The link between malignant mesothelioma (MM), and asbestos exposure (AE), is very high. AE may have occupational or environmental non-occupational source. The highest levels of AE occur in the workplace and mainly affect men. However, environmental AE, affect men and women equally. As the occupational AE prevails over the environmental non-occupational, a sex-ratio < 2 alert of possible environmental AE. The objective of this study is to evaluate the spatio-temporal distribution of the sex-ratio, in order to identify those areas with possibly higher environmental AE.
We conducted an analysis of the 6,143,124 deaths in Spain during the period 2000–2015, looking for those deaths caused by MM. Information regarding sex, year of death, age at death, province, and cause of death (ICD-10) was extracted from the deceased registry of the National Institute of Statistics. We calculated the sex-ratio between the deceased by MM according to its distribution by provinces and years, and the ratio of mortality rates adjusted for age (European standard population). We also obtained the proportion of MM among the total deceased (MM per 10,000 deaths).
MM deaths were 5,345. Men 4,025 and women 1,329 (sex-ratio: 3.31). During the 2000- 2015 period the sex-ratio remained relatively stable, ranging from 2.21 in 2007 to 4.31 in 2005. In the years 2000 and 2015 the sex-ratio was 3.34 and 3.07, respectively. Likewise, in the years 2000 y 2015 the men/women age-adjusted rates was 2.83 and 3.93, respectively. The variations by provinces were more pronounced. The lowest sex-ratio (1.5) corresponded to the 140 deaths of Navarra and the highest (12.67), to the 41 deaths of Vitoria. Other low sex-ratio values were detected for Almeria (2,07), Donostia (2,02), Huesca (2) and Tarragona (1,97). Among these provinces with a possible higher environmental AE risk (sex-ratio equal to or
The high provincial variability in Spain of the proportion of women who died of MM, makes necessary the carry out of new research focused in the provinces detected as with a possible greater risk of environmental asbestos exposure in the general population.
Clinical trial identification
Legal entity responsible for the study
Jose Miguel Sanz-Anquela; Junior Smith Torres-Roman
J.M. Sanz-Anquela: Occasionally has served as a consultant to the court, always at the request of plaintiff asbestos victims. All other authors have declared no conflicts of interest.