Use of GRADE in systematic reviews of health effects on pollutants and extreme temperatures: A cross-sectional survey

Xuping Song; Yan Ma; Jing Tang; Jiali Peng; Yue Hu; Yunze Han; Xinyu Fu; Xufei Luo; Xiuxia Li; Long Ge; Kehu Yang; Yaolong Chen

doi:10.1016/j.jclinepi.2023.05.021

Use of GRADE in systematic reviews of health effects on pollutants and extreme temperatures: A cross-sectional survey

J Clin Epidemiol. 2023 Jul:159:206-213. doi: 10.1016/j.jclinepi.2023.05.021. Epub 2023 May 28.

Authors

Xuping Song¹, Yan Ma², Jing Tang², Jiali Peng², Yue Hu², Yunze Han², Xinyu Fu³, Xufei Luo², Xiuxia Li⁴, Long Ge⁵, Kehu Yang⁶, Yaolong Chen⁷

Affiliations

¹ Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China; Institute of Health Data Science, Lanzhou University, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China; McMaster Health Forum, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton L8S4L8, Canada.
² Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.
³ Institute of Health Data Science, Lanzhou University, Lanzhou, China.
⁴ Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China.
⁵ Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China; Institute of Health Data Science, Lanzhou University, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
⁶ Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China; Institute of Health Data Science, Lanzhou University, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
⁷ Department of Social Medicine and Health Management, Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou, China; Institute of Health Data Science, Lanzhou University, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China. Electronic address: chenyaolong@lzu.edu.cn.

PMID: 37253394
DOI: 10.1016/j.jclinepi.2023.05.021

Abstract

Objectives: (i) To analyze trends and gaps in evidence of health effects on pollutants and extreme temperatures by evidence mapping; (ii) to conduct a cross-sectional survey on the use of the Grades of Recommendations Assessment Development and Evaluation (GRADE) in systematic reviews or meta-analyses (SR/MAs) of health effects on pollutants and extreme temperatures.

Study design and setting: PubMed, Embase, the Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched until July 7, 2022. SR/MAs investigated health effects of pollutants and extreme temperatures were included.

Results: Out of 22,658 studies, 312 SR/MAs were included in evidence mapping, and the effects of pollutants on cancer and congenital malformations were new research hotspots. Among 16 SR/MAs involving 108 outcomes that were rated using GRADE, the certainty of evidence was mostly downgraded for inconsistency (50, 42.7%), imprecision (33, 28.2%), and risk of bias (24, 20.5%). In contrast, concentration-response gradient (26, 65.0%) was the main upgrade factor.

Conclusion: GRADE is not widely used in SR/MAs of health effects on pollutants and extreme temperatures. The certainty of evidence is generally low, mainly because of the serious inconsistency or imprecision. Use of the GRADE in SR/MAs of health effects on pollutants and extreme temperatures should strengthen.

Keywords: Air pollution; Certainty of evidence; Cross-sectional study; Extreme temperature; GRADE; Greenhouse gases.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bias
Cross-Sectional Studies
Environmental Pollutants*
Humans
Systematic Reviews as Topic
Temperature

Substances

Environmental Pollutants