Global Mesothelioma Deaths Reported to the World Health Organization between 1994 and 2008/les Deces Mondiaux Par Mesotheliome Rapportes a l'Organisation Mondiale De la Sante Entre 1994 et 2008/muertes Por Mesotelioma En Todo El Mundo Notificadas a la Organizacion Mundial De la Salud Entre 1994 Y 2008

Introduction Malignant is a rare but fatal form of cancer which is difficult to diagnose. The disease is causally linked to asbestos exposure with an etiological fraction of 80% or more. (1,2) It has been reported that the incidence is much higher in men than women) The latency period for after initial exposure to asbestos is typically longer than 30 years and the median survival time after diagnosis is 9-12 months. (3) The World Health Organization (WHO) has recognized that asbestos is one of the most important occupational carcinogens and that the burden of asbestos-related disease is rising. Consequently, WHO has declared that asbestos-related diseases should be eliminated throughout the world. (4) The global burden is unclear. Driscoll et al. estimated that as many as 43 000 people worldwide die from the disease each year. (5) It has also been estimated that there are around 10 000 cases annually in Australia, Japan, North America and western Europe combined. (1) In addition, Park et al. suggested that one case may be overlooked for every four to five recorded. (6) Reports of an increase in the incidence of mesothdioma have been published in a wide range of countries. (7-11) However, to date there is no established global baseline that can be used to evaluate trends in disease occurrence. Since 1994, data on deaths have been included in the WHO mortality database, which records deaths in WHO Member States in each calendar year. Data are specified by disease category, gender and 5-year age intervals and are integrated across countries using a common format. (12) Data comparability improved with the introduction of the International Classification of Diseases (ICD), (13) though the category mesothelioma was included only in 1993 with the 10th revision (ICD-10). (14) However, as acknowledged by WHO, accuracy in diagnosing causes of death varies among countries. (13) By 30 January 2011, death figures were available for a 15-year period. The aim of this study was to improve the understanding and management of malignant by carrying out a descriptive analysis of global data available on deaths caused by the disease. Methods We extracted the numbers of deaths recorded in the WHO mortality database as malignant (i.e. ICD-10 category C45 or any subcategory thereof) between 1994 and 2008. In addition, we conducted a literature search of PubMed to identify papers published in English that could provide useful information on national data. However, the data identified lacked detailed information on the numbers of deaths (e.g. on year, age group and gender). Consequently, we used only data from the WHO mortality database in the analysis. The number of deaths was summed by calendar year and country and was stratified according to demographic characteristics, including gender and anatomical disease site. To calculate mortality rates, national population data were obtained from the WHO health statistics and health information systems (12) and the United States Census Bureau, (15) with priority being given to WHO data. National counts were further aggregated by region and income level. We merged the smaller regions defined by the United Nations Statistics Division (16) into the five continents: Africa, the Americas, Asia, Europe and Oceania. In addition, we adapted the World Bank categories of national income level (17) to form three categories: low, and high income. The World Bank up per middle and lower middle categories were merged into the category. National data on deaths were available for 1 to 15 years, depending on the country. As a consequence, the number of countries that reported data in any particular year ranged from 3 to 57. This variability was taken into account when calculating the mortality rate for a group of countries by ensuring that any particular country contributed data to both the numerator and denominator of the rate calculation only in those calendar years during which data were available for that country. …