Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study.
Adverse health effects associated with household air pollution: a systematic review, meta-analysis, and burden estimation study.
复制标题
DOI：
10.1016/s2214-109x(20)30343-0
复制
发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Shah ASV
中科院分区：
文献类型：
--
作者：
Lee KK;Bing R;Kiang J;Bashir S;Spath N;Stelzle D;Mortimer K;Bularga A;Doudesis D;Joshi SS;Strachan F;Gumy S;Adair-Rohani H;Attia EF;Chung MH;Miller MR;Newby DE;Mills NL;McAllister DA;Shah ASV
全世界有30亿人依赖污染燃料和技术来做饭和取暖。我们估计了与家庭空气污染暴露相关的全球、区域和国家健康负担。为了进行系统的综述和荟萃分析，我们系统地搜索了从数据库建立到2020年4月2日发表的四个数据库中的研究，这些研究评估了暴露在家庭空气污染中与不暴露相比的心肺、儿科和孕产妇不良结局的风险。我们使用随机效应模型来计算特定疾病的相对风险(RR)元估计。家庭空气污染暴露的定义是使用污染燃料(煤、木材、木炭、农业废弃物、动物粪便或煤油)来做饭或取暖。使用193个联合国成员国中183个国家的暴露流行数据，估计了2000年至2017年与家庭空气污染相关的死亡率和疾病负担的时间趋势，以残疾调整寿命年(DALY)衡量。95%的CI是通过使用基于模拟的方法传播来自RR元估计、家庭空气污染暴露的流行率以及特定疾病的死亡率和负担估计的不确定性来估计的。这项研究已在PROSPERO注册，CRD42019125060。来自123个国家的476项研究(1550万参与者)(其中99[80%]被归类为低收入和中等收入)符合纳入标准。家庭空气污染与哮喘(RR 1.23，95%CI 1.11~1.36)、成人(1.53，1.22~1.93)和儿童(1.39，1.29~1.49)、慢性阻塞性肺疾病(1.70，1.47~1.97)、肺癌(1.69，1.44~1.98)、肺结核(1.26，1.08~1.48)呈正相关；低出生体重(1·36，1·19-1·55)和死产(1·22，1·06-1·41)；5岁以下(1·25，1·18-1·33)，呼吸系统(1·19-1·20)和心血管(1·07，1·04-1·11)死亡率。2017年，家庭空气污染与180万(95%可信区间1·1-2.7)死亡和6090万(34.06-93.3DALY)死亡有关，与高收入国家(0.09万[0.01-0.40]DALY)相比，低收入和中等收入国家(6000万[34·6-92.9]DALY)的负担占压倒性优势。自2000年以来，与家庭空气污染有关的死亡率下降了36%(95%可信区间29-43)，疾病负担下降了30%(25-36)，其中高收入国家的下降幅度最大。与家庭空气污染有关的心肺疾病、儿科疾病和孕产妇疾病的负担在世界范围内有所下降，但在世界上最贫穷的地区仍然很高。迫切需要综合健康和能源战略，以减少家庭空气污染对健康的不利影响，特别是在低收入中等收入国家。英国心脏基金会，惠康信托。
3 billion people worldwide rely on polluting fuels and technologies for domestic cooking and heating. We estimate the global, regional, and national health burden associated with exposure to household air pollution. For the systematic review and meta-analysis, we systematically searched four databases for studies published from database inception to April 2, 2020, that evaluated the risk of adverse cardiorespiratory, paediatric, and maternal outcomes from exposure to household air pollution, compared with no exposure. We used a random-effects model to calculate disease-specific relative risk (RR) meta-estimates. Household air pollution exposure was defined as use of polluting fuels (coal, wood, charcoal, agricultural wastes, animal dung, or kerosene) for household cooking or heating. Temporal trends in mortality and disease burden associated with household air pollution, as measured by disability-adjusted life-years (DALYs), were estimated from 2000 to 2017 using exposure prevalence data from 183 of 193 UN member states. 95% CIs were estimated by propagating uncertainty from the RR meta-estimates, prevalence of household air pollution exposure, and disease-specific mortality and burden estimates using a simulation-based approach. This study is registered with PROSPERO, CRD42019125060. 476 studies (15·5 million participants) from 123 nations (99 [80%] of which were classified as low-income and middle-income) met the inclusion criteria. Household air pollution was positively associated with asthma (RR 1·23, 95% CI 1·11–1·36), acute respiratory infection in both adults (1·53, 1·22–1·93) and children (1·39, 1·29–1·49), chronic obstructive pulmonary disease (1·70, 1·47–1·97), lung cancer (1·69, 1·44–1·98), and tuberculosis (1·26, 1·08–1·48); cerebrovascular disease (1·09, 1·04–1·14) and ischaemic heart disease (1·10, 1·09–1·11); and low birthweight (1·36, 1·19–1·55) and stillbirth (1·22, 1·06–1·41); as well as with under-5 (1·25, 1·18–1·33), respiratory (1·19, 1·18–1·20), and cardiovascular (1·07, 1·04–1·11) mortality. Household air pollution was associated with 1·8 million (95% CI 1·1–2·7) deaths and 60·9 million (34·6–93·3) DALYs in 2017, with the burden overwhelmingly experienced in low-income and middle-income countries (LMICs; 60·8 million [34·6–92·9] DALYs) compared with high-income countries (0·09 million [0·01–0·40] DALYs). From 2000, mortality associated with household air pollution had reduced by 36% (95% CI 29–43) and disease burden by 30% (25–36), with the greatest reductions observed in higher-income nations. The burden of cardiorespiratory, paediatric, and maternal diseases associated with household air pollution has declined worldwide but remains high in the world's poorest regions. Urgent integrated health and energy strategies are needed to reduce the adverse health impact of household air pollution, especially in LMICs. British Heart Foundation, Wellcome Trust.