US Mesothelioma Mortality by State

U.S. Mesothelioma Mortality — Snapshot
New cases (2022)	2,669 (CDC)
Annual deaths (2023)	2,591 (GBD estimate)
Total deaths 1999–2020	54,905 (CDC WONDER)
Age-adjusted death rate	5.7 per million (2020)
Highest per-capita state	Maine (17 per million)
Highest absolute count	California (5,484)
Share occupational	~96% of 2023 deaths
Data period	1990–2023

U.S. mesothelioma mortality by state describes the geographic distribution of mesothelioma deaths across the United States. Mesothelioma killed an average of roughly 2,500 Americans a year between 1999 and 2020, but the burden is not shared equally: decades of asbestos use in shipyards, mines, refineries, and heavy industry have left distinct geographic fingerprints, with some states carrying mortality rates more than double the national average. This page tracks state-by-state mesothelioma mortality trends, identifies the highest-burden states by both per-capita rate and absolute count, and explains the industrial and environmental drivers behind the disparities.

Executive Summary

Nationally, U.S. mesothelioma mortality rates have declined by roughly one-third since 1990, yet the absolute number of deaths rose, from 1,981 in 1990 to 2,591 in 2023 in the study's modeled estimates, as population growth and aging outpaced the falling rates. The most comprehensive state-level analysis to date, published in JCO Global Oncology in 2026, found that disability-adjusted life years (DALYs) from mesothelioma actually rose 14% since 1990 even as rates fell. The burden is highly uneven. By per-capita death rate, Maine leads the nation (about 17 deaths per million), followed by Pennsylvania, West Virginia, Delaware, Montana, and Washington. By absolute count, the most populous industrial states — California, Florida, Pennsylvania, New York, and Texas — record the most deaths. A growing share of the burden now falls on women, whose mortality rose in 18 states even as men's rates fell sharply. Survival has not meaningfully improved across three decades, and approximately 96% of 2023 mesothelioma deaths remain attributable to occupational asbestos exposure.

At a Glance

• Mesothelioma caused 54,905 U.S. deaths between 1999 and 2020, an average of roughly 2,500 deaths per year.
• The age-adjusted mortality rate declined from 8.5 per million in 1999 to 5.7 per million in 2020, about a 1.9% annual decrease.
• Despite falling rates, annual diagnoses rose 28% from 1990 to 2023 (2,094 to 2,675 cases), because of population growth and aging.
• Maine has the highest per-capita mortality (~17 deaths per million, 1999–2020), driven by shipbuilding at Bath Iron Works.
• California records the most deaths in absolute terms (5,484, 1999–2020), reflecting population size and naturally occurring asbestos.
• New London County, Connecticut has the highest county-level death rate in the country — 22 per million, reported by the source as 2.2 per 100,000, or roughly 3.9 times the national rate of 5.7 per million — tied to the Naval Submarine Base and Electric Boat.
• Libby, Montana recorded asbestosis mortality 40 to 80 times higher than expected over 1979–1998, according to ATSDR, from W.R. Grace's contaminated vermiculite mine.
• Women's mesothelioma deaths rose about 25% from 1999 to 2020 (from roughly 489 to 614 per year), even as overall male rates declined.

Key Facts

Metric	Value	Source / Data Year
New U.S. cases	2,669 (2022)	CDC U.S. Cancer Statistics
Annual U.S. deaths (modeled)	2,591 (2023)	Edwards/Jani et al., 2026 (GBD)
Total deaths, 1999–2020	54,905	CDC WONDER
Age-adjusted death rate	5.7 per million (2020), down from 8.5 per million (1999)	CDC
Highest per-capita state	Maine, ~17 per million	CDC WONDER, 1999–2020
Highest absolute count	California, 5,484	CDC WONDER, 1999–2020
Highest county death rate	New London County, CT — 22 per million (reported as 2.2 per 100,000)	CDC/NCI
Male-to-female mortality disparity	Male mortality substantially higher; female age-adjusted rate 4.83 per million (1999) declining to 4.15 (2020)	CDC/NIOSH, 1999–2020
Share occupational (2023)	~96%	Edwards/Jani et al., 2026
Mortality-to-incidence ratio	~1 across 1990–2023	Edwards/Jani et al., 2026

How has national mesothelioma mortality changed over time?

Mesothelioma remains a rare but highly lethal cancer. The CDC's U.S. Cancer Statistics dataset recorded 2,669 new cases in 2022. Over the longer term, CDC WONDER recorded 54,905 mesothelioma deaths between 1999 and 2020, with the age-adjusted rate falling from 8.5 per million in 1999 to 5.7 per million in 2020.

The central finding of the 2026 JCO Global Oncology analysis is a paradox: age-standardized incidence and mortality rates declined by roughly one-third over the 1990–2023 study period, mirroring decades of asbestos regulation, yet the annual number of people diagnosed rose 28% and the disability burden (DALYs) climbed 14%. "Declining rates don't necessarily mean fewer lives affected," said Kyle Edwards, co-lead author and an M.D./M.P.H. student at the University of Miami Miller School of Medicine. "When you look at absolute numbers and disability, mesothelioma remains a substantial public health problem." The mortality-to-incidence ratio moved from 0.93 to 0.95 over the period, which the authors read as no meaningful population-level survival improvement.

Which states have the highest mesothelioma mortality rates?

Measured per capita, the highest mesothelioma death rates concentrate in states with deep shipbuilding, steel, mining, and chemical histories. The following ranking reflects CDC WONDER mortality data for 1999–2020.

Rank	State	Total Deaths	Rate (per million)	Primary Industrial Driver
1	Maine	490	17	Shipbuilding (Bath Iron Works)
2	Pennsylvania	3,488	13	Steel, railroads
3	West Virginia	530	13	Coal mining, power plants
4	Delaware	239	12	Chemical manufacturing, ports
5	Montana	256	12	Vermiculite mining (Libby)
6	Washington	1,717	12	Naval shipyards, Boeing
7	Massachusetts	1,642	11	Shipbuilding, textile
8	Minnesota	1,285	11	Iron/taconite mining
9	New Jersey	2,129	11	Oil refining, chemicals
10	Oregon	927	11	Shipbuilding

The 2026 JCO Global Oncology study ranks states for 2023 using modeled Global Burden of Disease estimates, built from vital registration and cancer-registry inputs and age-standardized to the GBD world standard population, so its rates are not directly comparable to the CDC WONDER figures above.

State (2023, GBD estimate)	Incidence per million (per 100,000)	Deaths per million (per 100,000)
Maine (highest)	7.4 (0.74)	7.0 (0.70)
Alaska	6.7 (0.67)	6.3 (0.63)
Washington	6.3 (0.63)	6.0 (0.60)
Minnesota	6.3 (0.63)	5.9 (0.59)
District of Columbia (lowest)	1.7 (0.17)	1.6 (0.16)
Hawaii	2.5 (0.25)	2.4 (0.24)
Georgia	3.0 (0.30)	2.9 (0.29)

The authors tie Maine's and Washington's rates to their shipbuilding histories, Minnesota's at least partially to asbestiform exposure among taconite iron ore miners, and Alaska's to widespread naturally occurring asbestos that construction can disturb.

Which states have the most mesothelioma deaths overall?

Per-capita rate and absolute burden tell different stories, and both matter. A patient in a high-population state may face a moderate per-capita rate but live in a state where most cases are actually diagnosed and treated. By total deaths over 1999–2020, the leading states are the largest industrial population centers.

State	Total Deaths (1999–2020)	Why High
California	5,484	Population size plus naturally occurring asbestos occurrences reported in 42 of 58 counties
Florida	3,676	Large population; retired industrial workers who relocated
Pennsylvania	3,488	Steel and rail heritage
New York	2,981	Shipbuilding, construction, manufacturing
Texas	2,900	Petrochemical, refining, construction

Why are women's mesothelioma rates rising?

Mesothelioma is among the most sex-imbalanced of all cancers: men experience substantially higher mortality than women. Among women, the age-adjusted death rate declined from 4.83 per 1 million women in 1999 to 4.15 in 2020. But the trend lines are diverging. Among men, both incidence and mortality fell sharply as the cohorts historically exposed in shipbuilding, construction, and insulation work aged out. Among women, declines were modest and often statistically insignificant: female incidence increased in 20 states, and female mortality rose in 18 states, with the largest long-term increases in South Dakota, Arkansas, Mississippi, and West Virginia. In absolute terms, women's mesothelioma deaths rose about 25% between 1999 and 2020, from roughly 489 to 614 per year. The JCO Global Oncology estimates point the same way over a longer window: between 1990 and 2023, annual diagnoses among women rose 64% (446 to 731) and deaths 61% (432 to 697), against 18% and 22% among men. Louisiana recorded the highest female disability burden in 2023, a DALY rate of 7.26 per 100,000, nearly 55% above the national average of 4.69.

This divergence points to exposure pathways beyond the factory floor. "For women, mesothelioma often doesn't come with a neat occupational history," said Estelamari Rodriguez, M.D., M.P.H., of Sylvester Comprehensive Cancer Center. "Environmental exposure, para-occupational exposure from family members and legacy asbestos in schools, homes and public buildings likely play a much larger role." These secondary and take-home exposure pathways remain undercounted in occupational statistics.

Where are the catastrophic county-level hotspots?

National and even state averages can blur intense, place-based risk. County-level data (CDC/NCI) identify a handful of communities with death rates far above the national figure.

County rates below are stated in deaths per million to match the national and state figures used throughout this page; the source's own per-100,000 figure follows in parentheses. The national age-adjusted rate for comparison is 5.7 per million.

• New London County, Connecticut — highest county death rate in the U.S. at 22 per million (2.2 per 100,000), about 3.9 times the national rate, tied to the Naval Submarine Base New London and the Electric Boat shipyard in Groton.
• Jackson County, Mississippi — 21 per million (2.1 per 100,000), driven by Ingalls Shipbuilding in Pascagoula.
• Jefferson Parish, Louisiana — 21 per million (2.1 per 100,000), from petrochemical plants and shipyards.
• Kitsap County, Washington — 20 per million (2.0 per 100,000), tied to the Puget Sound Naval Shipyard in Bremerton.
• Libby, Montana — the single most catastrophic domestic asbestos disaster, where ATSDR found asbestosis mortality 40 to 80 times higher than expected over 1979–1998, from W.R. Grace's vermiculite mine, which was contaminated with tremolite-actinolite asbestos. A later ATSDR study identified 694 Libby-area residents who died of asbestos-associated disease between 1979 and 2011.

What industries drive the geographic disparities?

The state and county map of mesothelioma mortality closely follows the map of 20th-century heavy industry.

• Shipbuilding (Atlantic and Pacific coasts) — the 2026 JCO Global Oncology authors tie Maine's and Washington's elevated rates to their shipbuilding histories, long associated with asbestos-related cancer among shipyard workers. Key sites include Bath Iron Works (Maine), Newport News Shipbuilding (Virginia), Ingalls (Mississippi), and Puget Sound Naval Shipyard (Washington).
• Steel and rail (Midwest and Mid-Atlantic) — Pennsylvania's Pittsburgh region (Edgar Thomson, Homestead, and Clairton Coke works) and Indiana's Gary Works.
• Mining (Mountain West and Upper Midwest) — Montana's Libby vermiculite and Minnesota's taconite iron-ore mining, where the 2026 JCO Global Oncology authors attribute Minnesota's rates, at least partially, to asbestiform exposure among taconite miners.
• Naturally occurring asbestos (NOA) — California is the most affected state, with reported occurrences in 42 of its 58 counties; the Eastern U.S. contains 331 reported natural asbestos sites following the Appalachian belt. El Dorado Hills, California, is the most-studied NOA community.
• Chemical and petrochemical (Gulf and Mid-Atlantic) — Texas, Louisiana, Delaware, and New Jersey, where refining and chemical manufacturing concentrated exposure.

Has survival improved?

The most sobering finding is what has not changed. Across three decades the mortality-to-incidence ratio remained near 1, meaning population-level survival gains have been minimal. Even as immune checkpoint inhibitors entered clinical practice in recent years, their impact has not yet shifted outcomes at a national scale. "Despite all our scientific advances, mesothelioma remains one of the most lethal solid tumors," said Gilberto Lopes, M.D., chief of medical oncology at Sylvester. For prognosis and stage-by-stage detail, see Survival_Statistics and Mesothelioma_Survival_Statistics_EEAT_enhanced.

What does the path forward look like?

Mesothelioma is overwhelmingly preventable: approximately 96% of 2023 U.S. deaths were attributable to occupational asbestos exposure, a proportion that has changed little since 1990. That persistence reflects the durability of asbestos embedded in older buildings, ships, and infrastructure, and the fact that the United States has never fully banned asbestos. The EPA's March 2024 chrysotile rule regulates certain conditions of use rather than imposing a general ban. Asbestos bankruptcy trusts hold documented remaining assets of at least $16.10 billion as of September 24, 2026 — a floor summed from the 44 trust records with a located net-asset figure, out of 54 active trusts tracked. Reducing the future burden will require sustained asbestos remediation, stronger surveillance — especially for women and non-occupationally-exposed patients — and continued investment in more effective treatments. For the legal time limits that apply to claims in each state, see Statute_of_Limitations_by_State; for veterans' claims tied to naval-shipyard exposure, see Veterans_Asbestos_Claims.

See also

• Survival_Statistics
• Veterans_Asbestos_Exposure
• Shipyard_Workers
• Vermiculite_Libby_Montana
• Statute_of_Limitations_by_State
• Settlement_Values_by_State

External Links

• CDC — U.S. Cancer Statistics: Mesothelioma
• CDC WONDER — Underlying Cause of Death database
• Danziger & De Llano — mesothelioma and asbestos exposure resources