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Household use of biomass and lung cancers

Household use of biomass and lung cancers. INTERIM RESULTS Imran Choudhury, Dan Pope, Mukesh Dherani , Nigel Bruce University of Liverpool & Amir Sapkota University of Maryland. Search strategy.

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Household use of biomass and lung cancers

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  1. Household use of biomass and lung cancers INTERIM RESULTS Imran Choudhury, Dan Pope, MukeshDherani, Nigel Bruce University of Liverpool & Amir Sapkota University of Maryland

  2. Search strategy • (Lung OR pulmonary OR bronchogenic OR bronchial OR “respiratory tract” OR bronch* OR trachea* OR “lower respiratory tract” ) • Cancer OR cancers OR carcinoma OR carcinomata OR neoplasm OR neoplasms OR tumor OR tumors OR tumour OR tumours OR “*small-cell”) • "IAP" OR "Indoor air" OR "pollution" OR "pollutant" OR "fuel" OR "fuels" OR "dung" OR "agricultural waste" OR "crop waste" OR "crop residue" OR "charcoal" OR "coal" OR "biomass" OR "wood" OR "stove" OR "stoves" OR "chula" OR "chulla" OR "oven" OR "ovens" OR "smoke" OR "smoky" OR heat* OR cook* OR light* OR burn*

  3. Databases • PubMed (Medline) • Embase (Scopus & Ovid) • Cochrane Controlled Trials Register • CINAHL (Ovid) • Global Health (Ovid) • DARE (Database of Abstracts of Reviews of Effects) – for reviews • LILACS (Latin American and Caribbean literature) • Scielo • Index Medicus Africanus • Chinese databases CNKI – by Ray Liu @UCB

  4. Search results (English) • 19,833 search results • 137 papers: full papers (English) or foreign language paper abstracts with solid fuel data • 60 potentially relevant for biomass review • 25 Chinese abstracts/full papers for Ray • 4 on request /awaiting translation • 17 papers with some form relevant data

  5. Search Results • Of the 17 papers which have data • All case control studies • 6 combine biomass with another fuel • 11 papers with estimates for meta-analysis • 1/11 later excluded

  6. Excluded from meta-analysis

  7. Included Studies

  8. Biomass specific exposure

  9. Subjects and Outcome Measures

  10. Quality Issues

  11. Quality Issues

  12. All studies (n=10)

  13. Publication bias • Begg's Test • adj. Kendall's Score (P-Q) = 22 • Std. Dev. of Score = 24.28 • Number of Studies = 17 • z = 0.91 • Pr > |z| = 0.365 • z = 0.87 (continuity corrected) • Pr > |z| = 0.387 (continuity corrected) • Egger's test • ------------------------------------------------------------------------------ • Std_Eff | Coef. Std. Err. t P>|t| [95% Conf. Interval] • -------------+---------------------------------------------------------- • -------------+------ • slope | .0722589 .173642 0.42 0.683 -.2978503 .442368 • bias | .4820188 .6609868 0.73 0.477 -.9268412 1.890879

  14. Biomass vs. clean fuel (n=8)

  15. Biomass vs. Clean fuel – excluding weaker studies n=5

  16. Key assumptions/issues • Unclear reference categories • Ever wood vs. never wood • Cooking as exposure when most of subjects are men • Studies with very low population prevalence of biomass use • Is there a separate pathway for adenocarcinoma?

  17. Issues • Comparable - probably • Valid – a lot of quality issues even before considering ventilation, behaviour etc • External validity might help?? • Heterogeneity • Meta-analysis does not give clear answer • Probably need better data? • Await Chinese studies

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