Effect modification by sex for associations of fine particulate matter (PM 2.5 ) with cardiovascular mortality, hospitalization, and emergency room visits

Systematic review and meta-analysis

Bibliographic Data

ID17804843
AuthorsSeongkum Heo (0000-0002-0786-5002, Yale University, corresponding author), Ji-Young Son (0009-0002-0071-9341, Yale University), Chris C Lim (0000-0003-1804-248X, University of Arizona), Kelvin C Fong (0000-0002-8659-6794, Yale University), Hayon Michelle Choi (0000-0002-0622-8554, Yale University), Raúl U Hernández-Ramírez (0000-0001-8272-1474), Raúl Ulises Hernández‐Ramírez (Yale University), Kate Nyhan (0000-0001-5397-2303, Yale University), Preet K Dhillon (0000-0002-0291-9454, Public Health Foundation of India), Suhela Kapoor (0000-0002-2720-1932, Tata Trusts), Dorairaj Prabhakaran (0000-0002-3172-834X, Centre for Chronic Disease Control), Donna Spiegelman (0000-0003-4006-4650, Yale University), Mary Lou Bell (0000-0002-3965-1359, Yale University)
Year2022
Volume17
Issue5
Pages053006-053006
Publication date2022-05-01
Open AccessYes
TypeARTICLE
VenueEnvironmental Research Letters (JOURNAL)
Journal identifiersISSN: 1748-9326 • E-ISSN: 1748-9326
PublisherIOP Publishing (PUBLISHER • GB)
DOI10.1088/1748-9326/ac6cfb
PMID35662857
OpenAlexW4229016491
LanguageEN
Citations received2
References cited124

Particulate matter with aerodynamic diameter no larger than 2.5 μm (PM 2.5 ) has been linked to cardiovascular diseases (CVDs) but evidence for vulnerability by sex remains unclear. We performed systematic review and meta-analysis to synthesize the state of scientific evidence on whether cardiovascular risks from PM 2.5 differ for men compared to women. The databases Pubmed, Scopus, Embase, and GreenFILE were searched for studies published Jan. 1995 to Feb. 2020. Observational studies conducting subgroup analysis by sex for impacts of short-term or long-term exposure to PM 2.5 on target CVDs were included. Data were independently extracted in duplicate and pooled with random-effects meta-regression. Risk ratios (RRs) for long-term exposure and percent changes in outcomes for short-term exposure were calculated per 10 μg/m 3 PM 2.5 increase. Quality of evidence of risk differences by sex was rated following Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 12,502 articles were screened, with 61 meeting inclusion criteria. An additional 32 studies were added from citation chaining. RRs of all CVD mortality for long-term PM 2.5 for men and women were the same (1.14; 95% CI: 1.09, 1.22) indicating no statistically different risks. Men and women did not have statistically different risks of daily CVD mortality, hospitalizations from all CVD, ischemic heart disease, cardiac arrest, acute myocardial infarction, and heart failure from short-term PM 2.5 exposure (difference in % change in risk per 10 μg/m 3 PM 2.5 : 0.04 (95% CI, -0.42 to 0.51); -0.05 (-0.47 to 0.38); 0.17 (-0.90, 1.24); 1.42 (-1.06, 3.97); 1.33 (-0.05, 2.73); and -0.48 (-1.94, 1.01), respectively). Analysis using GRADE found low or very low quality of evidence for sex differences for PM 2.5 -CVD risks. In conclusion, this meta-analysis and quality of evidence assessment of current observational studies found very limited evidence of the effect modification by sex for effects of PM 2.5 on CVD outcomes in adults, which can inform clinical approaches and policies

Aerodynamic diameter · Confidence interval · Meta-analysis · Myocardial infarction · Observational study · Particulates · Relative risk · Subgroup analysis · Air Quality and Health Impacts · Air Quality Monitoring and Forecasting · Climate Change and Health Impacts · Medicine · Internal Medicine

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