Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis.

Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis.
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DOI:
10.1136/thoraxjnl-2013-204492
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发表时间:
2014-07
期刊:
影响因子:
10
通讯作者:
Walton HA
Walton HA
中科院分区:
医学1区
文献类型:
--
作者:
Atkinson RW;Kang S;Anderson HR;Mills IC;Walton HA

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短期暴露于室外细颗粒物(空气动力学中值直径<2.5 μm (PM2.5)的颗粒)空气污染与不良健康影响有关。现有文献综述的规模和范围有限。我们对2011年5月医学数据库收录的110项同行评议的时间序列研究进行了全面、系统的回顾和荟萃分析,以评估PM2.5与日死亡率、一系列疾病和年龄的住院率之间关联的证据。我们按地理区域对分析进行分层,以确定世界范围内证据的一致性,并调查了小的研究偏倚。根据23项对全因死亡率的估计,PM2.5每增加10微克/立方米,死亡风险增加1.04% (95% CI 0.52%至1.56%)。在世界范围内,存在较大的区域差异(0.25% ~ 2.08%)。呼吸系统死亡原因的相关性大于心血管原因,分别为1.51%(1.01% ~ 2.01%)和0.84%(0.41% ~ 1.28%)。还观察到与大多数其他死亡原因的死亡率以及心血管和呼吸系统住院率呈正相关。我们在单城市死亡率研究和多城市心血管疾病研究中发现了小偏倚的证据。短期暴露于PM2.5对一系列重要健康结果和疾病的不利健康影响的证据的一致性支持了控制PM2.5浓度的政策措施。然而,世界不同区域效应估计存在异质性的原因需要进一步调查。在评估和量化PM2.5的健康风险时,也应考虑到小的研究偏差。
Short-term exposure to outdoor fine particulate matter (particles with a median aerodynamic diameter <2.5 μm (PM2.5)) air pollution has been associated with adverse health effects. Existing literature reviews have been limited in size and scope. We conducted a comprehensive, systematic review and meta-analysis of 110 peer-reviewed time series studies indexed in medical databases to May 2011 to assess the evidence for associations between PM2.5 and daily mortality and hospital admissions for a range of diseases and ages. We stratified our analyses by geographical region to determine the consistency of the evidence worldwide and investigated small study bias. Based upon 23 estimates for all-cause mortality, a 10 µg/m3 increment in PM2.5 was associated with a 1.04% (95% CI 0.52% to 1.56%) increase in the risk of death. Worldwide, there was substantial regional variation (0.25% to 2.08%). Associations for respiratory causes of death were larger than for cardiovascular causes, 1.51% (1.01% to 2.01%) vs 0.84% (0.41% to 1.28%). Positive associations with mortality for most other causes of death and for cardiovascular and respiratory hospital admissions were also observed. We found evidence for small study bias in single-city mortality studies and in multicity studies of cardiovascular disease. The consistency of the evidence for adverse health effects of short-term exposure to PM2.5 across a range of important health outcomes and diseases supports policy measures to control PM2.5 concentrations. However, reasons for heterogeneity in effect estimates in different regions of the world require further investigation. Small study bias should also be considered in assessing and quantifying health risks from PM2.5.
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