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Kunihito Nishikawa,¹ Ken Takahashi,¹ Antti Karjalainen,² Chi-Pang Wen,³ Sugio Furuya,⁴ Tsutomu Hoshuyama,¹ Miwako Todoroki,¹ Yoshifumi Kiyomoto,¹ Donald Wilson,¹ Toshiaki Higashi,⁵ Megu Ohtaki,⁶ Guowei Pan,⁷ and Gregory Wagner⁸

¹Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan; ²Finnish Institute of Occupational Health, Helsinki, Finland; ³Centre for Health Policy Research and Development, National Health Research Institutes, Taiwan; ⁴Japan Occupational Safety and Health Resource Centre, Tokyo, Japan; ⁵Department of Work, Systems, and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu City, Japan; ⁶Department of Environmetrics and Biometrics, Hiroshima University, Hiroshima, Japan; ⁷Department of Environmental Epidemiology, Liaoning Provincial Centre for Disease Prevention and Control, Shenyang, People's Republic of China; ⁸U.S. National Institute for Occupational Safety and Health, Washington, DC, USA

Abstract
Background: In response to the health risks posed by asbestos exposure, some countries have imposed strict regulations and adopted bans, whereas other countries have intervened less and continue to use varying quantities of asbestos.

Objectives: This study was designed to assess, on a global scale, national experiences of recent mortality from pleural mesothelioma, historical trends in asbestos use, adoption of bans, and their possible interrelationships.

Methods: For 31 countries with available data, we analyzed recent pleural mesothelioma (International Classification of Diseases, 10th Revision) mortality rates (MRs) using age-adjusted period MRs (deaths/million/year) from 1996 to 2005. We calculated annual percent changes (APCs) in age-adjusted MRs to characterize trends during the period. We characterized historical patterns of asbestos use by per capita asbestos use (kilograms per capita/year) and the status of national bans.

Results: Period MRs increased with statistical significance in five countries, with marginal significance in two countries, and were equivocal in 24 countries (five countries in Northern and Western Europe recorded negative APC values) . Countries adopting asbestos bans reduced use rates about twice as fast as those not adopting bans. Turning points in use preceded bans. Change in asbestos use during 1970–1985 was a significant predictor of APC in mortality for pleural mesothelioma, with an adjusted R² value of 0.47 (p < 0.0001) .

Conclusions: The observed disparities in global mesothelioma trends likely relate to country-to-country disparities in asbestos use trends.

Key words: asbestos, asbestos-related diseases, ban, epidemiology, lung cancer, mesothelioma, mortality, occupational cancer, pleural mesothelioma. Environ Health Perspect 116:1675–1680 (2008) .  doi:10.1289/ehp.11272 available via http://dx.doi.org/ [Online 14 August 2008]

Address correspondence to K. Takahashi, Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu City 807-8555, Japan. Telephone: 81-93-691-7401. Fax: 81-93-601-7324. E-mail: ktaka@med.uoeh-u.ac.jp

Supplemental Material is available online at http://www.ehponline.org/members/2008/11272/suppl.pdf

We thank H.S. Lee and T. Nawrot for providing data and A.B.A. Mahmud for providing expert advice.

This research was supported by Grants-in-Aid from the Ministry of Health, Labour, and Welfare of Japan (H18-IPPAN-002) , the Ministry of Education, Culture, Sports, Science, and Technology of Japan (18659190) , and the Japan Society for the Promotion of Science. The findings and conclusions expressed in this article are those of the authors and do not necessarily represent the views of the U.S. National Institute for Occupational Safety and Health.

S. Furuya works for the Japan Occupational Safety and Health Resource Centre, a nongovernmental organization that provides support to asbestos victims, but has not received payment from this organization. T. Higashi was a member of the Occupational Safety and Health Committee of the Japan Asbsestos Association but has not been paid by this association since 1996 and has never received funding for research on asbestos. The other authors declare they have no competing financial interests.

Received 15 January 2008 ; accepted 14 August 2008.