Ambient air pollution epidemiology systematic review and meta-analysis: A review of reporting and methods practice

Systems for rating bodies of evidence used in systematic reviews of air pollution exposure and reproductive and children's health: a methodological survey

BACKGROUND

Translating findings from systematic reviews assessing associations between environmental exposures and reproductive and children's health into policy recommendations requires valid and transparent evidence grading.

METHODS

We aimed to evaluate systems for grading bodies of evidence used in systematic reviews of environmental exposures and reproductive/ children's health outcomes, by conducting a methodological survey of air pollution research, comprising a comprehensive search for and assessment of all relevant systematic reviews. To evaluate the frameworks used for rating the internal validity of primary studies and for grading bodies of evidence (multiple studies), we considered whether and how specific criteria or domains were operationalized to address reproductive/children's environmental health, e.g., whether the timing of exposure assessment was evaluated with regard to vulnerable developmental stages.

RESULTS

Eighteen out of 177 (9.8%) systematic reviews used formal systems for rating the body of evidence; 15 distinct internal validity assessment tools for primary studies, and nine different grading systems for bodies of evidence were used, with multiple modifications applied to the cited approaches. The Newcastle Ottawa Scale (NOS) and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, neither developed specifically for this field, were the most commonly used approaches for rating individual studies and bodies of evidence, respectively. Overall, the identified approaches were highly heterogeneous in both their comprehensiveness and their applicability to reproductive/children's environmental health research.

CONCLUSION

Establishing the wider use of more appropriate evidence grading methods is instrumental both for strengthening systematic review methodologies, and for the effective development and implementation of environmental public health policies, particularly for protecting pregnant persons and children.

Methodological and reporting quality of systematic reviews on health effects of air pollutants were higher than extreme temperatures: a comparative study

BACKGROUND

An increasing number of systematic reviews (SRs) in the environmental field have been published in recent years as a result of the global concern about the health impacts of air pollution and temperature. However, no study has assessed and compared the methodological and reporting quality of SRs on the health effects of air pollutants and extreme temperatures. This study aims to assess and compare the methodological and reporting quality of SRs on the health effects of ambient air pollutants and extreme temperatures.

METHODS

PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Web of Science, and Epistemonikos databases were searched. Two researchers screened the literature and extracted information independently. The methodological quality of the SRs was assessed through A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The reporting quality was assessed through Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA).

RESULTS

We identified 405 SRs (286 for air pollution, 108 for temperature, and 11 for the synergistic effects). The methodological and reporting quality of the included SRs were suboptimal, with major deficiencies in protocol registration. The methodological quality of SRs of air pollutants was better than that of temperature, especially in terms of satisfactory explanations for any heterogeneity (69.6% v. 45.4%). The reporting quality of SRs of air pollution was better than temperature, however, adherence to the reporting of the assessment results of risk of bias in all SRs (53.5% v. 34.3%) was inadequate.

CONCLUSIONS

Methodological and reporting quality of SRs on the health effect of air pollutants were higher than those of temperatures. However, deficiencies in protocol registration and the assessment of risk of bias remain an issue for both pollutants and temperatures. In addition, developing a risk-of-bias assessment tool applicable to the temperature field may improve the quality of SRs.

Influence of Urbanization on the Spatial Distribution of Associations Between Air Pollution and Mortality in Beijing, China

This study investigated the influence of urbanization on the intra-city spatial distribution of associations between air pollution and mortality in Beijing, China. First, we utilized the generalized additive model to establish the exposure-response associations of PM_2.5, O₃, with nonaccidental and cardiorespiratory mortality between urban and suburban areas. Second, we assessed district-specific air pollution-related mortality and analyzed how these associations were affected by the degree of urbanization. Finally, we analyzed the changes in air pollution-related mortality before and after the enforcement of the Air Pollution Prevention and Control Action Plan (referred to as the Action Plan). The effect estimates of PM_2.5 for nonaccidental mortality were 0.20% (95% CI: 0.12-0.28) in urban areas and 0.46% (95% CI: 0.35-0.58) in suburban areas per 10 μg/m³ increase in PM_2.5 concentrations. The corresponding estimates of O₃ were 0.13% (95% CI: -0.04-0.29) in urban areas and 0.34% (95% CI: 0.12-0.56) in suburban areas per 10 μg/m³ increase in O₃ concentrations; however, the difference between the estimates of O₃ in urban and suburban areas was not statistically significant. The district-specific results suggested that the estimated risks increased along with urban vulnerability levels for the effects of PM_2.5. Implementing the Action Plan reduced the mortality risks of PM_2.5, but the risks of O₃ increased in some districts. However, the difference in the estimates between the pre- and post-emission reductions was not statistically significant. Our study indicated that populations living in less urbanized areas are more vulnerable to the adverse effects of air pollution in Beijing, particularly for PM_2.5.

Air pollution as a substantial threat to the improvement of agricultural total factor productivity: Global evidence

OBJECTIVE

This study aims to provide empirical evidence about whether and to what extent air pollution affects the global agricultural total factor productivity (TFP).

METHODS

The research sample covers 146 countries all over the world during 2010-2019. Two-way fixed effects panel regression models are used to estimate air pollution's impacts. A random forest analysis is conducted to assess the relative importance of independent variables.

RESULTS

The results show that, on average, a 1% increase in fine particulate matter (PM_2.5) and tropospheric ozone (O₃) concentration would cause the agricultural TFP to decline by 0.104% and 0.207%, respectively. Air pollution's adverse impact widely exists in various countries with different development levels, pollution degrees, and industrial structures. This study also finds that temperature has a moderating effect on the relationship between PM_2.5 and agricultural TFP. PM_2.5 pollution's detrimental impact is weaker (stronger) in a warmer (cooler) climate. In addition, the random forest analysis confirms that air pollution is among the most crucial predictors of agricultural productivity.

CONCLUSIONS

Air pollution is a substantial threat to the improvement of global agricultural TFP. Worldwide actions should be taken to ameliorate air quality, for the sake of agricultural sustainability and global food security.

City-scale assessment of long-term air quality impacts on the respiratory and cardiovascular health

Background

The impact of the urban environment on human health is a contemporary subject of environmental research. Air pollution is often considered a leading environmental driver. However, a plethora of other factors within the urban exposome may be involved. At the same time, the resolution of spatial data is also an important facet to consider. Generally, systematic tools for accurate health risk assessment in the urban environment are missing or are not implemented.

Methods

The long-term impact of air quality (PM₁₀, PM_2.5, NO₂, benzene, and SO₂) on respiratory and cardiovascular health was assessed with a log-linear model. We used the most accurate health data in high city scale spatial resolution over the period 2010 to 2018. Selected external exposome parameters were also included in the analysis.

Results

Statistically significant associations between air pollution and the health of the urban population were found. The strongest association was between benzene and the incidence of bronchitis in the adult population [RR 1.552 95% CI (1.415-1.704) per 0.5 μg/m³ change in benzene concentration]. A similar relation was observed between NO₂ and the same health condition [RR 1.483 95% CI (1.227-1.792) per 8.9 μg/m³ of change in NO₂]. Other weaker associations were also found between asthma in children and PMs, NO₂, or benzene. Cardiovascular-related hospitalizations in the general population were linked with NO₂ [RR 1.218 95% CI (1.119-1.325) per 9.7 μg/m³ change in NO₂]. The remaining pollutants were slightly less but still significantly associated with cardiovascular-related hospitalizations.

Conclusion

Our findings are mostly highly statistically significant (p ≤ 0.001) and are in line with current literature on the adverse effects of air pollution on the human population. The results highlight the need for continual improvements in air quality. We propose the implementation of this approach as a systematic tool for the investigation of possible health risks over a long period of time. However, further research involving other variables is an essential step toward understanding the complex urban exposome and its implications for human health. An increase in data spatial resolution is especially important in this respect as well as for improving city health risk management.

Oxidative potential and water-soluble heavy metals of size-segregated airborne particles in haze and non-haze episodes: Impact of the "Comprehensive Action Plan" in China

Air pollution is a major environmental health challenge in megacities, and as such a Comprehensive Action Plan (CAP) was issued in 2017 for Beijing, the capital city of China. Here we investigated the size-segregated airborne particles collected after the implementation of the CAP, intending to understand the change of oxidative potential and water-soluble heavy metal (WSHM) levels in 'haze' and 'non-haze' days. The DNA damage and the levels of WSHM were analyzed by Plasmid Scission Assay (PSA) and High-Resolution Inductively Coupled Plasma Mass Spectrometry (HR-ICP-MS) techniques. The PM mass concentration was higher in the fine particle size (0.43-2.1 μm) during haze days, except for the samples affected by mineral dust. The particle-induced DNA damage caused by fine sized particles (0.43-2.1 μm) exceeded that caused by the coarse sized particles (4.7-10 μm). The DNA damage from haze day particles significantly exceeded those collected on non-haze days. Prior to the instigation of the CAP, the highest value of DNA damage decreased, and DNA damage was seen in the finer size (0.43-1.1 μm). The Pearson correlation coefficient between the concentrations of water-soluble Pb, Cr, Cd and Zn were positively correlated with DNA damage, suggesting that these WSHM had significant oxidative potential. The mass concentrations of water-soluble trace elements (WSTE) and individual heavy metals were enriched in the finer particles between 0.43 μm to 1.1 μm, implying that smaller sized particles posed higher health risks. In contrast, the significant reduction in the mass concentration of water-soluble Cd and Zn, and the decrease of the maximum and average values of DNA damage after the CAP, demonstrated its effectiveness in restricting coal-burning emissions. These results have demonstrated that the Beijing CAP policy has been successful in reducing the toxicity of 'respirable' ambient particles.

An Integration Method for Regional PM2.5 Pollution Control Optimization Based on Meta-Analysis and Systematic Review

PM_2.5 pollution in China is becoming increasingly severe, threatening public health. The major goal of this study is to evaluate the mortality rate attributed to PM_2.5 pollution and design pollution mitigation schemes in a southern district of China through a two-objective optimization model. The mortality rate is estimated by health effect evaluation model. Subjected to limited data information, it is assumed that the meta-analysis method, through summarizing and combining the research results on the same subject, was suitable to estimate the percentage of deaths caused by PM_2.5 pollution. The critical parameters, such as the total number of deaths and the background concentration of PM_2.5, were obtained through on-site survey, data collection, literature search, policy analysis, and expert consultation. The equations for estimating the number of deaths caused by PM_2.5 pollution were established by incorporating the relationship coefficient of exposure to reaction, calculated residual PM_2.5 concentration of affected region, and statistical total base number of deaths into a general framework. To balance the cost from air quality improvement and human health risks, a two-objective optimization model was developed. The first objective is to minimize the mortality rate attributable to PM_2.5 pollution, and the second objective is to minimize the total system cost over three periods. The optimization results demonstrated that the combination of weights assigned to the two objectives significantly influenced the model output. For example, a high weight value assigned to minimizing the number of deaths results in the increased use of treatment techniques with higher efficiencies and a dramatic decrease in pollutant concentrations. In contrast, a model weighted more toward minimizing economic loss may lead to an increase in the death toll due to exposure to higher air pollution levels. The effective application of this model in the Nanshan District of Shenzhen City, China, is expected to serve as a basis for similar work in other parts of the world in the future.

Systematic Review of Ozone Effects on Human Lung Function, 2013 through 2020

Background

Ozone effects on lung function are particularly important to understand in the context of the air pollution-health outcomes epidemiologic literature, given the complex relationships between ozone and other air pollutants with known lung function effects.

Research Question

What has been learned about the association between ozone exposures and lung function from epidemiology studies published from 2013 through 2020?

Study Design and Methods

On March 18, 2018, and September 8, 2020, PubMed was searched using the terms health AND ozone, filtering to articles in English and about humans, from 2013 or later. An additional focused review searching for ozone AND (lung function OR FEV₁OR FVC) was performed June 26, 2021. Articles were selected for this review if they reported a specific relationship between a lung function outcome and ozone exposure.

Results

Of 3,271 articles screened, 53 ultimately met criteria for inclusion. A systematic review with assessment of potential for bias was conducted, but a meta-analysis was not carried out because of differences in exposure duration and outcome quantification. Consistent evidence exists of small decreases in children’s lung function, even associated with very low levels of short-term ozone exposure. The effects on adult lung function from exposure to low-level, short-term ozone are less clear, although ozone-associated decrements may occur in the elderly. Finally, long-term ozone exposure decreases both lung function and lung function growth in children, although few new studies have examined long-term ozone and lung function in adults.

Interpretation

Much of this literature involves concentrations below the current US Environmental Protection Agency’s National Ambient Air Quality Standard of 70 parts per billion over an 8-h averaging time, suggesting that this current standard may not protect children adequately from ozone-related decrements in lung function.

Association Between Air Pollution and COVID-19 Pandemic: An Investigation in Mumbai, India

Spatial hot spots of COVID-19 infections and fatalities are observed at places exposed to high levels of air pollution across many countries. This study empirically investigates the relationship between exposure to air pollutants that is, sulfur dioxide, nitrogen dioxide, and particulate matter (SO2, NO2, and PM10) and COVID-19 infection at the smallest administrative level (ward) of Mumbai City in India. The paper explores two hypotheses: COVID-19 infection is associated with air pollution; the pollutants act as determinants of COVID-19 deaths. Kriging is used to assess the spatial variations of air quality using pollution data, while information on COVID-19 are retrieved from the database of Mumbai municipality. Annual average of PM10 in Mumbai over the past 3 years is much higher than the WHO specified standard across all wards; further, suburbs are more exposed to SO2, and NO2 pollution. Bivariate local indicator of spatial autocorrelation finds significant positive relation between pollution and COVID-19 infected cases in certain suburban wards. Spatial Auto Regressive models suggest that COVID-19 death in Mumbai is distinctly associated with higher exposure to NO2, population density and number of waste water drains. If specific pollutants along with other factors play considerable role in COVID-19 infection, it has strong implications for any mitigation strategy development with an objective to curtail the spreading of the respiratory disease. These findings, first of its kind in India, could prove to be significant pointers toward disease alleviation and better urban living.

Association Between Air Pollution and COVID-19 Pandemic: An Investigation in Mumbai, India

Spatial hot spots of COVID-19 infections and fatalities are observed at places exposed to high levels of air pollution across many countries. This study empirically investigates the relationship between exposure to air pollutants that is, sulfur dioxide, nitrogen dioxide, and particulate matter (SO₂, NO₂, and PM₁₀) and COVID-19 infection at the smallest administrative level (ward) of Mumbai City in India. The paper explores two hypotheses: COVID-19 infection is associated with air pollution; the pollutants act as determinants of COVID-19 deaths. Kriging is used to assess the spatial variations of air quality using pollution data, while information on COVID-19 are retrieved from the database of Mumbai municipality. Annual average of PM₁₀ in Mumbai over the past 3 years is much higher than the WHO specified standard across all wards; further, suburbs are more exposed to SO₂, and NO₂ pollution. Bivariate local indicator of spatial autocorrelation finds significant positive relation between pollution and COVID-19 infected cases in certain suburban wards. Spatial Auto Regressive models suggest that COVID-19 death in Mumbai is distinctly associated with higher exposure to NO₂, population density and number of waste water drains. If specific pollutants along with other factors play considerable role in COVID-19 infection, it has strong implications for any mitigation strategy development with an objective to curtail the spreading of the respiratory disease. These findings, first of its kind in India, could prove to be significant pointers toward disease alleviation and better urban living.

Cross-Regional Highway Built through a City Centre as an Example of the Sustainable Development of Urban Transport

Sustainable development requires ensuring the mobility of residents and must not cause deterioration of the quality of the environment in the selected area. The purpose of this study is to verify if the construction of a cross-regional highway through the city centre affected air quality in the neighbourhood of a newly built road. Air quality was assessed based on measurements of concentrations of nitrogen dioxide, which is considered to be typical for automotive sources air pollution. The spectrophotometric method with passive sampling was used in the 24 h NO2 measurements. The calculated mean NO2 concentrations in the periods before and after road construction were within the ranges of 23.2–31.9 μg/m3 and 22.3–28.9 μg/m3, respectively. The relative NO2 concentrations determined in the study for 10 out of 11 sampling points were lower than the unity, including 5 points markedly lower (0.82–0.89). The obtained results indicate that the construction of the new artery by the city centre, using appropriate technical solutions and traffic organization (tunnel, noise barriers, roundabouts, speed limit) likely contributed to an overall reduction in NO2 concentrations. The presented solution may serve as an example for other cities struggling with problems of low air quality associated with inefficient transportation systems.

Air quality improvement in response to intensified control strategies in Beijing during 2013-2019

Beijing's air pollution has become of increasing concern in recent years. The central and municipal governments have issued a series of laws, regulations, and strategies to improve ambient air quality. The "Clean Air Action" issued in 2013 and the "Comprehensive Action" issued in 2017 largely addressed this concern. In this study, we assessed the effectiveness of the two action plans by environmental monitoring data and evaluated the influencing factors including meteorology, pollutant emissions, and energy structure. The spatial distributions of air pollutants were analyzed using the Kriging interpolation method. The Principal Component Analysis-Multiple Nonlinear Regression (PCA-MNLR) model was applied to estimate the effects of meteorological factors. The results have shown that Beijing's air quality had a measurable improvement over 2013-2019. "Good air quality" days had the highest increases, and "hazardous air quality" days had the most decreases. SO₂ decreased most, followed by CO, PM_2.5, PM₁₀, and NO₂ in descending order, but O₃ showed a fluctuant increase. The "Comprehensive Action" was more effective than the "Clean Air Action" in reducing heavy pollution days during the heating period. The meteorological normalized values of the main pollutants were lower than the observation data during 2013-2016. However, the observed values became lower than the normalized values after 2017, which indicated beneficial weather conditions in 2017 and afterwards. The emissions of SO₂ and dust significantly decreased while NOx had a slight decrease, and the energy structure changed with a dramatic decrease in coal consumption and an obvious increase in the use of natural gas and electricity. The significant reduction of coal-fired emissions played a dominant role in improving Beijing's air quality, and vehicle emission control should be further enhanced. The results demonstrated the effectiveness of the two action plans and the experience in Beijing should have potential implications for other areas and nations suffering from severe air pollution.

Energy and Climate Policy—An Evaluation of Global Climate Change Expenditure 2011–2018

Concern for climate change is one of the drivers of new, transitional energy policies oriented towards economic growth and energy security, along with reduced greenhouse gas (GHG) emissions and preservation of biodiversity. Since 2010, the Climate Policy Initiative (CPI) has been publishing annual Global Landscape of Climate Finance reports. According to these reports, US$3660 billion has been spent on global climate change projects over the period 2011–2018. Fifty-five percent of this expenditure has gone to wind and solar energy. According to world energy reports, the contribution of wind and solar to world energy consumption has increased from 0.5% to 3% over this period. Meanwhile, coal, oil, and gas continue to supply 85% of the world’s energy consumption, with hydroelectricity and nuclear providing most of the remainder. With this in mind, we consider the potential engineering challenges and environmental and socioeconomic impacts of the main energy sources (old and new). We find that the literature raises many concerns about the engineering feasibility as well as environmental impacts of wind and solar. However, none of the current or proposed energy sources is a “panacea”. Rather, each technology has pros and cons, and policy-makers should be aware of the cons as well as the pros when making energy policy decisions. We urge policy-makers to identify which priorities are most important to them, and which priorities they are prepared to compromise on.

A review of multivariate analysis: is there a relationship between airborne particulate matter and meteorological variables?

Among statistical tools for the study of atmospheric pollutants, trajectory regression analysis (TRA), cluster analysis (CA), and principal component analysis (PCA) can be highlighted. Therefore, this article presents a systematic review of such techniques based on (i) air mass influences on particulate matter (PM) and (ii) the study of the relationship between PM and meteorological variables. This article aims to review studies that use TRA and to review studies that adopt CA and/or PCA to identify the associations and relationship between meteorological variables and atmospheric pollutants. Papers published between 2006 and 2018 and indexed by five of the main scientific databases were considered (ScienceDirect, Web of Science, PubMed, SciELO, and Scopus databases). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations supported this systematic review. From the resulting most relevant papers, eight studies analyzed the influence of air mass trajectories on PM using TRA and twenty-one studies searched for the relationship between meteorological variables and PM using CA and/or PCA. A combination of TRA and time series models was identified as the possibility of future works. Besides, studies that simultaneously combine the three techniques to identify both the influence of air masses on PM and its relationship with meteorological variables are a possibility of future papers, because it can lead to a better comprehension of such a phenomenon.

Systematic Reviews in Occupational Health and Safety: where are we and where should we go?

Systematic Reviews have been introduced to improve the synthesis of available evidence and to reduce bias in the conclusions about a body of evidence. Nowadays, Systematic Review is an established method also in the Occupational Safety and Health (OSH) field. It is the Cochrane Work Review Group that facilitates authors to produce Cochrane reviews of intervention topics in this area. A variety of guidelines used Cochrane Work reviews for underpinning their recommendations. Due to the comprehensive search and reproducibility of the methods of a systematic review, it turned out that systematic reviews can be powerful in changing beliefs. For example, studies published in the eighties advocated the use of back schools. Nowadays, we know that the total body of evidence has changed the traditional view that training in lifting techniques could prevent back pain. ‘Sitting is the new smoking’ is an eye catching nicely alliterating motto, but it is of course highly overstated. The findings of a Cochrane review of the effects of interventions to decrease sitting at work showed that sitting time can be reduced by a bit less than two hours per day by providing sit-stand desks plus education. However, it is unclear if this is sufficient to counter the effects of sitting. A wealth of evidence on OSH interventions has been collected by international collaboration in the Cochrane Work Review Group. This can be extended to systematic reviews of the effects of exposure of workers to assess to which risks of adverse health effects they are exposed.

Air pollution and telomere length in adults: A systematic review and meta-analysis of observational studies

Telomere length (TL) has been suggested to be a surrogate for cellular ageing, and a record of cumulative inflammation and oxidative stress over life. An emerging body of evidence has associated exposure to air pollution to changes in TL. To date there is no available systematic review of literature on this association. We aimed to systematically review and conduct meta-analysis of published studies on the relationship between air pollution and TL in adults. Electronic databases were systematically searched for available English language studies on the association between air pollution and TL published up to 1 July 2018. Meta-analyses were conducted following MOOSE guidelines. The heterogeneity in the reported associations was assessed using Cochran's Q test and quantified as I² index. Publication bias was assessed using Egger's regression. Our search identified 19 eligible studies including 11 retrospective and eight prospective studies of which, four had excellent quality, ten had good quality and five had fair quality. Meta-analysis result of two studies on long-term exposure to PM_2.5 showed an inverse association between these exposures and TL (for 5 μg/m³ PM_2.5-0.03 95% CI; -0.05, -0.01). Meta-analysis of short-term exposure to PM_2.5 with three studies and Polychlorinated Biphenyls (PCBs) with two studies revealed a direct association between these exposures and TL (0.03 95% CI; 0.02, 0.04 and 0.10 95% CI; 0.06, 0.15 respectively). No statistically significant relationship between exposure to PM₁₀ and polycyclic aromatic hydrocarbons (PAHs) exposure and TL were observed. We observed suggestive evidence for associations between air pollution and TL with potentially different direction of associations for short- and long-term exposures.

Indoor air quality of environments used for physical exercise and sports practice: Systematic review

BACKGROUND

Systematic reviews have the potential to contribute substantially to environmental health and risk assessment.

OBJECTIVE

This study aimed to investigate indoor air quality of environments used for physical exercise and sports practice through a systematic review.

METHODS

The systematic review followed the PRISMA guidelines and was recorded in the PROSPERO registry (CRD42016036057). The search was performed using the SciELO, Science Direct, Scopus, LILACS, MEDLINE via PubMed, and SPORTDiscus databases, from their inception through April 2017. The search terms used in the databases were {air pollution" OR "air pollutants" OR "air quality"} AND {"physical exercise" OR "physical activity" OR "sport"}. The results of selected studies were divided into 5 categories for analysis: monitoring of air quality in the environment according to international guidelines, indoor-to-outdoor ratio (I/O), air quality during physical exercise, impact of air quality on health, and interventions to improve indoor air quality.

RESULTS

Among 1281 studies screened, 34 satisfied the inclusion criteria. The monitoring of pollutants was conducted in 20 studies. CO and NO₂ were the most investigated pollutants, and guidelines were discussed in most studies. The I/O ratio was investigated in 12 studies, of which 9 showed a higher concentration of some pollutants in indoor rather than outdoor environments. Among the 34 studies selected, only 7 investigated the impact of indoor air pollution on human health. The population in most of these studies consisted of hockey players.

CONCLUSION

Most studies conducted monitoring of pollutants in indoor environments used for physical exercise and sports practice. The earliest studies were conducted in ice skating rinks and the most recent evaluated gymnasiums, fitness centers, and sports centers. The CO, particulate matter, and NO₂ concentrations were the most investigated and have the longest history of investigation. These pollutants were within the limits established by guidelines in most studies. Studies that examined the association between air quality documented the adverse effects of pollution. There is a need for more studies focused on the relationship between pollution and health.

Concentration-Response Relationship between PM2.5 and Daily Respiratory Deaths in China: A Systematic Review and Metaregression Analysis of Time-Series Studies

The association between the particulate matters with aerodynamic diameter ≤ 2.5 μm (PM_2.5) and daily respiratory deaths, particularly the concentration-response pattern, has not been fully examined and established in China. We conducted a systematic review of time-series studies to compile information on the associations between PM_2.5 concentration and respiratory deaths and used metaregression to assess the concentration-response relationship. Out of 1,957 studies screened, eleven articles in English and two articles in Chinese met the eligibility criteria. For single-day lags, per 10 μg/m³ increase in PM_2.5 concentration was associated with 0.30 [95% confidence interval (CI): 0.10, 0.50] percent increase in daily respiratory deaths; for multiday lags, the corresponding increase in respiratory deaths was 0.69 (95% CI: 0.55, 0.83) percent. Difference in the effects was observed between the northern cities and the south cities in China. No statistically significant concentration-response relationship between PM_2.5 concentrations and their effects was found. With increasingly wider location coverage for PM_2.5 data, it is crucial to further investigate the concentration-response pattern of PM_2.5 effects on respiratory and other cause-specific mortality for the refinement and adaptation of global and national air quality guidelines and targets.

Scientific production on indoor air quality of environments used for physical exercise and sports practice: Bibliometric analysis

INTRODUCTION

In order to minimize adverse health effects and increase the benefits of physical activity, it is important to systematize indoor air quality study in environments used for physical exercise and sports.

OBJECTIVES

To investigate and analyze the scientific production related to indoor air quality of environments used for physical exercise and sports practice through a bibliometric analysis.

METHODS

The databases Scielo, Science Direct, Scopus, Lilacs, Medline via Pubmed, and SportDiscus were searched from their inception to March 2016. Bibliometric analysis was performed for authors, institutions, countries, and collaborative networks, in relation to publication year, theme, citation network, funding agency, and analysis of titles and keywords of publications. Country, area, and impact factor of the journals were analyzed.

RESULTS

Of 1281 studies screened, 34 satisfied the inclusion criteria. The first publication occurred in 1975. An increase in publications was observed in the last 15 years. Most of the studies were performed by researchers in the USA, followed by Portugal and Italy. Seventeen different scientific journals have published studies on the subject, and most are in the area of Environmental Sciences. It was noted that the categories of author keywords associated with "Pollutants," "Sport Environment," and "Physical Exercise" were the most commonly used in most studies. A total of 68% of the studies had at least one funding agency, and 81% of studies published in the last decade had funding.

CONCLUSIONS

Our results demonstrate that there is recent exponential growth, driven in the last decade by researchers in environmental science from European institutions.

Systematic Review and Meta-Analysis of the Association between Ambient Nitrogen Dioxide and Respiratory Disease in China

Objective: This study aimed to assess the quantitative effects of short-term exposure of ambient nitrogen dioxide (NO₂) on respiratory disease (RD) mortality and RD hospital admission in China through systematic review and meta-analysis. Methods: A total of 29 publications were finally selected from searches in PubMed, Web of Science, CNKI and Wanfang databases. Generic inverse variance method was used to pool effect estimates. Pooled estimates were used to represent the increased risk of RD mortality and RD hospital admission per 10 μg/m³ increase in NO₂ concentration. Results: Positive correlations were found between short-term NO₂ exposure and RD in China. RD mortality and RD hospital admission respectively increased by 1.4% (95% CI: 1.1%, 1.7%) and 1.0% (95% CI: 0.5%, 1.5%) per 10 μg/m³ increase in NO₂ concentration. Differences were observed across geographic regions of China. The risk of RD mortality due to NO₂ was higher in the southern region (1.7%) than in the north (0.7%). Conclusions: Evidence was found that short-term exposure to NO₂ was associated with an increased risk of RD mortality and RD hospital admission in China and these risks were more pronounced in the southern regions of the country, due in part to a larger proportion of elderly persons with increased susceptibility to NO₂ in the population compared with the north.