Outdoor Air Pollution and COPD-Related Emergency Department Visits, Hospital Admissions, and Mortality: A Meta-Analysis

Abstract

A systematic literature review was performed to identify all peer-reviewed literature quantifying the association between short-term exposures of particulate matter <2.5 microns (PM_2.5), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂) and COPD-related emergency department (ED) visits, hospital admissions (HA), and mortality. These results were then pooled for each pollutant through meta-analyses with a random effects model. Subgroup meta-analyses were explored to study the effects of selected lag/averaging times and health outcomes. A total of 37 studies satisfied our inclusion criteria, contributing to a total of approximately 1,115,000 COPD-related acute events (950,000 HAs, 80,000 EDs, and 130,000 deaths) to our meta-estimates. An increase in PM_2.5 of 10 ug/m³ was associated with a 2.5% (95% CI: 1.6-3.4%) increased risk of COPD-related ED and HA, an increase of 10 ug/m³ in NO₂ was associated with a 4.2% (2.5-6.0%) increase, and an increase of 10 ug/m³ in SO₂ was associated with a 2.1% (0.7-3.5%) increase. The strength of these pooled effect estimates, however, varied depending on the selected lag/averaging time between exposure and outcome. Similar pooled effects were estimated for each pollutant and COPD-related mortality. These results suggest an ongoing threat to the health of COPD patients from both outdoor particulates and gaseous pollutants. Ambient outdoor concentrations of PM_2.5, NO₂, and SO₂ were significantly and positively associated with both COPD-related morbidity and mortality.

Keywords: Air pollution; environmental epidemiology; environmental health; respiratory disease.

Figure 1.

Summary of Systematic Literature Review

Figure 2.

Outdoor Air Pollution and COPD Related ED Visits and HAs