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Long-term exposure to nitrogen dioxide and mortality: A systematic review and meta-analysis

作者:Shiwen Huang

关键词:Nitrogen dioxide;Air pollution;All-cause mortality;Cardiovascular mortality;Respiratory mortality;Meta-analysis

发表时间:2021

发表期刊:Science of the Total Environment

证据类型:系统评价/Meta分析

Background: Ambient air pollution is among the greatest environmental risks to human health. However, little is known about the health effects of nitrogen dioxide(NO 2 ), a traffic-related air pollutant. Herein,we aimed to conduct a meta-analysis to investigate the long-term effects of NO 2 on mortality. Methods: We conducted a systematic search for studies that were published up to February 2020 and performed a meta-analysisofallavailableepidemiologicstudiesevaluatingtheassociationsbetweenlong-term exposure to NO 2 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,I 2 =98.6%)per 10 ppb increase in annual NO 2 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, I 2 = 99.2%) and 1.05 (95%CI: 1.02–1.08, n = 17 studies, I 2 = 94.6%),respectively. The sensitivity analysis pooling estimates from multi-pollutant models suggest an independent effect of NO 2 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 NO 2 , 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.