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The effect of ambient fine particulate matter (PM2.5) on respiratory diseases in China: a systematic review and meta-analysis

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Abstract

Only a few recent systematic reviews and meta-analysis studies have quantitatively assessed the effect of short-term exposure to ambient fine particular matter with an aerodynamic diameter of less than 2.5 μm (PM2.5) on respiratory disease (RD) mortality and RD hospital outpatient visits in the Chinese population. A total of 46 articles were selected from Web of Science, PubMed, China National Knowledge Infrastructure and Wanfang databases. Generic inverse variance method was employed to pool individual effect estimates. Pooled estimates represented the increased risk of daily RD mortality and RD outpatient visits per 10 µg/m3 increase in PM2.5 concentrations. Positive associations were identified between short-term PM2.5 exposure and RD in China. The risk of RD mortality and RD outpatient visits increased by 0.48% (95% CI 0.40%, 0.55%) and 0.90% (95% CI 0.62%, 1.18%), respectively, per 10 µg/m3 increase in PM2.5 concentrations. A low increased risk of RD outpatient visits (0.62%, 95% CI 0.57%, 0.66%) was identified at a high level of annual mean PM2.5 concentrations (41.36–110.80 µg/m3) with 1.82% (95% CI 1.72%, 1.92%) at a low level of annual mean PM2.5 concentrations (29.86–40.20 µg/m3) through subgroup analysis. Short-term exposure to PM2.5 was associated with increased risks of RD mortality and RD outpatient visits. The increased risk of RD outpatient visits was pronounced at a low level of annual mean PM2.5 concentrations, but the exact mechanisms of this phenomenon require further investigation. Evidence demonstrated in this study could appeal to Chinese policymakers to improve air quality and alleviate the adverse health impact of PM2.5 pollutions.

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Availability of data and materials

All data analyzed during this study are included in this published article.

Abbreviations

WHO:

World Health Organization

AQG:

Air quality guideline

RD:

Respiratory disease

PM2.5 :

Fine particular matter with aerodynamic diameter less than 2.5 μm

TSP:

Total suspended particulate

PM10 :

Inhalable particulate matter with diameter less than 10 μm

PM2.5–10 :

Coarse particulate matter with aerodynamic diameter between 2.5 and 10 μm

SO2 :

Sulfur dioxide

NOx :

Nitrogen oxides

RR:

Relative risk

OR:

Odds ratio

ER:

Excess risk

CI:

Confidence interval

LCI:

Lower confidence interval

UCI:

Upper confidence interval

DOW:

Day of week

ICD:

International classification of diseases

CNKI:

China national knowledge infrastructure

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Acknowledgements

The authors would like to express gratitude to Junyan Ye for helping to make the map. We also thank Yingjie Fu, Huicui Shan and Linlin Yin for providing necessary materials and helpful comments on the article.

Funding

This research was funded by the Social Science Planning and Research Project of Shandong Province (19CZKJ02) and the Health Industry Research Project on Medical and Health Care of Shandong University (19SDUY01). Nan Zhang was partly supported by Cathie Marsh Institute for Social Research seedcorn funding about the impact of air pollution on wellbeing of older people in the Global South, and Global Challenge Research Fund (GCRF) Pump-Priming Grant.

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Authors and Affiliations

  1. Social Statistics, Manchester Institute for Collaborative Research on Ageing (MICRA), HBS Building, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Jiyao Sun & Nan Zhang

  2. Cathie Marsh Institute for Social Research (CMI), HBS Building, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Jiyao Sun & Nan Zhang

  3. School of Health Care Management, Shandong University, 44 Wenhuaxi Road, Li Xia District, Jinan, 250012, Shandong Province, China

    Jiyao Sun & Jian Wang

  4. NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012, China

    Jiyao Sun & Jian Wang

  5. Qingdao Municipal Hospital of Traditional Chinese Medicine, 4 Renmin Road, Shibei District, Qingdao, 266033, Shandong, China

    Xiaona Yan

  6. Peking University Third Hospital Yanqing Hospital, 28 Dongshuncheng Street, Yanqing District, Beijing, 102100, China

    Meng Wang

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  3. Xiaona Yan
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  4. Meng Wang
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  5. Jian Wang
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Contributions

JS and JW conceived and designed the research. JS, XY and MW retrieved and screened literatures and extracted data. JS conducted quantitative meta-analysis and finished the first version of the manuscript. NZ and JW provided project supervision and guidance to the writing of the article. They also reviewed, edited and modified the manuscript critically for some important content.

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Correspondence to Jian Wang.

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The authors declared no conflict of interest.

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Data were collected from published literatures rather than human subjects. No personal private information was included.

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Sun, J., Zhang, N., Yan, X. et al. The effect of ambient fine particulate matter (PM2.5) on respiratory diseases in China: a systematic review and meta-analysis. Stoch Environ Res Risk Assess 34, 593–610 (2020). https://doi.org/10.1007/s00477-020-01786-0

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