Department of Public Health Sciences, Karolinska Institutet, Sweden.
Department of Medical and Surgical Specialties Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Italy.
Chemosphere. 2019 Mar;218:211-222. doi: 10.1016/j.chemosphere.2018.11.088. Epub 2018 Nov 15.
Adverse health effects of cement plant exposure have been found in occupational contexts but are less defined for the general population living near plants. We aimed to summarize the evidence on the health effects of people exposed to ambient air pollution by cement plants. A systematic review using Embase, PubMed and Web of Science was performed. We included only non-occupational studies with a comparison group that focused on adverse health outcomes and biomarkers of internal dose or subclinical effect associated with cement plant exposure. Selection of articles was performed by two authors independently. Of 1491 articles identified by the initial search, 24 were included: 17 of them were included in the analysis of adverse health outcomes and 9 in the analysis of biomarkers of internal dose or subclinical effects. The studies were very heterogeneous in study design, measure of cement plant exposure, outcome detection, measure of association and adjustment for confounding. Almost all the studies found positive associations between cement plant exposure and respiratory diseases and symptoms. An excess risk of cancer incidence and mortality in both children and adults mainly concerning respiratory tract cancers was also reported in some studies. Higher values of heavy metals and of a biomarker of renal toxicity were found in the exposed compared to unexposed populations. In conclusion, there is some evidence for a possible role of cement plant exposure on health adverse effects, although many studies had serious or critical risk of bias and overall level of certainty was low.
水泥工厂暴露对健康的不良影响已在职业环境中得到证实，但在居住在工厂附近的普通人群中的定义尚不明确。我们旨在总结关于接触水泥厂环境空气污染人群的健康影响的证据。使用 Embase、PubMed 和 Web of Science 进行了系统评价。我们仅纳入了非职业性研究，这些研究有对照组，重点关注与水泥厂暴露相关的不良健康结果和内剂量或亚临床效应的生物标志物。文章的选择由两名作者独立进行。通过初步搜索共确定了 1491 篇文章，其中 24 篇被纳入：其中 17 篇被纳入不良健康结果分析，9 篇被纳入内剂量或亚临床效应生物标志物分析。这些研究在研究设计、水泥工厂暴露测量、结果检测、关联测量和混杂因素调整方面存在很大差异。几乎所有的研究都发现水泥厂暴露与呼吸道疾病和症状之间存在正相关关系。一些研究还报告了儿童和成人癌症发病率和死亡率的超额风险，主要与呼吸道癌症有关。暴露人群的重金属和肾毒性生物标志物的数值高于未暴露人群。总之，有一些证据表明水泥工厂暴露可能对健康产生不良影响，但许多研究存在严重或关键的偏倚风险，总体确定性水平较低。
