School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China.
School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China.
Sci Total Environ. 2024 Jan 1;906:167542. doi: 10.1016/j.scitotenv.2023.167542. Epub 2023 Oct 4.
The COVID-19 pandemic presents unprecedented challenge for global public health systems and exacerbates existing health disparities. Epidemiological evidence suggested a potential linkage between particulate and gaseous pollutants and COVID-19 mortality. We aimed to summarize the overall risk of COVID-19 mortality associated with ambient air pollutants over the short- and long-term.
For the systematic review and meta-analysis, we searched five databases for studies evaluating the risk of COVID-19 mortality from exposure to air pollution. Inclusion of articles was assessed independently on the basis of research topic and availability of effect estimates. The risk estimates (relative risk) for each pollutant were pooled with a random-effect model. Potential heterogeneity was explored by subgroup analysis. Funnel plots and trim-and-fill methods were employed to assess and adjust for publication bias.
The systematic review retrieved 2059 records, and finally included 43 original studies. PM (RR: 1.71, 95 % CI: 1.40-2.08, per 10 μg/m increase), NO (RR: 1.33, 1.07-1.65, per 10 ppb increase) and O (RR: 1.61, 1.00-2.57, per 10 ppb increase) were positively associated with COVID-19 mortality for long-term exposures. Accordingly, a higher risk of COVID-19 mortality was associated with PM (1.05, 1.02-1.08), PM (1.05, 1.01-1.08), and NO (1.40, 1.04-1.90) for short-term exposures. There was some heterogeneity across subgroups of income level and geographical areas.
Both long-term and short-term exposures to ambient air pollution may increase the risk of COVID-19 mortality. Future studies utilizing individual-level information on demographics, exposures, outcome ascertainment and confounders are warranted to improve the accuracy of estimates.
COVID-19 大流行对全球公共卫生系统提出了前所未有的挑战，并加剧了现有的健康差距。流行病学证据表明，颗粒物和气态污染物与 COVID-19 死亡率之间存在潜在联系。我们旨在总结短期和长期暴露于环境空气污染物与 COVID-19 死亡率之间的总体风险。
为了进行系统评价和荟萃分析，我们在五个数据库中搜索了评估暴露于空气污染对 COVID-19 死亡率风险的研究。根据研究主题和效应估计的可用性，独立评估文章的纳入。使用随机效应模型汇总每种污染物的风险估计值（相对风险）。通过亚组分析探索潜在异质性。使用漏斗图和修剪和填充方法评估和调整发表偏倚。
系统评价检索到 2059 条记录，最终纳入 43 项原始研究。PM（RR：1.71，95%CI：1.40-2.08，每增加 10μg/m）、NO（RR：1.33，1.07-1.65，每增加 10ppb）和 O（RR：1.61，1.00-2.57，每增加 10ppb）与长期暴露相关，与 COVID-19 死亡率呈正相关。因此，PM（1.05，1.02-1.08）、PM（1.05，1.01-1.08）和 NO（1.40，1.04-1.90）的短期暴露与 COVID-19 死亡率的风险增加有关。在收入水平和地理区域的亚组中存在一定的异质性。
短期和长期暴露于环境空气污染都可能增加 COVID-19 死亡率的风险。未来的研究需要利用个人层面的人口统计学、暴露、结果确定和混杂因素信息，以提高估计的准确性。
