Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, Paddington, London, W2 1PG, UK.
Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, Paddington, London, W2 1PG, UK.
Environ Int. 2014 Aug;69:120-32. doi: 10.1016/j.envint.2014.04.003. Epub 2014 May 12.
Public concern about potential health risks associated with incineration has prompted studies to investigate the relationship between incineration and risk of cancer, and more recently, birth outcomes. We conducted a systematic review of epidemiologic studies evaluating the relationship between waste incineration and the risk of adverse birth and neonatal outcomes.
Literature searches were performed within the MEDLINE database, through PubMed and Ovid interfaces, for the search terms; incineration, birth, reproduction, neonatal, congenital anomalies and all related terms. Here we discuss and critically evaluate the findings of these studies.
A comprehensive literature search yielded fourteen studies, encompassing a range of outcomes (including congenital anomalies, birth weight, twinning, stillbirths, sex ratio and infant death), exposure assessment methods and study designs. For congenital anomalies most studies reported no association with proximity to or emissions from waste incinerators and "all anomalies", but weak associations for neural tube and heart defects and stronger associations with facial clefts and urinary tract defects. There is limited evidence for an association between incineration and twinning and no evidence of an association with birth weight, stillbirths or sex ratio, but this may reflect the sparsity of studies exploring these outcomes.
The current evidence-base is inconclusive and often limited by problems of exposure assessment, possible residual confounding, lack of statistical power with variability in study design and outcomes. However, we identified a number of higher quality studies reporting significant positive relationships with broad groups of congenital anomalies, warranting further investigation. Future studies should address the identified limitations in order to help improve our understanding of any potential adverse birth outcomes associated with incineration, particularly focussing on broad groups of anomalies, to inform risk assessment and waste policy.
公众对与焚烧相关的潜在健康风险的关注促使研究调查焚烧与癌症风险的关系，以及最近与出生结果的关系。我们对评估废物焚烧与不良出生和新生儿结果之间关系的流行病学研究进行了系统评价。
在 MEDLINE 数据库中，通过 PubMed 和 Ovid 接口，使用以下搜索词进行文献检索：焚烧、出生、繁殖、新生儿、先天畸形和所有相关术语。在这里，我们讨论并批判性地评估了这些研究的结果。
全面的文献检索产生了 14 项研究，涵盖了一系列结果（包括先天畸形、出生体重、双胞胎、死产、性别比例和婴儿死亡）、暴露评估方法和研究设计。对于先天畸形，大多数研究报告说，与废物焚烧炉的接近程度或排放物没有关联，也没有关联“所有畸形”，但与神经管和心脏缺陷有关联较弱，与面部裂和泌尿道缺陷的关联较强。废物焚烧与双胞胎的关联证据有限，与出生体重、死产或性别比例无关，但这可能反映了研究这些结果的研究较少。
目前的证据基础尚无定论，并且经常受到暴露评估问题、可能存在的残余混杂、缺乏统计学效力以及研究设计和结果的可变性的限制。然而，我们确定了一些高质量的研究报告称，与广泛的先天畸形组存在显著的正相关关系，值得进一步研究。未来的研究应解决已确定的局限性，以帮助我们更好地了解与焚烧相关的任何潜在不良出生结果，特别是集中在广泛的畸形组，为风险评估和废物政策提供信息。
