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Environ Health. 2018 Dec 19;17(1):90. doi: 10.1186/s12940-018-0431-9.

Association between mesothelioma and non-occupational asbestos exposure: systematic review and meta-analysis.

Xu R1,2, Barg FK3,2, Emmett EA4,2, Wiebe DJ5,6,7, Hwang WT8,9,10.

Author information

1
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
2
Penn Superfund Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
3
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
4
Department of Environmental and Occupational Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
5
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. dwiebe@upenn.edu.
6
Penn Superfund Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. dwiebe@upenn.edu.
7
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 902 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA. dwiebe@upenn.edu.
8
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. whwang@upenn.edu.
9
Penn Superfund Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. whwang@upenn.edu.
10
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 610 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA. whwang@upenn.edu.

Abstract

BACKGROUND:

The risk of mesothelioma has been shown to be associated with exposure to asbestos fibers. Most of the existing literature focuses on occupational exposure; however, non-occupational asbestos exposure has also been identified as an important risk factor.

OBJECTIVE:

To estimate the association between mesothelioma and non-occupational asbestos exposure, and evaluate control recruitment and exposure measurement methods.

METHODS:

A systematic literature review was conducted to identify case-control (CC) and cohort studies that examined the association between mesothelioma and non-occupational exposure to asbestos, including neighborhood, domestic, and household exposure. Meta-analysis was performed to estimate a summary relative risk estimate (SRRE) and 95% confidence interval using random-effects models. Subgroup analyses were also conducted by exposure type, gender, region, and fiber type.

RESULTS:

Twenty CC and 7 cohort studies were selected. Controls in CC studies were selected from the general population (55%), hospital records (18%), cancer registry (23%) and a combination of population and hospital records (5%). Multiple methods were used to measure neighborhood exposure (e.g., linear distance and direction of residence from an asbestos factory), domestic (e.g., whether living with an asbestos worker) and household exposure (e.g., whether involved in asbestos-containing home improvement projects). Primary meta-analyses suggested a SRRE of mesothelioma of 5.33 (95%CI: 2.53, 11.23) from neighborhood exposure, 4.31 (95%CI, 2.58, 7.20) from domestic exposure, and 2.41 (95%CI, 1.30, 4.48) from household exposure with large I2 statistics ranging from 83-99%.

CONCLUSIONS:

Non-occupational asbestos exposure is significantly associated with an elevated risk of mesothelioma. Funnel plots indicated a potential of publication bias. Some SRREs should be interpreted with cautions because of high between-studies heterogeneity.

KEYWORDS:

Asbestos; Mesothelioma; Meta-analysis; Non-occupational exposure pathways; Systematic review

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