Abstract

Objective Total petroleum hydrocarbons are a significant environmental health concern globally, due to their extensive consumption and environmental release. However, their toxicological mechanisms and associated health consequences, particularly in their unburned forms, are poorly understood in humans. A notable gap is research on kerosene and kerosene-based jet fuels, with the latter accounting for 8% of total daily petroleum consumption.While previous reviews have examined health effects associated with these fuels, the focus on occupational settings and post-combustion forms limit our understanding of potential health implications. Recent drinking water contamination events which expand beyond the scope of existing research highlight these limitations, particularly for other settings and underrepresented groups. Therefore, we conducted a systematic review of the evidence of human health impacts of pre-combustion forms of kerosene and kerosene-based jet fuels across all exposure settings and population groups.

Material and Methods With the assistance of a public health librarian, a search strategy, search terms, and eligibility criteria were developed and executed following PRISMA guidelines. PubMed and Web of Science databases were used to search for eligible literature published between 2017 and 2024. Data extraction, analyses and quality assessment were conducted. Three reviewers participated in this review.

Results 28 articles were included. Limited evidence of a casual relationship between unburned kerosene and kerosene-based jet fuel and health outcomes were identified. Current research suggests that these fuels affect respiratory and neurological systems, but there was also evidence for gastrointestinal and dermatological outcomes. Respiratory effects were frequently observed following acute kerosene ingestion, whereas neurological health outcomes were common with chronic occupational jet fuel exposure, particularly through dermal and inhalation routes. The limited number of analytical studies available, and lack of consistency in exposure and outcome variables, challenge meaningful conclusions.

Conclusion The evidence identified by this review was limited. We provide recommendations for future studies, covering aspects such as exposure assessment methods, study designs, exposure context, and prioritization of underrepresented populations. Considering the global health implications of kerosene and kerosene-based jet fuels, and recent contamination events that underscore the limitations of existing research, furthering our understanding of human health risks associated with these fuels should be prioritized.

Competing Interest Statement

All authors report financial support from the Foundation for the Advancement of Military Medicine, Inc., through the Basic Overarching Cooperative Agreement for the Joint Disaster Medicine and Public Health Ecosystem (Ecosystem BOCA)/Red Hill Independent Health Registry (PTE/Prime Award No.: BOCAHU00D12429000. Subaward No.: PO# 1082378 FMP#6322). The authors declare no other known competing financial interests or relationships that influence the work reported in this paper.

Funding Statement

All authors report financial support from the Foundation for the Advancement of Military Medicine, Inc., through the Basic Overarching Cooperative Agreement for the Joint Disaster Medicine and Public Health Ecosystem (Ecosystem BOCA)/Red Hill Independent Health Registry (PTE/Prime Award No.: BOCAHU00D12429000. Subaward No.: PO# 1082378 FMP#6322). The authors declare no other known competing financial interests or relationships that influence the work reported in this paper.

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Data Availability

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AbbreviationsATSDRAgency for Toxic Substances and Disease RegistryB/DBarrels per DayEIAEnergy Information AdministrationEPAEnvironmental Protection AgencyJPJet PropellantNIOSHNational Institute for Occupational Safety and HealthPECOPopulation, Exposure, Comparator, OutcomePHPetroleum hydrocarbonsPRISMAPreferred Reporting Items for Systematic reviews and Meta-AnalysesPROSPEROThe International Prospective Register of Systematic ReviewsTPHTotal Petroleum Hydrocarbon