Burden and trends of cancer attributable to occupational asbestos exposure in China from 1990 to 2021.

BACKGROUND

Occupational exposure to asbestos remains a major public health concern in China, particularly due to the long latency of asbestos-related diseases and the persistent use of asbestos in male-dominated industries. However, the long-term trends and drivers of asbestos-related cancer burden have not been fully quantified.

METHODS

This study used data from the Global Burden of Disease Study 2021 to estimate the burden of total cancer attributable to occupational asbestos exposure in China from 1990 to 2021. Key indicators included deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), disaggregated by age, sex, cancer type, and time period. Joinpoint regression and age-period-cohort analyses were conducted to explore temporal dynamics, while decomposition analysis assessed the contributions of population growth, aging, and epidemiological changes.

RESULTS

In 2021, occupational asbestos exposure led to 29,020 deaths and 535,732 DALYs in China, with a significantly higher burden among males. The number of cases rose steadily from 1990, with sharp increases between 2000 and 2010, plateauing thereafter and rising again after 2017. Age-standardized rates showed dynamic trends: increasing until 2010-2011, declining until 2018, and rebounding modestly, particularly among females. The burden was highest among individuals aged 85-94 and showed a rightward shift over time. Lung cancer accounted for over 85% of asbestos-related DALYs, followed by mesothelioma, ovarian, and laryngeal cancers. Joinpoint and age-period-cohort analyses highlighted long-latency effects and generational shifts, while decomposition showed that aging and epidemiological changes were the dominant drivers of increased deaths, whereas DALYs were primarily driven by epidemiological factors and population growth.

CONCLUSION

The burden of asbestos-related cancers in China remains substantial and is rising due to demographic aging and persistent exposure risks. Stronger occupational safety regulations, exposure surveillance, and asbestos bans are urgently needed to curb future disease burden.