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Table 1.  

Characteristic No. of deaths (%) Death rate (95% CI)§
Total 12,227 (100) 4.59 (4.50–4.67)
Age group, yrs
25–34 71 (0.6) 0.16 (0.12–0.20)
35–44 282 (2.3) 0.60 (0.53–0.67)
45–54 781 (6.4) 1.66 (1.54–1.77)
55–64 1,857 (15.2) 4.68 (4.47–4.89)
65–74 3,203 (26.2) 11.69 (11.29–12.10)
75–84 4,018 (32.9) 23.17 (22.45–23.88)
≥85 2,015 (16.5) 25.10 (24.00–26.20)
Race
White 11,447 (93.6) 5.03 (4.93–4.93)
Black 550 (4.5) 2.02 (1.85–2.19)
Asian or Pacific Islander 179 (1.5) 1.58 (1.34–1.82)
American Indian or Alaska Native 51 (0.4) 2.82 (2.07–3.75)
Ethnicity
Hispanic or Latino 643 (5.3) 2.98 (2.75–3.22)
Non-Hispanic or Latino 11,561 (94.6) 4.69 (4.60–4.77)
Unknown 23 (0.2) NA
Anatomic site**
Pleura 968 (7.9) 0.35 (0.33–0.37)
Peritoneum 1,119 (9.2) 0.42 (0.39–0.44)
Pericardium 35 (0.3) 0 (—)
Other 1,385 (11.3) 0.52 (0.49–0.55)
Unspecified 8,842 (72.3) 3.29 (3.22–3.36)
Year
1999 489 (4.0) 4.83 (4.40–5.26)
2000 487 (4.0) 4.77 (4.34–5.19)
2001 486 (4.0) 4.66 (4.24–5.07)
2002 444 (3.6) 4.17 (3.78–4.56)
2003 499 (4.1) 4.64 (4.23–5.05)
2004 516 (4.2) 4.77 (4.35–5.18)
2005 556 (4.5) 4.99 (4.58–5.41)
2006 503 (4.1) 4.49 (4.10–4.89)
2007 531 (4.3) 4.67 (4.27–5.07)
2008 557 (4.6) 4.79 (4.39–5.19)
2009 559 (4.6) 4.66 (4.27–5.05)
2010 562 (4.6) 4.72 (4.33–5.12)
2011 543 (4.4) 4.40 (4.03–4.78)
2012 615 (5.0) 4.92 (4.52–5.31)
2013 621 (5.1) 4.89 (4.50–5.27)
2014 610 (5.0) 4.67 (4.29–5.05)
2015 550 (4.5) 4.12 (3.77–4.47)
2016 569 (4.7) 4.16 (3.81–4.50)
2017 672 (5.5) 4.85 (4.47–5.22)
2018 603 (4.9) 4.20 (3.86–4.54)
2019 641 (5.2) 4.36 (4.02–4.70)
2020 614 (5.0) 4.15 (3.81–4.48)
p-value for trend <0.001 0.038

Table 1. Number and rate of malignant mesothelioma deaths among women aged ≥25 years,* by selected characteristics and year — United States, 1999–2020

Source: CDC WONDER Multiple Cause of Death data. https://wonder.cdc.gov/mcd.html
Abbreviation: NA = not applicable.
*International Classification of Diseases, Tenth Revision codes C45.0 (mesothelioma of pleura), C45.1 (mesothelioma of peritoneum), C45.2 (mesothelioma of pericardium), C45.7 (mesothelioma of other sites), or C45.9 (mesothelioma, unspecified).
Age-adjusted deaths per 1 million women using 2000 U.S. standard population.
§https://wonder.cdc.gov/wonder/help/mcd.html#Confidence-Intervals
Age-specific deaths per 1 million women using 2000 U.S. standard population.
**The sum of individual site death totals exceeds the total number of deaths for any site because some decedents have more than one site of mesothelioma listed on their death certificates.

Table 2.  

Industry/Occupation No. of deaths (%)
Health care and social assistance 89 (15.7)
Registered nurses 28 (4.9)
Nursing, psychiatric, and home health aides 11 (1.9)
Personal care aides 6 (1.1)
Education service 64 (11.3)
Elementary and middle school teachers 32 (5.6)
Teacher assistants 5 (0.9)
Manufacturing 50 (8.8)
Secretaries and administrative assistants 7 (1.2)
Production workers, all other 6 (1.1)
Retail trade 37 (6.5)
Retail salespersons 10 (1.8)
First-line supervisors of retail sales workers 9 (1.6)
Cashiers 5 (0.9)
Public administration 27 (4.8)
Secretaries and administrative assistants 6 (1.1)
Finance and insurance 24 (4.2)
Professional, scientific, and technical services 24 (4.2)
Accommodation and food services 23 (4.1)
Food service managers 5 (0.9)
Waiters and waitresses 5 (0.9)
Other services (except public administration) 23 (4.1)
Hairdressers, hairstylists, and cosmetologists 7 (1.2)
Transportation and warehousing 13 (2.3)
Real estate and rental and leasing 8 (1.4)
Real estate brokers and sales agents 6 (1.1)
Administrative, support, and waste services 8 (1.4)
Information 7 (1.2)
Agriculture, forestry, fishing, and hunting 6 (1.1)
Construction 6 (1.1)
Arts, entertainment, and recreation 5 (0.9)
Other/Missing 153 (27.0)
Homemaker 129 (22.8)

Table 2. Usual industry and occupations* within industries associated with ≥5 malignant mesothelioma deaths among women aged ≥25 years — United States,§ 2020

Source: NCHS Mortality Multiple Cause Files 2020. https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm#Mortality_Multiple
Abbreviation: NCHS = National Center for Health Statistics.
*U.S. Census Bureau Industry and Occupation 2012 coding scheme. The industry grouping is the two-digit simple industry recode based on the 2012 North American Industry Classification System–informed codes obtained from the U.S. Census Bureau. Usual occupation is the occupation the person did for "most of his or her working life." https://www.cdc.gov/nchs/data/dvs/Industry-and-Occupation-data-mortality-2020.pdf
International Classification of Diseases, Tenth Revision codes C45.0 (mesothelioma of pleura), C45.1 (mesothelioma of peritoneum), C45.2 (mesothelioma of pericardium), C45.7 (mesothelioma of other sites), or C45.9 (mesothelioma, unspecified). https://wonder.cdc.gov
§Starting with the 2020 data year, NCHS and the National Institute for Occupational Safety and Health began a collaboration to translate industry and occupation information, submitted by 46 states and New York City (Arizona, North Carolina, Rhode Island, and District of Columbia did not participate in this program for 2020) to NCHS as part of their death certificate data, to U.S. Census Bureau Industry and Occupation codes (data collected from Iowa were inconsistent with other states' data and were excluded). https://www.cdc.gov/nchs/data/dvs/Industry-and-Occupation-data-mortality-2020.pdf
Includes mining, utilities, wholesale trade, and management of companies and enterprises.

CME / ABIM MOC / CE

Malignant Mesothelioma Mortality in Women — United States, 1999–2020

  • Authors: Jacek M. Mazurek, MD; David J. Blackley, DrPH; David N. Weissman, MD
  • CME / ABIM MOC / CE Released: 8/16/2022
  • Valid for credit through: 8/16/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for public health and prevention officials, occupational health clinicians, oncologists, pulmonologists, nurses, pharmacists, and other clinicians caring for women with or at risk for mesothelioma.

The goal of this activity is for learners to be better able to describe deaths associated with mesothelioma and temporal trends in mesothelioma mortality among women in the United States, based on an analysis of annual Multiple Cause of Death records from the National Vital Statistics System for 1999 to 2020, the most recent years for which complete data are available.

Upon completion of this activity, participants will:

  • Evaluate deaths associated with mesothelioma and temporal trends in mesothelioma mortality among women in the United States, based on an analysis of annual Multiple Cause of Death records from the National Vital Statistics System for 1999 to 2020
  • Assess the geographic factors and occupations associated with mesothelioma-related deaths, based on an analysis of annual Multiple Cause of Death records from the National Vital Statistics System for 1999 to 2020
  • Describe the clinical and public health implications of deaths associated with mesothelioma and temporal trends in mesothelioma mortality among women in the United States, based on an analysis of annual Multiple Cause of Death records from the National Vital Statistics System for 1999 to 2020


Faculty

  • Jacek M. Mazurek, MD

    Respiratory Health Division 
    National Institute for Occupational Safety and Health
    Centers for Disease Control and Prevention

    Disclosures

    Jacek M. Mazurek, MD, has no relevant financial relationships.

  • David J. Blackley, DrPH

    Respiratory Health Division 
    National Institute for Occupational Safety and Health
    Centers for Disease Control and Prevention

    Disclosures

    David J. Blackley, DrPH, has no relevant financial relationships.

  • David N. Weissman, MD

    Respiratory Health Division 
    National Institute for Occupational Safety and Health
    Centers for Disease Control and Prevention

    Disclosures

    David N. Weissman, MD, has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie

Compliance Reviewer/Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has no relevant financial relationships.


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CME / ABIM MOC / CE

Malignant Mesothelioma Mortality in Women — United States, 1999–2020

Authors: Jacek M. Mazurek, MD; David J. Blackley, DrPH; David N. Weissman, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 8/16/2022

Valid for credit through: 8/16/2023

processing....

Abstract and Introduction

Introduction

Inhalation of asbestos fibers can cause malignant mesothelioma, a rapidly progressing and lethal cancer of the mesothelium, the thin layer of tissues surrounding internal organs in the chest and abdomen. Patients with malignant mesothelioma have a poor prognosis, with a median survival of 1 year from diagnosis. The estimated median interval from initial occupational asbestos exposure to death is 32 years (range = 13–70 years).[1] Occupational asbestos exposure is most often reported in men working in industries such as construction and manufacturing; however, women are also at risk for exposure to asbestos fibers, and limited data exist on longer-term trends in mesothelioma deaths among women. To characterize deaths associated with mesothelioma and temporal trends in mesothelioma mortality among women in the United States, CDC analyzed annual Multiple Cause of Death records from the National Vital Statistics System for 1999–2020, the most recent years for which complete data are available. The annual number of mesothelioma deaths among women increased significantly, from 489 in 1999 to 614 in 2020; however, the age-adjusted death rate per 1 million women declined significantly, from 4.83 in 1999 to 4.15 in 2020. The largest number of deaths was associated with the health care and social assistance industry (89; 15.7%) and homemaker occupation (129; 22.8%). Efforts to limit exposure to asbestos fibers, including among women, need to be maintained.

Malignant mesothelioma deaths were identified for 1999–2020 and included any death certificates for which an International Classification of Diseases, Tenth Revision (ICD-10) code for malignant mesothelioma was listed in the CDC WONDER Multiple Cause of Death mortality data.* Given the predominantly occupational etiology and long latency of mesothelioma, analysis was limited to deaths of women aged ≥25 years. The annual death rate (per 1 million women) was age-adjusted to the 2000 U.S. standard population. Age-adjusted death rates were mapped by state using geographic information system software (MapInfo Pro v2019.3; Precisely). Joinpoint Regression Program software (version 4.9.0.0.; National Cancer Institute) was used to evaluate time trends in deaths and log-transformed age-adjusted rates. Standard information about the usual industry and occupation§ was identified in the 2020 NCHS Mortality Multiple Cause of Death file for decedents in 46 states and New York City. Occupations classified according to the four-digit 2012 U.S. Census Bureau coding system and the two-digit simple industry recode based on the 2012 North American Industry Classification System** were examined using SAS software (version 9.4; SAS Institute).

During 1999–2020, 12,227 (age-adjusted death rate: 4.59 per 1 million women) malignant mesothelioma deaths occurred among women aged ≥25 years in the United States; 11,093 (90.7%) occurred among women aged ≥55 years, 11,447 (93.6%) occurred among White women, and 11,561 (94.6%) among non-Hispanic women (Table 1); 11,499 (94.0%) had malignant mesothelioma listed as the underlying cause of death. Mesothelioma deaths were classified as mesothelioma of pleura (968; 7.9%), peritoneum (1,119; 9.2%), pericardium (35; 0.3%), other sites (1,385; 11.3%), and unspecified location (8,842; 72.3%). The annual number of malignant mesothelioma deaths increased 25%, from 489 in 1999 to 614 in 2020 (p<0.001), and the annual age-adjusted death rate declined from 4.83 per 1 million women in 1999 to 4.15 in 2020 (p = 0.038). During 1999–2020, the annualized state mesothelioma age-adjusted death rate exceeded 6.0 per 1 million women in seven states: Louisiana, Maine, Minnesota, Montana, Oregon, Washington, and Wisconsin (Figure).

Enlarge

FIGURE. Malignant mesothelioma* annualized age-adjusted death rate† per 1 million women aged ≥25 years — United States, 1999–2020
Source: CDC WONDER Multiple Cause of Death data. https://wonder.cdc.gov/mcd.html
Abbreviation: DC = District of Columbia.
*International Classification of Diseases, Tenth Revision codes C45.0 (mesothelioma of pleura), C45.1 (mesothelioma of peritoneum), C45.2 (mesothelioma of pericardium), C45.7 (mesothelioma of other sites), and C45.9 (mesothelioma, unspecified).
†Adjusted using 2000 U.S. standard population. Age-adjusted death rates were not calculated for states with ≤20 malignant mesothelioma deaths (Alaska and DC).

Industry and occupation information was available for 567 (92.3%) of 614 malignant mesothelioma deaths among residents of 47 jurisdictions that occurred in women aged ≥25 years during 2020 (Table 2). Among 21 industry groups, the three with the most deaths were health care and social assistance (89; 15.7%); education services (64; 11.3%); and manufacturing (50; 8.8%). One hundred thirty-two occupations were reported on death certificates for malignant mesothelioma decedents among women during 2020. The three occupations with the highest numbers of mesothelioma deaths were homemakers (129; 22.8%); elementary and middle school teachers (32; 5.6%); and registered nurses (28; 4.9%).