Spain's Pleural Cancer Mortality 1984-2023: Insights From a Delayed Asbestos Prohibition

Spain implemented a national asbestos ban in 2002 after decades of high industrial use. The long-term impact on pleural mesothelioma (PM) mortality remains incompletely characterised. This study evaluates age-, sex-, and cohort-specific mortality trends up to 2023 to assess regulatory effects.

We analysed national mortality registry data spanning 1980-2023. Age-period-cohort (A-P-C) models were applied to quantify temporal trends, identify cohort and period effects, and examine sex-specific patterns. Local drifts and net drifts were estimated to assess age-specific changes in MPM mortality.

Male mortality showed a biphasic pattern, peaking around 2001-2002, followed by a modest decline in age-standardised rates. Female mortality declined steadily across the study period. Pronounced birth cohort effects were observed, with an 85% risk reduction between 1944 and 1974 male cohorts, reflecting reductions in occupational exposures over successive generations. Age-specific trends indicate steep declines among younger age groups, contrasting with continued elevated mortality in older cohorts exposed during Spain's industrial peak. Period effects were significant in men but not in women. Overall, trends suggest that post-2002 regulatory measures are starting to lower mortality rates, especially in younger age groups.

Spain is entering a transitional phase in which the long-term benefits of asbestos ban are becoming empirically evident. However, substantial mortality persists among older cohorts due to the prolonged latency of MPM. These findings underscore the value of early regulatory action and highlight the continued need for surveillance, clinical care, and legacy asbestos remediation to mitigate the long-term public health burden.