Residential exposure to pesticides as risk factor for childhood and young adult brain tumors: A systematic review and meta-analysis

Background: Accumulating evidence suggests a positive association between exposure to non-agricultural pesticides and childhood brain tumors (CBT).Objective: (1) To conduct a systematic review and meta-analysis of published studies on the association betweenresidential/household/domestic exposure to pesticides and childhood brain tumors. (2) To clarify variables thatcould impact the results.Methods: Publications in English were identified from a MEDLINE search through 28 February 2017 and fromthe reference list of identified publications. Risk estimates were extracted from 18 case-control studies publishedbetween 1979 and 2016 and study quality assessments were performed. Summary odds ratios (mOR) werecalculated according to fixed and random-effect meta-analysis models. Separate analyses were conducted afterstratification for study quality, critical exposure period, exposure location, specific exposures, pesticide category,application methods, type of pest treated, type of CBT, child's age at diagnosis and geographic location.Results: Statistically significant associations were observed with CBT after combining all studies (mOR: 1.26;95% CI: 1.13–1.40) without evidence of inconsistency between study results or publication bias. Specifically,increased risks were observed for several groupings and more particularly for gliomas and exposure involvinginsecticides. Statistical significance was also reached for high quality studies, for all exposure periods, for indoorexposure and, more particularly, during the prenatal period for all stratifications involving insecticides (exceptfor outdoor use), for pet treatments, for flea/tick treatment, for studies from USA/Canada and studies fromEurope (borderline) as well as for data from studies including children of up to 10 years at diagnosis and of up to15 years.Conclusions: Our findings support an association between residential exposure to pesticides and childhood braintumors. Although causality cannot be established, these results add to the evidence leading to recommendlimiting residential use of pesticides and to support public health policies serving this objective.