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Association between ambient air pollution and Parkinson's disease: Systematic review and meta-analysis

Hu, Cheng-Yang, Fang, Yuan, Li, Feng-Li, Dong, Bao, Hua, Xiao-Guo, Jiang, Wen, Zhang, Heng, Lyu, Yong, Zhang, Xiu-Jun
Environmental research 2019 v.168 pp. 448-459
Parkinson disease, air pollution, carbon monoxide, chronic exposure, confidence interval, dose response, etiology, income, meta-analysis, nitrogen dioxide, ozone, particulates, relative risk, risk factors, sulfur dioxide, systematic review
Air pollution has been evaluated as a possible risk factor for Parkinson's disease (PD), but, the present results are inconsistent and have not been combined. We performed a systematic review and meta-analysis to estimate the association between long-term exposure to ambient air pollution and PD, given the nature of disease etiology. A total of 10 studies were identified by searching Web of Science, Science Direct, and PubMed before October 2017. We found a significantly increased risk of PD with 10 parts per billion (ppb) increase in nitrogen oxides (NOx) exposure (relative risk (RR) = 1.06; 95% confidence interval (CI): 1.04, 1.09). The pooled RR for the association between carbon monoxide (CO) exposure, 1 parts per million (ppm) increment, and the risk of PD was 1.65 (95% CI: 1.10, 2.48). The pooled RRs for the association between nitrogen dioxide (NO2) and ozone (O3) exposure per 1 ppb increment, and the risk of PD were 1.01 (95% CI: 1.00, 1.03) and 1.01 (95% CI: 1.00, 1.02), respectively. There was a significant heterogeneity in the meta-analysis for fine particulate matter (PM2.5), NO2, sulfur dioxide (SO2), and CO. We concluded that NO2, NOx, CO and O3 exposure were associated with an increased risk of PD, although there is high risk of bias. The dose-response effects evaluated by high-quality studies are needed. Researches should be expanded to low- and/or middle- income countries where indoor and outdoor air pollution are high.Long-term exposure to ambient NO2, NOx, CO and O3 can increase the risk of Parkinson's disease.