Yeah, MTBF is meaningless without conditions. Most calculations miss the frequency and weighting that transients deserve.
The AC line is expected to have a mean maximum of 127VAC (264VAC elsewhere), which would probably give the stated MTBF based on the usual calculation method (a single activation energy extrapolation from an accelerated life test).
But the real AC line is also expected to have transients, with roughly a 1/f distribution of frequency and severity. Very frequent events (such as RFI and ESD) are high frequency AC, or short duration transients, easily filtered. Infrequent events (surges, dips, swells) contain more energy, perhaps enough to stress all the capacitors in a typical circuit (filter followed by bridge rectifier and bulk cap). Lightning is the largest, least frequent transient that gets tested, and is quite capable of exploding capacitors.
Y caps are made to, at worst, arc over from such operation. The line-to-ground voltage (including transients) is expected to be quite large under normal circumstances (i.e., 2500VAC isolation), and mustn't cause increased ground leakage (a safety hazard if the device becomes ungrounded).
X caps are made to be self-healing and self-extinguishing. They naturally die from high voltage operation, as more and more of the dielectric gets burned away.
Clearly, an MTBF calculation including transients will give a significantly shorter lifetime expectation. Breakdown is exponential with voltage, so even if the expected voltage is doubly inverse with time, it's quite reasonable to expect failure within a modest time frame. Of course, you'd have to do a lot of characterization and calculation to establish what that time frame is.
As far as I know, equipment is not expected to pass EMC after initial sale and installation, so I guess no one cares about this as a failure mode. Seems kind of dumb, but it would be rather hard to address, after all.
Tim