Cement plant emissions and health effects in the general population: a systematic review

Adverse health effects of cement plant exposure have been found in occupational contexts but are less defined for the general population living near plants. We aimed to summarize the evidence on the health effects of people exposed to ambient air pollution by cement plants. A systematic review using Embase, PubMed and Web of Science was performed. We included only non-occupational studies with a comparison group that focused on adverse health outcomes and biomarkers of internal dose or subclinical effect associated with cement plant exposure. Selection of articles was performed by two authors independently. Of 1491 articles identified by the initial search, 24 were included: 17 of them were included in the analysis of adverse health outcomes and 9 in the analysis of biomarkers of internal dose or subclinical effects. The studies were very heterogeneous in study design, measure of cement plant exposure, outcome detection, measure of association and adjustment for confounding. Almost all the studies found positive associations between cement plant exposure and respiratory diseases and symptoms. An excess risk of cancer incidence and mortality in both children and adults mainly concerning respiratory tract cancers was also reported in some studies. Higher values of heavy metals and of a biomarker of renal toxicity were found in the exposed compared to unexposed populations. In conclusion, there is some evidence for a possible role of cement plant exposure on health adverse effects, although many studies had serious or critical risk of bias and overall level of certainty was low.