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Environmental Science and Pollution Research

, Volume 25, Issue 15, pp 15133–15145 | Cite as

Exposure to nitrogen dioxide and chronic obstructive pulmonary disease (COPD) in adults: a systematic review and meta-analysis

  • Zili Zhang
  • Jian Wang
  • Wenju LuEmail author
Research Article

Abstract

Exposure to nitrogen dioxide (NO2) has long been linked to elevated mortality and morbidity from epidemiological evidences. However, questions remain unclear whether NO2 acts directly on human health or being an indicator of other ambient pollutants. In this study, random-effect meta-analyses were performed on examining exposure to nitrogen oxide (NOx) and its association with chronic obstructive pulmonary disease (COPD). The overall relative risk (RR) of COPD risk related to a 10 μg/m3 increase in NO2 exposure increased by 2.0%. The pooled effect on prevalence was 17% with an increase of 10 μg/m3 in NO2 concentration, and 1.3% on hospital admissions, and 2.6% on mortality. The RR of COPD cases related to NO2 long-term exposure was 2.5 and 1.4% in short-term exposure. The COPD effect related with a 10 μg/m3 increase in exposure to a general outdoor-sourced NO2 was 1.7 and 17.8% to exposure to an exclusively traffic-sourced NO2; importantly, we did observe the effect of NO2 on COPD mortality with a large majority in lag0. Long-term traffic exerted more severe impairments on COPD prevalence than long-term or short-term outdoor effect; long-term mortality effect on COPD was serious in single model from this meta-analysis. Overall, our study reported consistent evidence of the potential positive association between NO2 and COPD risk.

Keywords

COPD NO2 Relative risk Air pollution Exposure assessment 

Notes

Funding sources

This work was supported by grants from National Natural Science Foundation of China (81520108001, 81700043), the 973 Key Scheme of China (2015CB553406), Guangzhou Department of Education for Innovative Team (13C08) and Guangdong Natural Science Foundation (2016A030313593), state Key Laboratory of Respiratory Diseases (SKLRD), and Guangzhou Institute of Respiratory Health (SKLRD- QN-201719). The funding sponsors had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, and in the decision to publish the results.

Compliance with ethical standards

Conflict of interest

The authors declared that no competing interests have existed

Supplementary material

11356_2018_1629_Fig9_ESM.gif (11 kb)
Figure S1.

Funnel plot of study-specific estimates of the relative risk (RR) of COPD relevant to a 10 μg/m3 increase in NO2 exposure. The meta-analysis represented by the vertical solid line of the funnel plot was based on a random-effect. (GIF 10 kb)

11356_2018_1629_MOESM1_ESM.tif (47 kb)
High Resolution Image (TIFF 47 kb)
11356_2018_1629_Fig10_ESM.gif (22 kb)
Figure S2.

Sensitivity analysis of study-specific estimates of the relative risk (RR) of COPD relevant to a 10 μg/m3 increase in NO2 exposure. Dot represents the omitted study, Short Line is 95%CI. (GIF 21 kb)

11356_2018_1629_MOESM2_ESM.tif (91 kb)
High Resolution Image (TIFF 91 kb)
11356_2018_1629_Fig11_ESM.gif (39 kb)
Figure S3.

Forest plot of study-specific estimates of relative risk (RR) of COPD relevant to a 10 μg/m3 increase in NO2 exposure stratified by adjustment or not, and random effects meta-analyses employed. (GIF 39 kb)

11356_2018_1629_MOESM3_ESM.tif (184 kb)
High Resolution Image (TIFF 184 kb)
11356_2018_1629_Fig12_ESM.gif (36 kb)
Figure S4.

Forest plot of study-specific estimates of relative risk (RR) of COPD relevant to a 10 μg/m3 increase in NO2 exposure stratified by study region, and random effects meta-analyses employed. (GIF 36 kb)

11356_2018_1629_MOESM4_ESM.tif (164 kb)
High Resolution Image (TIFF 163 kb)
11356_2018_1629_Fig13_ESM.gif (38 kb)
Figure S5.

Forest plot of study-specific estimates of relative risk (RR) of COPD relevant to a 10 μg/m3 increase in exposure to NO2 stratified by lag periods, and random effects meta-analyses employed. (GIF 37 kb)

11356_2018_1629_MOESM5_ESM.tif (167 kb)
High Resolution Image (TIFF 166 kb)
11356_2018_1629_Fig14_ESM.gif (37 kb)
Figure S6.

Forest plot of study-specific estimates of relative risk (RR) of COPD relevant to a 10 μg/m3 increase in exposure to NO2 stratified by lag periods-exposure ending, and random effects meta-analyses used. (GIF 37 kb)

11356_2018_1629_MOESM6_ESM.tif (179 kb)
High Resolution Image (TIFF 179 kb)
11356_2018_1629_Fig15_ESM.gif (31 kb)
Figure S7.

Forest plot of study-specific estimates of relative risk (RR) of COPD relevant to a 10 μg/m3 increase in exposure to NO2 stratified by lag periods-exposure term-exposure ending, and random effects meta-analyses used. (GIF 31 kb)

11356_2018_1629_MOESM7_ESM.tif (164 kb)
High Resolution Image (TIFF 164 kb)
11356_2018_1629_Fig16_ESM.gif (34 kb)
Figure S8.

Forest plot of study-specific estimates of relative risk (RR) of COPD relevant to a 10 μg/m3 increase in exposure to NO2 stratified by exposure term-exposure ending, and random effects meta-analyses used. (GIF 34 kb)

11356_2018_1629_MOESM8_ESM.tif (169 kb)
High Resolution Image (TIFF 169 kb)
11356_2018_1629_MOESM9_ESM.docx (28 kb)
ESM 1 (DOCX 27 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina
  2. 2.Division of Translational and Regenerative Medicine, Department of MedicineThe University of ArizonaTucsonUSA
  3. 3.Department of Laboratory Medicine, The First Affiliated HospitalGuangzhou Medical UniversityGuangzhouChina

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