to project future age-stratified mortality rates (2020-2034) for pleural mesothelioma (PM) in Italy, both nationally and for each administrative region.

Methods: Data on pleural cancers and PM in Italy between 1980 and 2019 were extracted from death registries, adjusted for PM misclassification in ICD-9, and aggregated in eight periods, eighteen age classes, and fifteen birth cohorts. Bayesian age-period-cohort models were implemented to generate age-specific mortality projections, stratified by sex assigned at birth.

Results: Between 1980 and 2019, 33,889 people died from PM in Italy, and 19,092 more deaths are expected between 2020 and 2034. The national peak is predicted for 2020-2024, with 6,740 deaths. Age groups under 75 years have already reached the peak of mortality rates. Region-specific trends by sex and time reflect the country's industrialization history.

Discussion: These results align with the literature in predicting the timing of the mesothelioma peak and offer new insights into age-specific trends, the rate of decline, and geographical patterns. They provide valuable evidence on the heterogeneous asbestos legacy across regions, supporting targeted public health actions and health planning.

Copyright © 2026 Sartore, Stoppa, Minelli, Mensi, Consonni, Manno, Marinaccio, Fazzo, Biggeri and Catelan.

In plain English

This study used Italian death records from 1980 to 2019 to project pleural mesothelioma deaths for 2020 to 2034, nationally and for 20 regions, separately for males and females. The coding system used until 2002 did not separate mesothelioma from other pleural tumors. The authors therefore corrected the earlier counts using detailed death-certificate records from 1995 to 2002, then applied a Bayesian age-period-cohort statistical model. Italy recorded 33,889 pleural mesothelioma deaths in 1980–2019 (23,471 males, 10,418 females). The model projected 19,092 more deaths in 2020–2034: 6,740 in 2020–2024, the predicted peak, then 6,501 in 2025–2029 and 5,850 in 2030–2034. These estimates were lower than earlier Italian projections. Death rates had already peaked in age groups up to 74 years old. The 75–79 age group peaked in 2015–2019, while the 85-and-older group was projected to peak in 2025–2029. The authors concluded that the decline is gradual, and that regional patterns reflect the history of asbestos consumption and occupational exposures. They noted that they used aggregate data rather than individual exposure histories and lacked information on environmental exposure.

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: Population-level analysis of national death registry data with Bayesian age-period-cohort modelling to project future mortality
• Who was studied: All deaths from pleural malignant tumors (ICD-9 code 163) and pleural mesothelioma (ICD-10 code C45.0) in Italy, 1980–2019, from the national mortality database, at national level and for 20 regions, by sex. Projections used ISTAT population projections for 2020–2034.
• Exposure: No individual exposure was measured. Asbestos exposure in general is the context. No fiber types are analysed. The study used aggregate death data, not exposure histories.
• Main results:
  • Correction for ICD-9 misclassification: 6,242 people who died from pleural mesothelioma were identified in 1995–2002 using multiple-cause-of-death records
  • Observed pleural mesothelioma deaths in Italy, 1980–2019: 33,889 (23,471 males and 10,418 females)
  • Projected deaths 2020–2034: 19,092, of which 14,008 males (90% CrI: 13,555, 14,463) and 5,084 females (90% CrI: 4,799, 5,371)
  • Absolute peak predicted in 2020–2024 with 6,740 deaths (4,946 males; 1,794 females, 90% CrI: 1,687, 1,903)
  • After the peak: 6,501 deaths projected for 2025–2029 and 5,850 for 2030–2034
  • Age-standardised (WHO World Standard) death rates peaked in 2010–2014 for males at 1.390 per 100,000 (90% CrI: 1.366, 1.415) and in 2000–2004 for females at 0.419 per 100,000 (90% CrI: 0.406, 0.432)
  • Peaks by age class, similar in males and females: 45–49 in 1990–1994; 55–59 in 2000–2004; 65–69 in 2010–2014; 75–79 in 2015–2019; 85+ in 2025–2029
  • The peak has already been reached by most age classes up to 74 years old
  • The study's estimates were lower than previous Italian projections
  • Regional trends: among males in Lombardy, the 70–74 age group was still stable in 2015–2019. In Piedmont and Friuli Venezia Giulia it had decreased since 2015–2019. In Liguria it peaked in 2005–2009.
  • A national calibration test found no sign of miscalibration in any age class
• The authors' conclusion: The authors concluded that the peak has already been reached in most age classes up to 74 years old. They found a gradual rather than abrupt decline, which in their view supports the hypothesis of prolonged environmental exposure from residual asbestos. They placed the peak of absolute pleural mesothelioma mortality around 30 years after asbestos bans.
• Limitations the authors state:
  • Aggregate data were used rather than individual-level exposure histories
  • Possible improvements in prognosis were not explicitly modelled
  • No stratification by occupation or socioeconomic factors, because the information was not available
  • No information on ongoing environmental asbestos exposure, for example from existing buildings
  • Regional predictions are less precise because of smaller numbers of deaths
  • The second-order random walk prior could oversmooth

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Latency, Asbestos-Containing Material (ACM).

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