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. 2020 Apr;9(2):204-217.
doi: 10.21037/tlcr.2020.02.11.

Lung cancer occurrence attributable to passive smoking among never smokers in China: a systematic review and meta-analysis

Yihui Du  1 , Xiaonan Cui  2   3 , Grigory Sidorenkov  1 , Harry J M Groen  4 , Rozemarijn Vliegenthart  2 , Marjolein A Heuvelmans  1   5 , Shiyuan Liu  6 , Matthijs Oudkerk  7 , Geertruida H de Bock  1
Affiliations

Lung cancer occurrence attributable to passive smoking among never smokers in China: a systematic review and meta-analysis

Yihui Du et al. Transl Lung Cancer Res. 2020 Apr.

Abstract

Background: Quantifying the occurrence of lung cancer due to passive smoking is a necessary step when forming public health policy. In this study, we estimated the proportion of lung cancer cases attributable to passive smoking among never smokers in China.

Methods: Six databases were searched up to July 2019 for original observational studies reporting relative risks (RRs) or odds ratios (ORs) for the occurrence of lung cancer associated with passive smoking in Chinese never smokers. The population attributable fraction (PAF) was then calculated using the combined proportion of lung cancer cases exposed to passive smoking and the pooled ORs from meta-analysis. Data are reported with their 95% confidence intervals.

Results: We identified 31 case-control studies of never smokers and no cohort studies. These comprised 9,614 lung cancer cases and 13,093 controls. The overall percentages of lung cancers attributable to passive smoking among never smokers were 15.5% (9.0-21.4%) for 9 population-based studies and 22.7% (16.6-28.3%) for 22 hospital-based studies. The PAFs for women were 17.9% (11.4-24.0%) for the population-based studies and 20.9% (14.7-26.7%) for the hospital-based studies. The PAF for men was only calculable for hospital-based studies, which was 29.0% (95% CI: 8.0-45.2%). Among women, the percentage of lung cancer cases attributable to household exposure (19.5%) was much higher than that due to workplace exposure (7.2%).

Conclusions: We conclude that approximately 16% of lung cancer cases among never smokers in China are potentially attributable to passive smoking. This is slightly higher among women (around 18%), with most cases occurring due to household exposure.

Keywords: Population attributable fraction (PAF); environmental tobacco smoke; lung cancer; passive smoking; secondhand smoke.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr.2020.02.11). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Selection of studies for inclusion in the systematic review. CBM, and the China Biology Medical literature database; CNKI, China National Knowledge Infrastructure; VIP, Database of Chinese Scientific & Technical Periodicals; WF, Wan Fang database.
Figure 2
Figure 2
Forest plot of the random effects meta-analysis for the association between passive smoking and lung cancer among never smokers in China. CI, confidence interval; OR, odds ratio.
Figure 3
Figure 3
Forest plot of the random effects meta-analysis for the association between passive smoking and lung cancer among never smokers in China by study setting. CI, confidence interval; OR, odds ratio.
Figure S1
Figure S1
Data extraction form. Note: more tables can be added if needed. CI, confidence interval; OR, odds ratio; PS, passive smoking; RR, relative risk.
Figure S2
Figure S2
Sensitivity analysis for the association between passive smoking and lung cancer risk among never smokers in China.
Figure S3
Figure S3
Funnel plot of publication for the association between passive smoking and lung cancer risk among never smokers in China.
Figure S4
Figure S4
Funnel plot of possible publication bias in population-based studies. Data are for the association between passive smoking and lung cancer risk among never smokers in China.
Figure S5
Figure S5
Funnel plot of possible publication bias in hospital-based studies. Data are for the association between passive smoking and lung cancer risk among never smokers in China.
Figure S6
Figure S6
Forest plot of the random effects meta-analysis in population-based studies. Data are for the association between passive smoking and lung cancer risk among never smokers for women and men in China. CI, confidence interval; OR, odds ratio.
Figure S7
Figure S7
Forest plot of the random effects meta-analysis in hospital-based studies. Data are for the association between passive smoking and lung cancer risk among never smokers for women and men in China. CI, confidence interval; OR, odds ratio.
Figure S8
Figure S8
Forest plot of random effects meta-analysis for the association between passive smoking and lung cancer among female never smokers by exposure source in China. CI, confidence interval; OR, odds ratio.
Figure S9
Figure S9
Forest plot of random effects meta-analysis for the association between passive smoking and lung cancer among never smokers by histological type in China. CI, confidence interval; OR, odds ratio.
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References

    1. Öberg M, Jaakkola MS, Woodward A, et al. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet 2011;377:139-46. 10.1016/S0140-6736(10)61388-8 - DOI - PubMed
    1. Zhang J, Smith KR. Indoor air pollution: a global health concern. Br Med Bull 2003;68:209-25. 10.1093/bmb/ldg029 - DOI - PubMed
    1. International Agency for Research on Cancer. Tobacco smoke and involuntary smoking. IARC Monographs on the evaluation of carcinogenic risks to humans Lyon, France: IARC, 2004. - PMC - PubMed
    1. Office of the Surgeon General (US). Publications and Reports of the Surgeon General. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US), 2006. - PubMed
    1. Couraud S, Zalcman G, Milleron B, et al. Lung cancer in never smokers--a review. Eur J Cancer 2012;48:1299-311. 10.1016/j.ejca.2012.03.007 - DOI - PubMed