Exposure and Non-accidental Mortality in Asian Populations: A Meta-analysis of Time-series and Case-crossover Studies

Objectives: We investigated the association between particulate matter less than $10{\mu}m$ in aerodynamic diameter ($PM_{10}$) exposure and non-accidental mortality in Asian populations by meta-analysis, using both time-series and case-crossover analysis. Methods: Among the 819 published studies searched from PubMed and EMBASE using key words related to $PM_{10}$ exposure and non-accidental mortality in Asian countries, 8 time-series and 4 case-crossover studies were selected for meta-analysis after exclusion by selection criteria. We obtained the relative risk (RR) and 95% confidence intervals (CI) of non-accidental mortality per $10{\mu}g/m^3$ increase of daily $PM_{10}$ from each study. We used Q statistics to test the heterogeneity of the results among the different studies and evaluated for publication bias using Begg funnel plot and Egger test. Results: Testing for heterogeneity showed significance (p<0.001); thus, we applied a random-effects model. RR (95% CI) per $10{\mu}g/m^3$ increase of daily $PM_{10}$ for both the time-series and case-crossover studies combined, time-series studies relative risk only, and case-crossover studies only, were 1.0047 (1.0033 to 1.0062), 1.0057 (1.0029 to 1.0086), and 1.0027 (1.0010 to 1.0043), respectively. The non-significant Egger test suggested that this analysis was not likely to have a publication bias. Conclusions: We found a significant positive association between $PM_{10}$ exposure and non-accidental mortality among Asian populations. Continued investigations are encouraged to contribute to the health impact assessment and public health management of air pollution in Asian countries.