Department of Environmental Health, American University of Beirut, Beirut, Lebanon.
Nature Conservation Centre, American University of Beirut, Beirut, Lebanon.
BMJ Glob Health. 2021 Feb;6(2). doi: 10.1136/bmjgh-2020-004166.
The US military first deployed depleted uranium (DU) weapons in Iraq during the Gulf War in 1990 and in the 2003 invasion of Iraq. Research into the health impacts of DU has been mired in debate and controversy. Research funded by the US government has denied the health risks posed by DU to the Iraqi population, while opponents have claimed that DU is responsible for increased rates of birth defects and cancers in Iraq. Others assert that the public health impacts of DU weapons remain uncertain. This systematic review identified, appraised and synthesised all human observational studies assessing adverse health outcomes associated with DU exposure among the Iraqi population. To our knowledge, no systematic review has been conducted on the topic previously.
We searched 11 electronic databases for human observational studies published between 1990 and 2020 that measured association between exposure to weaponised uranium and health outcomes (including cancer, birth defects, immune system function and mortality) among the Iraqi population. We assessed risk of bias using the Navigation Guide's risk of bias tool and rated certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach (PROSPERO: CRD42018108225).
Our searches identified 2601 records, of which 28 met our inclusion criteria. We identified five additional eligible reports from other sources. Two articles reported the results of multiple relevant studies; our final set included 33 articles reporting on 36 eligible studies. Most studies (n=30, 83%) reported a positive association between uranium exposure and adverse health outcomes. However, we found that the reviewed body of evidence suffers from a high risk of bias.
The available evidence suggests possible associations between exposure to depleted uranium and adverse health outcomes among the Iraqi population. More primary research and the release of missing data are needed to design meaningful health and policy interventions in Iraq.
美国军方于 1990 年海湾战争期间首次在伊拉克部署贫铀（DU）武器，并于 2003 年入侵伊拉克。对 DU 对健康影响的研究一直存在争议。由美国政府资助的研究否认了 DU 对伊拉克民众构成的健康风险，而反对者则声称 DU 是导致伊拉克出生缺陷和癌症发病率上升的原因。其他人则断言 DU 武器对公共健康的影响仍不确定。本系统评价确定、评估并综合了所有评估 DU 暴露与伊拉克人群不良健康结局之间关联的人体观察性研究。据我们所知，以前尚未就该主题进行过系统评价。
我们搜索了 11 个电子数据库，以获取 1990 年至 2020 年期间发表的评估武器化铀暴露与伊拉克人群健康结局（包括癌症、出生缺陷、免疫系统功能和死亡率）之间关联的人体观察性研究。我们使用 Navigation Guide 的偏倚风险工具评估偏倚风险，并使用推荐评估、制定与评估分级方法（PROSPERO：CRD42018108225）评估证据确定性。
我们的搜索共确定了 2601 条记录，其中 28 条符合纳入标准。我们还从其他来源确定了另外 5 份符合条件的报告。两篇文章报告了多项相关研究的结果；我们的最终研究集包括 33 篇报告 36 项合格研究的文章。大多数研究（n=30，83%）报告铀暴露与不良健康结局之间存在正相关。然而，我们发现，所审查的证据体存在高度偏倚风险。
现有证据表明，伊拉克人群中 DU 暴露与不良健康结局之间可能存在关联。需要开展更多的原始研究并发布缺失数据，以便在伊拉克制定有意义的健康和政策干预措施。
Zotero 插件