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Occupational-related exposure to diesel exhaust and risk of leukemia: systematic review and meta-analysis of cohort studies

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Abstract

Purpose

Diesel exhaust (DE) is an established lung carcinogen. The association with leukemia is not well established. We conducted a systematic review and meta-analysis of cohort studies to determine the association between occupational DE exposure and risk of leukemia.

Methods

A systematic literature review was performed to identify all cohort studies on occupational exposure to DE and associated risk of leukemia. STROBE guidelines and PECOS criteria were followed. Meta-analyses with fixed effects (and random-effects model in cases of high heterogeneity) were performed to calculate summary relative risks (RR) and 95% confidence intervals (CI), including subgroup analyses by outcome (mortality or incidence), sex, geographic region, industry type, and study quality. Study quality was assessed using the the Joanna Briggs Institute (JBI) critical appraisal checklist for cohort studies.

Results

Of the 30 studies retained, 20 (8 from North America, 12 from Europe) reported a total of 33 estimates of the risk of leukemia. Overall, the relative risk (RR) of leukemia was 1.01 (95% CI = 0.97–1.05, I2 = 21.2%, n = 33); corresponding results for leukemia incidence and mortality were RR = 1.02 (95% CI = 0.98–1.06, I2 = 27.9%, n = 19) and RR = 0.91 (95% CI = 0.81–1.02, I2 = 0.0%, n = 15), respectively. The main results were confirmed in analyses by sex and geographic area. A statistically significant association was detected for miners (RR = 1.58, 95% CI = 1.15–2.15, I2 = 77.0%, n = 2) but not for other occupational groups. Publication bias was not detected (p = 0.7).

Conclusion

Our results did not indicate an association between occupational DE exposure and leukemia, with the possible exception of miners. Residual confounding cannot be excluded.

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Data availability

The research was conducted on publicly available data. STATA codes used for the meta-analysis are available upon request from the authors.

References

  • Andersen MHG, Frederiksen M, Saber AT et al (2019) Health effects of exposure to diesel exhaust in diesel-powered trains. Part Fibre Toxicol 16(1):21

    Article  PubMed  PubMed Central  Google Scholar 

  • Attfield MD, Schleiff PL, Lubin JH et al (2012) The diesel exhaust in miners study: a cohort mortality study with emphasis on lung cancer. J Natl Cancer Inst 104(11):869–883

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Balarajan R, McDowall ME (1988) Professional drivers in London: a mortality study. Br J Ind Med 45(7):483–486

    PubMed  PubMed Central  CAS  Google Scholar 

  • Bender AP, Parker DL, Johnson RA et al (1989) Minnesota highway maintenance worker study: cancer mortality. Am J Ind Med 15(5):545–556

    Article  PubMed  CAS  Google Scholar 

  • Birdsey J, Alterman T, Li J, Petersen MR, Sestito J (2010) Mortality among members of a truck driver trade association. AAOHN J 58(11):473–480

    Article  PubMed  Google Scholar 

  • Boffetta P (2004) Risk of acute myeloid leukemia after exposure to diesel exhaust: a review of the epidemiologic evidence. J Occup Environ Med 46:1076–1083

    Article  PubMed  Google Scholar 

  • Boffetta P, Stellman SD, Garfinkel L (1988) Diesel exhaust exposure and mortality among males in the American cancer society prospective study. Am J Ind Med 14(4):403–415

    Article  PubMed  CAS  Google Scholar 

  • Boffetta P, Dosemeci M, Gridley G, Bath H, Moradi T, Silverman D (2001) Occupational exposure to diesel engine emissions and risk of cancer in Swedish men and women. Cancer Causes Control 12(4):365–374

    Article  PubMed  CAS  Google Scholar 

  • Bogdanowicz A, Kniaziewicz T (2020) Marine diesel engine exhaust emissions measured in ship’s dynamic operating conditions. Sensors (basel) 20(22):6589

    Article  PubMed  ADS  CAS  Google Scholar 

  • Cogliano VJ, Baan R, Straif K et al (2011) Preventable exposures associated with human cancers. J Natl Cancer Inst 103(24):1827–1839

    Article  PubMed  PubMed Central  Google Scholar 

  • Cumpston M, Li T, Page MJ et al (2019) Updated guidance for trusted systematic reviews: a new edition of the cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.ED000142

    Article  PubMed  PubMed Central  Google Scholar 

  • DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  PubMed  CAS  Google Scholar 

  • Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Gubéran E, Usel M, Raymond L, Bolay J, Fioretta G, Puissant J (1992) Increased risk for lung cancer and for cancer of the gastrointestinal tract among Geneva professional drivers. Br J Ind Med 49(5):337–344

    PubMed  PubMed Central  Google Scholar 

  • Guo J, Kauppinen T, Kyyrönen P, Heikkilä P, Lindbohm ML, Pukkala E (2004) Risk of esophageal, ovarian, testicular, kidney and bladder cancers and leukemia among finnish workers exposed to diesel or gasoline engine exhaust. Int J Cancer 111(2):286–292

    Article  PubMed  CAS  Google Scholar 

  • Gustafsson L, Wall S, Larsson LG, Skog B (1986) Mortality and cancer incidence among Swedish dock workers–a retrospective cohort study. Scand J Work Environ Health 12(1):22–26

    Article  PubMed  CAS  Google Scholar 

  • Hansen ES (1993) A follow-up study on the mortality of truck drivers. Am J Ind Med 23(5):811–821

    Article  PubMed  CAS  Google Scholar 

  • Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558

    Article  PubMed  Google Scholar 

  • Howe GR, Fraser D, Lindsay J, Presnal B, Yu SZ (1983) Cancer mortality (1965–77) in relation to diesel fume and coal exposure in a cohort of retired railway workers. J Natl Cancer Inst 70(6):1015–1019

    PubMed  CAS  Google Scholar 

  • Hutton B, Salanti G, Caldwell DM et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784

    Article  PubMed  Google Scholar 

  • International Agency for Research on Cancer. (2014) Diesel and gasoline engine exhaust. In: IARC Monographs on the evaluation of carcinogenic risks to humans, Diesel and gasoline engine exhaust and some nitroarenes. Lyon: International Agency for Research on Cancer, Vol. 105. p. 39–486.

  • Kennedy D, Bates RR, Watson AY (1988) Assessment of carcinogenicity: generic issues and their application to diesel exhaust. In: Air pollution, the automobile, and public health. National Academies Press

  • Leem JH, Jang YK (2014) Increase of diesel car raises health risk in spite of recent development in engine technology. Environ Health Toxicol 29:e2014009

    Article  PubMed  PubMed Central  Google Scholar 

  • McHale CM, Zhang L, Smith MT (2012) Current understanding of the mechanism of benzene-induced leukemia in humans: implications for risk assessment. Carcinogenesis 33(2):240–252

    Article  PubMed  CAS  Google Scholar 

  • Merlo DF, Stagi E, Fontana V et al (2010) A historical mortality study among bus drivers and bus maintenance workers exposed to urban air pollutants in the city of Genoa. Italy Occup Environ Med 67(9):611–619

    Article  PubMed  Google Scholar 

  • Miranda-Filho A, Piñeros M, Ferlay J, Soerjomataram I, Monnereau A, Bray F (2018) Epidemiological patterns of leukaemia in 184 countries: a population-based study. Lancet Haematol 5(1):e14–e24

    Article  PubMed  Google Scholar 

  • Munn Z, Tufanaru C, Aromataris E (2014) JBI’s systematic reviews: data extraction and synthesis. Am J Nurs 114(7):49–54

    Article  PubMed  Google Scholar 

  • Nokso-Koivisto P, Pukkala E (1994) Past exposure to asbestos and combustion products and incidence of cancer among Finnish locomotive drivers. Occup Environ Med 51(5):330–334

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Park HS, Oh MK, Lee JW et al (2022) Diesel exhaust particles impair therapeutic effect of human Wharton’s Jelly-derived mesenchymal stem cells against experimental colitis through ROS/ERK/cFos Signaling pathway. Int J Stem Cells 15(2):203–216

    Article  PubMed  CAS  Google Scholar 

  • Porritt K, Gomersall J, Lockwood C (2014) JBI’s Systematic reviews: study selection and critical appraisal. Am J Nurs 114(6):47–52

    Article  PubMed  Google Scholar 

  • Pukkala E, Martinsen JI, Lynge E et al (2009) Occupation and cancer – follow-up of 15 million people in five Nordic countries. Acta Oncol 48(5):646–790

    Article  PubMed  CAS  Google Scholar 

  • Rafnsson V, Gunnarsdóttir H (1991) Mortality among professional drivers. Scand J Work Environ Health 17(5):312–317

    Article  PubMed  CAS  Google Scholar 

  • Rushton L, Alderson MR, Nagarajah CR (1983) Epidemiological survey of maintenance workers in London transport executive bus garages and Chiswick Works. Br J Ind Med 40(3):340–345

    PubMed  PubMed Central  CAS  Google Scholar 

  • Schenker MB, Smith T, Muñoz A, Woskie S, Speizer FE (1984) Diesel exposure and mortality among railway workers: results of a pilot study. Br J Ind Med 41(3):320–327

    PubMed  PubMed Central  CAS  Google Scholar 

  • Shin J, Kim B, Kim HR (2020) Characteristics of occupational exposure to diesel engine exhaust for shipyard transporter signal workers. Int J Environ Res Public Health 17(12):4398

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Soll-Johanning H, Bach E, Olsen JH, Tüchsen F (1998) Cancer incidence in urban bus drivers and tramway employees: a retrospective cohort study. Occup Environ Med 55(9):594–598

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Van Den Eeden SK, Friedman GD (1993) Exposure to engine exhaust and risk of subsequent cancer. J Occup Med 35(3):307–311

    PubMed  Google Scholar 

  • Volk J, Heck JE, Schmiegelow K, Hansen J (2019) Parental occupational exposure to diesel engine exhaust in relation to childhood leukaemia and central nervous system cancers: a register-based nested case-control study in Denmark 1968–2016. Occup Environ Med 76(11):809–817

    Article  PubMed  Google Scholar 

  • von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349

    Article  Google Scholar 

  • Wernke MJ (2022) Diesel exhaust reference module in biomedical sciences. Elsevier

    Google Scholar 

  • Wong O, Morgan RW, Kheifets L, Larson SR, Whorton MD (1985) Mortality among members of a heavy construction equipment operators union with potential exposure to diesel exhaust emissions. Br J Ind Med 42(7):435–448

    PubMed  PubMed Central  CAS  Google Scholar 

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Funding

The research was conducted with internal resources of the participating institutions. DS and VD were supported by the Stony Brook Cancer Center Medical Student Summer Research Fellowship.

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Authors and Affiliations

  1. Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA

    Darshi Shah & Vincent DeStefano

  2. Department of Medical and Surgical Sciences, University of Bologna, 40138, Bologna, Italy

    Giulia Collatuzzo, Federica Teglia & Paolo Boffetta

  3. Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA

    Paolo Boffetta

  4. Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA

    Paolo Boffetta

Authors
  1. Darshi Shah
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  2. Vincent DeStefano
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  3. Giulia Collatuzzo
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  4. Federica Teglia
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  5. Paolo Boffetta
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Corresponding author

Correspondence to Paolo Boffetta.

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Conflict of interest

PB acted as expert witness in litigation involving DE exposure and leukemia risk, unrelated to current work. Other authors have no conflicts of interest.

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This project was based on publicly available data; no permission was needed from an institutional review board.

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Shah, D., DeStefano, V., Collatuzzo, G. et al. Occupational-related exposure to diesel exhaust and risk of leukemia: systematic review and meta-analysis of cohort studies. Int Arch Occup Environ Health 97, 165–177 (2024). https://doi.org/10.1007/s00420-023-02034-y

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  • DOI: https://doi.org/10.1007/s00420-023-02034-y

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