Air pollution and liver cancer: A systematic review

Air pollution has previously been linked to several adverse health outcomes, but the potential association between air pollution and liver cancer remains unclear. We searched PubMed, EMBASE, and Web of Science from inception to 10 October 2021, and manually reviewed the references of relevant papers to further identify any related literature investigating possible associations between air pollution and liver cancer. Risk estimates values were represented by statistical associations based on quantitative analyses. A total of 13 cohort studies obtained from 11 articles were included, with 10,961,717 participants. PM_2.5 was the most frequently examined pollutant (included in 11 studies), followed by NO₂ and NO_x (included in 6 studies), and fewer studies focused on other pollutants (PM_{2.5 absorbance}, PM₁₀, PM_2.5-10, O₃, and BC). In all the 16 associations for liver cancer mortality, 14 associations reported the effect of PM_2.5 on liver cancer mortality. Eight associations on PM_2.5 were significant, showing a suggestive association between PM_2.5 and liver cancer mortality. Among 24 associations shown by risk estimates for liver cancer incidence, most associations were not statistically significant. For other air pollutants, no positive associations were presented in these studies. PM_2.5 was the most frequently examined pollutant, followed by NO₂ and NO_x, and fewer studies focused on other pollutants. PM_2.5 was associated with liver cancer mortality, but there was no association for other air pollutants. Future research should use advanced statistical methods to further assess the impact of multiple air pollutants on liver cancer in the changing socio-environmental context.