Changning Center for Disease Control and Prevention, Shanghai 200051, China.
School of Public Health, & Key Laboratory of Public Health Safety of Ministry of Education of China, Fudan University, Shanghai 200032, China.
Int J Environ Res Public Health. 2020 Mar 23;17(6):2130. doi: 10.3390/ijerph17062130.
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and ozone exposure is a main cause of its disease burden. However, studies on COPD hospitalizations from short-term ambient level ozone exposure have not generated consensus results. To address the knowledge gap, comprehensive and systematic searches in several databases were conducted using specific keywords for publications up to February 14, 2020. Random-effect models were used to derive overall excess risk estimates between short-term ambient-level ozone exposure and COPD hospitalizations. The influence analyses were used to test the robustness of the results. Both meta-regression and subgroup analyses were used to explore the sources of heterogeneity and potential modifying factors. Based on the results from 26 eligible studies, the random-effect model analyses show that a 10 µg/m increase in maximum 8-h ozone concentration was associated with 0.84% (95% CI: 0.09%, 1.59%) higher COPD hospitalizations. The estimates were higher for warm season and multiple-day lag but lower for old populations. Results from subgroup analyses also indicate a multiple-day lag trend and bigger significant health effects during longer day intervals. Although characteristics of individual studies added modest heterogeneity to the overall estimates, the results remained robust during further analyses and exhibited no evidence of publication bias. Our systematic review and meta-analysis indicate that short-term ambient level ozone exposure was associated with increased risk of COPD hospitalizations. The significant association with multiple-day lag trend indicates that a multiple-day exposure metric should be considered for establishing ambient ozone quality and exposure standards for improvement of population health. Future investigations and meta-analysis studies should include clinical studies as well as more careful lag selection protocol.
慢性阻塞性肺疾病（COPD）是全球第三大致死原因，臭氧暴露是其疾病负担的主要原因。然而，关于短期环境臭氧暴露与 COPD 住院之间关系的研究尚未得出一致的结果。为了弥补这一知识空白，我们使用特定的关键词对截至 2020 年 2 月 14 日的出版物在多个数据库中进行了全面而系统的搜索。使用随机效应模型得出短期环境臭氧暴露与 COPD 住院之间的总体超额风险估计值。影响分析用于检验结果的稳健性。Meta 回归和亚组分析均用于探索异质性的来源和潜在的调节因素。基于 26 项符合条件的研究结果，随机效应模型分析表明，最大 8 小时臭氧浓度每增加 10 µg/m³，COPD 住院率将增加 0.84%（95%CI：0.09%，1.59%）。在温暖季节和多日滞后时，估计值较高，而在老年人群中则较低。亚组分析的结果也表明存在多日滞后趋势和较长时间间隔内更大的显著健康影响。尽管个别研究的特征给总体估计值增加了适度的异质性，但进一步分析结果仍然稳健，且没有发表偏倚的证据。我们的系统评价和荟萃分析表明，短期环境臭氧暴露与 COPD 住院风险增加有关。与多日滞后趋势的显著关联表明，在制定环境臭氧质量和暴露标准以改善人群健康时，应考虑多日暴露指标。未来的研究和荟萃分析应包括临床研究，并应更仔细地选择滞后时间。
