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Quantitative systematic review of the associations between short-term exposure to nitrogen dioxide and mortality and hospital admissions.

Mills, IC; Atkinson, RW; Kang, S; Walton, H; Anderson, HR (2015) Quantitative systematic review of the associations between short-term exposure to nitrogen dioxide and mortality and hospital admissions. BMJ Open, 5 (5). e006946. ISSN 2044-6055 https://doi.org/10.1136/bmjopen-2014-006946
SGUL Authors: Atkinson, Richard William Anderson, Hugh Ross

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Abstract

BACKGROUND: Short-term exposure to NO₂ has been associated with adverse health effects and there is increasing concern that NO₂ is causally related to health effects, not merely a marker of traffic-generated pollution. No comprehensive meta-analysis of the time-series evidence on NO₂ has been published since 2007. OBJECTIVE: To quantitatively assess the evidence from epidemiological time-series studies published worldwide to determine whether and to what extent short-term exposure to NO₂ is associated with increased numbers of daily deaths and hospital admissions. DESIGN: We conducted a quantitative systematic review of 204 time-series studies of NO₂ and daily mortality and hospital admissions for several diagnoses and ages, which were indexed in three bibliographic databases up to May 2011. We calculated random-effects estimates by different geographic regions and globally, and also tested for heterogeneity and small study bias. RESULTS: Sufficient estimates for meta-analysis were available for 43 cause-specific and age-specific combinations of mortality or hospital admissions (25 for 24 h NO₂ and 18 of the same combinations for 1 h measures). For the all-age group, a 10 µg/m(3) increase in 24 h NO₂ was associated with increases in all-cause, cardiovascular and respiratory mortality (0.71% (95% CI 0.43% to 1.00%), 0.88% (0.63% to 1.13%) and 1.09% (0.75% to 1.42%), respectively), and with hospital admissions for respiratory (0.57% (0.33% to 0.82%)) and cardiovascular (0.66% (0.32% to 1.01%)) diseases. Evidence of heterogeneity between geographical region-specific estimates was identified in more than half of the combinations analysed. CONCLUSIONS: Our review provides clear evidence of health effects associated with short-term exposure to NO₂ although further work is required to understand reasons for the regional heterogeneity observed. The growing literature, incorporating large multicentre studies and new evidence from less well-studied regions of the world, supports further quantitative review to assess the independence of NO₂ health effects from other air pollutants.

Item Type: Article
Additional Information: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Correction available at http://dx.doi.org/10.1136/bmjopen-2014-006946corr1
Keywords: EPIDEMIOLOGY, PUBLIC HEALTH, Air Pollutants, Air Pollution, Cardiovascular Diseases, Environmental Monitoring, Evaluation Studies as Topic, Hospitalization, Humans, Lung Diseases, Multicenter Studies as Topic, Nitrogen Dioxide, Particulate Matter, Time Factors, Humans, Lung Diseases, Cardiovascular Diseases, Nitrogen Dioxide, Air Pollutants, Hospitalization, Air Pollution, Environmental Monitoring, Time Factors, Particulate Matter, Evaluation Studies as Topic, Multicenter Studies as Topic
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: BMJ Open
ISSN: 2044-6055
Language: eng
Dates:
DateEvent
11 May 2015Published
13 February 2015Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
Projects:
Project IDFunderFunder ID
PRP 002/037Department of Healthhttp://dx.doi.org/10.13039/501100000276
PubMed ID: 25967992
Web of Science ID: WOS:000354648100023
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111632
Publisher's version: https://doi.org/10.1136/bmjopen-2014-006946

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