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A Systematic Review and Meta-Analysis on Short-Term Particulate Matter Exposure and Chronic Obstructive Pulmonary Disease Hospitalizations in China

Wang, Kan, MS; Hao, Yanhui, PhD; Au, William, PhD; Christiani, David C., PhD; Xia, Zhao-Lin, MD, PhD

Journal of Occupational and Environmental Medicine: April 2019 - Volume 61 - Issue 4 - p e112–e124
doi: 10.1097/JOM.0000000000001539

Objective: We conducted a meta-analysis of short-term particulate matter (PM) exposure and chronic obstructive pulmonary disease (COPD) hospitalizations in China, including data from two-pollutant model.

Methods: From PubMed and Web of Science, we selected case-crossover or time-series studies conducted in Mainland China, Hong Kong, Macao, or Taiwan to investigate the association between PM exposure and COPD hospitalizations. The meta-analysis was performed using data from both single-pollutant and two-pollutant models for PM2.5 and PM10.

Results: A total of 16 studies were included in our analysis. Short-term exposure to PM2.5 and PM10 were both significantly associated with COPD hospitalizations. The results remained robust in two-pollutant model, whereas subgroup analyses demonstrated a modest heterogeneity.

Conclusions: Our review shows a small but obvious exposure-hospitalization effect in China. More studies are needed to generate the needed evidence, and advocacy is needed to stimulate initiation of solutions to the problem.

School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education of China, Fudan University, Shanghai, China (Mr Wang, Dr Hao, and Dr Xia); Shantou University Medical College, Shantou, China (Dr Au); University of Medicine and Pharmacy, Tirgu Mures, Romania (Dr Au); Environmental and Occupational Medicine and Epidemiology Program, Harvard T.H. Chan School of Public Health, Boston, MA (Dr Christiani).

Address correspondence to: Zhao-Lin Xia, MD, PhD, Department of Occupational Health and Toxicology, School of Public Health, Fudan University, P.O. Box 288, 130 DongAn Road, Shanghai 200032, China (

This work was supported by the National Basic Research Program of China (973Program) (2011CB503801 and 2015CB553404).

The authors report no conflicts of interest.

Copyright © 2019 by the American College of Occupational and Environmental Medicine