Health Risks of Structural Firefighters from Exposure to Polycyclic Aromatic Hydrocarbons: A Systematic Review and Meta-Analysis

Int J Environ Res Public Health. 2021 Apr 15;18(8):4209. doi: 10.3390/ijerph18084209.


Firefighters have an elevated risk of cancer, which is suspected to be caused by occupational and environmental exposure to fire smoke. Among many substances from fire smoke contaminants, one potential source of toxic exposure is polycyclic aromatic hydrocarbons (PAH). The goal of this paper is to identify the association between PAH exposure levels and contributing risk factors to derive best estimates of the effects of exposure on structural firefighters' working environment in fire. We surveyed four databases (Embase, Medline, Scopus, and Web of Science) for this systematic literature review. Generic inverse variance method for random effects meta-analysis was applied for two exposure routes-dermal and inhalation. In dermal, the neck showed the highest dermal exposure increased after the fire activity. In inhalation, the meta-regression confirmed statistically significant increases in PAH concentrations for longer durations. We also summarized the scientific knowledge on occupational exposures to PAH in fire suppression activities. More research into uncontrolled emergency fires is needed with regard to newer chemical classes of fire smoke retardant and occupational exposure pathways. Evidence-based PAH exposure assessments are critical for determining exposure-dose relationships in large epidemiological studies of occupational risk factors.

Keywords: firefighter; meta-analysis; occupational exposure; polycyclic aromatic hydrocarbons; systematic review.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Air Pollutants, Occupational* / analysis
  • Firefighters*
  • Fires*
  • Humans
  • Occupational Exposure* / adverse effects
  • Occupational Exposure* / analysis
  • Polycyclic Aromatic Hydrocarbons* / analysis
  • Polycyclic Aromatic Hydrocarbons* / toxicity


  • Air Pollutants, Occupational
  • Polycyclic Aromatic Hydrocarbons