Assessing the global burden of mesothelioma: trends, socioeconomic influences, and asbestos exposure – a retrospective cohort study

Abstract

Introduction:

Mesothelioma is an uncommon type of cancer that has received little attention. This study aims to evaluate the global disease burden, trends of mesothelioma by age, sex, and geographic locations, and its risk factors at the population level.

Methods:

The Global Cancer Observatory in 2022 and 2019 Global Burden of Disease were accessed for mesothelioma incidence and its risk factors worldwide. Multivariable linear regression analyses were conducted to explore the associations between mesothelioma incidence and key predictors, including Human Development Index (HDI), Gross Domestic Product (GDP) per capita, and occupational asbestos exposure, adjusting for age and sex across global regions.

Results:

This study identified 30 870 global cases of mesothelioma in 2022, with a higher age-standardized incidence rate in males (0.25 per 100 000) compared to females (0.39 per 100 000). Geographical analysis indicated the highest disease burden in Northern Europe, with particular prevalence in more developed regions. The incidence was also significantly associated with a higher HDI, with a β coefficient of 0.133 overall, and GDP per capita, with a β coefficient of 0.101. These socioeconomic factors exhibited stronger associations in the elderly population, especially with HDI (β=0.512) and GDP (β=0.389), than in adults. Additionally, occupational exposure to asbestos remained a significant risk factor across all groups, except for the younger adult population, with an overall β of 0.122 for incidence. The temporal trend analysis revealed a general decrease in mesothelioma incidence, particularly in the 15–49 years age group.

Conclusions:

The analysis indicates a higher mesothelioma incidence in males and in developed regions, with marked disparities noted particularly in Northern Europe. Significant correlations with socioeconomic indicators – HDI and GDP – and occupational asbestos exposure were identified, particularly affecting the elderly. Despite a decline in global incidence, especially among younger individuals, persistent cases in females highlight the need for continued public health measures addressing both occupational and environmental exposures.

Introduction

Highlights

• Comprehensive global analysis: this study presents a detailed evaluation of the global burden of mesothelioma, examining trends by age, sex, and geographic location using data from the Global Cancer Observatory (GCO) and the Global Burden of Disease study.

• Socioeconomic influences: significant associations were found between mesothelioma incidence and socioeconomic factors, specifically Human Development Index (HDI) and Gross Domestic Product (GDP) per capita, highlighting the influence of socioeconomic status on disease burden.

• Asbestos exposure: occupational asbestos exposure remains a critical risk factor for mesothelioma across all demographic groups, with stronger associations observed in the elderly population.

• Geographic disparities: Northern Europe exhibits the highest mesothelioma incidence rates, reflecting the historical industrial use of asbestos in this region.

• Sex differences: the study identifies a higher incidence rate of mesothelioma in males compared to females, emphasizing the role of occupational exposure in historically male-dominated industries.

• Temporal trends: a general decline in mesothelioma incidence was observed, particularly among younger individuals aged 15–49 years, indicating the potential impact of global asbestos regulations and improved occupational safety standards.

• Public health implications: the findings underscore the need for targeted public health interventions and policies to mitigate the long-term effects of asbestos exposure and address ongoing environmental risks.

Mesothelioma is an aggressive form of cancer that predominantly affects the lining of the lungs (pleura) but can also occur in the lining of the abdominal cavity (peritoneum), heart, or testicles^1,2. As a relatively rare neoplasm, mesothelioma has historically received less attention in cancer research and public health policy, overshadowed by the higher prevalence of other cancers^3–5. The insidious nature of the disease is underscored by its long latency period, often presenting symptoms several decades after exposure to the primary risk factor, asbestos, a fibrous mineral group known for its resistance to heat and durability, was once ubiquitous in various industries before widespread restrictions were imposed in the 1980s^6–8. Nonetheless, the enduring legacy of its use continues to present significant health challenges. Occupational exposure to asbestos remains the most documented risk factor for mesothelioma, with a substantial proportion of cases, particularly among men, linked to industrial environments^9,10. Mesothelioma’s reach extends beyond occupational hazards; however, environmental exposure also plays a critical role. This includes residential proximity to asbestos manufacturing sites and naturally occurring asbestos deposits. The quantification of environmental exposure is fraught with difficulties, given the often involuntary and unrecognized nature of such contact^11,12.

The pathways of asbestos exposure span both occupational and environmental contexts. High-risk occupational groups include those in construction, shipbuilding, and manufacturing industries, where asbestos use has been historically prevalent. Environmental exposure, by contrast, does not discriminate, potentially impacting all individuals within affected vicinities, including women and children. The correlation between the extent of asbestos exposure and the risk of developing mesothelioma has been clearly established, with a dose–response relationship corroborated by numerous studies.

Contemporary research into mesothelioma incidence has been constrained by regional limitations and the use of dated data. This gap hinders a thorough comprehension of mesothelioma’s global burden. Our study intends to bridge this divide by providing a comprehensive analysis of mesothelioma incidence and trends on a global scale, disaggregated by region, country, sex, and age group. We also seek to examine the relationship between mesothelioma incidence and socioeconomic factors, such as the HDI and GDP, alongside the extent of occupational asbestos exposure. This investigation aspires to furnish a detailed portrait of mesothelioma incidence, which will inform global public health strategies and stimulate pertinent areas of future research.

Materials and methods

Data sources and study design

This study utilized comprehensive global cancer data from the GCO for the year 2022, encompassing mesothelioma incidence across 185 countries. GCO, maintained by the International Association of Cancer Registries in collaboration with the WHO, provides data on 26 cancer types disaggregated by age and sex, which is crucial for our analyses of demographic variations in mesothelioma incidence.

Additionally, we integrated data from the 2019 Global Burden of Disease study, which offers insights into premature mortality and disability associated with over 350 diseases. This database is instrumental in understanding the broader epidemiological context of mesothelioma, allowing for comparisons across different socioeconomic backdrops defined by HDI levels and GDP per capita, sourced, respectively, from the United Nations and the World Bank.

The GCO and the Global Burden of Disease study employ specific criteria for case inclusion and exclusion to ensure the integrity and accuracy of their data. For GCO, cases must be confirmed via reliable diagnostic methods and include essential demographic details such as age and sex, with any duplicates or incomplete records excluded. Meanwhile, the Global Burden of Disease study includes all age groups and sexes and covers a wide range of health outcomes for over 350 diseases, excluding data of poor quality or from nonstandard diagnostic criteria. These rigorous criteria enable both databases to provide a robust framework for understanding the epidemiology of diseases like mesothelioma, reflecting the global health landscape and informing public health decisions effectively.

The 2019 HDI, GDP per capita, and occupational exposure to asbestos are pivotal metrics for exploring cancer incidence in 2022. HDI reflects the capacity of health infrastructure and public health initiatives, influencing both the detection and reporting of cancer. GDP per capita indicates the economic resources available for healthcare, affecting the accessibility and quality of cancer treatment and diagnosis. Occupational exposure to asbestos directly correlates with specific cancer risks, highlighting demographic and geographical variations in cancer prevalence. Together, these factors offer a comprehensive framework for understanding the multifactorial nature of cancer incidence across different regions.

To ensure data quality across different countries, despite inherent variations due to the data collection methods of population-based cancer registries, several comprehensive strategies have been implemented. Firstly, the International Agency for Research on Cancer (IARC) plays a crucial role not only in evaluating and compiling data from its collaborators globally but also in enhancing local data quality. This is achieved by collaborating directly with national staff to improve registry coverage and analytical capabilities. Additionally, the launch of the Global Initiative for Cancer Registry Development marks a significant step towards enhancing data quality, particularly in low-income and middle-income countries. Global Initiative for Cancer Registry Development focuses on improving the coverage, quality, and utility of population-based cancer registration data worldwide. This initiative supports the development of cancer registries by providing training, resources, and technical assistance to countries, thereby ensuring that data collection meets international standards of quality and reliability.

Statistical analysis

Choropleth maps were generated to illustrate the global mesothelioma incidence using the age-standardized rates (ASRs) for different countries by sex and age group. The ASR is the weighted arithmetic mean of age-specific rates per 100 000 people, where the weights correspond to the ratio of people in the Segi-Doll world reference population.

The associations between mesothelioma incidence and risk factors, including HDI, GDP per capita, and occupational exposure to asbestos, were evaluated for each country by multivariable linear regression analysis by sex and age. β coefficients and the corresponding 95% confidence intervals (CIs) were generated correspondingly from the regression. The β estimates are the amount of change in the outcome variable (ASR of incidence) for every unit increase in a predictor variable (risk factor). Statistical significance was determined as a P value less than 0.05, and all CIs are expressed at 95% value.

A multivariable linear regression model was employed to evaluate the relationships between mesothelioma incidence and various risk factors such as HDI, GDP per capita, and occupational exposure to asbestos. This analysis was conducted separately for each country and adjusted for potential confounders, including age and sex. The model aimed to isolate the effect of each predictor on the ASR of mesothelioma incidence. β coefficients and their corresponding 95% CIs were calculated to estimate the magnitude and precision of the associations. Each β coefficient represents the expected change in the ASR of mesothelioma per unit increase in the predictor variable, holding all other variables constant.

Statistical significance was assessed using P values, with a threshold set at less than 0.05. All analyses were conducted using R Statistical Software (v4.3.2), which provides robust tools for handling complex regression models in epidemiological research. This approach allowed for a comprehensive understanding of how socioeconomic status and exposure levels relate to mesothelioma risk across different demographics and geographies.

Furthermore, the trends of mesothelioma incidence of different population groups were evaluated by age groups (all population: 0–85þ years, young population: 15–49 years, old population: 50–85 years), sexes (male and female), and geographic locations (Asia, Oceania, America, Europe, and Africa).

The work has been reported in line with the STROCSS criteria¹³.

Results

Mesothelioma incidence and mortality in 2022

It revealed a global incidence of mesothelioma totaling 30 870 cases. The incidence rates were disproportionately higher among males than females, with males exhibiting an ASR of 0.25 per 100 000, corresponding to 26 278 cases (Fig. 1). In contrast, females demonstrated a higher ASR of 0.39 per 100 000, albeit with a lower total of 7597 cases (Fig. 2).

Figure 1.

Global incidence of mesothelioma by sex, all ages, males, in 2022.

Figure 2.

Global incidence of mesothelioma by sex, all ages, females, in 2022.

Regional distribution of mesothelioma

Europe emerged as the continent with the highest incidence, reporting 13 648 cases. Within Europe, Northern Europe was particularly affected, registering 3946 cases. Notably, the ASR in Northern Europe was the highest observed, with males at 0.31 per 100 000 and females at 0.29 per 100 000. Other European regions such as Western, Southern, and Eastern Europe also reported significant incidences but exhibited lower ASRs than Northern Europe. Asia followed Europe in terms of high-incidence rates, tallying a total of 9735 cases. Among Asian regions, Eastern Asia reported the highest number of cases (5815), though the ASRs were moderately lower compared to Europe. South Central Asia and Western Asia also noted considerable case numbers but with correspondingly lower incidence rates. In Northern America, the incidence stood at 4119 cases with moderate ASRs, suggesting a lesser burden compared to Europe but higher than many regions in Asia and Africa. Oceania, and specifically Australia and New Zealand, showed a notably high ASR of 0.57 per 100 000. In more precise terms, Australia and New Zealand alone accounted for 943 cases with a staggering ASR of 1.2 per 100 000 for males and two per 100 000 for females, highlighting a significant regional public health concern (Fig. 3).

Figure 3.

Age-standardized rate (world) per 100 000, incidence, males and females, in 2022.

Incidence of cancer in young versus old populations

In examining the global distribution of cancer incidence, there is a marked contrast in ASRs between younger (ages 15–49) and older (ages 50–85+) populations. The ASR of cancer in the older age cohort significantly surpassed that of the younger group. For instance, in regions such as Northern Europe, Australia and New Zealand, and Western Europe, the incidence in older populations was substantially elevated.

Specifically, the highest ASR incidence in the older population was observed in Australia and New Zealand, demonstrating an ASR category exceeding 1130 per 100 000 individuals. This starkly contrasts with the ASRs for the younger cohort, which fell into lower categories, not surpassing the 170.1–207.8 range in the same regions. Similarly, Northern Europe exhibited high-incidence rates in the older age group, followed closely by Western Europe.

In contrast, among the younger population, the highest incidence rates were recorded in regions with a relatively lower overall cancer burden in older adults. It is noteworthy that countries such as Luxembourg, the United Kingdom, and the Netherlands displayed ASRs that, while lower than their older counterparts, were significant within the context of the younger demographic.

Figure 4 and Figure 5 clearly illustrates these disparities, with a pronounced darkening of hues on the map corresponding to older populations, especially noticeable in the aforementioned regions. This visual representation underscores the heightened incidence rates of cancer with increasing age, as well as regional variations that may reflect underlying genetic, environmental, or lifestyle factors.

Figure 4.

Global incidence of mesothelioma by age, both sexes, age (15–49), in 2022.

Figure 5.

Global incidence of mesothelioma by age, both sexes, age (50–85+), in 2022.

Associations of risk factors with mesothelioma incidence

Human Development Index

The multivariable linear regression analysis delineated a positive association between the HDI and the incidence of mesothelioma. Specifically, the β coefficient for HDI overall was 0.133 (95% CI: 0.107–0.159, P<0.001), suggesting that for every 0.1 increase in HDI, there is an associated increase in the age-standardized incidence rate of mesothelioma. This trend was more pronounced in males (β=0.209, P<0.001) compared to females (β=0.066, P<0.001), and particularly significant in the elderly population (β=0.512, P<0.001), as opposed to the adult population (β=0.011, P=0.002) (Fig. 6).

Figure 6.

Correlation of mesothelioma incidence with socioeconomic factors and occupational asbestos exposure.

Gross Domestic Product

The regression analysis also indicated that the GDP per capita is significantly correlated with mesothelioma incidence, with a β coefficient of 0.101 (95% CI: 0.085–0.118, P<0.001) for every $10 000 increase in GDP per capita. This association also varies by sex, with males displaying a stronger correlation (β=0.149, P<0.001) than females (β=0.059, P<0.001). A noticeable difference is evident between the adult (β=0.011, P<0.001) and the elderly populations (β=0.389, P<0.001), with the latter showing a much higher association of GDP with mesothelioma incidence (Fig. 6).

Occupational exposure to asbestos

Occupational exposure to asbestos showed a significant positive correlation with mesothelioma incidence across the board, with an overall β of 0.122 (95% CI: 0.106–0.137, P<0.001) per unit increase in asbestos exposure. This relationship is evident in both males (β=0.102, P<0.001) and females (β=0.098, P<0.001), but no significant association was observed in the adult population subgroup (β=0.025, P=0.3). However, a substantial correlation was found in the elderly group (β=0.195, P<0.001) (Fig. 6).

Multivariable analysis of mesothelioma incidence

The multivariable trend analysis, which accounts for multiple factors concurrently, still finds a significant association of mesothelioma incidence with HDI (β=0.043, P=0.002), GDP (β=0.036, P<0.001), and asbestos (β=0.085, P<0.001). The strength of these associations varies when stratified by sex and age, indicating a complex interaction between these risk factors and the burden of mesothelioma.

In summary, the data reveal a clear link between higher socioeconomic status (as reflected by HDI and GDP) and increased mesothelioma incidence. This is compounded by the long-recognized risk posed by asbestos exposure. The strength of these associations is most evident among males and the elderly, suggesting a targeted impact of these risk factors within these groups. Notably, the trends underscore the lingering repercussions of asbestos exposure, echoing the need for continued surveillance and preventive measures in both occupational and environmental settings.

Discussion

Summary of major findings

This comprehensive global analysis has delineated critical aspects of the disease burden, risk factors, and temporal trends of mesothelioma. The major findings from the study can be summarized as follows: there is a pronounced geographic disparity in the burden of mesothelioma, with the highest incidence rates identified in more developed regions, exemplified by Northern Europe. This suggests a correlation between mesothelioma incidence and regional industrial development, potentially reflecting historical asbestos use in these areas, a higher incidence of mesothelioma correlates significantly with increased HDI levels and GDP per capita. This association was consistent across all demographics except the younger population, suggesting that socioeconomic development and health resource allocation influence the reporting and diagnosis rates of mesothelioma. Additionally, the analysis confirms that occupational asbestos exposure remains a significant risk factor, particularly affecting the elderly population, reinforcing the need for ongoing public health attention to past exposures and their current implications, and the study has captured an overall decline in the incidence of mesothelioma over the past decade, with a notable decrease in the younger population aged 15–49 years. This trend could reflect the global efforts to restrict asbestos use and improve occupational safety standards. However, the persistent rise in incidence among females across various age brackets may indicate continuing environmental exposure to asbestos or other similar mineral fibers, necessitating targeted environmental health interventions.

Variation in the disease burden

Sex disparity could be attributed to historical occupational exposure patterns, where males were predominantly employed in industries with high asbestos use, such as construction and manufacturing. Previous studies indicate that the variations in incidence rates between sexes underscore the role of occupational exposure, which has historically been more prevalent among male populations due to the nature of industrial work^14,15. However, the apparent contradiction in the findings where males show a higher total number of cases but a lower age-standardized incidence rate compared to females, can be explained as follows. Even though more males were historically exposed to asbestos through their occupations, the intensity and duration of exposure could vary widely. Females, though less frequently exposed, might have experienced more intense or prolonged exposures in certain contexts, or if the data might reflect recent changes in occupational roles or protections. Also, the discrepancy might be due to the different population age structures of males and females. Men might have a younger population structure in the studied regions, reducing the ASR despite a higher number of cases. This could be further complicated by longevity differences, with women typically living longer and possibly developing diseases at older ages. Studies suggest biological differences in sensitivity or response to carcinogens like asbestos. Females might have a higher incidence rate when adjusted for age despite lower overall exposure^14,16.

The present study has illuminated significant geographic variation in the burden of mesothelioma, with developed regions such as Northern Europe presenting a higher incidence. These regional disparities may reflect the enduring impact of historical asbestos use, consistent with findings from studies like those by Alpert and colleagues and Wilk and colleagues, who documented extensive industrial use of asbestos in these regions over the past decades^16,17.

Europe, particularly Northern Europe, exhibits the highest burden, which could be reflective of occupational exposure patterns or environmental factors unique to the region¹⁸. Similarly, the high rates observed in Australia and New Zealand warrant further epidemiological scrutiny to ascertain the underlying causes and potential occupational health interventions¹⁸. The pronounced sex disparity in incidence rates globally calls for targeted research to understand the biological, environmental, and occupational factors contributing to the higher male susceptibility to mesothelioma¹⁹.

The observed dichotomy in cancer incidence between the younger and older demographics, as evidenced by the ASRs, suggests a multifaceted interplay of etiological factors that augment cancer risk with advancing age. These heightened ASR figures in older adults may reflect age-related biological susceptibility, including genomic instability and declining immune surveillance. Studies have shown that genomic instability and a decline in immune surveillance contribute significantly to increased cancer risks in older adults²⁰. The marked increase in incidence rates among older populations, especially in regions like Australia, Northern Europe, and Western Europe, likely mirrors cumulative exposure to carcinogenic factors over a lifetime¹².

Additionally, the stark differences in ASRs between the younger and older cohorts could also be indicative of improvements in early detection and prevention strategies targeting the younger population. Countries with notable healthcare systems and cancer screening programs, such as the United Kingdom and the Netherlands, demonstrate this trend²¹. However, it is worth considering that the lower ASRs in the younger demographic in these countries, despite being significant within their age group, may also be a function of the delayed onset of cancer, where the impact of lifestyle choices and environmental exposures might not yet be apparent²². Furthermore, Luxembourg’s position as a high-incidence region for the younger population presents a unique case for in-depth epidemiological scrutiny. This may elucidate specific local or national factors contributing to the anomaly, potentially involving occupational hazards or genetic predispositions^23,24.

It is crucial to contextualize these geographical and age-specific variations within the broader spectrum of global health disparities. Access to health resources, socioeconomic status, and public health initiatives are all factors that contribute to the observed disparities in cancer incidence rates across the globe. The implementation of effective health policies, tailored to address the specific needs of different age groups and regional populations, remains an imperative derived from these findings. The data further emphasizes the necessity for a sustained focus on age-specific cancer research, with a particular emphasis on modifiable risk factors and interventions that can mitigate the rising cancer burden in aging populations²⁵. Equally, the urgency to bolster cancer prevention and control measures in younger populations should not be overlooked, as the foundation for a healthier older age begins with effective health strategies during the earlier years of life²⁶.

Associated risk factors

The regression analyses reinforce the association between higher HDI scores, higher GDP per capita, and increased mesothelioma incidence. The strength of the associations suggests that socioeconomic factors may influence the recognition, diagnosis, and reporting of mesothelioma, potentially contributing to higher recorded incidence rates in wealthier countries. Furthermore, occupational exposure to asbestos remains a significant risk factor, with the strongest associations seen in the elderly demographic. This could indicate that the full effects of asbestos exposure are more likely to manifest as the population ages, reflecting both prolonged latency periods and possibly sustained low-level exposure over time.

Human Development Index and Gross Domestic Product

The positive association between mesothelioma incidence and higher HDI, reflected by a β coefficient of 0.133 (P<0.001), aligns with previous studies suggesting that higher HDI correlates with better health system resources and consequently higher diagnostic rates^26,27,28. The stronger association observed in the elderly (β=0.512, P<0.001) compared to adults (β=0.011, P=0.002) underscores the potential impact of cumulative asbestos exposure over time, as well as improved disease recognition in this demographic.

Similarly, the relationship between GDP per capita and mesothelioma incidence (β=0.101, P<0.001) suggests that economic prosperity may facilitate better occupational health practices and disease surveillance, as discussed by Zhai and colleagues^29,30. The variance in β coefficients between males (β=0.149, P<0.001) and females (β=0.059, P<0.001) could reflect sex differences in occupational roles and exposures historically.

Occupational exposure to asbestos

The significant correlation of asbestos exposure with mesothelioma incidence (overall β=0.122, P<0.001) is consistent with the extensive body of literature identifying asbestos as the primary etiological factor for mesothelioma^31,17. The lack of a significant association in the younger adult subgroup (β=0.025, P=0.3) might indicate the success of recent regulations reducing asbestos exposure in workplaces. In addition to the occupational exposure discussed, environmental exposure to asbestos also plays a critical role in the epidemiology of mesothelioma. The marked correlation of asbestos exposure with mesothelioma incidence in the elderly (β=0.195, P<0.001) not only underscores the long latency period of the disease but also highlights the pervasive impact of environmental asbestos, which can linger in communities long after the cessation of industrial use. Particularly concerning is the residential proximity to former asbestos manufacturing sites and areas with naturally occurring asbestos deposits. Studies have shown that populations living near these sites, even in regions that have banned asbestos use, continue to face heightened risks¹⁸. For instance, in the town of Casale Monferrato in Italy, a significant legacy of asbestos pollution from a former asbestos cement plant has been linked to persistently high rates of mesothelioma among residents decades after the plant’s closure. The environmental persistence of asbestos fibers in the soil and buildings continues to pose a risk to these communities, necessitating ongoing public health interventions and remediation efforts. Moreover, naturally occurring asbestos deposits, such as those found in parts of California and Western Australia, further complicate the public health landscape. In these regions, disturbances of the earth’s surface, whether through construction, natural disasters, or other activities, can release asbestos fibers into the air, inadvertently exposing populations to carcinogenic fibers. The geographical and geological mapping of these deposits is crucial for implementing zoning laws and safety regulations to protect public health.

Multifactorial analysis

The multifactorial analysis, which accounts for multiple risk factors concurrently, still identifies significant associations of mesothelioma incidence with HDI (β=0.043, P=0.002), GDP (β=0.036, P<0.001), and asbestos exposure (β=0.085, P<0.001). These findings, suggesting a complex interaction between socioeconomic status, economic conditions, and direct environmental exposure, align with the multifactorial nature of cancer epidemiology described by Mbemi, who emphasizes the interplay of genetic, environmental, and social factors in cancer risk^32,33. In conducting the multifactorial analysis of mesothelioma incidence, several key confounders were identified and controlled to isolate the effects of the HDI, GDP, and asbestos exposure. These confounders included age and sex, which were adjusted for in the regression models due to their known influence on cancer incidence rates. Additionally, regional variations were considered, as mesothelioma incidence can vary significantly between urban and rural areas, partly due to differences in healthcare access and environmental monitoring. Despite these measures, other potential confounding factors could further influence the study’s findings. For instance, genetic predispositions to cancer were not explicitly included in our analysis. Research has indicated that certain genetic markers may increase susceptibility to asbestos-related diseases, including mesothelioma. Furthermore, lifestyle factors such as smoking, which is a well-known risk factor for many types of cancer, including lung cancer, could also modify the risk of developing mesothelioma independently or synergistically with asbestos exposure. Future research should aim to integrate these additional variables into the analysis to provide a more comprehensive understanding of mesothelioma risk. This could involve collecting detailed patient histories to assess genetic and lifestyle factors or conducting genome-wide association studies to identify specific genetic variations associated with increased susceptibility to mesothelioma. Additionally, longitudinal studies could help elucidate the interaction between these factors and long-term asbestos exposure, potentially leading to more targeted prevention and treatment strategies.

Recommendation and policy implications

In light of our study’s identification of high mesothelioma incidence in developed regions, notably Northern Europe and parts of Australia, there is a compelling need for surgical intervention strategies tailored to these high-risk areas. The data suggest a disproportionate disease burden in these locales, underlining the importance of surgical care in the management of mesothelioma. Enhancing surgical techniques and improving early detection through collaborative research between surgeons, epidemiologists, occupational health professionals, and environmental scientists can lead to significant advancements in patient outcomes. Furthermore, the strong associations we observed between mesothelioma incidence and socioeconomic factors, such as the HDI and GDP, underscore the potential for public health policies to influence surgical care availability. This study advocates for policies that not only support but also enhance the infrastructure for surgical care in regions with elevated incidence rates. By fostering a multidisciplinary approach to research and treatment, we can better understand the multifactorial nature of mesothelioma and develop targeted interventions that reduce the burden of this disease. Therefore, it is imperative that we leverage our findings to support the development of policies that ensure access to cutting-edge surgical care and encourage ongoing collaborative research efforts. Such initiatives would significantly enhance the manuscript’s relevance to the surgical community, offering tangible pathways to mitigate the global impact of mesothelioma.

In regions such as Northern Europe, particularly in countries like Sweden and Finland, which our study identified as having a high-incidence of mesothelioma, public health interventions have been pivotal. For instance, Sweden has implemented comprehensive asbestos regulations and public health campaigns focused on asbestos awareness and safe removal practices. These measures have contributed to a gradual decline in new cases, reflecting the effectiveness of proactive regulatory frameworks and public education in managing environmental health risks. Conversely, in Eastern Australia, despite stringent asbestos use regulations, mesothelioma incidence remains notably high, likely due to historical asbestos exposure. Ongoing challenges in these regions include managing legacy asbestos in older buildings and educating the public about the risks associated with inadvertent exposure during renovations. The case of Australia highlights the complex interplay between past practices and current public health outcomes, emphasizing the need for sustained efforts in monitoring, education, and infrastructure remediation to mitigate the effects of historical asbestos use. These regional examples underscore the importance of tailored public health strategies that consider both the historical context and current socioeconomic conditions. They also demonstrate the potential for successful interventions to mitigate mesothelioma incidence and provide a template for other regions facing similar challenges. Policymakers and public health professionals can draw valuable insights from these case studies to develop targeted interventions that address both the legacy and ongoing risks associated with asbestos exposure.

Strength and limitations

This study represents a comprehensive examination of the global burden and trends of mesothelioma bolstered by robust cancer registry data. The temporal analysis indicates a general decline in the incidence of mesothelioma, particularly in younger age groups, which could be attributed to the global reduction in asbestos use and improvements in occupational health regulations. However, the increasing trend in mesothelioma incidence observed among females might suggest a rise in nonoccupational exposure to asbestos or other mineral fibers. This emphasizes the need for public health efforts to address both historical occupational exposures and ongoing environmental risks. The observed decline in incidence among younger populations may also reflect the benefits of regulatory interventions. However, the increasing incidence in older adults is concerning and highlights the need for continued public health vigilance and research into the long-term consequences of asbestos exposure.

Nevertheless, we must acknowledge potential limitations, such as underreporting in regions with lower HDI, which may skew the interpretation of our of mesothelioma incidence, as these regions may lack the healthcare infrastructure necessary for accurate diagnosis and reporting of asbestos-related diseases. This underreporting potentially masks the true prevalence of mesothelioma in less developed areas, leading to underestimations of its global burden. To address these limitations, sensitivity analyses could be performed to estimate the impact of different levels of underreporting on our results. By modeling various scenarios where underreporting is adjusted according to the HDI of each region, we can better understand how these biases might affect our findings. Such analyses would provide a more nuanced view of the epidemiology of mesothelioma, highlighting the need for improved surveillance and reporting systems in lower HDI regions. Additionally, variances in data collection methodologies across regions and countries must be considered when interpreting the global landscape of mesothelioma incidence.

Implications

The study’s findings offer an incisive view into the complex global landscape of mesothelioma and underscore the persistent impact of asbestos on public health. It also highlights the success of regulatory measures in reducing incidence rates among younger demographics, indicating a positive shift in public health trajectories. However, the sustained disease burden in older populations and the emerging patterns of female incidence warrant further investigation into the latency of disease onset and the potential ongoing risks posed by environmental exposure.

Our study’s findings have profound implications for public health policy, particularly in reinforcing the need for global asbestos control initiatives and targeted health resources in regions with identified disease burdens. The study also highlights the importance of continued surveillance and healthcare strategies to address both the lingering occupational risks and the emerging concerns of environmental exposure.

The associations between mesothelioma, socioeconomic factors, and asbestos exposure provide essential insights that can guide future research and policy decisions aimed at mitigating the impact of this disease. As the global community continues to grapple with the consequences of past asbestos use, this study’s insights are invaluable in shaping a proactive response to a legacy hazard that continues to affect populations worldwide.

To deepen the understanding and enhance response to mesothelioma, specific types of future studies are recommended. Longitudinal studies that track exposure and health outcomes over time are crucial to investigate the long-term effects of both occupational and environmental asbestos exposure. These studies should aim to clarify the latency periods associated with different levels of exposure and to assess the effectiveness of current regulations and public health interventions. Moreover, intervention studies are needed to evaluate the impact of new health policies and community health initiatives designed to reduce asbestos exposure. These studies should focus on high-risk regions and consider the socioeconomic factors influencing health outcomes. Key questions for these studies could include: How effective are current asbestos abatement and monitoring strategies in reducing mesothelioma incidence? What role do socioeconomic disparities play in the efficacy of these interventions? By addressing these questions, future research can provide critical insights that guide policy decisions and help mitigate the impact of mesothelioma globally. As the world continues to deal with the legacy of asbestos use, the insights from our study are invaluable in shaping a proactive public health response that aims to protect and improve the lives of populations at risk.

Ethical approval

This study did not involve patients or direct clinical research; hence, ethical approval was not required. Data were obtained from publicly available databases, including the Global Cancer Observatory and the Global Burden of Disease study.

Consent

Not applicable. This study did not involve individual patient data or case reports.

Source of funding

This research received no specific grant from any funding agency in the public, commercial, or not for-profit sectors.

Author contribution

Z. Z.: study concept and design, data collection, data analysis and interpretation, and writing the paper. J.L.: study design, data collection, data interpretation, writing, and critical revision of the paper. F.T.: data analysis and interpretation, and drafting and revising the manuscript. Q.X.: data collection and analysis, and manuscript preparation. S.G.: data interpretation and manuscript revision. J.H.: study supervision, data interpretation, and manuscript revision.

Conflicts of interest disclosure

The authors declare no conflicts of interest.

Research registration unique identifying number (UIN)

This study utilized publicly available data and does not involve new human subjects. Registration was not applicable.

Guarantor

Jiagen Li and Jie He are the guarantors of this study, accepting full responsibility for the work, access to the data, and control over the decision to publish.

Data availability statement

The datasets generated during and/or analyzed during the current study are publicly available from the Global Cancer Observatory (https://gco.iarc.fr/) and the Global Burden of Disease study (https://www.healthdata.org/gbd).

Provenance and peer review

Not commissioned, externally peer-reviewed.

Data statement for manuscript submission

The datasets generated during and/or analyzed during the current study are publicly available from the Global Cancer Observatory (https://gco.iarc.fr/) and the Global Burden of Disease study (https://www.healthdata.org/gbd).