Systematic Review and Meta-Analysis of the Association between Ambient Nitrogen Dioxide and Respiratory Disease in China
Abstract
:1. Introduction
2. Materials and Methods
2.1. Databases
2.2. Literature Selection and Data Extraction
2.3. Quality Assessment
2.3.1. RD Diagnosis
2.3.2. Air Pollutant Measurement
2.3.3. Adjustment of Confounders
2.4. Meta-Analysis
2.5. Sensitivity Analysis
3. Results
3.1. Mortality
3.1.1. Meta-Regression
3.1.2. Subgroup Analysis
3.1.3. Publication Bias and Sensitivity Analysis
3.2. Hospital Admission
3.2.1. Heterogeneity and Sensitivity Analysis
3.2.2. Publication Bias
4. Discussion
5. Strengths
6. Limitations
7. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Number | Author | Study Period | Publication Year | Study Design | No. of Events | City | Annual Mean Concentration of NO2 (μg/m3) | RR or OR and 95% CI 5 | Adjusted Confounding Factors | ||
---|---|---|---|---|---|---|---|---|---|---|---|
RR or OR | LCI | UCI | |||||||||
Mortality | |||||||||||
[40] | Chen et al. | 2004–2006 | 2010 | Case-crossover | 20,805 | Anshan | 25.5 | 0.9982 | 0.9461 | 1.0502 | Long-term and seasonal trends, temperature, relative humidity, DOW 6. |
[41] | Zhang et al. | 2003–2008 | 2011 | Time-series | 4825 | Beijing | 64.8 | 1.00947 | 1.00759 | 1.01135 | Long-term and seasonal trends, temperature, relative humidity, DOW, air pressure. |
[42] | Zhang et al. | 2004–2008 | 2011 | Time-series | 4165 | Beijing | 63.9 | 1.0161 | 1.003 | 1.0292 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[26] | Yang | 2009–2010 | 2015 | Time-series | 15,038 | Beijing | 55.02 | 1.0089 | 1.0005 | 1.0172 | Long-term and seasonal trends, temperature, relative humidity, DOW, air pressure. |
[27] | Zeng et al. # | 2007–2009 | 2015 | Time-series | 13,505 | Beijing | 56.6 | 1.0017 | 0.9939 | 1.0096 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[43] | Zhao | 2004–2005 | 2007 | Time-series | 7241 | Beijing | 68.94 | 1.0041 | 1.0007 | 1.0074 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[44] | Liu et al. | 2006–2009 | 2014 | Time-series | 17,532 | Beijing | 59.5 | 1.0061 | 0.9975 | 1.0148 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[8] | Tao et al. | 2006–2008 | 2012 | Time-series | 5809 | Foshan | 70.4 | 1.016 | 1.006 | 1.0261 | Long-term and seasonal trends, temperature, relative humidity, DOW, year, public holidays, influenza epidemics. |
[45] | Huang et al. | 2004–2008 | 2012 | Time-series | 27,740 | Guangzhou | 66.6 | 1.0164 | 1.011 | 1.0219 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[27] | Zeng et al. | 2007–2009 | 2015 | Time-series | 6570 | Guangzhou | 60.1 | 1.0266 | 1.0142 | 1.039 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[8] | Tao et al. # | 2006–2008 | 2012 | Time-series | 16,659 | Guangzhou | 53.9 | 1.0299 | 1.0213 | 1.0386 | Long-term and seasonal trends, temperature, relative humidity, DOW, year, public holidays, influenza epidemics. |
[46] | Yu et al. | 2006–2009 | 2011 | Time-series | 8327 | Guangzhou | 47.69 | 1.0147 | 1.0066 | 1.0229 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[9] | Wong et al. | 1995–1998 | 2009 | Time-series | 24,820 | Hong Kong | 56.4 | 1.013 | 1.004 | 1.022 | Long-term and seasonal trends, temperature, relative humidity, DOW, influenza epidemics. |
[28] | Qiu et al. | 2001–2011 | 2015 | Time-series | 78,508 | Hong Kong | - | 1.013 | 1.009 | 1.018 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[47] | Wong et al. | 1995–1997 | 2001 | Time-series | 18,732 | Hong Kong | 48.1 | 1.0171 | 1.0044 | 1.0273 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays, influenza epidemics. |
[48] | Wong et al. # | 1996–2002 | 2008 | Time-series | 41,391 | Hong Kong | 58.7 | 1.0115 | 1.0042 | 1.0188 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays, influenza epidemics. |
[49] | Tsai et al. | 1994–2000 | 2003 | Case-crossover | 2811 | Kaohsiung | 53.79 | 0.9973 | 0.9365 | 1.0623 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[29] | He et al. | 2009–2013 | 2016 | Time-series | 28,835 | Ningbo | 41.7 | 1.0177 | 1.0044 | 1.0311 | Long-term and seasonal trends, temperature, relative humidity, DOW, air pressure and wind speed. |
[48] | Wong et al. | 2001–2004 | 2008 | Time-series | 20,893 | Shanghai | 66.6 | 1.0122 | 1.0042 | 1.0201 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays, influenza epidemics. |
[50] | Jia et al. | 2000–2002 | 2004 | Case-crossover | 1752 | Shanghai | 69.1 | 1.033 | 1.006 | 1.06 | Long-term and seasonal trends, temperature, relative humidity, DOW, air pressure. |
Mortality | |||||||||||
[27] | Zeng et al. | 2007–2009 | 2015 | Time-series | 13,578 | Shanghai | 54.8 | 1.0036 | 0.9954 | 1.012 | Long-term and seasonal trends, temperature, relative humidity, DOW 6, public holidays. |
[10] | Yang et al. | 1994–1998 | 2004 | Case-crossover | 3689 | Taipei | 57.45 | 1.0065 | 0.9628 | 1.0517 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[27] | Zeng et al. | 2007–2009 | 2015 | Time-series | 6278 | Tianjin | 41.4 | 1.0074 | 0.9853 | 1.0301 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[51] | Zhang et al. | 2005–2007 | 2010 | Time-series | 4380 | Tianjin | 47 | 1.0144 | 0.9896 | 1.0398 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[52] | He | 2005–2013 | 2014 | Time-series | 19,710 | Wuhan | 49.53 | 1.0206 | 1.0108 | 1.0302 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[27] | Zeng et al. | 2007–2009 | 2015 | Time-series | 1314 | Wuhan | 45.2 | 1.018 | 0.984 | 1.0476 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[48] | Wong et al. | 2001–2004 | 2008 | Time-series | 10,227 | Wuhan | 51.8 | 1.0368 | 1.0177 | 1.0563 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays, influenza epidemics. |
[53] | Qian et al. | 2000–2004 | 2007 | Time-series | 10,287 | Wuhan | 51.8 | 1.0223 | 1.0052 | 1.0396 | Long-term and seasonal trends, temperature, relative humidity, DOW, year. |
[27] | Zeng et al. | 2007–2009 | 2015 | Time-series | 1898 | Xi’an | 54 | 1.0161 | 0.9746 | 1.0594 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[8] | Tao et al. | 2006–2008 | 2012 | Time-series | 4056 | Zhongshan | 48.4 | 1.0344 | 1.0167 | 1.0525 | Long-term and seasonal trends, temperature, relative humidity, DOW, year, public holidays, influenza epidemics. |
[8] | Tao et al. | 2006–2008 | 2012 | Time-series | 1205 | Zhuhai | 38.1 | 1.0246 | 0.9841 | 1.0667 | Long-term and seasonal trends, temperature, relative humidity, DOW, year, public holidays, influenza epidemics. |
Hospital admission | |||||||||||
[12] | Zhang et al. | 2008–2011 | 2014 | Time-series | 46,752 | Guangzhou | 56 | 1.0147 | 1.0062 | 1.0233 | Long-term and seasonal trends, temperature, relative humidity, DOW, air pressure. |
[14] | Liu | 2010–2012 | 2014 | Time-series | 24,792 | Hangzhou | 83 | 1.007 | 1.0025 | 1.0144 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[11] | Wong et al | 1994–1995 | 1999 | Time-series | 61,320 | Hong Kong | 51.39 | 1.02 | 1.013 | 1.028 | Long-term and seasonal trends, temperature, relative humidity, DOW, year, public holidays. |
[54] | Lan | 2006–2008 | 2012 | Time-series | 5808 | Jinchang | 23 | 1.0336 | 1.0009 | 1.068 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[13] | Tao | 2001–2005 | 2009 | Time-series | 28,057 | Lanzhou | 46 | 1.011 | 1.002 | 1.019 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[55] | Chen et al. | 2005–2007 | 2010 | Time-series | 144,540 | Shanghai | 57 | 1.0001 | 0.993 | 1.0073 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays. |
[56] | Bao et al. | 2005–2009 | 2013 | Time-series | 24,935 | Urumqi | 48.8 | 1.0056 | 1.0024 | 1.0121 | Long-term and seasonal trends, temperature, relative humidity, DOW. |
[25] | Wang et al. | 2013–2015 | 2016 | Time-series | 3314 | Wuhan | 63.13 | 1.005 | 0.984 | 1.026 | Long-term and seasonal trends, temperature, relative humidity, DOW, public holidays, air pressure. |
Category | Regression Coefficient | SE | T | P | 95% CI | |
---|---|---|---|---|---|---|
LCI | LCI | |||||
Region | 1.009707 | 0.0026565 | 3.67 | 0.001 | 1.004289 | 1.015155 |
Concentration | 0.999765 | 0.0001986 | −1.18 | 0.247 | 0.9993583 | 1.000172 |
Study design | 1.00385 | 0.010779 | 0.36 | 0.723 | 0.9820451 | 1.02614 |
Stratification | Study Characteristics (Number of Studies) | Combined Estimate | 95% CI | I2 | |
---|---|---|---|---|---|
LCI | UCL | ||||
Research region | Northern cities (3) | 1.01 | 1.00 | 1.02 | 44.80% |
Southern cities (5) | 1.01 | 1.00 | 1.02 | 75.70% | |
Annual mean concentration of NO2 | 23 μg/m3–53 μg/m3 (4) | 1.01 | 1.00 | 1.02 | 75.00% |
53 μg/m3–83 μg/m3 (4) | 1.01 | 1.00 | 1.01 | 55.00% |
Study Omitted | Combined Estimates | 95% CI | I2 | |
---|---|---|---|---|
LCI | UCI | |||
Lan | 1.009 | 1.004 | 1.015 | 65.7% |
Tao | 1.010 | 1.003 | 1.016 | 70.5% |
Bao et al. | 1.011 | 1.004 | 1.017 | 66.2% |
Wong et al. | 1.008 | 1.003 | 1.012 | 42.2% |
Zhang et al. | 1.009 | 1.003 | 1.015 | 67.6% |
Chen et al. | 1.011 | 1.006 | 1.016 | 58.4% |
Wang et al. | 1.010 | 1.004 | 1.016 | 70.8% |
Lui | 1.010 | 1.004 | 1.017 | 70.5% |
Combined estimates | 1.010 | 1.005 | 1.015 | 66.2% |
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Sun, J.; Barnes, A.J.; He, D.; Wang, M.; Wang, J. Systematic Review and Meta-Analysis of the Association between Ambient Nitrogen Dioxide and Respiratory Disease in China. Int. J. Environ. Res. Public Health 2017, 14, 646. https://doi.org/10.3390/ijerph14060646
Sun J, Barnes AJ, He D, Wang M, Wang J. Systematic Review and Meta-Analysis of the Association between Ambient Nitrogen Dioxide and Respiratory Disease in China. International Journal of Environmental Research and Public Health. 2017; 14(6):646. https://doi.org/10.3390/ijerph14060646
Chicago/Turabian StyleSun, Jiyao, Andrew J. Barnes, Dongyang He, Meng Wang, and Jian Wang. 2017. "Systematic Review and Meta-Analysis of the Association between Ambient Nitrogen Dioxide and Respiratory Disease in China" International Journal of Environmental Research and Public Health 14, no. 6: 646. https://doi.org/10.3390/ijerph14060646