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Sex/gender in the association between ambient air pollution and cardiovascular mortality: Systematic review and meta-analysis.
Ecotoxicol. Environ. Saf. 300:118443 (2025)
When assessing the association between air pollution and cardiovascular mortality, it remains unclear whether females or males are more susceptible and whether and to what extent the pre-existing studies have accounted for different sex/gender dimensions. We searched three databases to identify short-term and long-term studies on the association between air pollution and cardiovascular mortality published 2000-2023 to assess their integration of sex/gender. We further evaluated whether sex/gender was a source of heterogeneity within these through a moderator analysis using random effects models. We examined sex/gender differences through random effects pooling of the female-to-male-ratio (FMR) of each study. We identified 106 studies, all of which operationalised sex/gender in binary terms and lacked a sex/gender-theoretical concept. However, the biological and social dimensions of sex/gender were indirectly included in the discussions. Meta-analyses did not identify sex/gender as a source of heterogeneity (e.g. short-term particulate matter with a diameter <10μm (PM10): p-value of moderator test= 0.85; long-term: 0.34). The pooled FMR showed no sex/gender differences for short-term associations (1.0[CI: 0.0;0.0] for each air pollutant) and a trend towards higher effect estimates for males than females in long-term studies with a pooled FMR ranging from 0.93 to 0.99. Binary categorisation without conceptualisation does not appear to be sufficient to identify vulnerable sex/gender groups, if any, in the association between air pollution and cardiovascular mortality. Considering the multiple biological and sociocultural dimensions of sex/gender from the very beginning of study planning will help to move beyond speculative discussions and derive meaningful action for prevention and health care.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Air Pollution ; Cardiovascular Mortality ; Gender ; Intersectionality ; Meta-analysis ; Sex ; Systematic Review; Long-term Exposure; Fine Particulate Matter; Time-series Analysis; Disease Mortality; Health Research; Million Adults; Gender Bias; Ozone; Intersectionality; Pollutants
ISSN (print) / ISBN
0147-6513
e-ISSN
0147-6513
Quellenangaben
Volume: 300,
Article Number: 118443
Publisher
Elsevier
Publishing Place
525 B St, Ste 1900, San Diego, Ca 92101-4495 Usa
Non-patent literature
Publications
Reviewing status
Peer reviewed
Institute(s)
Institute of Epidemiology (EPI)
Grants
German Federal Ministry of Education and Research