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Meta-Analysis
. 2025 Mar 27;20(1):35.
doi: 10.5334/gh.1409. eCollection 2025.

Climate, Air Quality and Their Contribution to Cardiovascular Disease Morbidity and Mortality in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Stephaney Gyaase  1   2 , Solomon Nyame  1   2 , Kerstin Klipstein-Grobusch  2   3 , Kwaku Poku Asante  1 , George S Downward  2   4
Affiliations
Meta-Analysis

Climate, Air Quality and Their Contribution to Cardiovascular Disease Morbidity and Mortality in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Stephaney Gyaase et al. Glob Heart. .

Abstract

Background: Increasing exposure to climatic features is strongly linked to various adverse health outcomes and mortality. While the link between these features and cardiovascular outcomes is well established, most studies are from high-income countries.

Objectives: This review synthesizes evidence as well as research gaps on the relationship between climate indicators, household/ambient air pollution, and all-cause cardiovascular disease (CVD) morbidity and mortality in low- and middle-income countries (LMICs).

Methods: Seven electronic databases were searched up to June 15, 2024. Articles were included if they focused on LMICs, addressed all-cause CVD morbidity and/or mortality, and studied climate or environmental exposures. Studies were selected using ASReview LAB, extracted and analyzed with random effect meta-analysis performed if sufficient articles were identified.

Results & conclusion: Out of 7,306 articles, 58 met the inclusion criteria: 26 on morbidity, 29 on mortality, and 3 on both. Exposures included PM10, PM2.5, NO2, SO2, BC, O3, CO, solid fuel usage, and temperature variation. Short-term exposure to PM2.5 was significantly associated with CVD morbidity (RR per 10 µg/m3 increase:1.006, 95% CI 1.003-1.009) and mortality (RR:1.007, 95% CI 1.002-1.012). Short-term exposure to NO2 and O3 also increased CVD mortality risk. Long-term exposure to PM2.5 elevated CVD morbidity (RR per 10 µg/m3 increase:1.131, 95% CI 1.057-1.210) and mortality (RR:1.092, 95% CI 1.030-1.159). High and low temperatures and long-term solid fuel use were linked to CVD deaths. The bulk of studies were from mainland China (72%), which may not accurately reflect the situation in other LMICs. Sub-Saharan Africa was particularly lacking, representing a major research gap.

Keywords: cardiovascular disease morbidity; exposures; long-term; mortality; short-term.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Flow diagram showing articles selected on climate’s impact on CVD
Figure 1
Description of the articles selection processes.
Forest plot highlighting PM2.5 ffect on CVD risk outcome
Figure 2
Meta-analysis of short-term PM2.5 exposure and CVD morbidity and mortality.
Forest plot showing short-term NO2 exposure’s effect on CVD outcome
Figure 3
Meta-analysis of short-term NO2 exposure and CVD morbidity and mortality.
Forest plot of short-term effect of O3 on CVD outcomes
Figure 4
Meta-analysis of short-term O3 exposure and CVD morbidity and mortality.
Forest plot illustrating long-term effect of PM2.5 on CVD outcome
Figure 5
Meta-analysis of long-term PM2.5 exposure and cardiovascular disease morbidity and mortality.
See this image and copyright information in PMC

References

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    1. World Health Organization (WHO). Air pollution [Internet]. World Health Organization; 2024. Available from: https://www.who.int/health-topics/air-pollution#tab=tab_1.

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