Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
Universidad Tecnológica Nacional, Facultad Regional San Nicolás, Colon 332, San Nicolas de los Arroyos, Argentina.
Environ Health. 2023 Mar 30;22(1):31. doi: 10.1186/s12940-023-00979-8.
The adverse effects of air pollution on human health include many diseases and health conditions associated with mortality, morbidity and disability. One example of these outcomes that can be translated into economic costs is the number of days of restricted activity. The aim of this study was to assess the effect of outdoor exposure to particulate matter with an aerodynamic diameter less than or equal to 10 and 2.5 μm (PM, PM), nitrogen dioxide (NO), and ozone (O), on restricted activity days.
Observational epidemiological studies with different study designs were included, and pooled relative risks (RR) with 95% confidence intervals (95%CI) were calculated for an increase of 10 μg/m of the pollutant of interest. Random-effects models were chosen because of the environmental differences between the studies. Heterogeneity was estimated using prediction intervals (PI) and I-Squared (I2) values, while risk of bias was assessed using a tool developed by the World Health Organization specifically designed for air pollution studies, and based on different domains. Subgroup and sensitivity analyses were performed where possible. The protocol for this review was registered with PROSPERO (CRD42022339607).
We included 18 articles in the quantitative analysis. Associations between pollutants and restricted activity days in time-series studies of short-term exposures, measured as work-loss days, school-loss days, or both were significant for PM (RR: 1.0191; 95%CI: 1.0058-1.0326; 80%PI: 0.9979-1.0408; I2: 71%) and PM (RR: 1.0166; 95%CI: 1.0050-1.0283; 80%PI: 0.9944-1.0397; I2: 99%), but not for NO or O. Some degree of heterogeneity between studies was observed, but sensitivity analysis showed no differences in the direction of the pooled relative risks when studies with a high risk of bias were excluded. Cross-sectional studies also showed significant associations for PM and restricted activity days. We could not perform the analysis for long-term exposures because only two studies analysed this type of association.
Restricted activity days and related outcomes were associated with some of the pollutants under evaluation, as shown in studies with different designs. In some cases, we were able to calculate pooled relative risks that can be used for quantitative modelling.
空气污染对人类健康的不良影响包括许多与死亡率、发病率和残疾有关的疾病和健康状况。这些结果中可以转化为经济成本的一个例子是限制活动的天数。本研究的目的是评估室外暴露于空气动力学直径小于或等于 10 和 2.5 μm 的颗粒物（PM₁₀ 和 PM₂.₅）、二氧化氮（NO）和臭氧（O）对限制活动天数的影响。
纳入了不同研究设计的观察性流行病学研究，并计算了污染物每增加 10μg/m³时的相对风险（RR）及其 95%置信区间（95%CI）。由于研究之间的环境差异，选择了随机效应模型。使用预测区间（PI）和 I 平方（I²）值来估计异质性，同时使用世界卫生组织专门为空气污染研究制定的工具评估偏倚风险，该工具基于不同的领域。在可能的情况下进行了亚组和敏感性分析。本综述的方案已在 PROSPERO（CRD42022339607）中注册。
我们对 18 篇文章进行了定量分析。在短期暴露（以工作日损失、上学日损失或两者兼有的工作-上学日损失衡量）的时间序列研究中，PM 和 PM 与限制活动日之间存在关联，RR 分别为 1.0191（95%CI：1.0058-1.0326）、1.0166（95%CI：1.0050-1.0283），PI 为 80%时的 95%CI 为 0.9979-1.0408，I²为 71%）和 PM（RR：1.0166；95%CI：1.0050-1.0283；80%PI：0.9944-1.0397；I²：99%），但 NO 或 O 则不然。观察到研究之间存在一定程度的异质性，但敏感性分析表明，当排除偏倚风险高的研究时，汇总相对风险的方向没有差异。横断面研究也显示 PM 与限制活动日之间存在显著关联。由于只有两项研究分析了这种类型的关联，因此我们无法对长期暴露进行分析。
一些评估中的污染物与限制活动日和相关结果有关，这在具有不同设计的研究中得到了证明。在某些情况下，我们能够计算出可用于定量建模的汇总相对风险。
