Mesothelioma among vehicle mechanics: a controversy?

The paper by Thomsen et al1 is a significant contribution to the now-substantial body of literature on the relationship between asbestos-related diseases and vehicle repair work. It is a large study, inclusive of all registered vehicle mechanics in the country for the designated years, with a mean follow-up time of 20 years and a maximum of 45 years. Several comprehensive administrative databases were linked for exposure and disease outcomes. The numbers of outcomes for the three main diseases of interest produced relatively narrow CIs.

The authors present data indicating that reliance on administrative databases for health outcomes was unlikely to be a problem for mesothelioma and lung cancer; however, it is reasonable to question the validity of the diagnoses of asbestosis based on administrative data alone. As the authors point out, the statistically significant elevation in asbestosis mortality and morbidity is somewhat puzzling given the relatively high...