Air Quality, Atmosphere & Health

, Volume 6, Issue 1, pp 57–68 | Cite as

Long-term exposure to outdoor air pollution and the prevalence of asthma: meta-analysis of multi-community prevalence studies

  • H. Ross Anderson
  • Graziella Favarato
  • Richard W. Atkinson


The effect of outdoor air pollution on variations in asthma prevalence is unclear. We have conducted a meta-analysis of multi-community studies to evaluate and quantify the evidence for an association between community levels of pollution and asthma prevalence. We identified peer-reviewed articles reporting associations between community levels of air pollution and the prevalence of wheeze symptom or asthma diagnosis which were based on five or more communities. Associations were investigated by meta-analysis and by analysis of the direction and statistical significance of estimates. We identified 21 studies of more than five communities (range 6 to 62). The proportion of studies reporting at least one significantly positive association was 43% but, of the total of 178 pollution-outcome estimates, only 11% were statistically significantly positive. Thirteen studies reported associations with pollution analysed as a quantitative variable, and these results were meta-analysed. For period prevalence (mainly wheeze symptom), the results were null: Random effects estimates (95% confidence intervals) for the odds ratios of nitrogen dioxide, particulate matter with aerodynamic diameter <10 μm, ozone and sulphur dioxide were 1.00 (0.95, 1.06), 1.00 (0.94, 1.07), 1.01 (0.96, 1.07) and 1.03 (0.97, 1.09), respectively. For lifetime prevalence (mainly asthma diagnosis), the random effects estimates were similar: 1.00 (0.99, 1.01), 0.99 (0.96, 1.02), 1.06 (0.98, 1.14) and 1.00 (0.96, 1.05), respectively. We found no evidence of an association between community levels of outdoor air pollution and asthma prevalence.


Air pollution Asthma prevalence Epidemiology Meta-analysis Review 



We gratefully acknowledge the support of Mary Field-Smith in the preparation of the paper for publication and the encouragement of the Health Protection Agency Air Quality Unit (Head: Professor Robert Maynard) in developing this study.

The study was funded by the Policy Research Unit of the UK Department of Health. The views expressed in this paper are those of the authors alone and do not necessarily reflect those of the Department of Health.

Competing interests

The authors declare that they have no competing interests.

Supplementary material

11869_2011_145_MOESM1_ESM.pdf (36 kb)
Online Resource 1Key words, flow chart for literature and protocols for selection of articles (PDF 35 kb)
11869_2011_145_MOESM2_ESM.pdf (59 kb)
Online Resource 2Conversions and scaling (PDF 58 kb)
11869_2011_145_MOESM3_ESM.pdf (56 kb)
Online Resource 3Algorithms and rules for selecting estimates for meta-analyses (PDF 55 kb)
11869_2011_145_MOESM4_ESM.pdf (37 kb)
Online Resource 4Summary of multi-community studies reporting quantitative associations between outdoor air pollution and asthma (PDF 36 kb)
11869_2011_145_MOESM5_ESM.pdf (69 kb)
Online Resource 5Summary of multi-community prevalence studies reporting qualitative associations between outdoor air pollution and asthma (PDF 69 kb)
11869_2011_145_MOESM6_ESM.pdf (144 kb)
Online Resource 6Details of estimates for quantitative studies (PDF 143 kb)
11869_2011_145_MOESM7_ESM.pdf (87 kb)
Online Resource 7Details of estimates for qualitative studies (PDF 86 kb)
11869_2011_145_MOESM8_ESM.pdf (63 kb)
Online Resource 8Analysis of estimates by direction and statistical significance (PDF 62 kb)
11869_2011_145_MOESM9_ESM.pdf (82 kb)
Online Resource 9Meta-analysis plots of associations between community levels of NO2, PM10, O3, SO2 and lifetime prevalence of asthma (PDF 81 kb)


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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • H. Ross Anderson
    • 1
  • Graziella Favarato
    • 1
  • Richard W. Atkinson
    • 1
  1. 1.MRC-HPA Centre for Environment and Health, Division of Population Health Sciences and EducationSt George’s, University of LondonLondonUK

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