Geographic, Temporal, and Sex-Specific Trends in Mesothelioma Burden in the United States, 1990–2023

PURPOSE: Mesothelioma is a rare, aggressive cancer, strongly linked to asbestos. Although US regulations limiting asbestos use were introduced beginning in the 1970s, the long latency necessitates ongoing evaluation of population-level burden. METHODS: Age-standardized incidence (ASIR) and mortality rates (ASMR), disability-adjusted life-years (DALYs), and occupational-attributable fractions were obtained from the Global Burden of Disease study for mesothelioma at the national and state levels from 1990 to 2023 for males, females, and both sexes combined. Mortality-to-incidence ratios (MIRs) were calculated. Temporal trends were evaluated using joinpoint regression to estimate annual percent change and average annual percent change. RESULTS: Nationally, ASIR declined 33% (0.64-0.43 per 100,000) and ASMR declined 31% (0.60-0.41) from 1990 to 2023, with markedly steeper reductions among males (ASIR, -42%; ASMR, -41%) than females (ASIR, -7%; ASMR, -8%), while absolute cases and deaths increased. The MIR rose from 0.93 to 0.95 overall and increased among males (0.95-0.98), indicating no meaningful population-level survival improvement. Occupational asbestos exposure accounted for 95.7% of deaths in 2023. Age-standardized DALY rates declined 40% overall, although absolute DALYs increased 14%. At the state level, Maine, Alaska, Washington, and Minnesota had the highest ASIRs and ASMRs. Female incidence increased in 20 states and mortality in 18, with the largest increases in South Dakota, Arkansas, Mississippi, and West Virginia. CONCLUSION: Although mesothelioma rates have declined nationally, progress has been uneven across sexes and states. Persistently high mortality-to-incidence ratios, rising female burden in multiple states, and substantial geographic heterogeneity emphasize the need for targeted surveillance, remediation of legacy asbestos, and investment in more effective therapies.