Long-term exposure to nitrogen dioxide and mortality: A systematic review and meta-analysis,Science of the Total Environment

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Long-term exposure to nitrogen dioxide and mortality: A systematic review and meta-analysis
Science of the Total Environment ( IF 8.2 ) Pub Date : 2021-02-19 , DOI: 10.1016/j.scitotenv.2021.145968
Shiwen Huang ₁ , Haomin Li ₂ , Mingrui Wang ₁ , Yaoyao Qian ₁ , Kyle Steenland ₁ , William Michael Caudle ₁ , Yang Liu ₁ , Jeremy Sarnat ₁ , Stefania Papatheodorou ₃ , Liuhua Shi ₁

Affiliation

Background

Ambient air pollution is among the greatest environmental risks to human health. However, little is known about the health effects of nitrogen dioxide (NO₂), a traffic-related air pollutant. Herein, we aimed to conduct a meta-analysis to investigate the long-term effects of NO₂ on mortality.

Methods

We conducted a systematic search for studies that were published up to February 2020 and performed a meta-analysis of all available epidemiologic studies evaluating the associations between long-term exposure to NO₂ with all-cause, cardiovascular, and respiratory mortality. Overall pooled effect estimates as well as subgroup-specific pooled estimates (e.g. location, exposure assessment method, exposure metric, study population, age at recruitment, and key confounder adjustment) and 95% confidence intervals were calculated using random-effects models. Risk of bias assessment was accessed by following WHO global air quality guidelines. Publication bias was accessed by visually inspecting funnel plot and Egger's liner regression was used to test of asymmetry.

Results

Our search initially retrieved 1349 unique studies, of which 34 studies met the inclusion criteria. The pooled hazard ratio (HR) for all-cause mortality was 1.06 (95%CI: 1.04–1.08, n = 28 studies, I² = 98.6%) per 10 ppb increase in annual NO₂ concentrations. The pooled HRs for cardiovascular and respiratory mortality per 10 ppb increment were 1.11 (95%CI: 1.07–1.16, n = 20 studies, I² = 99.2%) and 1.05 (95%CI: 1.02–1.08, n = 17 studies, I² = 94.6%), respectively. The sensitivity analysis pooling estimates from multi-pollutant models suggest an independent effect of NO₂ on mortality. Funnel plots indicate that there is no evidence for publication bias in our study.

Conclusion

We provide robust epidemiological evidence that long-term exposure to NO₂, a proxy for traffic-sourced air pollutants, is associated with a higher risk of all-cause, cardiovascular, and respiratory mortality that might be independent of other common air pollutants.

中文翻译：

长期暴露于二氧化氮和死亡率：系统评价和荟萃分析

背景

环境空气污染是人类健康面临的最大环境风险之一。_{然而，人们对与交通有关的空气污染物二氧化氮 (NO 2} )对健康的影响知之甚少。_{在此，我们旨在进行一项荟萃分析，以研究 NO 2}对死亡率的长期影响。

方法

我们对截至 2020 年 2 月发表的研究进行了系统搜索，并对所有可用的流行病学研究进行了荟萃分析，评估长期暴露于 NO ₂与全因、心血管和呼吸系统死亡率之间的关联。使用随机效应模型计算总体汇总效应估计值以及特定亚组的汇总估计值（例如位置、暴露评估方法、暴露指标、研究人群、招募年龄和关键混杂因素调整）和 95% 置信区间。偏倚风险评估是按照世卫组织全球空气质量指南进行的。通过目视检查漏斗图来访问发表偏倚，并使用 Egger 线性回归来测试不对称性。

结果

我们的搜索最初检索到 1349 项独特的研究，其中 34 项研究符合纳入标准。_{每年 NO 2}浓度每增加 10 ppb ，全因死亡率的汇总风险比 (HR) 为 1.06（95%CI：1.04–1.08，n = 28 项研究，I ² = 98.6%）。每增加 10 ppb 的心血管和呼吸系统死亡率的汇总 HR 分别为 1.11（95%CI：1.07-1.16，n = 20 项研究，I ² = 99.2%）和 1.05（95%CI：1.02-1.08，n = 17 项研究， I ² = 94.6%)。来自多污染物模型的敏感性分析汇总估计表明 NO _{2的独立影响}关于死亡率。漏斗图表明我们的研究中没有发表偏倚的证据。