Mesothelioma mortality trends and geographic burden in Peru, 2017–2025: a nationwide ecological time-series study

Mesothelioma is a rare malignancy associated with asbestos exposure and limited survival. Despite its public health relevance, recent evidence on mortality trends in Peru remains scarce. This study aimed to estimate age-standardized mesothelioma mortality rates, evaluate temporal mortality trends, and describe the geographic distribution of mesothelioma mortality in Peru between 2017 and 2025. We conducted a nationwide ecological time-series study using mortality data from the National Death Information System (SINADEF). Mesothelioma-related deaths (ICD-10 code C45 and subcategories) recorded between 2017 and 2025 were included. Age-standardized mortality rates (ASMRs) per 100,000 person-years were calculated by direct standardization to the SEGI world standard population. For department-level analyses covering the entire study period, annual population denominators were summed across 2017–2025 to obtain person-years before direct age standardization. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and 95% confidence intervals (95% CIs). During the study period, 325 mesothelioma-related deaths were recorded, with a higher proportion among males (58.46%) than females (41.54%). Mortality was concentrated among older adults, particularly those 65–74 years (31.08%), and pleural mesothelioma accounted for most cases (64.62%). Annual ASMRs ranged from 0.08 to 0.14 per 100,000 person-years among men, and from 0.04 to 0.11 per 100,000person-years among women. No statistically significant temporal changes in mesothelioma mortality were detected during the study period for either sex (overall APC: −0.9; 95% CI: −8.5 to 7.3; p = 0.79). Marked geographic variation was observed, with Huancavelica showing the highest department-level ASMR during 2017–2025 in both men and women. No statistically significant temporal change in mesothelioma mortality was detected between 2017 and 2025. Mortality was higher among men and older adults, and marked geographic variation was observed across departments. These findings highlight the importance of strengthening mortality surveillance, diagnostic capacity, and further epidemiological investigation in areas with higher mortality.