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Meta-Analysis
. 2018 Apr 18;17(1):41.
doi: 10.1186/s12940-018-0380-3.

Cardiorespiratory health effects of gaseous ambient air pollution exposure in low and middle income countries: a systematic review and meta-analysis

Katherine Newell  1 , Christiana Kartsonaki  2   3 , Kin Bong Hubert Lam  2 , Om Kurmi  2
Affiliations
Meta-Analysis

Cardiorespiratory health effects of gaseous ambient air pollution exposure in low and middle income countries: a systematic review and meta-analysis

Katherine Newell et al. Environ Health. .

Abstract

Background: Lack of research on the effects of gaseous pollutants (nitrogen oxides [NOx], sulfur dioxide [SO2], carbon monoxide [CO] and ozone [O3]) in the ambient environment on health outcomes from within low and middle income countries (LMICs) is leading to reliance on results from studies performed within high income countries (HICs). This systematic review and meta-analysis examines the cardiorespiratory health effects of gaseous pollutants in LMICs exclusively.

Methods: Systematic searching was carried out and estimates pooled by pollutant, lag and outcome, and presented as excess relative risk per 10 μg/m3 (NOx, SO2, O3) or 1 ppm (CO) increase pollutant. Sub-group analysis was performed examining estimates by specific outcomes, city and co-pollutant adjustment.

Results: Sixty studies met the inclusion criteria, most (44) from the East Asia and Pacific region. A 10 μg/m3 increase in same day NOx was associated with 0.92% (95% CI: 0.44, 1.39), and 0.70% (0.01, 1.40) increases in cardiovascular and respiratory mortality respectively, same day NOx was not associated with morbidity. Same day sulfur dioxide was associated with 0.73% (0.04, 1.42) and 0.50% (0.01, 1.00) increases in respiratory morbidity and in cardiovascular mortality respectively.

Conclusions: Acute exposure to gaseous ambient air pollution (AAP) is associated with increases in morbidity and mortality in LMICs, with greatest associations observed for cardiorespiratory mortality.

Keywords: Air pollution; Cardiovascular; LMICs; Meta-analysis; Respiratory; Systematic review.

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Conflict of interest statement

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Study selection for the cardiorespiratory impacts of gaseous air pollution in LMICs
Fig. 2
Fig. 2
Pooled associations between gaseous ambient air pollution and cardiorespiratory mortality/morbidity stratified by outcome and lag time (days)
Fig. 3
Fig. 3
Pooled associations between carbon monoxide and cardiorespiratory mortality stratified by outcome and lag time (days)
Fig. 4
Fig. 4
Pooled associations between gaseous pollutants and cardiorespiratory mortality/morbidity stratified by specific health outcomes (lags 0–3 days inclusively)
Fig. 5
Fig. 5
Pooled associations between gaseous pollutants and cardiorespiratory mortality/morbidity stratified by city (lags 0–3 days inclusively)
Fig. 6
Fig. 6
Pooled association between gaseous pollutants and cardiorespiratory outcomes adjusted for additional pollutants (lags 0–3 days inclusively)
Fig. 7
Fig. 7
Pooled associations between gaseous pollutants and cardiorespiratory outcomes with studies with high risk of bias removed
See this image and copyright information in PMC

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