Kraus Ute, Horstmann Sophie, Dandolo Lisa, Bolte Gabriele, Peters Annette, Schneider Alexandra
Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany.
Ecotoxicol Environ Saf. 2025 Jul 15;300:118443. doi: 10.1016/j.ecoenv.2025.118443. Epub 2025 Jun 3.
When assessing the association between air pollution and cardiovascular mortality, it remains unclear whether females or males are more susceptible and whether and to what extent the pre-existing studies have accounted for different sex/gender dimensions. We searched three databases to identify short-term and long-term studies on the association between air pollution and cardiovascular mortality published 2000-2023 to assess their integration of sex/gender. We further evaluated whether sex/gender was a source of heterogeneity within these through a moderator analysis using random effects models. We examined sex/gender differences through random effects pooling of the female-to-male-ratio (FMR) of each study. We identified 106 studies, all of which operationalised sex/gender in binary terms and lacked a sex/gender-theoretical concept. However, the biological and social dimensions of sex/gender were indirectly included in the discussions. Meta-analyses did not identify sex/gender as a source of heterogeneity (e.g. short-term particulate matter with a diameter <10μm (PM): p-value of moderator test= 0.85; long-term: 0.34). The pooled FMR showed no sex/gender differences for short-term associations (1.0[CI: 0.0;0.0] for each air pollutant) and a trend towards higher effect estimates for males than females in long-term studies with a pooled FMR ranging from 0.93 to 0.99. Binary categorisation without conceptualisation does not appear to be sufficient to identify vulnerable sex/gender groups, if any, in the association between air pollution and cardiovascular mortality. Considering the multiple biological and sociocultural dimensions of sex/gender from the very beginning of study planning will help to move beyond speculative discussions and derive meaningful action for prevention and health care.
在评估空气污染与心血管疾病死亡率之间的关联时，女性或男性是否更易受影响，以及现有研究是否以及在何种程度上考虑了不同的性别维度，目前仍不清楚。我们检索了三个数据库，以确定2000年至2023年发表的关于空气污染与心血管疾病死亡率之间关联的短期和长期研究，以评估它们对性别的整合情况。我们还通过使用随机效应模型的调节分析，进一步评估性别是否是这些研究中异质性的一个来源。我们通过对每项研究的女性与男性比例（FMR）进行随机效应合并来检查性别差异。我们共识别出106项研究，所有这些研究都以二元方式对性别进行操作化，并且缺乏性别理论概念。然而，性别在生物学和社会层面的因素在讨论中被间接提及。荟萃分析未将性别确定为异质性的来源（例如，短期直径<10μm的颗粒物（PM）：调节检验的p值 = 0.85；长期：0.34）。汇总的FMR显示，短期关联不存在性别差异（每种空气污染物的FMR为1.0[置信区间：0.0；0.0]），而在长期研究中，汇总的FMR在0.93至0.99之间，男性的效应估计值有高于女性的趋势。如果不进行概念化，仅二元分类似乎不足以识别空气污染与心血管疾病死亡率之间关联中可能存在的易受影响的性别群体。从研究规划的一开始就考虑性别的多个生物学和社会文化层面，将有助于超越推测性讨论，并为预防和医疗保健采取有意义的行动。
