Introduction Malignant pleural mesothelioma (MPM) is a rare but aggressive malignancy associated with asbestos exposure for more than 80% of cases. The average latency of MPM is twenty to forty years. The history of asbestos use in Taiwan showed the massive importation during 1960–1980, but was under control by legislation since 1989, and was totally banned by legislation since 2018.

Objective The aim of study is to investigate the temporal trend and spatial pattern of mortality for malignant pleural mesothelioma in Taiwan during recent decades.

Method The standardized rates of mortality for MPM (ICD-9: 163, ICD-10: C45.0 & C45.9) in Taiwan were computed at national and regional levels during 1975–2019; the sex ratios of male to female deaths for MPM were also computed at regional level.

Result The trend of national mortality for MPM in Taiwan is still increasing in twenty to thirty years after the asbestos control, especially among male population; the pattern of regional mortality for MPM reflects the distribution of the asbestos-related industrial settlements in the country.

Conclusion In adequate response to the epidemic of asbestos-related diseases, it is necessary to implement a national comprehensive program for the surveillance, diagnosis, and treatment healthcare to protect workers and community people.