Abstract
The impact of pesticides on health is a major public health concern. A higher risk to develop chronic lymphoid malignancies has been demonstrated to be associated with occupational pesticide exposure (OPE). By contrast, little is known of the impact of OPE on the occurrence of myeloid malignancies especially acute myeloid leukemia (AML). The purpose of this meta-analysis is to summarize data on the association between OPE and AML. A relevant dataset of case–control studies was extracted. Among 6784 references extracted, 14 were selected, representing 3,955 AML patients and 9,948 control subjects diagnosed between 1976 and 2010. An adverse association was found between OPE and AML (OR = 1.51; 95%CI: 1.10–2.08), not affected by sensitivity analyses. Funnel plot asymmetry suggested a publication bias underestimating OR. Stratified analysis showed the association to be driven by studies with: (1) monocentric AML patients and hospital-based control population, (2) Newcastle–Ottawa scale > 6 and the group of studies identified as with the lowest risk, (3) exposure assessment through peer-to-peer interview, (4) diagnosis in North America and Asia and after 1995, (5) restriction to de novo AML. Moreover, the association between OPE and AML was significant with insecticides. These findings broaden the spectrum of pesticide toxicity to myeloid malignancies.
Highlights
The impact of pesticides on health is a major public health concern
In the acute myeloid leukemia (AML) subgroup, this study reported an association between occupational pesticide exposure (OPE) and AML exclusively in cohort studies but not in case–control s tudies[18]
Six studies were identified that were more likely to be associated with a lower risk of bias and for which the OR was higher than in the eight others (2.03 vs. 1.03)[34,40,42,43,44,46]. These results suggest that the association between OPE and AML observed in this meta-analysis is partly driven by studies with lower bias and higher quality
Summary
The impact of pesticides on health is a major public health concern. A higher risk to develop chronic lymphoid malignancies has been demonstrated to be associated with occupational pesticide exposure (OPE). The carcinogenic effects of pesticides have been thoroughly investigated in lymphoid hematological malignancies, revealing a pejorative impact of occupational pesticide exposure (OPE) on the incidence and outcome of non-Hodgkin lymphoma[5,6,7,8,9,10,11]. This association has not been clearly demonstrated to date in myeloid malignancies, especially acute myeloid leukemia (AML). In three other studies, AML cases were exclusively identified based on the cause of death on death certificates, well known to be imprecise[21] and only selecting non-surviving patients obviously unable to answer questionnaires
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