Air Quality, Atmosphere & Health

, Volume 5, Issue 4, pp 383–391 | Cite as

Systematic review and meta-analysis of epidemiological time-series studies on outdoor air pollution and health in Asia

  • R. W. AtkinsonEmail author
  • A. Cohen
  • S. Mehta
  • H. R. Anderson


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.


Systematic 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.

Supplementary material

11869_2010_123_MOESM1_ESM.pdf (529 kb)
ESM 1 (PDF 529 kb)


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • R. W. Atkinson
    • 1
    Email author
  • A. Cohen
    • 2
  • S. Mehta
    • 2
  • H. R. Anderson
    • 1
  1. 1.Division of Population Health Sciences & Education and MRC-HPA Centre for Environment and HealthSt. George’s, University of LondonLondonUK
  2. 2.Health Effects InstituteBostonUSA

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