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Background <p>Exposure to ambient air pollution increases the risk of respiratory tract infections (RTIs). This systematic review and meta-analysis quantified the association between ambient air pollution and RTIs in low- and middle-income countries (LMICs).</p> Methods <p>We searched Ovid Medline, Embase, and related databases for studies published between January 2000 and December 2024 reporting on ambient air pollution and RTIs in LMICs. Two reviewers independently screened studies, assessed risk of bias using the RoBANS tool, and conducted a random-effects meta-analysis. Studies reporting odds ratios (ORs) were included in a random-effects meta-analysis, and separately for each pollutant–outcome combination for studies reporting multiple pollutants.</p> Results <p>Of 2,201 records identified, 111 full texts were assessed, 17 studies were included in the systematic review and 7 in the meta-analysis. Exposure to ambient air pollution was associated with increased odds of respiratory tract infections (pooled OR: 1.25, 95% CI: 1.04–1.49), with substantial heterogeneity (I² = 65.2%). Subgroup analyses suggested stronger associations in studies conducted in Africa (OR: 1.94, 95% CI: 1.46–2.58) compared to Asia (OR: 1.16, 95% CI: 0.92–1.45), and for pneumonia (OR: 1.74, 95% CI: 1.38–2.18) compared to other respiratory tract infections; though based on few studies. Among pollutants, PM2.5 showed the most consistent association with respiratory tract infections (OR: 1.05, 95% CI: 1.03–1.08), while associations for NO₂ and NOx were not statistically significant. Evidence of publication bias was suggested by funnel plot asymmetry. Meta-regression indicated a declining trend in effect estimates over time from 2018 to 2024.</p> Conclusion <p>Ambient air pollution, particularly PM2.5, is significantly associated with increased RTI risk, with stronger effects in African settings and for pneumonia. The association appears to weaken in more recent studies, potentially reflecting changing exposure patterns or research methodological advancements.</p> Trial registration <p>PROSPERO Registration: CRD42024586784. </p>

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Ambient air pollution and risk of respiratory tract infections in low- and middle-income countries: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月2日

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  • Mudarshiru Bbuye,
  • Simon Kasasa,
  • Adrian Mwota Nampogo,
  • Winters Muttamba,
  • Stella Zawedde Muyanja,
  • Sharifah Sekalala,
  • Bruce J Kirenga,
  • Stephen Okoboi,
  • Wilber Sabiiti,
  • Lynn M. Atuyambe,
  • Esther Buregyeya,
  • Olalekan A. Uthman

摘要

Background

Exposure to ambient air pollution increases the risk of respiratory tract infections (RTIs). This systematic review and meta-analysis quantified the association between ambient air pollution and RTIs in low- and middle-income countries (LMICs).

Methods

We searched Ovid Medline, Embase, and related databases for studies published between January 2000 and December 2024 reporting on ambient air pollution and RTIs in LMICs. Two reviewers independently screened studies, assessed risk of bias using the RoBANS tool, and conducted a random-effects meta-analysis. Studies reporting odds ratios (ORs) were included in a random-effects meta-analysis, and separately for each pollutant–outcome combination for studies reporting multiple pollutants.

Results

Of 2,201 records identified, 111 full texts were assessed, 17 studies were included in the systematic review and 7 in the meta-analysis. Exposure to ambient air pollution was associated with increased odds of respiratory tract infections (pooled OR: 1.25, 95% CI: 1.04–1.49), with substantial heterogeneity (I² = 65.2%). Subgroup analyses suggested stronger associations in studies conducted in Africa (OR: 1.94, 95% CI: 1.46–2.58) compared to Asia (OR: 1.16, 95% CI: 0.92–1.45), and for pneumonia (OR: 1.74, 95% CI: 1.38–2.18) compared to other respiratory tract infections; though based on few studies. Among pollutants, PM2.5 showed the most consistent association with respiratory tract infections (OR: 1.05, 95% CI: 1.03–1.08), while associations for NO₂ and NOx were not statistically significant. Evidence of publication bias was suggested by funnel plot asymmetry. Meta-regression indicated a declining trend in effect estimates over time from 2018 to 2024.

Conclusion

Ambient air pollution, particularly PM2.5, is significantly associated with increased RTI risk, with stronger effects in African settings and for pneumonia. The association appears to weaken in more recent studies, potentially reflecting changing exposure patterns or research methodological advancements.

Trial registration

PROSPERO Registration: CRD42024586784.