Professional drivers and lung cancer: a systematic review and meta-analysis
- Correspondence to Professor Lap Ah Tse, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China;
Contributors All authors have made substantial contributions to study conception and design, execution, or analysis and interpretation of data and have been involved in drafting the article or revising it critically for important intellectual content.
- Accepted 3 June 2012
- Published Online First 5 July 2012
The objective of this study was to conduct a systematic review to provide summarised evidence on the association between professional drivers and lung cancer in the last decade after taking into consideration the potential confounding effect of cigarette smoking. We systematically searched all published cohort and case–control studies in English from Medline and Embase, from January 1996 to January 2011. We extracted the risk estimate (ie, RR, OR, and standardised mortality ratio) from each individual study, and meta-analysis was used to combine the RR of individual studies. The methodological quality of each study was assessed using a standard approach proposed by Downs and Black. Nineteen studies were included in the meta-analysis. A significantly increased risk of lung cancer (pooled smoking-adjusted RR 1.18, 95% CI 1.05 to 1.33) among professional drivers was observed after combining four cohort studies and nine case–control studies. A higher pooled RR was observed among smoking-adjusted studies reporting 10 years or more of employment (RR 1.19, 95% CI 1.06 to 1.34) as compared with the study having a shorter duration of employment (6 years) (RR 1.00, 95% CI 0.92 to 1.09). This systematic review revealed that a 18% excess risk of lung cancer was linked to professional drivers who are potentially exposed to diesel exhaust, after adjustment for the confounding effect of smoking. There is a tendency for a positive lung cancer gradient with increasing years of employment as a professional driver.
- Lung cancer
- professional drivers
- systematic review
- general expertise
- primary care
- public health
- organ system
- disease type
- exposures and occupational groups
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.