Systematic review and meta-analysis of epidemiological time-series studies on outdoor air pollution and health in Asia
- 1.3k Downloads
Asia is experiencing rapid increases in industrialization, urbanization, and motor vehicle transport with correspondingly high levels of pollution. We undertook a systematic review and meta-analysis of the Asian time-series literature to assess the evidence from health effects of short-term exposure to outdoor air pollution. Eighty-two studies provided estimates suitable for quantitative meta-analysis. Summary estimates for daily mortality and hospital admissions were calculated for particulate matter with aerodynamic diameters less than 10 and 2.5 μm (PM10 and PM2.5), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide. For 10 μg/m3 increases in PM10, daily mean numbers of deaths increased by 0.27% (95% confidence interval: 0.12%, 0.42%), 0.86% (0.34%, 1.39%), and 0.36% (0.09%, 0.62%) for all cause, respiratory, and cardiovascular deaths, respectively. Associations in the 65+ age group tended to be larger than those for all ages combined. All other pollutants were positively associated with both mortality and hospital admissions. We found no evidence to suggest that the size and direction of PM10 estimates were modified by either the average level of particles in the city or the year of publication (a proxy for more up-to-date statistical methods and the most recent pollutant concentrations and sources). There were insufficient reports for PM2.5 to enable a quantitative meta-analysis. Our findings were generally consistent with the range of effects found in other parts of the world and suggest that global guidelines and health impacts based largely on evidence derived from the USA and Europe are likely to be reasonably reliable.
KeywordsSystematic review Air pollution Health Time-series Asia Mortality Admissions
The Air Pollution Epidemiology Database (APED) was supported by the Department of Health, UK. The authors are grateful to Graziella Favarato and Mary Field-Smith at St. George's, University of London for their diligent work maintaining the APED database and to C. Arden Pope III at Brigham Young University, Utah for providing Fig. 3.
Conflict of Interest
The authors declare that they have no conflict of interest.
The views expressed in this paper are those of the authors and do not necessarily reflect the views of the Health Effects Institute or its sponsors.
- Balakrishnan K, Ganguli B, Ghosh S, Sankar S, Thanasekaraan V, Rayudu VN, Caussy H (2010) Short-Term Effects of Air Pollution on Mortality: Results from a Time-Series Analysis in Chennai, India. HEI Research Report. Health Effects Institute, Boston, MA (in press)Google Scholar
- Cohen AJ, Anderson HR, Ostro B, Pandey KD, Krzyzanowski M, Künzli N et al (2004) Mortality impacts of urban air pollution. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL (eds) Comparative quantification of health risks: global and regional burden of disease due to selected major risk factors, vol 2. World Health Organization, Geneva, pp 1353–1433Google Scholar
- HEI (2004) Health effects of outdoor air pollution in developing countries of Asia: a literature review. Special Report 15, Health Effects Institute, Boston, MA. http://pubs.healtheffects.org/getfile.php?u=13. Accessed May 2010
- HEI PAPA-SAN (2010) Public health and air pollution in Asia: Science access on the net. http://www.healtheffects.org/Asia/papasan-home.htm. Accessed May 2010
- HEI Public Health and Air Pollution in Asia Program (2010) Public Health and Air Pollution in Asia (PAPA): coordinated studies of short-term exposure to air pollution and daily mortality in four cities. HEI Research Report 154. Health Effects Institute, Boston, MAGoogle Scholar
- Kan HD, London SJ, Chen G, Zhang Y, Song G, Zhao N, Jiang L, Chen B (2008) Season, sex, age, and education as modifiers of 14 the effects of outdoor air pollution on daily mortality in Shanghai China: The Public Health and Air Pollution in Asia (PAPA) study. Environ Health Perspect 116:1183–1188CrossRefGoogle Scholar
- Katsouyanni K, Samet JM, Anderson HR, Atkinson RW, Le Tertre A, Medina S et al (2009) Air pollution and health: a European and North American approach report no 142. Health Effects Institute, BostonGoogle Scholar
- Light RJ, Pillemer DB (1984) Summing up: the science of reviewing research. Harvard University Press, CambridgeGoogle Scholar
- Rajarathnam U, Seghal M, Nairy S, Patnayak RC, Chhabra SK, Kilnani, Santhosh Ragavan KV (2010) Time-Series Study on Air Pollution and Mortality in Delhi. HEI Research Report. Health Effects Institute, Boston, MA (in press)Google Scholar
- World Health Organization (2002) The World Health Report 2002: Reducing risks, promoting healthy life: World Health Organization. http://www.who.int/whr/2002/en Accessed October 2009
- World Health Organization (2003) Health aspects of air pollution with particulate matter, ozone and nitrogen dioxide. Report of a WHO Working Group, EUR/03/5042688, WHO European Centre for Environment and Health, Bonn, Germany.Google Scholar
- World Health Organization (2006) Air quality guidelines. Global update 2005. Copenhagen: World Health Organization, Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0005/78638/E90038.pdf. Accessed May 2010