Health inequality and the global burden of mesothelioma: insights from the global burden of disease study 2021

Abstract

Background

This study aims to systematically analyze the disease burden and epidemiological trends of mesothelioma at the global, regional, and national levels from 1990 to 2021, based on the Global Burden of Disease (GBD) 2021 database, and to explore its relationship with health inequality.

Method

DALYs were calculated by integrating Years of Life Lost due to premature mortality (YLL) and Years Lost due to disability (YLD) to comprehensively assess the disease burden. Additionally, the study analyzes cross-country health inequalities using the Slope Index of Inequality (SII) and the Concentration Index (CI).

Results

Over the past 32 years, global mesothelioma prevalence, incidence, DALYs, and death cases have increased significantly. In 2021, prevalence and incidence rates were highest in the high SDI regions, while the fastest growth occurred in the middle SDI regions. At the national level, Qatar, Bahrain, and Kuwait experienced the largest increases. The 75–79 age group had the highest prevalence and death cases globally. The analysis of health inequity indicates that countries with higher SDI levels are facing a more severe disease burden.

Conclusion

From 1990 to 2021, the disease burden of mesothelioma exhibited a sustained upward trend. The widening gap in DALYs rates between countries with the highest and lowest SDI levels highlights the growing health inequality. Therefore, there is an urgent need for effective public health policies aimed at reducing occupational exposure, alleviating disease burden, and narrowing health disparities between countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-025-14590-2.

Introduction

Mesothelioma is a rare but highly aggressive cancer primarily associated with asbestos exposure and poses a significant public health burden [1]. It has a long latency period, typically ranging from 20 to 50 years, and most patients present with symptoms such as dyspnea and chest pain only at advanced stages [2]. The prognosis is extremely poor, with a five-year survival rate of less than 10% [3]. Diagnosis is complex, as its pathological features can be easily confused with other conditions, and confirmation relies on immunohistochemical markers. However, in low-income countries, limited diagnostic resources contribute to high misdiagnosis rates. Treatment remains highly challenging due to strong tumor resistance, and the efficacy of surgery, chemotherapy, radiotherapy, and immunotherapy is limited, with costs often placing a heavy financial burden on patients and their families [4–6]. Although global incidence and mortality rates of mesothelioma have generally shown a declining trend, the incidence is expected to continue rising in developing countries where asbestos is still in use. Mesothelioma imposes a substantial burden not only on patients but also on society and the economy, particularly affecting industrial workers and their families. Therefore, understanding the global burden of mesothelioma is crucial for informing effective disease management strategies and guiding the development of evidence-based public health policies.

Health inequity refers to differences in health outcomes that arise from factors such as socioeconomic status and occupational environment [7]. Studies have shown that the incidence of mesothelioma is higher in countries and regions with higher socioeconomic status [8]. However, this is not due to a greater exposure risk, but rather because these areas possess better medical resources and diagnostic capabilities, allowing for more accurate case reporting. In contrast, in low- and middle-income countries, occupational exposure is more widespread. Workers often lack adequate occupational health protection and face a higher risk of asbestos exposure, yet limited medical resources lead to insufficient diagnostic and treatment capabilities [6, 9, 10]. This imbalance in the distribution of health resources further exacerbates health inequity.

The purpose of this study, based on the Global Burden of Disease (GBD) 2021 database, was to systematically analyze the disease burden and epidemiological trends of mesothelioma at the global, regional, and national levels from 1990 to 2021, with a particular emphasis on its association with health inequality. By comprehensively assessing key indicators—including prevalence, incidence, mortality, and disability-adjusted life years (DALYs)—the study reveals dynamic changes in the mesothelioma burden across different Socio-demographic Index (SDI) levels. These findings provide important evidence to support the development of precision prevention strategies and tailored intervention measures.

Methods

Data source and disease definition

The GBD 2021 database integrates epidemiological data on 371 diseases and injuries from 204 countries and regions between 1990 and 2021 [11–13]. In this study, mesothelioma is defined as a rare but deadly tumor primarily caused by long-term asbestos exposure, usually occurring in the pleura, peritoneum, or pericardium. The latency period of mesothelioma is long, with onset potentially occurring 20 to 50 years after exposure. Mesothelioma is coded as C45 in the International Classification of Diseases (ICD-10) and is further categorized based on its specific location: C45.0 Pleural mesothelioma, C45.1 Peritoneal mesothelioma, C45.2 Pericardial mesothelioma, C45.7 Mesothelioma of other sites, and C45.9 Mesothelioma of unspecified site.

Disability-adjusted life years

DALYs is a comprehensive indicator used to measure the burden of disease and assess its impact on population health [14]. It is calculated by summing the Years of Life Lost due to premature mortality (YLL) and the Years Lost due to disability (YLD), with the formula: DALY = YLL + YLD. YLL refers to the healthy life years lost due to premature death, calculated as YLL = Number of deaths × (Standard life expectancy - Actual age at death). YLD refers to the healthy life years lost due to illness or disability, calculated as YLD = Number of cases × Duration of illness × Disability weight(DW). The DW is a value between 0 and 1, used to measure the impact of illness or disability on quality of life; the closer the DW is to 1, the greater the impact on quality of life.

Estimated annual percentage change

Estimated Annual Percentage Change (EAPC) is an epidemiological indicator used to measure the trend of a disease metric over a specific period [15]. If EAPC > 0, it indicates an annual increase in the metric, if EAPC < 0, it indicates an annual decrease. EAPC is widely used in GBD studies to quantitatively present dynamic changes in disease burden, facilitating comparisons of disease trends across different regions or time periods and providing data support for public health policy-making.

Cross-country inequalities analysis

The GBD study utilizes various indicators to quantify health inequality, such as the Slope Index of Inequality (SII) and the Concentration Index (CI) [7, 16–18]. The SII is an absolute measure of health inequality, used to assess the extent of differences in health outcomes among different socioeconomic groups. It reflects the absolute gap in health outcomes by calculating the difference in health indicators between the highest and lowest socioeconomic groups. The CI is a relative measure of health inequality, developed based on the Lorenz curve. It evaluates the relative degree of health inequality by analyzing the distribution of health indicators across different socioeconomic groups.

Results

Global Level

Over the past 32 years, the prevalence, incidence, DALYs, and mortality cases of mesothelioma have shown significant increases worldwide. In 2021, these values reached 51,596.54, 31,907.89, 689,358.83, and 29,618.93 respectively, representing increases of 80%, 93%, 78%, and 96% compared to 1990. The corresponding prevalence, incidence, DALYs, and mortality rates were 0.65, 0.40, 8.74, and 0.38 per 100,000 population, with EAPCs of 0.83 (0.72–0.93), 1.08 (0.98–1.19), 0.77 (0.67–0.86), and 1.15 (1.05–1.26), respectively (Fig. 1A-F; Table 1, and Supplementary Tables 1–3).

Fig. 1.

Temporal trend of mesothelioma burden in global and 5 territories. A Percentage change in cases of prevalent, incident, DALYs, and deaths in 1990 and 2021. B The EAPC of prevalence, incidence, DALYs and death rates from 1990 to 2021. The rates of prevalence (C), incidence (D), DALYs (E), and death (F) from 1990 to 2021. Temporal trend of global prevalent (G), incident (H), DALYs (I), and death (J) rates of mesothelioma from 1990 to 2021

Table 1.

The prevalence of mesothelioma cases and rates in 1990 and 2021, and the trends from 1990 to 2021

Location	Num_1990	Num_2021	Percentage change	Rate_1990	Rate_2021	EAPC
Global	28588.28 (26587.74-30908.26)	51596.54 (48140.58-54974.78)	0.8	0.54 (0.5-0.58)	0.65 (0.61-0.7)	0.83 (0.72-0.93)
High SDI	16821.04 (15361.65-18489.52)	26051.26 (24224.52-27250.24)	0.55	1.91 (1.75-2.1)	2.38 (2.21-2.49)	1 (0.83-1.17)
High-middle SDI	5977.17 (5475.2-6633.21)	9527.49 (8852.37-10137.95)	0.59	0.56 (0.51-0.62)	0.73 (0.68-0.78)	0.93 (0.82-1.03)
Middle SDI	3123.01 (2807.23-3381.96)	8461.87 (7653.44-9324.34)	1.71	0.18 (0.16-0.2)	0.35 (0.31-0.38)	2.13 (2.04-2.21)
Low-middle SDI	1844.9 (1310.93-2273.15)	5469.62 (4643.66-6335.28)	1.96	0.16 (0.11-0.2)	0.28 (0.24-0.33)	1.96 (1.86-2.05)
Low SDI	798.54 (469.53-1155.92)	2039.55 (1325.37-2848.51)	1.55	0.16 (0.09-0.23)	0.18 (0.12-0.25)	0.4 (0.19-0.61)
Andean Latin America	107.11 (77.47-144.38)	226.5 (181.88-279.61)	1.11	0.28 (0.2-0.38)	0.34 (0.28-0.42)	-0.06 (-0.52-0.4)
Australasia	1064.45 (895.24-1273.28)	1829.09 (1660.03-1994.92)	0.72	5.25 (4.42-6.28)	5.91 (5.36-6.44)	0.67 (0.5-0.84)
Caribbean	95.88 (88.53-107.3)	174.88 (151.26-201.59)	0.82	0.27 (0.25-0.3)	0.37 (0.32-0.42)	0.86 (0.68-1.04)
Central Asia	129.24 (118.16-141.92)	317.84 (283.94-356.41)	1.46	0.19 (0.17-0.2)	0.33 (0.3-0.37)	1.5 (1.19-1.81)
Central Europe	470.21 (446.36-492.44)	1258.78 (1161.49-1358.67)	1.68	0.38 (0.36-0.39)	1.09 (1.01-1.18)	4.34 (4.03-4.66)
Central Latin America	339.31 (320.53-360.11)	1167.17 (1032.81-1302.75)	2.44	0.21 (0.19-0.22)	0.46 (0.41-0.51)	2.81 (2.59-3.03)
Central Sub-Saharan Africa	80.76 (25.32-188.74)	233.25 (75.37-518.03)	1.89	0.15 (0.05-0.34)	0.17 (0.06-0.38)	0.49 (0.18-0.8)
East Asia	1639.73 (1385.69-1926.55)	3900.16 (3186.28-4713.81)	1.38	0.13 (0.11-0.16)	0.26 (0.22-0.32)	2.69 (2.42-2.96)
Eastern Europe	1194.38 (1039.46-1345.35)	1575.96 (1450.64-1708.6)	0.32	0.53 (0.46-0.59)	0.76 (0.7-0.83)	0.72 (0.45-0.99)
Eastern Sub-Saharan Africa	319.63 (222.2-420.87)	841.87 (581.48-1127.33)	1.63	0.17 (0.12-0.22)	0.2 (0.14-0.26)	0.51 (0.31-0.7)
High-income Asia Pacific	1160.4 (1083.55-1247.76)	3064.62 (2798.05-3255.41)	1.64	0.67 (0.62-0.72)	1.65 (1.51-1.76)	3.53 (3.21-3.86)
High-income North America	4413.28 (4087.44-4736.34)	5550.78 (5126.13-5808.32)	0.26	1.57 (1.45-1.68)	1.5 (1.38-1.57)	-0.3 (-0.42--0.18)
North Africa and Middle East	1098.58 (872.31-1462.17)	2447.06 (2068.31-2913.22)	1.23	0.32 (0.26-0.43)	0.39 (0.33-0.47)	0.51 (0.28-0.74)
Oceania	7.65 (4.83-10.19)	19.79 (14.04-25.24)	1.59	0.12 (0.07-0.16)	0.14 (0.1-0.18)	0.81 (0.68-0.94)
South Asia	1556.83 (988.93-2038.88)	5108.62 (4090.84-6136.24)	2.28	0.14 (0.09-0.19)	0.28 (0.22-0.33)	2.18 (2.04-2.32)
Southeast Asia	746.03 (651.75-863.96)	1931.53 (1683.37-2178.37)	1.59	0.16 (0.14-0.19)	0.28 (0.24-0.31)	1.67 (1.6-1.73)
Southern Latin America	239.66 (223.95-257.2)	635.21 (593.17-672.94)	1.65	0.48 (0.45-0.52)	0.94 (0.88-0.99)	2.92 (2.6-3.24)
Southern Sub-Saharan Africa	244.26 (173.13-335.36)	606.36 (455.13-792.26)	1.48	0.47 (0.33-0.64)	0.76 (0.57-0.99)	1.02 (0.28-1.77)
Tropical Latin America	670.82 (638.34-705.22)	1769.32 (1676.7-1853.05)	1.64	0.44 (0.42-0.46)	0.78 (0.74-0.81)	2.06 (1.94-2.17)
Western Europe	12565.71 (11166.48-14178.79)	17917 (16607.59-18950)	0.43	3.27 (2.9-3.69)	4.1 (3.8-4.33)	1.09 (0.91-1.28)
Western Sub-Saharan Africa	444.36 (245.34-694.01)	1020.74 (553.78-1566.98)	1.3	0.23 (0.13-0.36)	0.21 (0.11-0.32)	-0.52 (-0.75--0.29)

In 2021, prevalence, incidence, and mortality cases among males were approximately three times higher than those among females, while DALYs were about twice as high. Similarly, prevalence, incidence, DALYs, and mortality rates were significantly higher in males than in females. Thus, the disease burden of mesothelioma was substantially greater in males (Fig. 1G-J, and Supplementary Tables 4–7).

SDI region level

Among the five SDI regions, the highest prevalence, incidence, DALYs, and mortality cases were observed in high SDI regions, with values of 26,051.26, 15,976.5, 276,175.63, and 14,505.01, respectively. Percentage changes since 1990 were 55%, 69%, 45%, and 72%. However, the largest increases over the past 32 years occurred in low-middle SDI regions, with percentage changes of 196%, 202%, 185%, and 200%, respectively (Fig. 1A).

In 2021, the highest prevalence, incidence, DALYs, and mortality rates were also in high SDI regions, at 2.38, 1.46, 25.24, and 1.33 per 100,000 population, with EAPCs of 1.00 (0.83–1.17), 1.00 (0.83–1.17), 0.79 (0.64–0.94), and 1.40 (1.25–1.54), respectively. The most rapid increases in these rates were observed in middle SDI regions, with EAPCs of 2.13 (2.04–2.21), 2.34 (2.24–2.44), 1.95 (1.83–2.06), and 2.35 (2.25–2.45) (Fig. 1B).

GBD region level

Over the past 32 years, prevalence, incidence, DALYs, and mortality cases of mesothelioma increased significantly across 21 GBD regions, with 81% of GBD regions experiencing growth rates above the global average. The largest increases were observed in Central Latin America, with percentage changes of 244%, 255%, 216%, and 252%, respectively.

Among these regions, 85% exhibited significant rises in prevalence, incidence, DALYs, and mortality rates. The highest rates were found in Australasia, with values of 5.91, 3.44, 8.74, and 3.08 per 100,000 population, and EAPC of 0.67 (0.5–0.84), 1.27 (1.09–1.46), 0.73 (0.53–0.94), and 0.01 (−0.44–0.46) respectively. Central Europe had the highest EAPC for prevalence, incidence, and DALYs rates, with values of 4.34 (4.03–4.66), 4.67 (4.34–5.01), and 4.15 (3.82–4.48) respectively. Oceania had the highest EAPC for mortality rates at 4.68 (4.33–5.03). Notably, Southern Latin America experienced a significant decline in mortality rates, with an EAPC of −0.67 (−0.87–−0.48) (Fig. 2A-F).

Fig. 2.

Temporal trend of mesothelioma burden in regions. Prevalence (A), incidence (B), DALYs (C), and death (D) rate per 100,000 population in 1990 and 2021. E Percentage change in cases of prevalent, incident, DALYs, and deaths in 1990 and 2021. F EAPC of rates of prevalent, incident, DALYs, and deaths from 1990 to 2021

Country level

From 1990 to 2021, prevalence, incidence, DALYs, and mortality cases of mesothelioma increased significantly in most countries. The three countries with the largest increases were Qatar, Bahrain, and Kuwait, with percentage changes of 1240%, 872%, and 860% for prevalence; 1270%, 895%, and 929% for incidence; 1183%, 853%, and 823% for DALYs; and 1235%, 862%, and 929% for mortality, respectively (Fig. 3A-B).

Fig. 3.

Temporal trend of mesothelioma burden globally. Percentage change in prevalence (A) and DALYs (B) cases across 204 countries in 1990 and 2021. EAPC in prevalence (C) and DALYs (D) rates across 204 countries from 1990 to 2021

Over 80% of countries showed significant increases in prevalence, incidence, DALYs, and mortality rates. The highest EAPCs for prevalence were observed in Georgia, Greenland, and Moldova at 9.5 (8.38–10.62), 6.83 (5.71–7.96), and 6.69 (5.46–7.94), respectively. For incidence, the highest EAPC was in Georgia, Poland, and Moldova, at 9.62 (8.45–10.8), 7.08 (6.45–7.72), and 7.01 (5.74–8.3) respectively. For DALYs, the highest EAPC was in Georgia, Moldova, and Poland, at 9.29 (8.14–10.45), 6.69 (5.39–8.0), and 6.57 (5.93–7.2) respectively. For mortality, the highest EAPC was in Georgia, Poland, and Moldova, at 9.68 (8.49–10.89), 7.17 (6.52–7.83), and 7.04 (5.75–8.35) respectively (Fig. 3C–D and Supplementary Tables 8–11).

Age pattern

Over the past 32 years, the global burden of mesothelioma exhibited distinct patterns across age groups (Fig. 4A-D). The highest numbers of prevalence and mortality cases were observed in the 75–79 age group, with 8,623.53 and 4,674.05 cases, respectively, representing percentage changes of 109% and 100% since 1990. The highest incidence and DALYs cases occurred in the 70–74 age group, with 4,986.16 and 91,471.85 cases, corresponding to percentage changes of 116% and 110% (Fig. 4E-F, Supplementary Fig. 1–2 and Supplementary Tables 12–15).

Fig. 4.

Temporal trend of mesothelioma burden by age pattern in different regions. Prevalence (A), incidence (B), DALYs (C), and death (D) cases of 16 age groups (20 + years, 5-year intervals) from 1990 to 2021 globally and in 5 territories (low to high SDI). Percentage change in prevalence (E) and DALYs (F) cases of 16 age groups globally and in 5 territories in 1990 and 2021. EAPC of prevalence (G) and DALYs (H) rates of 16 age groups globally and in 5 territories from 1990 to 2021. The distribution of prevalence (I), incidence (J), DALYs (K), and death (L) cases across 16 age groups as percentages globally, in 5 territories, and 21 GBD regions in 1990 and 2021. Analysis of the prevalence (M), incidence (N), DALYs (O), and death (P) rates of mesothelioma disease burden by gender and age structure in 2021

Regarding rates, the 75–79 age group had the highest prevalence rates at 6.54 per 100,000 population, with an EAPC of 0.28 (0.17–0.39). The highest incidence rates was in the 85–89 age group at 4.91 per 100,000, with an EAPC of 1.24 (1.07–1.41). The highest DALYs rates was in the 80–84 age group at 58.74 per 100,000, with an EAPC of 0.58 (0.48–0.68). The highest mortality rates was observed in the 85–89 age group at 5.46 per 100,000, with an EAPC of 1.14 (0.97–1.30). The fastest growth in prevalence, incidence, DALY, and mortality rates was seen in the 90–94 age group, with EAPCs of 1.43 (1.29–1.58), 1.41 (1.26–1.56), 1.31 (1.16–1.46), and 1.31 (1.16–1.46), respectively (Fig. 4G-H and Supplementary Fig. 3–4).

In high SDI regions, the highest prevalence rates was observed in the 75–79 age group at 16.42 per 100,000, with an EAPC of 0.81 (0.64–0.98). The highest incidence rates was in the 85–89 age group at 9.68 per 100,000, with an EAPC of 1.86 (1.68–2.05). The highest DALYs rates was in the 75–79 age group at 127.7 per 100,000, with an EAPC of 0.51 (0.36–0.66). The highest mortality rates was in the 85–89 age group at 10.33 per 100,000, with an EAPC of 1.76 (1.57–1.96).

In 2021, the 75–79 age group accounted for the largest proportion of global prevalence (17%), a 3% increase since 1990. The 70–74 age group had the highest proportion of incidence (16%), up by 2%. DALYs were highest in the 70–74 age group (13%), with a 2% increase. Mortality was highest in the 75–79 age group (16%), up by 1% (Fig. 4I-L). By gender, females had higher prevalence and incidence rates than males in the 20–24 and 25–29 age groups, whereas males had higher rates in populations aged 30 and above (Fig. 4M-P).

Relationship between mesothelioma burden and SDI

From 1990 to 2021, prevalence, incidence, DALYs, and mortality rates of mesothelioma were significantly positively correlated with SDI levels (Fig. 5 and Supplementary Fig. 5–7). When SDI was below 0.65, these rates remained relatively stable with increasing SDI. However, above 0.65, these rates increased exponentially until stabilizing at around 0.85 SDI. Notably, some regions such as Australasia and Western Europe had significantly higher burdens than predicted, while High-income Asia Pacific and High-income North America had significantly lower burdens, warranting further investigation.

Fig. 5.

The associations between the SDI and prevalent rates per 100,000 population of mesothelioma across 21 GBD regions

Cross-country inequality analysis of mesothelioma burden

According to SII analysis, from 1990 to 2021, the gaps in prevalence, incidence, DALYs, and mortality rates between countries with the highest and lowest SDI increased from 0.42, 0.25, 6.14, and 0.23 to 0.93, 0.58, 12.32, and 0.53, respectively. This indicates that countries with higher SDI bear a heavier disease burden and that health inequality is worsening. However, over the 32-year period, the CI did not show significant change (Fig. 6A-H).

Fig. 6.

DALYs

Discussion

Mesothelioma is a rare but highly aggressive malignant tumor primarily caused by asbestos exposure [19, 20]. Its public health implications are complex, involving occupational health, environmental exposure, socioeconomic disparities, and healthcare resource allocation. Globally, the prevalence, incidence, DALYs, and mortality cases of mesothelioma have all significantly increased over the past 32 years. In 2021, the global prevalence, incidence, DALYs, and mortality rates of mesothelioma reached 0.65, 0.40, 8.74, and 0.38 per 100,000 population, respectively. These indicators were significantly higher in males, largely due to greater occupational exposure in industries such as construction, shipbuilding, and manufacturing. However, women may also develop the disease due to environmental exposure, particularly in areas heavily contaminated with asbestos. In the future, with the strengthening of global asbestos regulations, the incidence of mesothelioma is expected to gradually decline. Nonetheless, public health interventions for high-risk populations—such as older adults and men—still need to be intensified. Moreover, there is an urgent need for the development of new treatment options, such as immunotherapy, to improve patient outcomes, as well as for in-depth research into the impact of environmental exposure on mesothelioma incidence.

In 2021, high SDI regions recorded the highest prevalence, incidence, DALYs, and mortality rates, whereas the most rapid increases occurred in middle SDI regions. Among the 21 GBD regions, Central and South America experienced the most significant growth in mesothelioma burden. From 1990 to 2021, most countries showed a marked increase in mesothelioma burden, though the trends varied widely. In particular, some Middle Eastern countries—such as Qatar, Bahrain, and Kuwait—saw sharp rises in prevalence, incidence, DALYs, and mortality rates. These disparities reflect the differing impacts of asbestos use and public health policies across nations. High incidence rates in high-income countries are mainly attributed to the historical widespread use of asbestos, while the rapid increase in some low- and middle-income countries may be linked to growing asbestos exposure during recent industrialization [9]. Although many countries have gradually banned asbestos use, mesothelioma’s long latency period means its burden will likely remain high in the coming decades [21, 22].

Over the past 32 years, the global burden of mesothelioma has also shown significant differences among different age groups. The highest number of prevalent and death cases occurred in the 75–79 age group, while the highest incidence and DALYs cases were found in the 70–74 age group. In high SDI regions, the highest prevalence and DALYs rates were observed in the 75–79 age group, and the highest incidence and mortality rates in the 85–89 age group. These data indicate that the burden of mesothelioma is especially severe among older adults, likely due to historically higher levels of asbestos use. With the global population aging, the mesothelioma burden among older populations may continue to rise. Therefore, strengthening asbestos exposure regulation, expanding enforcement of asbestos bans, and improving access to healthcare resources are essential steps to reduce the global mesothelioma burden.

Unlike previously published studies [22–24], our research not only analyzes the mesothelioma burden at global, regional, and national levels but also focuses on the quantitative assessment of health inequality. By using the SII and the CI, we reveal disparities in health outcomes across countries with different socioeconomic development levels, providing critical evidence for more targeted public health policymaking. According to the SII, the disparities in prevalence, incidence, DALYs, and mortality rates between countries with the highest and lowest SDI levels widened significantly from 1990 to 2021, indicating that high SDI regions are bearing a disproportionately greater mesothelioma burden and that health inequality is worsening. However, the CI showed no significant change during the same period, suggesting that while absolute differences have increased, the relative distribution has remained relatively stable.

This growing inequality may be driven by multiple factors. On one hand, although high SDI regions have advantages in healthcare resources and public health systems, their high levels of industrialization contribute to greater risks of occupational and environmental exposure. On the other hand, these countries are also experiencing more pronounced population aging, which exacerbates the burden of age-related diseases such as mesothelioma. These findings offer vital insights for public health and policy development. Public health professionals should prioritize enhanced surveillance and early screening systems for mesothelioma in high SDI regions, improve diagnostic capacity, and implement targeted health education for high-risk occupational groups and older adults. Cross-sectoral collaboration is needed to integrate medical resources effectively. Policymakers should enforce stringent occupational exposure protections and environmental regulations, strengthen aging population health policies, optimize healthcare resource allocation, and promote international cooperation to share prevention strategies and participate in setting global standards. Through multi-level and coordinated interventions, it is possible to alleviate health inequalities related to mesothelioma, reduce the disease burden, and support the sustainable development of global public health systems.

Limitation

This study provides a comprehensive analysis of the mesothelioma burden based on the GBD 2021 database, but it has several limitations. First, the study relies on secondary data from the GBD 2021 database, which may be influenced by the original data collection methods, quality control, and reporting standards. This is particularly true in low- and middle-income countries, where data completeness and accuracy may be insufficient. Additionally, the GBD 2021 database lacks detailed individual-level information, such as occupational and environmental exposure histories, which limits in-depth analysis of individual risk factors.

Conclusion

This study provides an in-depth analysis of the changes in mesothelioma disease burden globally, regionally, and nationally from 1990 to 2021. We found that over the 32-year period, the global incidence, prevalence, DALYs, and mortality cases for mesothelioma significantly increased. In 2021, although the high SDI regions had the highest incidence and prevalence rates, middle SDI regions showed the fastest growth rate. Health inequity analysis revealed that between 1990 and 2021, the gap in the SII between the highest and lowest SDI regions widened significantly, reflecting a worsening of health inequality. These findings suggest that public health policies should focus on occupational health protection, environmental monitoring and management, optimizing the allocation of public health resources, raising public health awareness, and strengthening international collaboration and research to reduce the mesothelioma disease burden, improve global public health levels, and narrow the health inequality gap between countries.

Abbreviations

ASDR

Age-standardized disability-adjusted life years

ASMR

Age-standardized mortality rates

CI

Concentration Index

DALYs

Disability-adjusted life years

GBD 2021

Global Burden of Disease Study 2021

SDI

Sociodemographic Index

SII

Slope Index of Inequality

YLL

Years of life lost

YLD

Years lived with disability

Authors’ contributions

YSJ designed this study and drafted the initial manuscript. LL, WG, DMF, and BY participated in data analysis. GL and CM provided financial support and revised the article. All authors read and approved the final manuscript.

Funding

Not applicable.

Data availability

The datasets presented in this study can be found in online (http://ghdx.healthdata.org/gbd-results-tool). Further information can be directed to the corresponding author.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.