The global burden of asbestos-related disease - occupational exposures

Transcription

1 The global burden of asbestos-related disease - occupational exposures Tim Driscoll School of Public Health University of Sydney

2 Outline Background to GBD Overview of methods relevant to asbestos Overview of GBD 2013 results relevant to asbestos Consideration of some of the important issues Consideration of uses and implications of the results NB: GBD 2013 results presented are DRAFT results

3 A little GBD history 3

4 GLOBAL, COMPARABLE, EVIDENCE-BASED information on injuries and diseases and associated risk factors A response to the need for comprehensive, consistent and comparable information on diseases and injuries at global, regional and national levels (WHO) Diseases and injuries, and the risk factors that cause them

5 GBD

6 GBD 1990 Commissioned in 1991 by World Bank Run by Chris Murray and Alan Lopez Focussed on 1990 Released in 1996 Involved collaborators from many countries Primarily looked at outcomes (overall burden) diseases and injuries and ten risk factors

7 The Comparative Risk Assessment project

8 The Comparative Risk Assessment project Ran from 2000 to 2004 Looked at burden in 2000 Focussed on risk factors Involved working groups for specific areas Occupational risk factors working group led by Marilyn Fingerhut

9 The new GBD initiative 9

10 The new GBD initiative Run by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington Funded by Bill and Melinda Gates Foundation Expert groups provide advice to central team but final decisions made centrally Originally GBD 2005, became GBD 2010 and now GBD 2013 Regular updates planned Each update incorporates new information and methods

11 GBD regions

12 Occupational risk factors 12

13 Occupational risk factors that were included Carcinogens Airborne exposures Ergonomic risk factors for low back pain (combined exposure) Noise Occupational injury risk factors (Pneumoconiotic dusts)

14 Occupational risk factors that were included Carcinogens Airborne exposures Ergonomic risk factors for low back pain (combined exposure) Noise Occupational injury risk factors (Pneumoconiotic dusts)

15 Carcinogens Only IARC Group 1 carcinogens Only outcomes with sufficient epidemiological evidence (as per IARC) 14 carcinogens Seven cancer types 18 carcinogen cancer pairs - Four involve asbestos ICOH 2015 Seoul Burden from occupational risk factors

16 Asbestos-related cancers included in GBD 2013 Laryngeal cancer Lung cancer Mesothelioma Ovarian cancer ICOH 2015 Seoul Burden from occupational risk factors

17 Results 17

18 Global deaths from occupational risk factors , , ,000 Deaths 200, , ,000 50,

19 Global deaths from occupational risk factors , , ,000 Deaths 200, , ,000 50,

20 Global deaths from occupational asbestos exposure ,000 - cancer: 194,000 - asbestosis 21,000 87% male 10% of all lung cancer deaths 64% of all occupational cancer deaths

21 Age - deaths 90,000 Asbestos-related cancer deaths 80,000 70,000 60,000 Deaths 50,000 40,000 30,000 20,000 10, Age 21

22 Age deaths per capita 450 Asbestos-related cancer deaths (per million) Deaths per million Age 22

23 Type of cancer Asbestos-related cancer deaths Mesothelioma Ovarian cancer Cancer type Lung cancer Larynx cancer 0 50, , , ,000 Deaths 23

24 Type of disease Asbestos-related deaths Mesothelioma Ovarian cancer Disease type Lung cancer Larynx cancer Asbestosis 0 50, , , ,000 Deaths 24

25 Cancer type ALL exposures - type of cancer Leukemia Mesothelioma Kidney cancer Ovarian cancer Nasopharynx cancer Lung cancer Larynx cancer 0 50, , , , , ,000 Deaths 25

26 Cancer type ALL exposures - type of cancer Leukemia Mesothelioma Kidney cancer Ovarian cancer Nasopharynx cancer Lung cancer Larynx cancer 0 50, , , , , ,000 Deaths 26

27 Cancer type ALL exposures Type of cancer excluding lung cancer Leukemia Mesothelioma Kidney cancer Ovarian cancer Nasopharynx cancer Larynx cancer 0 5,000 10,000 15,000 20,000 25,000 30,000 Deaths 27

28 Cancer type ALL exposures Type of cancer excluding lung cancer Leukemia Mesothelioma Kidney cancer Ovarian cancer Nasopharynx cancer Larynx cancer 0 5,000 10,000 15,000 20,000 25,000 30,000 Deaths 28

29 Carcinogen ALL exposures Lung cancer carcinogen type Silica PAH Nickel SHS Diesel Chromium Cadmium Beryllium Arsenic Asbestos 0 20,000 40,000 60,000 80, , , , , ,000 Deaths 29

30 Carcinogen ALL exposures Lung cancer carcinogen type Silica PAH Nickel SHS Diesel Chromium Cadmium Beryllium Arsenic Asbestos 0 20,000 40,000 60,000 80, , , , , ,000 Deaths 30

31 The legacy of asbestos use 31

32 Region ALL exposures Region deaths per capita World Western Sub-Saharan Africa Southern Sub-Saharan Africa Eastern Sub-Saharan Africa Central Sub-Saharan Africa South Asia North Africa and Middle East Tropical Latin America Central Latin America Andean Latin America Caribbean High-income North America Southern Latin America Western Europe Australasia High-income Asia Pacific Eastern Europe Central Europe Central Asia Oceania Southeast Asia East Asia Deaths per million 32

33 Region ALL exposures Region deaths per capita World Western Sub-Saharan Africa Southern Sub-Saharan Africa Eastern Sub-Saharan Africa Central Sub-Saharan Africa South Asia North Africa and Middle East Tropical Latin America Central Latin America Andean Latin America Caribbean High-income North America Southern Latin America Western Europe Australasia High-income Asia Pacific Eastern Europe Central Europe Central Asia Oceania Southeast Asia East Asia Deaths per million 33

34 Asbestos-related cancers deaths per capita Western Sub-Saharan Africa Southern Sub-Saharan Africa Eastern Sub-Saharan Africa Central Sub-Saharan Africa South Asia North Africa and Middle East Tropical Latin America Central Latin America Andean Latin America Caribbean High-income North America Southern Latin America Western Europe Australasia High-income Asia Pacific Eastern Europe Central Europe Central Asia Oceania Southeast Asia East Asia Global Deaths per million 34

37 Occupational cancer deaths % asbestos-related 37

38 Occupational cancer deaths % asbestos-related Western Sub-Saharan Africa Southern Sub-Saharan Africa Eastern Sub-Saharan Africa Central Sub-Saharan Africa South Asia North Africa and Middle East Tropical Latin America Central Latin America Andean Latin America Caribbean High-income North America Southern Latin America Western Europe Australasia High-income Asia Pacific Eastern Europe Central Europe Central Asia Oceania Southeast Asia East Asia Global Per cent 38

41 What can the data be used for?

42 What can the data be used for? Guide sensible decisions on prevention and control Highlight and learn from disparities Raise awareness 42

44 Some things to think about

45 Methodology and assumptions Burden estimates need information on Exposure Proportion of population exposed Risk measure Background exposure Population measures of the disease or injury of interest Considerable assumptions or methodological decisions often needed for all of these

46 Methodological issues Lack of relevant exposure data Matching the risk information to the exposure level Latency Persistent risk after exposure ceases Reduction of risk after exposure ceases How much evidence is required? 46

47 More issues

48 More issues Populations not included: - Informal workforce - Child workers Represents the effect of past exposures

49 Relevance of burden estimates - issues

50 Relevance of burden estimates - issues Interventions now may take many years to have an effect need to convey this effectively to the decision makers. For asbestos-related disease, current burden measures can t be used as a sensitive monitor of recent interventions. Different groups produce different estimates due to different assumptions this makes it difficult for external users of the information. 50

51 Does the uncertainty matter? 51

52 Does the uncertainty matter? It doesn t matter what the exact number of deaths is. The key aspects to consider are: Are the results in appropriate relative order? Is the problem big enough to do something about? If so, what should be done? What are the priorities? What is the best evidence available for deciding this?

53 Occupational risk factors - collaborators 53

54 Occupational risk factors - collaborators EWG CORE MEMBERS Tim Driscoll Lesley Rushton Sally Hutchings Kyle Steenland Kurt Straif GBD CORE TEAM MEMBERS Greg Freedman Astha KC Mehrdad Fourzanfar Theo Vos Steve Lim Majid Ezzati OTHER CONTRIBUTING MEMBERS Carissa Bonner Claire Bryan-Hancock James Harrison Anthony Hogan Ryan Hoy Gemma Jacklyn Kevin McGeechan Jess Orchard Erin Passmore Neil Pearce Warwick Williams Qialing Zhang 54

55 Conclusions 55

56 Conclusions The Global Burden of Disease study is explicitly evidenced-based. It provides evidence on burden, and the risk factors that produce that burden. Occupational exposure to asbestos is estimated to cause about 215,000 deaths per year. This is probably an underestimate. The findings for Developed countries provide key lessons for Developing countries.

57 Conclusions Methodological challenges remain. The information from the GBD study should be used to guide policy and resource allocation, and to raise awareness through education. Most importantly, the information should lead to ACTION to eliminate exposure to asbestos as much as possible!

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