Association Between Environmental and Socioeconomic Risk Factors and Hepatocellular Carcinoma: A Meta-Analysis

Wenfeng Lu; Fengjiao Zheng; Zhi Li; Rui Zhou; Lugang Deng; Wenwei Xiao; Wenyan Chen; Rong Zhao; Yulan Chen; Yuxing Tan; Zhibo Li; Limin Liu; Duxun Tan; Nan Liu

doi:10.3389/fpubh.2022.741490

Association Between Environmental and Socioeconomic Risk Factors and Hepatocellular Carcinoma: A Meta-Analysis

Front Public Health. 2022 Feb 18:10:741490. doi: 10.3389/fpubh.2022.741490. eCollection 2022.

Authors

Wenfeng Lu^{1

2}, Fengjiao Zheng³, Zhi Li^{1

2}, Rui Zhou^{1

2}, Lugang Deng^{1

2}, Wenwei Xiao^{1

2}, Wenyan Chen^{1

2}, Rong Zhao^{1

2}, Yulan Chen^{1

2}, Yuxing Tan^{1

2}, Zhibo Li^{1

2}, Limin Liu^{2

4}, Duxun Tan¹, Nan Liu^{1

2

4}

Affiliations

¹ Institute of Environment and Health, Health Science Center, South China Hospital, Shenzhen University, Shenzhen, China.
² College of Public Health, Zhengzhou University, Zhengzhou, China.
³ Department of Clinical Laboratory, The Air Force Hospital of Southern Theater Command of Chinese People's Liberation Army (PLA), Guangzhou, China.
⁴ Institute of Chronic Disease Risks Assessment, School of Nursing and Health, Henan University, Kaifeng, China.

Abstract

Background: The association between environmental and socioeconomic risk factors and the occurrence of hepatocellular carcinoma (HCC) are still inconclusive. A meta-analysis was conducted to address this issue.

Methods: We systematically searched the databases including PubMed, Web of Science, and Google Scholar and collected the related risk factors of HCC before March 6, 2020. Statistical analysis was performed on the odds ratio (OR) value and 95% CI of the correlation between environmental and socioeconomic factors and HCC. Begg's rank correlation test, Egger's linear regression test, and the funnel plot were employed for identification of the publication bias.

Results: Out of 42 studies, a total of 57,892 participants were included. Environmental and socioeconomic risk factors including ever educated (illiteracy); race (Black, Hispanic, and Asian); medium and low incomes; occupations (farmer and labor); passive smoking; place of residence (rural); blood aflatoxin B1 (AFB1) adduct level; exposure of pesticide, etc., were statistically increased with the occurrence of HCC (P < 0.05) and OR values and 95% CIs were 1.37 (1.00, 1.89), 2.42 (1.10-5.31), 1.90 (0.87-4.17), 5.36 (0.72-40.14), 1.48 (1.11, 1.96), 1.74 (1.00-3.03), 1.49 (1.06-2.08), 1.52 (1.07-2.18), 1.43 (0.27, 7.51), 1.46 (1.09, 1.96), 2.58 (1.67-3.97), and 1.52 (0.95-2.42), respectively. We found 6-9, 9-12, and ≥12 years of education that statistically reduced the risk of the occurrence of HCC (P < 0.05) and OR values and 95% CIs were 0.70 (0.58, 0.86), 0.52 (0.40, 0.68), and 0.37 (0.23, 0.59), respectively. No significant associations (P > 0.05) were observed between race (Hispanic and Asian), passive smoking, marital status, place of birth, place of residence, and HCC. In stratified analysis, exposure of pesticide was statistically significant (P < 0.05), while race of black was on the contrary.

Conclusion: Environmental and socioeconomic risk factors have great impacts on the incidence rate of HCC. Improving national education and income levels can significantly reduce the risk of HCC.

Prospero registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020151710.

Keywords: environmental factor; hepatocellular carcinoma; liver cancer; meta-analysis; risk factors.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Carcinoma, Hepatocellular* / epidemiology
Carcinoma, Hepatocellular* / etiology
Humans
Liver Neoplasms* / epidemiology
Liver Neoplasms* / etiology
Pesticides*
Risk Factors
Socioeconomic Factors
Tobacco Smoke Pollution*

Substances

Pesticides
Tobacco Smoke Pollution