A Systematic Review and Meta-Analysis on Long-Term Exposure to Particulate Matter and All-Cause and Cause-Specific Mortality in the Asia-Pacific States

Abstract

Background: Global Burden of Disease (GBD) studies have proposed integrated exposureresponse models primarily based on North American and European data, which may not be directly applicable to the Asia-Pacific region.Through a systematic review and meta-analysis, we aimed to explore the association between long-term exposure to ambient particulate matter (PM) and mortality in the Asia-Pacific states.Methods: We searched 3 databases (PubMed [n = 8,326], Embase [n = 4,709], and Cochrane Library [n = 357]) between 1st January 1990 and 31st July 2023.Our search focused on studies examining the associations between long-term exposure to PM with an aerodynamic diameter < 2.5 m (PM 2.5 ) and 10 m (PM 10 ) and all-cause (or non-accidental) and causespecific mortality, including cardiovascular disease (CVD), ischemic heart disease (IHD), stroke, acute lower respiratory infection, chronic obstructive pulmonary disease, and lung cancer deaths in the Asia-Pacific states.We conducted a meta-analysis to pool the estimates in the studies.Results: We identified 71 articles investigating the association between long-term exposure to PM and all-cause and cause-specific mortality.For a 10 g/m 3 increase in PM 2.5 , the pooled relative risk (RR) with 95% confidence intervals (CI) for all-cause mortality was 1.11 (95% CI, 1.05-1.17),1.13 (95% CI, 1.06-1.21)for CVD, 1.13 (95% CI, 1.02-1.25)for IHD, 1.12 (95% CI, 1.02-1.24)for stroke, and 1.12 (95% CI, 1.08-1.16)for lung cancer.For a 10 g/m 3 increase in PM 10 , the pooled RR for all-cause mortality was 1.12 (95% CI, 1.00-1.24)and 1.33 (95% CI, 1.28-1.38)for IHD.Conclusion: Our analysis revealed positive associations between long-term exposure to PM and all-cause and cause-specific mortality for CVD, IHD, stroke, and lung cancer in the Asia-Pacific states.

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