Graduate Institute of Public Health, College of Public Health, China Medical University, Taichung 406, Taiwan.
Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung 406, Taiwan.
Environ Int. 2020 Dec;145:106090. doi: 10.1016/j.envint.2020.106090. Epub 2020 Sep 12.
The global burden of leukemia, which grew by 19% from 2007 to 2017, poses a threat to human development and global cancer control. Factors contributing to this growth include massive industrial pollution, especially from large-scale petrochemical industry complexes (PICs). Globally, around 700 PICs are continuously operating. Data on the impact of PICs on leukemia incidence and mortality in residents are sparse and inconsistent.
To determine the association between residential exposure to PICs and leukemia incidence and mortality using systematic review and meta-analysis.
The studies were identified through seven databases (Clinical Key, Cochrane Library, EBSCOhost, Embase, PubMed, ScienceDirect, and Web of Science). We screened the eligibility of studies using following criteria: (1) observational studies that focused on residential exposure to PICs; (2) exposure group that was defined as residents living close to PICs; (3) outcome that was defined as all leukemia incidence and mortality; and (4) available population data. We applied the Grading of Recommendations Assessment, Development, and Evaluation to assess the certainty of evidence. The random-effects model used to estimate the pooled effects in the meta-analysis.
We identified thirteen epidemiologic studies (including eleven for leukemia incidence, one for leukemia mortality, and one for both), covering 125,580 individuals from Croatia, Finland, Italy, Serbia, Spain, Sweden, Taiwan, the United Kingdom, and the United States. We found moderate certainty of evidence indicated the risk of leukemia incidence (relative risk [RR] = 1.18; 95% CI = 1.03-1.35) and mortality (RR = 1.26; 95% CI = 1.10-1.45) in residents living close to PICs. Our subgroup analysis found increased RRs for leukemia incidence in studies using distance-based exposure indicator (RR = 1.11; 95% CI = 1.00-1.23), and with longer follow-up periods (RR = 1.24; 95% CI = 1.06-1.45).
Our analysis provides low-certainty evidence of increased leukemia incidence and moderate-certainty evidence of increased leukemia mortality among residents living close to PICs. While the global petrochemicals sector is growing, our findings suggest the need to consider disease prevention and pollution control measures during the development of PICs.
从 2007 年到 2017 年，全球白血病负担增长了 19%，这对人类发展和全球癌症控制构成了威胁。导致这种增长的因素包括大规模工业污染，尤其是来自大型石化工业综合体（PIC）的污染。全球约有 700 个 PIC 正在持续运营。关于 PIC 对居民白血病发病率和死亡率影响的数据很少且不一致。
通过系统评价和荟萃分析，确定居民接触 PIC 与白血病发病率和死亡率之间的关系。
通过七个数据库（Clinical Key、Cochrane Library、EBSCOhost、Embase、PubMed、ScienceDirect 和 Web of Science）来确定研究。我们使用以下标准筛选研究的资格：（1）以居民接触 PIC 为重点的观察性研究；（2）将暴露组定义为居住在 PIC 附近的居民；（3）将结局定义为所有白血病发病率和死亡率；（4）具有可供使用的人群数据。我们应用推荐评估、制定与评估分级来评估证据的确定性。荟萃分析中采用随机效应模型来估计汇总效应。
我们确定了十三项流行病学研究（包括十一项白血病发病率研究、一项白血病死亡率研究和一项同时研究发病率和死亡率的研究），涵盖了来自克罗地亚、芬兰、意大利、塞尔维亚、西班牙、瑞典、中国台湾、英国和美国的 125580 个人。我们发现，有中等确定性的证据表明，居住在 PIC 附近的居民患白血病的风险增加，包括发病率（相对风险 [RR] = 1.18；95%置信区间 [CI] = 1.03-1.35）和死亡率（RR = 1.26；95% CI = 1.10-1.45）。我们的亚组分析发现，使用基于距离的暴露指标（RR = 1.11；95% CI = 1.00-1.23）和随访时间较长（RR = 1.24；95% CI = 1.06-1.45）的研究中，RR 更高。
我们的分析提供了居住在 PIC 附近的居民白血病发病率增加的低确定性证据和白血病死亡率增加的中等确定性证据。随着全球石化行业的发展，我们的研究结果表明，在开发 PIC 时需要考虑疾病预防和污染控制措施。
