Lucia Cayuela, Anna Michela Gaeta, Julián Librero, Victoria Achaval Rodríguez, Aurelio Cayuela
Pleural cancer mortality in Spain demonstrates a persistent geographic legacy of industrial asbestos utilisation, with entrenched male mortality clusters in historically documented shipbuilding and asbestos-cement manufacturing regions. In contrast, greater temporal variability in women suggests a shift towards non-occupational and environmental exposures. These findings highlight the need for sustained, geographically targeted surveillance and remediation strategies in the post-ban era.
BACKGROUND: Pleural cancer mortality, largely attributable to past asbestos exposure, persists despite regulatory bans. We assessed nationwide spatiotemporal trends in Spain (1999-2023) to characterise geographical inequalities and sex-specific exposure patterns in the post-ban era.
METHODS: A province-level ecological study was conducted using a hierarchical Bayesian framework implemented via Integrated Nested Laplace Approximation. Sex-specific mortality was modelled using 160 candidate specifications incorporating spatial structure, temporal effects, and spatiotemporal interactions. Model fit was evaluated using deviance and Watanabe-Akaike information criteria. Relative risks (RRs) and posterior exceedance probabilities were estimated to identify high-risk areas.
RESULTS: In men, mortality risk was largely explained by spatial variation (96.8%), reflecting a stable occupational legacy. The optimal male model, with an Intrinsic Conditional Autoregressive (iCAR) structure, identified persistent clusters along the northern and eastern industrial corridor, notably in Vizcaya (RR = 2.30), Cantabria, and Barcelona. In women, mortality showed greater temporal variability (21.2%) and weaker spatial dependence (Leroux prior), suggesting a stronger contribution of non-occupational exposures. Temporally, male RR remained stable (≈1.0), whereas female risk showed a gradual decline from an early high peak, consistent with differing exposure dynamics.
CONCLUSIONS: Pleural cancer mortality in Spain demonstrates a persistent geographic legacy of industrial asbestos utilisation, with entrenched male mortality clusters in historically documented shipbuilding and asbestos-cement manufacturing regions. In contrast, greater temporal variability in women suggests a shift towards non-occupational and environmental exposures. These findings highlight the need for sustained, geographically targeted surveillance and remediation strategies in the post-ban era.