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Malignant mesothelioma among US Medicare beneficiaries: incidence, prevalence and therapy, 2016–2019
  1. Laura Kurth,
  2. Jacek M Mazurek,
  3. David J Blackley
  1. Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
  1. Correspondence to Dr Laura Kurth, National Institute for Occupational Safety and Health, Respiratory Health Division, Morgantown, West Virginia, USA; vrz6{at}


Objectives Mesothelioma is a rare, aggressive cancer caused by exposure to asbestos fibres. Mesothelioma patients who receive trimodal therapy (chemotherapy, surgical resection and radiation) survive longer than those who receive two or fewer therapy modalities. This study analyses the 2016–2019 Medicare claims data to estimate the burden of malignant mesothelioma and describe therapy patterns (when available) among continuously enrolled fee-for-service (FFS; Medicare parts A and B) beneficiaries.

Methods We analysed claims and enrolment information from 42 529 117 FFS Medicare beneficiaries using three mesothelioma case definitions (broad, intermediate and narrow) with varying levels of diagnostic requirements. Results are presented as ranges of values for the three definitions.

Results Among FFS beneficiaries, 8213–19 036 beneficiaries with mesothelioma were identified depending on the case definition. The annual prevalence per 100 000 beneficiaries ranged from 8.8 in 2016 (narrow) to 31.3 in 2019 (broad) and annual incidence per 100 000 beneficiaries ranged from 4.5 in 2019 (narrow) to 12.6 in 2017 (broad). Depending on the mesothelioma case definition, 41.8%–81.5% had available therapy claim information indicating that 7.6%–11.3% received chemotherapy alone, 1.3%–1.5% received radiation alone, and 14.3%–27.0% underwent surgery only, with 4.6%–10.5% receiving all three therapy modalities.

Conclusions Mesothelioma was a prevalent disease among FFS Medicare beneficiaries during 2016–2019, and a limited proportion of beneficiaries received all three therapy modalities. Medicare data build on findings from cancer registry data to enhance our understanding of the mesothelioma burden and therapy patterns.

  • Asbestos
  • Mesothelioma
  • Public Health Surveillance
  • Occupational Health
  • Health services research

Data availability statement

CMS data are available on approved request through the Research Data Assistance Center

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Data availability statement

CMS data are available on approved request through the Research Data Assistance Center

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  • Contributors LK and DJB participated in the conception and design of the work; LK participated in the analysis of data and drafted the work; LK, JMM and DJB participated in the interpretation of data for the work, revised drafts of the work, and provided the final approval of this article to be published and agree to be accountable for all aspects of the work. LK is responsible for the overall content as the guarantor.

  • Funding Support for this work was obtained from the National Occupational Research Agenda Intramural Research Competition, NIOSH, CDC. Award/grant number not applicable. All authors are employees of the Federal Government and all work was performed as part of their official duties.

  • Disclaimer The findings and conclusions of this report are those of the authors and do not necessarily represent the view of the National Institute for Occupational Safety and Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.