低收入和中等收入国家暴露于室外细颗粒物空气污染对心肺健康的影响：一项系统评价和荟萃分析

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

作者信息

Newell Katherine, Kartsonaki Christiana, Lam Kin Bong Hubert, Kurmi Om P

机构信息

Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

出版信息

Lancet Planet Health. 2017 Dec;1(9):e368-e380. doi: 10.1016/S2542-5196(17)30166-3. Epub 2017 Dec 8.

DOI:10.1016/S2542-5196(17)30166-3

PMID:29851649

Abstract

BACKGROUND

Most prospective studies on the health effects of particulate ambient air pollution exposure have focused on high-income countries, which have much lower pollutant concentrations than low-income and middle-income countries (LMICs) and different sources of pollution. We aimed to investigate the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs exclusively.

METHODS

For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, LILACS, Global Health, and Proquest for studies published between database inception and Nov 28, 2016, investigating the cardiorespiratory health effects of particulate ambient air pollution exposure in LMICs. Data were extracted from published studies by one author, and then checked and verified by all authors independently. We pooled estimates by pollutant type (particulate matter with a diameter of <2·5 μm [PM] or 2·5-10 μm [PM]), lag, and outcome, and presented them as excess relative risk per 10 μg/m increase in particulate ambient air pollution. We used a random-effects model to derive overall excess risk. The study protocol is registered with PROSPERO, number CRD42016051733.

FINDINGS

Of 1553 studies identified, 91 met the full eligibility criteria. Only four long-term exposure studies from China were identified and not included in the meta-analysis. A 10 μg/m increase in same-day PM was associated with a 0·47% (95% CI 0·34-0·61) increase in cardiovascular mortality and a 0·57% (0·28-0·86) increase in respiratory mortality. A 10 μg/m increase in same-day PM was associated with a 0·27% (0·11-0·44) increase in cardiovascular mortality and a 0·56% (0·24-0·87) increase in respiratory mortality.

INTERPRETATION

Short-term exposure to particulate ambient air pollution is associated with increases in cardiorespiratory morbidity and mortality in LMIC's, with apparent regional-specific variations.

FUNDING

None.

摘要

背景

大多数关于暴露于环境细颗粒物空气污染对健康影响的前瞻性研究都集中在高收入国家，这些国家的污染物浓度远低于低收入和中等收入国家（LMICs），且污染源也不同。我们旨在专门研究LMICs中暴露于环境细颗粒物空气污染对心肺健康的影响。

方法

对于这项系统评价和荟萃分析，我们检索了PubMed、科学网、Embase、LILACS、全球健康数据库和ProQuest，以查找在数据库建立至2016年11月28日期间发表的研究，这些研究调查了LMICs中暴露于环境细颗粒物空气污染对心肺健康的影响。数据由一位作者从已发表的研究中提取，然后由所有作者独立检查和核实。我们按污染物类型（直径<2.5μm的颗粒物[PM₂.₅]或2.5 - 10μm的颗粒物[PM₁₀]）、滞后时间和结局进行合并估计，并将其表示为环境细颗粒物空气污染每增加10μg/m³时的超额相对风险。我们使用随机效应模型得出总体超额风险。该研究方案已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42016051733。

结果

在识别出的1553项研究中，91项符合全部纳入标准。仅识别出来自中国的四项长期暴露研究，未纳入荟萃分析。当日PM₂.₅每增加10μg/m³，心血管死亡率增加0.47%（95%CI 0.34 - 0.61），呼吸死亡率增加0.57%（0.28 - 0.86）。当日PM₁₀每增加10μg/m³，心血管死亡率增加0.27%（0.11 - 0.44），呼吸死亡率增加0.56%（0.24 - 0.87）。