Burden of cancer attributable to occupational asbestos exposure in the Americas, 1990-2023: an analysis using the Global Burden of Disease Study 2023.

Background: Asbestos remains a leading occupational carcinogen, particularly in countries where its use persists despite known health risks. This study provides a systematic analysis of the burden of cancer attributable to occupational asbestos exposure in the Americas from 1990 to 2023, using estimates from the Global Burden of Disease (GBD) Study 2023. Age-standardised mortality and disability-adjusted life-years (DALYs) attributable to asbestos were analysed for mesothelioma, lung, laryngeal, and ovarian cancers, stratified by sex and region. Methods: We conducted a descriptive analysis to assess spatiotemporal trends in the burden of cancer attributable to occupational asbestos in the Americas from 1990 to 2023. We analysed trends in age-standardized mortality and DALY rates using segmented joinpoint regression. Age-period-cohort analyses were performed for age-specific mortality and DALY rates. All analyses were stratified by cancer type, sex and GBD regions, with estimated 95% uncertainty intervals (95% UI). Findings: In 2023, High-income North America had the highest burden of cancer attributable to occupational asbestos, with 5·1 deaths (95% UI 3·9; 6·4) and 84·9 DALYs (65·6; 108·5) per 100,000 population for both sexes. However, the region also experienced the most pronounced decline, with average annual reductions of 2·0% (-2·0; -1·9) in mortality and 2·5% (-2·5; -2·4) in DALYs. Southern Latin America had the second highest rates for cancer attributable to occupational asbestos, with 2·7 deaths (2·1; 3·5) and 53·1 DALYs (40·4; 69·3) for both sexes in 2023, and showed the strongest increase in women with 2·3% (2·2; 2·4) both in mortality and DALYs annually. Age-period-cohort modelling revealed marked increases in burden of cancer attributable to occupational asbestos among women, with mortality and DALY rate ratios (RR) for lung cancer rising to 1·31 (1·20; 1·44) in Tropical and Southern Latin America, and RR for mesothelioma rising to 1·22 (1·06; 1·40) in Southern Latin America. Interpretation: Our study revealed inequalities in the burden of cancer attributable to occupational asbestos exposure among regions in the Americas, as well as remarkable sex disparities. Although rates were declining in North America, there is growing concern over rising rates of lung cancer and mesothelioma among women in Tropical and Southern Latin America regions, especially in Argentina and Brazil. These disparities likely reflect differences in environmental and industrial regulatory practices, as well as gendered occupational exposure patterns. Also, upward trends in female lung cancer rates may reflect increased smoking among women, while mesothelioma is much more specific to asbestos exposure. Despite regulatory advances, legacy exposures and ongoing asbestos use persist in parts of Latin America, reinforcing the need for stricter occupational health policies and asbestos bans. The findings underscore the shifting epidemiology of asbestos-related cancers and call for targeted prevention efforts, improved surveillance, and gender-responsive occupational protections. Funding: This study was partially funded by the Bill & Melinda Gates Foundation and "