Association between air pollution and cardiovascular mortality in China: a systematic review and meta-analysis

Lei Zhao, Heng-Rui Liang, Feng-Ying Chen, Zi Chen, Wei-Jie Guan and Jian-Hua Li _

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Oncotarget. 2017; 8:66438-66448. https://doi.org/10.18632/oncotarget.20090

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Lei Zhao1,2,*, Heng-Rui Liang3,*, Feng-Ying Chen1, Zi Chen5,6, Wei-Jie Guan4 and Jian-Hua Li1

1Key Laboratory of Protein Modification and Degradation, School of Basic Medical Sciences, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, 511436, China

2The Sixth Affiliated Hospital, Guangzhou Medical University, Guangzhou, 511436, China

3Nan Shan School, Guangzhou Medical University, Guangzhou, 511436, China

4State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China

5Huashan Hospital, Fudan University, Shanghai, 200040, China

6QuintilesIMS Asia Medical Oncology, Shanghai, 200032, China

*These authors contributed equally to this work

Correspondence to:

Jian-Hua Li, email: [email protected]

Wei-Jie Guan, email: [email protected]

Zi Chen, email: [email protected]

Keywords: air pollution, cardiovascular, mortality, China, meta-analysis

Received: June 13, 2017     Accepted: July 26, 2017     Published: August 09, 2017


Air pollutant levels in many Chinese cities remained significantly higher than the upper limits stated in World Health Organization guidelines. In light of limited evidence in China, we conducted a meta-analysis summarizing the association between acute exposure of air pollution and cardiovascular mortality. We searched PubMed, and CNKI databases etc. for literature published in English or Chinese up to January 2017. Outcomes were pooled and compared using random-effects model. Excess risks (ERs) per 10 μg/m3 increase in PM2.5, PM10, NO2, SO2 and O3 were evaluated. Subgroup analysis was conducted according to lag patterns (lags 0, 1, 2, 0–1, 0–2 days), gender (male vs. female), temperature (cool vs. warm) and age (< 65 vs. ≥ 65). Study bias was detected using Begg’s and Egger’s test. Of 299 articles identified, 30 met inclusion criteria. Each 10 μg/m3 increase in the concentration was associated with a higher incidence of cardiovascular mortality for PM2.5 (0.68%, 95% CI: 0.39–0.97%), PM10 (0.39%, 95% CI: 0.26–0.53%), NO2 (1.12%, 95% CI: 0.76–1.48%), SO2 (0.75%, 95% CI: 0.42–1.09%), and O3 (0.62%, 95% CI: 0.33–0.92%), respectively. Air pollution conferred greater adverse impacts on cardiovascular mortality for longer duration of exposures. Strongest associations were seen for lag 0–1 day of exposure among all pollutants. Female, lower temperature, and age > 65 years were associated with greater risks of cardiovascular mortality for all pollutants. Higher concentrations of air pollutants correlated with a greater short-term increase in cardiovascular mortality. Further high-quality studies in China are urgently warranted to determine the susceptible population, which would offer reference for policy-making to minimize adverse health effects.

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