Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran.
Environ Res. 2019 Jun;173:135-156. doi: 10.1016/j.envres.2019.03.030. Epub 2019 Mar 15.
ADHD is a common neurodevelopmental disorder highly attributed to genetics, but the combination of other social and environmental determinants, as well as potential gene-environment interactions, can also be responsible. This paper aims to review relevant literature published up to April 2018 for determining whether air pollution caused by ambient gaseous (NO, SO, PCDD/Fs, Benzene) and particulate matters (PM, PM, PM, PAH, BC/EC) as an environmental risk factor is associated with increased risk of ADHD in children. Relevant literature was identified through electronic searches of PubMed, Embase, Web of Science, Scopus database and gray literature. A total of 872 articles were initially identified 28 of which meeting the defined inclusion criteria were included. The methodological quality of the included articles was evaluated using the modified Critical Appraisal Skills Programs (CASP) and confounding variables, exposure and outcome measurement were assessed. The results of this systematic review revealed that there is more evidence on the detrimental effects of EC, BC, and PM on ADHD compared to PAH. Among gaseous air pollutants, association was found between SO and urinary level of t,t-MA (trans, trans-muconic acid) as a proxy-biomarker of NO exposure, not merely benzene. However few studies related to NO (0.46%) found detrimental effects. Overall, the number of studies reporting an association between air pollution and increased risk of ADHD is relatively higher compared to the number of studies reporting no association. However, the findings of the studies provided limited evidence to support the idea that exposure to air pollution may be linked to increased risk of ADHD. Well-designed and harmonized studies considering standard methods for individual exposure assessment, critical windows of susceptibility, and appropriate tools for outcome measurement, can improve the quality of epidemiological studies and strengthen the evidence. Since ADHD with its long-term consequences can impose large costs to communities and impact the children performance, determination of the risk factors in children and particularly the role of the environment as priorities for research should be considered.
注意缺陷多动障碍（ADHD）是一种常见的神经发育障碍，主要归因于遗传因素，但其他社会和环境决定因素以及潜在的基因-环境相互作用也可能起作用。本文旨在回顾截至 2018 年 4 月发表的相关文献，以确定环境中气态（NO、SO、PCDD/Fs、苯）和颗粒物质（PM、PM、PM、PAH、BC/EC）引起的空气污染是否会增加儿童患 ADHD 的风险。通过电子检索 PubMed、Embase、Web of Science、Scopus 数据库和灰色文献，确定了相关文献。最初确定了 872 篇文章，其中 28 篇符合既定纳入标准的文章被纳入。使用改良的批判性评价技能计划（CASP）评估纳入文章的方法学质量，并评估混杂变量、暴露和结局测量。这项系统综述的结果表明，与 PAH 相比，EC、BC 和 PM 对 ADHD 的有害影响的证据更多。在气态空气污染物中，发现 SO 与作为 NO 暴露替代生物标志物的尿中 t,t-MA（反式，反式-粘康酸）之间存在关联，而不仅仅是苯。然而，与 NO 相关的研究很少（0.46%）发现有害影响。总的来说，报告空气污染与 ADHD 风险增加之间存在关联的研究数量相对高于报告无关联的研究数量。然而，这些研究的结果提供的证据有限，不足以支持接触空气污染可能与 ADHD 风险增加有关的观点。考虑到个体暴露评估、易感关键窗口期和适当结局测量工具的标准方法，精心设计和协调一致的研究可以提高流行病学研究的质量，并加强证据。由于 ADHD 及其长期后果会给社区带来巨大成本，并影响儿童的表现，因此应考虑确定儿童的风险因素，特别是环境的作用，作为研究的优先事项。
