Long-term Concentrations of Nitrogen Dioxide and Mortality: A Meta-analysis of Cohort Studies.
Long-term Concentrations of Nitrogen Dioxide and Mortality: A Meta-analysis of Cohort Studies.
复制标题
DOI：
10.1097/ede.0000000000000847
复制
发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Maynard RL
中科院分区：
文献类型：
--
作者：
Atkinson RW;Butland BK;Anderson HR;Maynard RL
补充数字内容可在文本中找到。室外二氧化氮（NO2）浓度与死亡率增加有关。来自队列研究的风险比（HR）用于评估人群健康影响和负担。我们进行了荟萃分析，以获得适合这种评价的浓度-反应函数，并根据队列特征评估其对研究选择的敏感性。我们检索了在线数据库和现有综述，以查找截至2016年10月发表的队列研究，这些研究报告了NO2和死亡率的HR。我们使用固定/随机效应模型计算荟萃分析汇总估计值。我们确定了48篇文章，分析了28个队列。HR的荟萃分析发现NO2与所有原因之间存在正相关性（1.02 [95%置信区间（CI）：1.01，1.03];预测区间[PI]：[0.99，1.06]每10 µg/m3 NO2增量），心血管（1.03 [95% CI：1.02，1.05]; PI：[0.98，1.08]），呼吸道（1.03 [95% CI：1.01，1.05]; PI：[0.97，1.10]）和肺癌死亡率（1.05 [95% CI：1.02，1.08]; PI：[0.94，1.17]），有证据表明研究之间存在实质性异质性。在亚组分析中，总体HR随入组时的年龄、污染估计的空间分辨率以及在个体水平上对吸烟和体重指数的调整而变化;对于某些亚组，HR接近于1，置信下限低于1。考虑到在评估这一证据基础中固有的许多不确定性，以及健康影响计算对HR大小的微小变化的敏感性，计算减少长期暴露于NO2的政策对健康的影响应使用预测区间和报告影响范围，而不是集中在点估计上。
Supplemental Digital Content is available in the text. Concentrations of outdoor nitrogen dioxide (NO2) have been associated with increased mortality. Hazard ratios (HRs) from cohort studies are used to assess population health impact and burden. We undertook meta-analyses to derive concentration–response functions suitable for such evaluations and assessed their sensitivity to study selection based upon cohort characteristics. We searched online databases and existing reviews for cohort studies published to October 2016 that reported HRs for NO2 and mortality. We calculated meta-analytic summary estimates using fixed/random-effects models. We identified 48 articles analyzing 28 cohorts. Meta-analysis of HRs found positive associations between NO2 and all cause (1.02 [95% confidence interval (CI): 1.01, 1.03]; prediction interval [PI]: [0.99, 1.06] per 10 µg/m3 increment in NO2), cardiovascular (1.03 [95% CI: 1.02, 1.05]; PI: [0.98, 1.08]), respiratory (1.03 [95% CI: 1.01, 1.05]; PI: [0.97, 1.10]), and lung cancer mortality (1.05 [95% CI: 1.02, 1.08]; PI: [0.94, 1.17]) with evidence of substantial heterogeneity between studies. In subgroup analysis, summary HRs varied by age at cohort entry, spatial resolution of pollution estimates, and adjustment for smoking and body mass index at the individual level; for some subgroups, the HR was close to unity, with lower confidence limits below 1. Given the many uncertainties inherent in the assessment of this evidence base and the sensitivity of health impact calculations to small changes in the magnitude of the HRs, calculation of the impact on health of policies to reduce long-term exposure to NO2 should use prediction intervals and report ranges of impact rather than focusing upon point estimates.