Relationship between fine particulate matter (PM2.5) concentration and risk of hospitalization due to chronic obstructive pulmonary disease: a systematic review and meta-analysis

Mouloud Agajani Delavar; Mohammad Ali Jahani; Mahdi Sepidarkish; Saeide Alidoost; Hamed Mehdinezhad; Zeynab Farhadi

doi:10.1186/s12889-023-17093-6

Relationship between fine particulate matter (PM_2.5) concentration and risk of hospitalization due to chronic obstructive pulmonary disease: a systematic review and meta-analysis

BMC Public Health. 2023 Nov 13;23(1):2229. doi: 10.1186/s12889-023-17093-6.

Authors

Mouloud Agajani Delavar¹, Mohammad Ali Jahani², Mahdi Sepidarkish², Saeide Alidoost³, Hamed Mehdinezhad⁴, Zeynab Farhadi⁵

Affiliations

¹ Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
² Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
³ National Center for Strategic Research in Medical Education, Tehran, Iran.
⁴ Department of Internal Medicine, School of Medicine, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
⁵ Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. farhadi_zeynab@yahoo.com.

Abstract

Background: Short-term exposure to PM2.5 has been associated with human health risks. However, evidence on the association between short-term exposure to PM_2.5 and the risk of chronic obstructive pulmonary disease (COPD) remains limited and controversial. This study aimed to specifically assess the relationship between exposure to PM_2.5 and the risk of hospitalization due to COPD.

Methods: A systematic search was conducted in PubMed, Web of Science, and Google Scholar databases from January 1, 2010 to May 1, 2022. The odds ratio (OR) statistic was calculated as a common measure of effect size. Publication bias was also examined in all eligible studies on COPD hospitalization using funnel plots and Egger's test, as well as trim-and-fill method for missing studies on COPD hospitalization.

Results: A total of 19 studies were included in this meta-analysis. Random-effects models were plotted to calculate the pooled effect size by measuring OR (χ² = 349.95; df = 18; I₂ = 94.86%; P = 0.007; Z = 2.68; P < 0.001). A 10-mg/m³ daily increase in PM_2.5 concentration was associated with a 1.6% (95% CI: 0.4-2.9%) increase in COPD hospitalization. There was no publication bias regarding the association between COPD hospitalization and PM_2.5 (bias = 1.508; 95% CI: -1.475, 4.491; t = 1.066; P = 0.301). The subgroups of age ≥ 65 years and Asian countries were associated with an increased risk of COPD hospitalization. Besides, higher risks were estimated in the subgroups of studies performed in the warm season, case-crossover studies, studies with three lag days, and studies without adjustments for humidity and temperature confounders, with very small heterogeneity.

Conclusion: Evidence suggests that short-term exposure to PM_2.5 increases COPD hospitalization. Further studies are needed to understand the mechanism of the association between PM_2.5 and COPD for reducing air pollution, which can be beneficial for COPD patients.

Keywords: Air Pollutants; Chronic Obstructive; Hospitalization; Humans; Introduction; Particulate Matter; Pulmonary Disease.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Aged
Air Pollutants* / adverse effects
Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
Environmental Exposure / adverse effects
Environmental Exposure / analysis
Hospitalization
Humans
Particulate Matter / adverse effects
Particulate Matter / analysis
Pulmonary Disease, Chronic Obstructive* / epidemiology

Substances

Particulate Matter
Air Pollutants