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<p>Ambient air pollution remains a major public health concern in Europe despite recent improvements. This systematic review synthesizes evidence (2020–2025) on short- and long-term effects of PM<sub>10</sub>, PM<sub>2.5</sub>, NO₂ and O₃ on cause-specific mortality, integrating Italian BEEP and BIGEPI projects with European studies for the first time. Searches of PubMed, Web of Science, and Scopus (to 31 July 2025) identified 31 studies; meta-analyses were conducted when ≥ 5 studies were available (18 studies included for PM<sub>2.5</sub>). Risk of bias was assessed using ROBINS-E (v1, June 2023) by two independent reviewers. PM<sub>2.5</sub> was significantly associated with mortality: all-cause RR ≈ 1.10 per 10&#xa0;µg/m³ (I²=97.9%), cardiovascular RR = 1.026 (95%CI 1.014–1.039; I²=91.7%), and respiratory RR = 1.032 (95%CI 1.013–1.050; I²=88.3%), with stronger effects for long-term exposure. Long-term PM<sub>2.5</sub> and NO₂ exposures were consistently linked to increased all-cause, cardiovascular, and respiratory mortality; PM<sub>10</sub> showed weaker associations. Short-term increases in PM and NO₂ were associated with acute mortality rises, while O₃ evidence was heterogeneous. Limitations include substantial heterogeneity (I² 78–98%), evidence of small-study effects (Egger <i>p</i> &lt; 0.05), and risk of bias rated “Some concerns” in most studies (16/18). Overall, air pollution continues to impose a measurable mortality burden in Europe, supporting stricter standards aligned with WHO guidelines. Funding: PNC PREV- A-2022-12376981.</p>

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Air pollution and cause-specific mortality in EU: a review integrating meta-analysis and meta-regression

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月18日

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  • Ilaria Stanisci,
  • Andrea Perri,
  • Sandra Baldacci,
  • Sara Maio,
  • Giuseppe Sarno,
  • Sofia Tagliaferro,
  • Velia Malizia,
  • Mirella Profita,
  • Pietro Alfano,
  • Filippo Sapienza,
  • Giovanni Viegi,
  • Stefania La Grutta

摘要

Ambient air pollution remains a major public health concern in Europe despite recent improvements. This systematic review synthesizes evidence (2020–2025) on short- and long-term effects of PM10, PM2.5, NO₂ and O₃ on cause-specific mortality, integrating Italian BEEP and BIGEPI projects with European studies for the first time. Searches of PubMed, Web of Science, and Scopus (to 31 July 2025) identified 31 studies; meta-analyses were conducted when ≥ 5 studies were available (18 studies included for PM2.5). Risk of bias was assessed using ROBINS-E (v1, June 2023) by two independent reviewers. PM2.5 was significantly associated with mortality: all-cause RR ≈ 1.10 per 10 µg/m³ (I²=97.9%), cardiovascular RR = 1.026 (95%CI 1.014–1.039; I²=91.7%), and respiratory RR = 1.032 (95%CI 1.013–1.050; I²=88.3%), with stronger effects for long-term exposure. Long-term PM2.5 and NO₂ exposures were consistently linked to increased all-cause, cardiovascular, and respiratory mortality; PM10 showed weaker associations. Short-term increases in PM and NO₂ were associated with acute mortality rises, while O₃ evidence was heterogeneous. Limitations include substantial heterogeneity (I² 78–98%), evidence of small-study effects (Egger p < 0.05), and risk of bias rated “Some concerns” in most studies (16/18). Overall, air pollution continues to impose a measurable mortality burden in Europe, supporting stricter standards aligned with WHO guidelines. Funding: PNC PREV- A-2022-12376981.