A Systematic Review and Meta-Analysis of Short-Term Ambient Ozone Exposure and COPD Hospitalizations

Hui Gao, Kan Wang, William W. Au, Wensui Zhao and Zhao-lin Xia
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Hui Gao: Changning Center for Disease Control and Prevention, Shanghai 200051, China
Kan Wang: School of Public Health, & Key Laboratory of Public Health Safety of Ministry of Education of China, Fudan University, Shanghai 200032, China
William W. Au: University of Medicine, Pharmacy, Science and Techonology, 540142 Tirgu Mures, Romania
Wensui Zhao: Changning Center for Disease Control and Prevention, Shanghai 200051, China
Zhao-lin Xia: School of Public Health, & Key Laboratory of Public Health Safety of Ministry of Education of China, Fudan University, Shanghai 200032, China

IJERPH, 2020, vol. 17, issue 6, 1-14

Abstract: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and ozone exposure is a main cause of its disease burden. However, studies on COPD hospitalizations from short-term ambient level ozone exposure have not generated consensus results. To address the knowledge gap, comprehensive and systematic searches in several databases were conducted using specific keywords for publications up to February 14, 2020. Random-effect models were used to derive overall excess risk estimates between short-term ambient-level ozone exposure and COPD hospitalizations. The influence analyses were used to test the robustness of the results. Both meta-regression and subgroup analyses were used to explore the sources of heterogeneity and potential modifying factors. Based on the results from 26 eligible studies, the random-effect model analyses show that a 10 µg/m 3 increase in maximum 8-h ozone concentration was associated with 0.84% (95% CI: 0.09%, 1.59%) higher COPD hospitalizations. The estimates were higher for warm season and multiple-day lag but lower for old populations. Results from subgroup analyses also indicate a multiple-day lag trend and bigger significant health effects during longer day intervals. Although characteristics of individual studies added modest heterogeneity to the overall estimates, the results remained robust during further analyses and exhibited no evidence of publication bias. Our systematic review and meta-analysis indicate that short-term ambient level ozone exposure was associated with increased risk of COPD hospitalizations. The significant association with multiple-day lag trend indicates that a multiple-day exposure metric should be considered for establishing ambient ozone quality and exposure standards for improvement of population health. Future investigations and meta-analysis studies should include clinical studies as well as more careful lag selection protocol.

Keywords: ozone; chronic obstructive pulmonary disease; environmental health; meta-analysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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