Short-term Exposure to Nitrogen Dioxide and Mortality: a systematic review and meta-analysis Öffentlichkeit

Abstract

Background: Ambient air pollution has been characterized as a leading cause of mortality worldwide and has been associated with cardiovascular and respiratory diseases. There is increasing evidence that short-term exposure to nitrogen dioxide (NO2), is related to adverse health effects and mortality. 

Methods: We conducted a systematic review of short-term NO2 and daily mortality, which were indexed in PubMed and Embase up to February 2020. We calculated random-effects estimates by different continents and globally, and tested for heterogeneity and publication bias. 

Results: We included 79 articles in our quantitative analysis. NO2 and all-cause as well as cause-specific mortality were positively associated in the main analysis. For all-cause mortality, a 10 ppb increase in NO2 was associated with a 1.49% (95%CI 1.24% to 1.75%, I2 = 90.8%, Eggers’ test p < 0.01, N= 51) increase in the risk of death. For cause-specific mortality, a 10 ppb increase in NO2 was associated with a 1.79% (95%CI 1.45% to 2.12%, I2 = 88.3%, Eggers’ test p < 0.01, N= 38) increase in cardiovascular mortality and a 2.15% (95%CI 1.56% to 2.74%, I2 = 80.1%, Eggers’ test p = 0.013, N= 34) increase in respiratory mortality. In the sensitivity analysis, the meta-estimates for all-cause mortality, cardiovascular and respiratory mortality were nearly identical. The heterogeneity would decline to varying degrees through regional and study-type stratification.

Conclusions: This study provides evidence of an association between short-term exposure to NO2 and all-cause, cardiovascular and respiratory mortality. The results are robust based on sensitivity analysis and we provide a possible explanation for the high heterogeneity observed between the regions.

Table of Contents

1. Introduction ----------------------------------------------------------------------------------------- 1

2. Methods --------------------------------------------------------------------------------------------- 2

 2.1 Studies search and selection ----------------------------------------------------------------------- 2

 2.2 Data extraction ------------------------------------------------------------------------------------ 3

  2.3 Risk of bias ---------------------------------------------------------------------------------------- 3

  2.4 Statistical analysis -------------------------------------------------------------------------------- 4

3. Results ----------------------------------------------------------------------------------------------- 6

  3.1 Characteristic of the eligible studies -------------------------------------------------------------- 6

  3.2 Risk of bias assessment ---------------------------------------------------------------------------- 6

  3.3 Results of the meta-analysis ----------------------------------------------------------------------- 7

    3.3.1 All-cause mortality ----------------------------------------------------------------------------- 8

    3.3.2 Cardiovascular mortality ----------------------------------------------------------------------- 8

    3.3.3 Respiratory mortality --------------------------------------------------------------------------- 9

    3.3.4 Publication bias -------------------------------------------------------------------------------- 10

    3.3.5 Sensitivity analysis ----------------------------------------------------------------------------- 10

4. Discussion ------------------------------------------------------------------------------------------- 11

5. Reference -------------------------------------------------------------------------------------------- 14

6. Figures ----------------------------------------------------------------------------------------------- 18

7. Tables ------------------------------------------------------------------------------------------------ 27

8. Acknowledgement ----------------------------------------------------------------------------------- 32

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Statistics Health Sciences, Epidemiology Environmental Health
Stichwort	Mortality Meta-analysis Air pollution Nitrogen dioxide
Committee Chair / Thesis Advisor	Liuhua, Shi, Emory University

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