The Global Burden of and Public Health Action for Asbestos-Related Diseases

Transcription

1 ISEE 17, Sydney, Sep 2017 The Global Burden of and Public Health Action for Asbestos-Related Diseases Ken Takahashi MD, PhD, MPH Director and Professor, Asbestos Diseases Research Institute (ADRI)

2 Background: WHO Position on Asbestos From WHO Website (accessed 11 Sep 2017) The most efficient way to eliminate ARDs is to stop the use of all types of asbestos Replace with safer substitutes; develop economic and technological mechanisms for replacement Prevent exposure to asbestos in place Improve diagnosis, treatment and medical rehabilitation of ARDs and establish registries 2

3 Outline 1. Estimate Global Burden of Mesothelioma from Incomplete National Data OEM, Online First 2. Reported Mortality of Mesothelioma and Asbestosis 3. Public Health Action for Asbestos-Related Diseases Collate Transferrable Know-How and Capacities for ARD Elimination (IJERPH, started) 3

4 1. Estimate Global Burden of Mesothelioma from Incomplete National Data

5 Global Estimates for Mesothelioma Driscoll (AJIM, 2005) Delgermaa* (Bull WHO, 2011) Park* (EHP, 2011) Pruss-Ustun (WHO, 2011) Lim (Lancet, 2012) Diandini* (AJIM, 2013) 43,000 Annual Deaths 92,253 Reported Deaths (83 countries, ) 38,900 (Deaths Estimated for 33 unreported countries, 94 08) 59,000 Annual Deaths 33,610 Annual Deaths (Asbestos-Related Cancers) 11,884 Reported Deaths (82 countries, ) GBD Collaborators (Lancet, 2015; 2016) 33,700 (2015) & 32,400 (2016) Annual Deaths

6 Methods Mortality Rates (MR) 1 Crude MR Judge Data Quality 2 Age-adjusted MR Assess Trend: Choose Best Model from Most Recent 1/2/3 yr of Reported Data 3 Gender and Age-Specific MR Extrapolate Rates from Countries to Reference to Countries to Estimate Extrapolation 1 Cumulative * Per Capita Asbestos Use ( ) 4 groups ( no use low middle high ) 2 Continent : 5 groups (Oceania, Africa, Asia, Europe and Americas) 6 3 Employment in Industrial Sector: 4 groups ( low middle high no data )

7 National Data Reported to WHO Extracted Region Country Oceania Africa FJI AUS NZL EGY MAR MUS REU TUN ZAF Data reported; Data not reported 7

8 Criteria for Poor Quality of Reported Data Method Crude MR 0.5 deaths per million Reported Number of Years 2 Total Reported Number of Deaths of 104 Countries Reporting Data Judged to have Poor Quality 8

9 Crude MR vs Number of Reporting Years CMR (per Million) 0.5 Number of Reporting Years 2 :Countries used for reference rates :Countries with poor quality data with <10 and >10 deaths

10 Crude MR vs Total Number of Deaths CMR (per Million) 0.5 Total Number of Deaths 10 :Countries used for reference rates :Countries with poor quality data with <3 and >3 reporting years

11 National Data Reported to WHO Extracted Region Country Oceania Africa FJI AUS NZL EGY MAR MUS REU TUN ZAF Data reported; Data not reported 11

12 Breakdown of National Data Extracted Data not reported; Data reported but poor quality; Data reported with quality; Data reported with quality and referenced 12

13 Breakdown of National Data Countries to Reference Rates (N=59) 230 Countries High Quality Data 59 Poor Quality Data 45 No Data 126 Countries to Estimate Rates (N=171) 13

14 Estimated Number of Global Meso Deaths 100,000 Reported Estimated 14,466 10,000 20,776 1,839 3,354 3,586 13,883 1,893 8,630 2,794 10,403 4,413 4,599 16,964 Number of deaths 1, , High Medium Low No use Africa America Asia Europe Oceania High Medium Low No use 35/ /12 0 7/16 0 5/ /590 14/ / /21 0 2/ / /30 0 3/58 0 0/49 0 Level of asbestos use Asbestos Continent Employment 15,011/23,377 15,011/21,247 15,011/22,444 38,388 36,258 37,455

15 Global Estimates for Mesothelioma Driscoll (AJIM, 2005) 43,000 Annual Deaths Our Current Study (OEM, in press) 38,400 Annual Deaths GBD Collaborators (Lancet, 2015; 2016) 33,700 (2015) & 32,400 (2016) Annual Deaths Overemphasis on Detailed Numbers: Unproductive! Our Findings Easily Reproducible Commonly accessible data + Straightforward algorithm Amenable to Verification and Update

16 Discussion & Conclusion Odgerel C-O et al. Estimation of the global burden of mesothelioma deaths from incomplete national mortality data. Occup Environ Med, in press Strengths Accounted for Gender and Age structure of ALL countries Unconstrained by Number of Deaths due to Other Causes Limitations Arbitrary Criteria for Quality Possible Underestimation (developed countries) and Overestimation (developing countries) Conclusion Mesothelioma Mortality Data Variable for Availability and Quality Global Mesothelioma Burden Estimated at 38,400 Annual Deaths

17 2. Reported Mortality of Mesothelioma and Asbestosis from Incomplete National Data

18 Annual Number of Reported Mesothelioma Deaths in World (Average for ) Men Women 18

19 Age-Adjusted MR of Reported Mesothelioma in World (Average for ) Men Women 19

20 Annual Number of Reported Asbestosis Deaths in World (Average for ) Men Women 20

21 Age-Adjusted MR of Reported Asbestosis in World (Average for ) Men Women 21

22 Ecological relations: Current mortality rates of asbestos-related diseases vs historical asbestos consumption (weighted by size of sex-specific national populations) Lin R-T, Takahashi K, et al. Lancet 2007, 369, (A) All mesothelioma (B) Pleural mesothelioma (C) Peritoneal mesothelioma (D) Asbestosis

23 3. Public Health Action for Asbestos-Related Diseases

24 Status of National Status Bans According to Cumulative Volume of Asbestos Use Countries banned asbestos Countries not banned asbestos * Countries produced (mined) any amount of asbestos during the same period that the asbestos volume is calculated for

25 Status of National Status Bans According to Per Capita Volume of Asbestos Use Countries banned asbestos Countries not banned asbestos * Countries produced (mined) any amount of asbestos during the same period that the asbestos volume is calculated for

26 Int J Environ Res Pub Health Guest Editors: Ken Takahashi, Jukka Takala and Annete David Special Issue Global Panorama of National Experiences in Public Health Actions to Ban Asbestos Showcase national experiences and key lessons learned in the context of leadership, know-how and capacity ( soft technology), which are transferrable to the many countries still using asbestos, but with a vision to ban asbestos. WHO Position: The most efficient way to eliminate ARDs is to stop the use of all types of asbestos

27 Acknowledgments Dr. Chimed-Ochir Odgerel (Research Associate, Department of Environmental Epidemiology, IIES, University of Occupational and Environmental Health, Japan) Dr. Jukka Takala (Senior Consultant, Ministry of Manpower, Singapore) Professor Thomas Sorahan (University of Birmingham, U.K.) Professor Tim Driscoll (School of Public Health, University of Sydney) Dr. Matthew Soeberg (Asbestos Diseases Research Institute, University of Sydney) 27

28 ISEE 17, Sydney, Sep 2017 The Global Burden of and Public Health Action for Asbestos-Related Diseases Ken Takahashi MD, PhD, MPH Director and Professor, Asbestos Diseases Research Institute (ADRI)

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30 Following Slides are NOT to be Used!

31 Since 2014, WHO Emphasizes Chrysotile Stop using all types of asbestos Asbestos, Including Chrysotile, Causes Cancer of Lung, Larynx and Ovary, Mesothelioma and Asbestosis 107,000 Deaths Worldwide Every Year For Chrysotile Exposure, Mesothelioma : ARLC = 1 : 6 31

32 ISEE 17, Sydney, Sep 2017 The Global Burden of and Public Health Action for Asbestos-Related Diseases Ken Takahashi, MD, PhD, MPH Director and Professor, Asbestos Diseases Research Institute (ADRI)