Analyses of Asbestosis Hospitalizations and Mortality Data at the County Level, New Jersey, 2002-2009

BACKGROUND: Asbestosis is an obstructive lung disease caused by inhaling asbestos fibers. In New Jersey (NJ), the rates of asbestosis hospitalizations and deaths have remained consistently higher than the U.S. even though asbestos exposure has declined.  There have been over 12,000 hospitalizations and over 500 deaths due to asbestosis from 2002 to 2009. NJ has had an extensive history of asbestos production and use.  Rates of mesothelioma, an asbestos-related cancer, are higher in the counties of NJ with substantial exposure from historic asbestos industries.  The purpose of this analysis is to examine whether hospitalization or mortality due to asbestosis was also elevated in these same counties, and whether there are temporal trends in rates of these outcomes. 

METHODS: Hospital discharge data and death certificates were used to identify hospitalizations and deaths due to asbestosis in the period 2002-2009, based on ICD-9 and ICD-10 codes.  Counties were grouped as “high risk” or “low risk” based on mesothelioma rates.  Poisson regression was used to calculate the relative rates of asbestosis hospitalization or death comparing low- to high-risk counties, controlling for age, gender, and race/ethnicity.  Analyses also evaluated trends in hospitalization or mortality rates of asbestosis from 2002-2009.  

RESULTS: This study found an association between the county risk group and rates of hospitalization and death from asbestosis.  The adjusted rate ratio for asbestosis hospitalization in low-risk counties was 0.26 (95% CI: 0.25-0.27) compared to high-risk counties; the adjusted rate ratio for asbestosis deaths was 0.27 (95% CI: 0.22-0.32) comparing low- to high-risk counties.   Rates of asbestosis hospitalization or death did not show a consistent increase or decrease over time. 

CONCLUSIONS: In NJ, counties where mesothelioma has been elevated also show increased rates of hospitalizations and death due to asbestosis.  Even though exposure to asbestos has decreased substantially, rates of asbestos-related disease have yet to show declines, due to the long latency period between exposure and diagnosis or death.  Asbestos-related disease remains a public health burden in NJ, and continued surveillance is warranted.