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

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.

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.

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.

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).