Projecting future mortality risk of pleural mesothelioma in Italy (2020-2034): Bayesian age-period-cohort analysis over 40 years of death registration.

Introduction: Italy, a major former producer, banned asbestos in 1992. A high incidence of mesothelioma, one of the asbestos legacies, is still observed due to the long latency and exposure from residual asbestos-containing materials. Future mortality forecasts at both national and subnational levels are still lacking. This work aims to project future age-stratified mortality rates (2020-2034) for pleural mesothelioma (PM) in Italy, both nationally and for each administrative region. Methods: Data on pleural cancers and PM in Italy between 1980 and 2019 were extracted from death registries, adjusted for PM misclassification in ICD-9, and aggregated in eight periods, eighteen age classes, and fifteen birth cohorts. Bayesian age-period-cohort models were implemented to generate age-specific mortality projections, stratified by sex assigned at birth. Results: Between 1980 and 2019, 33,889 people died from PM in Italy, and 19,092 more deaths are expected between 2020 and 2034. The national peak is predicted for 2020-2024, with 6,740 deaths. Age groups under 75 years have already reached the peak of mortality rates. Region-specific trends by sex and time reflect the country's industrialization history. Discussion: These results align with the literature in predicting the timing of the mesothelioma peak and offer new insights into age-specific trends, the rate of decline, and geographical patterns. They provide valuable evidence on the heterogeneous asbestos legacy across regions, supporting targeted public health actions and health planning.