A Systematic Review: Adverse Health Effects and Particulate Matter

This report provides a systematic review of the adverse health effects associated with particulate matter (PM) and other air pollutants. It begins with an introduction highlighting the global concern of air pollution and its link to premature deaths caused by diseases like strokes, heart attacks, and respiratory illnesses. The report then details the PICO question and search strategy used to find relevant articles from databases such as CINAHL, ScienceDirect, and PubMed. Inclusion and exclusion criteria are clearly defined, focusing on cohort and observational studies published after 2016. The study results section summarizes findings from five selected articles, each exploring the relationship between air pollution and specific health outcomes, including atrial fibrillation, mortality, diabetes, and myocardial infarction. Biological plausibility is discussed, citing research that explains how PM exposure can lead to respiratory and cardiovascular diseases. The report concludes by emphasizing the critical need for global efforts to reduce air pollution and protect human health, suggesting future research on the effectiveness of control measures for different air pollutants. The report includes a comprehensive list of references supporting the research findings.

Running head: ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
Adverse Health Effect and Particulate Matter
Name of the Student
Name of the University
Author Note

1ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
Introduction
In modern world the issue of air pollution is one of the major concerns for the
different countries of the world and it is related various health related adverse conditions.
This exposure to the environmental pollutants is responsible for almost 5 million premature
deaths around the world due to the diseases such strokes, diabetes, heart attacks, lung cancer,
chronic obstructive pulmonary disease and respiratory diseases and this deaths are more than
death cases of tuberculosis, AIDS and malaria. One of major types of air pollutants in the
modern world is the particulate matter and it is made up of small and minute airborne
particles such as dust, carbon particles, soot and drops of liquids. Based on the sizes of the
particulate matters, the PMs are named as PM 10, PM 5 (World Health Organization, 2020).
However, apart from these particulate matters, there are various other air pollutants such as
nitrogen dioxide (NO2), ozone (O3) and sulphur dioxide (SO2) that have serious health related
effect on the body of the individuals. According to the data of the World Health Organization
(2020), it is observed that the worldwide air pollution accounts for 29 per cent of all diseases
and deaths from the lung cancer, 17 per cent of all diseases and deaths from the acute lower
respiratory infection, 24 per cent of all deaths from the stroke, 25 per cent of all diseases and
deaths from the ischemic heart diseases, 43 per cent of all diseases and deaths from the
chronic obstructive pulmonary disease (World Health Organization, 2020). The health risks
associated with the particulate matters are much crucial as it can penetrate deep into the lung
passageways and thereby enters into the bloodstream.
PICO Question
P- Exposure to the air pollutants (PM, SO2, nitrogen dioxide (NO2), ozone (O3))
I- Reduction of air pollution by fuel policy

2ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
C- Withdrawal of old vehicles
O- Reduction of air pollution and reduced rate of adverse health effect.
Search Strategy
In this systematic review study the researchers conducted a literature search process in
the online databases in order to get the relevant articles from the databases. As a part of this
the researchers used mainly three databases and from those online sources the 5 articles were
selected based on the inclusion and exclusion criteria set by the researchers. The researchers
conducted the search in the online databases such as CINAHL, ScienceDirect, PubMed.
Initially the key words like “ Air pollution”, “ health effect”, “adverse health”, “particulate
matter”, “pulmonary disease”, “cardiovascular disease”, “Cohort study” was used by using
the Boolean operator AND, OR in between the key words to identify the most relevant
articles.
Inclusion and Exclusion Criteria
As a part of the inclusion and exclusion criteria the researchers used a few criteria.
For inclusion criteria, only the articles published after 2016 were included. Moreover, other
inclusion criteria were the language of the article that was the articles published in English.
As a part of the exclusion criteria, apart from the cohort studies and observational studies, all
other studies were excluded from the final review analysis. Along with this those articles
were also excluded from the study which only had the access of the abstract portion of the
study. As a part of the study outcome the researchers searched for those articles that are
associated with the disease incidents among the human populations. In this regard, it can be
stated that the main advantages of selecting cohort study is the fact that it can help the
researchers to assess the long term effect of the air pollution on the health of the human

3ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
beings. Another advantage of this method is the fact that this study method can help to
identify the relationship in between the exposure and outcome of a particular conditions. As
a part of the limitations, it can be stated that this methodological approach is very much time
consuming and may lead to loss of follow up cases of the subject populations due to the long
running process of the study.
Study Results
From the above search process the researchers selected 5 articles for the final review
based on the exclusion and inclusion criteria of the study and all of the studies were
conducted in different regions and those studies were reporting about adverse health related
consequences due to air pollution.
Author
name
and
Year
Research
Setting
Study
Design
Study
Population
Exposure Outcome Bias/
Confoundi
ng factors
Results
Kim et
al.
(2018)
Korean
General
population
Cohort
Study
432,587
general
population
of Korea
PM 2.5 Onset of
AF
NA AF was
observed
among
350
population
per
100,000
population
per year.
Significant
relationshi
p was
reported
among the
long term
exposure
and onset
of AF.
Moreover,
the effect
was more
prominent
among the

4ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
male,
older
adults,
person
with
history of
previous
myocardia
l
infarction.
Fisher et
al.
(2020)
Urban area
of
Netherland
Cohort
Study
Urban
population
database of
Netherland
and they
were
followed till
8 years.
long-term
exposure
to
particulate
air
pollution
from
diverse
source
Mortality NA The study
result
showed
that all of
the
sources of
air
pollution
except the
agricultura
l sources
are
associated
with the
non-
accidental
mortality
among the
study
cohorts.
However,
aerosol
showed
less
associatio
n with the
mortality
rate.
Clark et
al.
(2017)
British
Columbia,
Canada
Cohort
Study
The people
of 45-84
year old
were
recruited as
study
population
and all of
them must
be
registered in
Air
Pollution
Onset of
diabetes
Presence of
noise
pollution
was
considered
as a
confoundin
g factor.
Along with
this socio
economic
The study
result
reported
that the
exposure
to PM2.5
is
associated
with the
onset of
diabetes.

5ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
the MSP
central
registry.
However,
people who
already had
diabetes
were
excluded
from the
study.
status and
ethnicity
were also
considered
as
confoundin
g factor.
However,
there is no
significant
relationshi
p in
between
the NO2
exposure
and
diabetes
incidents.
Chen et
al.
(2020)
Augsburg,
Germany
Cohort
Study
5,898 cases
of nonfatal
MI cases
were used
by the
researchers.
Exposure
to
different
air
pollutant
particles
cases of
MI.
NA The sizes,
number of
particulate
matter is
associated
with an
enhance of
MI 6 h
later by
3.27 %,
5.71 %
and 5.84%
due to
size,
numbers
and
surface
area
concentrat
ions of air
pollutants.
Ghorani-
Azam,
Riahi-
Zanjani,
&
Balali-
Mood
(2016)
Iran Observ
ational
study
People of
Iran- an
overview
Exposure
to
different
air
pollutant
particles
Different
health
related
conditions
such as
resoiratory
problem,
cardiovasc
ular
problem,
neurologic
al problem
NA The study
result
showed
that the air
pollution
conditions
have
major
impact on
human
health and
causes
various
diseases.

6ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
In the study of Kim et al. (2019), the relationship in between the fine particulate
matter exposure and onset of adverse cardiovascular outcomes was analysed. This study
specifically concentrated on the relationship in between the long term exposure of PM 2.5
and incidents of the atrial fibrillation (AF) among the people of Korea and the data of
432,587 general populations not having AF were collected from the Korean National Health
Insurance Service-National Sample Cohort from 2009 to 2013. Along with this, the medical
records of the subjects were assessed from 2002 to examine the medical history of subjects.
In order to assess the exposure-outcome relationship the residential area and hourly pollution
rate were analysed. Therefore the study result concluded that even in Asian population long
tern exposure of PM2.5 can enhance the new diagnosis of AF.
In another study by Fisher et al. (2020), the association of various air pollutants and
mortality rate of the people of The Netherland was established through a cohort study was
reported. In this study the authors examine the pollution of different sources and mortality
rate in a Dutch cohort among 7.5 million adults. The cohort databases of the Dutch National
Database related to mortality, residential history, and air pollution category were collected by
the researchers. The cohort was followed for 8 years and the study concluded that there was a
significant relationship in between the mortality rate and different types of the air pollutant
such as primary particulate matter (PM10 and PM 2.5), elemental carbon, nitrogen di oxide
emission and inorganic aerosol and it is important to address this issue in a wider spectrum in
spite of specific source modification strategies.
In the study of Clark et al. (2017) reported about the association in between the long
term exposure to traffic related air pollution and incidence of diabetes among the population
based cohort in British Columbia, Canada. In this present study, the researchers examined the
association of traffic pollutants and onset of diabetes onset among the cohort population.
Moreover, this study also considered one potential confounding factor that is the issue of

7ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
noise pollution and association of diabetes incidence. Hence the study concluded that there
was modest association in between the onset of diabetes and exposure to the PM2.5 and along
with this they found no association in between the NO2 exposure and onset of diabetes
among the selected cohort.
In another cohort study conducted in Augsburg, Germany by the Chen et al. (2020), it
was reported that there is a significant relationship in between myocardial infarction (MI) and
the different particle metrics comprising length (PLC), particle number (PNC), and surface
area (PSC) concentrations at an hourly timescale. The data were collected by the researchers
during the 2005- 2015 from a MI registry in Augsburg, Germany. The researchers assessed
the effect of PM 10 and PM 2.5, ozone, nitrogen dioxide and black carbon on the incidence of
MI.
In the study of Ghorani-Azam, Riahi-Zanjani and Balali-Mood (2016), the various
adverse health related effects of the air pollutants was reported and the study was conducted
in Iran. In this observational study the authors reported about the different types of air
pollutant and their effect on the human health. Moreover, this study also suggested about the
control measures for reducing the air pollution in Iran.
Biological Plausibility
From the above research findings, it is observed that there is a significant relationship
in between the pollution exposure and onset of various diseases. Therefore, it is reported by
the study of Li et al. (2017) that due to the exposure of PM, the epithelial cells of the human
bronchitis led to a degeneration in CCAAT/enhancer-binding protein alpha (C/EBPα) that
stimulates the abnormal expression of NADH dehydrogenase genes and eventually led to

8ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
enhanced autophagy. As a consequence of this COPD and other respiratory diseases are
observed in the individuals. On the other hand, the onset of cardiovascular disease and
inhalation of the pollutants is established by the causation of inflammatory cytokines due to
the inhalation and it also causes the alteration of the cardiac autonomic nervous system and
leads to cardiovascular diseases (Du et al., 2016).
Conclusion
Hence, it can be concluded that the adverse impact of the air pollution is very serious
and it can cause various chronic diseases. Thus, it can be stated that around the world, all of
the countries should concentrate on the reduction of air pollution in order to protect the
human being. Most of the studies mainly tried to find the exposure outcome relationship and
so in future effectiveness of the control measures for different air pollutants can be studied.

9ADVERSE HEALTH EFFECT AND PARTICULATE MATTER
References
Chen, K., Schneider, A., Cyrys, J., Wolf, K., Meisinger, C., Heier, M., ... & Breitner, S.
(2020). Hourly Exposure to Ultrafine Particle Metrics and the Onset of Myocardial
Infarction in Augsburg, Germany. Environmental Health Perspectives, 128(1), 017003.
Clark, C., Sbihi, H., Tamburic, L., Brauer, M., Frank, L. D., & Davies, H. W. (2017).
Association of long-term exposure to transportation noise and traffic-related air pollution
with the incidence of diabetes: a prospective cohort study. Environmental health
perspectives, 125(8), 087025.
Du, Y., Xu, X., Chu, M., Guo, Y., & Wang, J. (2016). Air particulate matter and
cardiovascular disease: the epidemiological, biomedical and clinical evidence. Journal of
thoracic disease, 8(1), E8.
Fischer, P. H., Marra, M., Ameling, C. B., Velders, G. J., Hoogerbrugge, R., de Vries, W., ...
& Houthuijs, D. (2020). Particulate air pollution from different sources and mortality in
7.5 million adults—The Dutch Environmental Longitudinal Study (DUELS). Science of
The Total Environment, 705, 135778.
Ghorani-Azam, A., Riahi-Zanjani, B., & Balali-Mood, M. (2016). Effects of air pollution on
human health and practical measures for prevention in Iran. Journal of research in
medical sciences: the official journal of Isfahan University of Medical Sciences, 21.
Kim, I. S., Yang, P. S., Lee, J., Yu, H. T., Kim, T. H., Uhm, J. S., ... & Joung, B. (2019).
Long-term exposure of fine particulate matter air pollution and incident atrial fibrillation
in the general population: a nationwide cohort study. International journal of
cardiology, 283, 178-183.

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Li, X., Yang, H., Sun, H., Lu, R., Zhang, C., Gao, N., ... & Wu, J. (2017). Taurine
ameliorates particulate matter-induced emphysema by switching on mitochondrial NADH
dehydrogenase genes. Proceedings of the National Academy of Sciences, 114(45), E9655-
E9664.
World Health Organization (2020). Ambient Air Pollution: Health Impacts. World Health
Organization. Retrieved from-
https://www.who.int/airpollution/ambient/health-impacts/en/ [Accessed on 10th April
2020]

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