Household coal use and lung cancer: Systematic review and meta-analysis of case-control studies, with an emphasis on geographic variation

H. Dean Hosgood, Hu Wei, Amir Sapkota, Imran Choudhury, Nigel Bruce, Kirk R. Smith, Nathaniel Rothman, Qing Lan

Research output: Contribution to journalArticlepeer-review

85 Scopus citations


Background Emissions from household coal combustion associated with cooking and heating are an important public health issue, particularly in China where hundreds of millions of people are exposed. Although coal emissions are a known human carcinogen, there is still uncertainty about the level of risk for lung and other cancers.Methods We performed a meta-analysis on 25 case-control studies (10 142 cases and 13 416 controls) to summarize the association between household coal use and lung cancer risk, and to explore the effect modification of this association by geographical location.Results Using random-effects models, household coal use was found to be associated with lung cancer risk among all studies throughout the world [odds ratio (OR) = 2.15; 95% confidence interval (CI) = 1.61-2.89, N studies = 25], and particularly among those studies carried out in mainland China and Taiwan (OR = 2.27; 95% CI = 1.65-3.12, N studies = 20). Stratification by regions of mainland China and Taiwan found a variation in effects across the regions, with south/southeastern (OR = 3.27; 95% CI = 1.27-8.42, N studies = 3) and southwestern China (OR = 2.98; 95% CI = 1.18-7.53, N studies = 3) experiencing the highest risk. The elevated risk associated with coal use throughout Asia was also observed when stratifying studies by gender, smoking status, sample size, design (population vs hospital case-control) and publication language. No significant publication bias was found (p Begg's = 0.15).Conclusions Our results provide evidence that although the carcinogenic effect of coal use varies by location, coals from many locations exhibit elevated lung cancer risks. Published by Oxford University Press on behalf of the International Epidemiological Association 2011.

Original languageEnglish (US)
Article numberdyq259
Pages (from-to)719-728
Number of pages10
JournalInternational journal of epidemiology
Issue number3
StatePublished - Jun 2011
Externally publishedYes


  • China
  • Cooking
  • Heating
  • India
  • Indoor air pollution
  • Solid fuels
  • Taiwan

ASJC Scopus subject areas

  • Epidemiology


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