Effects Of Ambient Air Pollution Research Articles

Association between ambient air pollutants and influenza – A systematic review and meta-analysis

• BACKGROUND AND AIM There is emerging evidence that ambient air pollution exposure is not linked solely to chronic diseases but might also impact incidence and mortality of infectious diseases. The aim of this systematic review and meta-analysis was to examine the association between exposure to ambient air pollutants and risk of influenza/influenza like illness (ILI) and associated infection, morbidity and mortality. • METHODS We conducted a systematic literature search and subsequently performed a random-effects meta-analysis using the Knapp-Hartung method with a restricted maximum likelihood (REML) estimator if at least four studies with similar outcome and exposure were available. We converted the estimates for each outcome into standardized increments for a 10 µg/m³ increase in air pollutant. Heterogeneity was assessed using I² and Cochranes Q. The study was registered at PROSPERO (CRD42020199906). An update including literature up to February 2022 is currently being prepared. • RESULTS The literature search from 01.01.1980 to 27.10.2020 yielded 233 studies from PubMed and Web of Science and one study from the preprint server MedRxiv. In total, 10 articles were reviewed in-depth and risk of bias assessed. For short-term studies, small positive associations were seen for a 10 µg/m³ increase in PM₂.₅ for influenza incidence [relative risk: 1.02, 95%confidence interval: 1.01; 1.03]. The search yielded only two studies for hospital admission and no long-term studies or studies on mortality. • CONCLUSIONS Our analysis indicates that ambient air pollution can exacerbate influenza infections. Lowering the current EU standards for PM₂.₅ will reduce the adverse effects of ambient air pollution for chronic as well as infectious diseases. The results for influenza might also give some implications of possible associations for ambient air pollution with other respiratory virus diseases including SARS-CoV-2. • KEYWORDS Influenza, influenza-like illness, meta-analysis, ambient air pollution, PM₂.₅

Acute effects of ambient air pollution on asthma emergency department visits in 10 US states

Background: Ambient air pollution is a major risk factor for increased asthma morbidity. However, previous short-term health effect studies in the US have been limited to a small number of cities or pollutants. Objectives: This study examined acute age-specific effects of exposure to particulate matter (PM2.5, PM10), major PM2.5 components (elemental carbon [EC], organic carbon [OC], nitrate, sulfate), and gaseous pollutants (O3, NOx/NO2, SO2, CO) on emergency department (ED) visits for asthma during 2005-2014 in 10 US states (Arizona, California, Georgia, Maryland, Missouri, Nevada, New Jersey, New York, North Carolina, and Utah). Methods: We used quasi-Poisson log-linear time-series models with unconstrained distributed lags to estimate acute (8-day) effects of air pollution exposure on asthma ED visits at agency monitoring sites, controlling for meteorology, time, and influenza ED visits. We used a Bayesian hierarchical model to combine site-specific associations. We also conducted age-stratified analyses (aged 1-4, 5-17, 18-49, 50-64, and 65+). Results: We observed positive associations between 8-day exposure to particulate matter (e.g., PM2.5: rate ratio [RR] = 1.016, 95% confidence internal [CI] = [1.008, 1.025] per 6.21 μg/m³ increase), major PM2.5 components (e.g., EC: RR of 1.010 [1.002, 1.018] per 0.52 μg/m³), and gaseous pollutants (e.g., O3: RR of 1.048 [1.026, 1.070] per 0.02 ppm). Associations of traffic-related pollutants (NOx, CO, EC, and OC) were generally weaker for same day (lag 0) exposures than for exposures at longer lags before the ED visit; in contrast, PM and O3 showed strongest effects at lag day 0. Total and carbonaceous PM had more pronounced associations within younger age groups (aged 17 and below) than older age groups. Conclusions: This study reports associations between short-term air pollution exposure and increased risks of asthma ED visits. We found that short-term particular matter exposure posed a higher risk on children and adolescents than on adults.

Ambient air pollutants and pulmonary function in children after COVID-19 pandemic

BACKGROUND AND AIM: The acute effects of air pollutants on pulmonary function remain unclear. After COVID-19 spreads, fear drives patients away from hospitals. Smartphone applications may help asthma care. This study investigated the acute effects of ambient air pollution on pulmonary function among asthma in children by smartphone applications. METHODS: We designed a smartphone app to provide timely support for patients with asthma. Peak expiratory flow (PEF) recordings were made twice daily and was corrected by age and gender. The severity of asthma by GINA guideline and asthma control test (ACT) test score were also monitored. Ambient air pollution parameters of particulate matter (PM), ozone(O3), oxides of nitrogen (NO2),carbon monoxide (CO), and sulfur dioxide (SO2) were measured from each nearby air monitoring station at each time while PEF recordings by linking to Global Positioning System. Allergen-specific IgE were also measured by MAST. Effects of exposure to pollutants on PEF were assessed in person-days of observations by GEE model. RESULTS: In lag 0 (the same day), PM10, NO2, CO, and SO2 were negatively correlated with PEF (p=0.030, 0.031, 0.008, 0.017). In lag1 (one day before), NO2, CO, and SO2 were found to be correlated PEF (p=0.005, 0.010, 0.025). In lag2, PM2.5, PM10, NO2, and SO2 were associated with PEF (p=0.031, 0.023, 0.031, 0.005). Analyses stratified by mite allergen sensitization revealed that PM10, NO2, CO, and SO2 air pollutant levels negatively correlated with PEF only in mite sensitization children. CONCLUSIONS: Exposure to air pollutants can lead to acute effects on the pulmonary function in children with asthma. Pollutants may reduce lung function and have different effects over time. Mite sensitization might modify the effect of air pollutant exposures on lung function on asthma. Smartphone applications are readily available tools to help individual air monitoring and asthma care after COVID-19 pandemic.

The effect of ambient air pollution and wildfire smoke on emergency department visits for persons experiencing homelessness in San Diego, California

Background: Homelessness may increase vulnerability to the adverse health effects of air pollution. San Diego (SD) was the urban center with the fifth largest number of people experiencing homelessness in the United States. This study aims to determine the effect of wildfire-specific PM2.5 and PM2.5 from other sources on emergency department (ED) visits for individuals experiencing homelessness in SD. Methods: A unique dataset with granularity on socio-demographics of ED visits from 2012 to 2020 was utilized. A validated ensemble model combining machine learning algorithms and spatio-temporal imputation technique was applied to isolate daily wildfire-specific PM2.5. A weighted daily exposure was estimated based on point-in-time counts of people experiencing homelessness in SD. A time stratified case-crossover design was applied to study the association between wildfire-specific PM2.5 and PM2.5 from other sources and ED visits for respiratory diagnoses, adjusting for specific humidity, wind speed and maximum temperature. Results: While representing less than 0.3% of SD County, over 10% of the 33,446 ED patients admitted for respiratory disease to a single health system were experiencing homelessness at the time of admission. For housed patients, an effect was observed for every 10g/m3 increase in non-wildfire PM2.5 [OR:1.14, 95%CI: 1.03,1.27] with weaker imprecise estimates for wildfire-PM2.5 [OR:1.02, 95%CI: 0.9,1.17]. In contrast, no strong evidence was found for non-wildfire PM2.5 on ED visits of people experiencing homelessness [OR:0.94, 95%CI: 0.69,1.29], while wildfire-specific PM2.5 had stronger albeit imprecise impacts [OR:1.22, 95%CI: 0.92,1.61]. Conclusions: As the intensity of wildfires rises, understanding risks for vulnerable populations such as those experiencing homelessness is critical in developing effective mitigation strategies. As the first epidemiological study to quantify effects of PM2.5 on this population, we hope to pave the way for future research to understand their risks in the context of climate and social change. Keywords: Wildfire smoke; homelessness; PM2.5; time-stratified case-crossover

Effects of Ambient Air Pollutants on Cardiac Structure and Function in ECHO-SOL

Effects of Ambient Air Pollutants on Cardiac Structure and Function in ECHO-SOL

The Interactive Effects of Ambient Air Pollution and Residential Greenness on Overweight and Obesity in Older Adults: Findings from the Chinese Longitudinal Healthy Longevity Survey

The Interactive Effects of Ambient Air Pollution and Residential Greenness on Overweight and Obesity in Older Adults: Findings from the Chinese Longitudinal Healthy Longevity Survey

Interactive effects of ambient air pollution and sunshine duration on the risk of intrahepatic cholestasis of pregnancy

IntroductionWhile the associations among ambient pollutants and various pregnancy complications are well documented, the effect of ambient pollutants on intrahepatic cholestasis of pregnancy (ICP) has not been examined. This study aimed to explore the effects of ambient pollutants and sunshine duration on ICP. MethodsThe study enrolled 169,971 pregnant women who delivered between 2015 and 2020 in two hospitals. The associations between ICP and exposure to ambient pollutants and sunshine duration, averaged throughout different periods (including the 3 months before conception, 1st trimester and 2nd trimester), were estimated using a generalized linear model. The interaction effects of ambient pollutants and sunshine duration on ICP were estimated. ResultsThe fitted curves for ICP incidence were similar to the temporal trends of PM2.5, PM10, SO2, CO and NO2 but not that of O3. The risk of ICP was significantly elevated following a 10-μg/m3 increase in PM2.5 (aOR [adjusted odds ratio] = 1.057, 95% CI [confidence interval]: 1.017–1.099) and PM10 (aOR = 1.043, 95% CI: 1.013–1.074) and a 1-h decrease in sunshine duration (aOR = 1.039, 95% CI: 1.011–1.068) during the 3 months before conception. In the second trimester, a 1-μg/m3 increase in the concentration of SO2 was associated with an increased risk of ICP (aOR = 1.011, 95% CI: 1.001–1.021). Increased concentrations of PM2.5 and PM10 had interactive effects with reduced sunshine duration during the 3 months before conception on increasing the risk of ICP. ConclusionsExposure to PM2.5 and PM10 during the 3 months before conception and exposure to SO2 in the second trimester were associated with an increased ICP risk. Reduced sunshine duration had an interactive effect with increased concentrations of PM2.5 and PM10 during the 3 months before conception on the occurrence of ICP.

Synergistic Effects between Ambient Air Pollution and Second-Hand Smoke on Inflammatory Skin Diseases in Chinese Adolescents.

Atopic dermatitis (AD), chronic hand eczema (CHE), and urticaria are common inflammatory skin diseases among adolescents and associated with air quality. However, the synergistic effects of ambient air pollution and second-hand smoke (SHS) have been unclear. We conducted a cross-sectional study including 20,138 Chinese college students where dermatological examinations and a questionnaire survey were carried out. A generalized linear mixed model was applied for the association between individualized exposure of O3, CO, NO2, SO2, PM2.5, and PM10 and the prevalence of inflammatory skin diseases. Interactions between air pollutants and SHS were analyzed. As a result, CO, NO2, SO2, PM2.5, and PM10 were positively correlated with the prevalence of AD, CHE, and urticaria. Higher frequency of SHS exposure contributed to increased probabilities of AD (p = 0.042), CHE (p < 0.001), and urticaria (p = 0.002). Of note, CO (OR: 2.57 (1.16–5.69) in third quartile) and NO2 (OR: 2.38 (1.07–5.27) in third quartile) had positive interactions with SHS for AD, and PM2.5 synergized with SHS for CHE (OR: 2.25 (1.22–4.15) for second quartile). Subgroup analyses agreed with the synergistic results. In conclusion, SHS and ambient air pollution are both associated with inflammatory skin diseases, and they have a synergistic effect on the prevalence of AD and CHE.

Long-term effects of ambient air pollution on lung cancer and COPD mortalities in China: A systematic review and meta-analysis of cohort studies

The long-term effects of ambient air pollution on lung cancer (LC) and chronic obstructive pulmonary disease (COPD) mortalities in the more polluted regions in the world require a comprehensive analysis. In this study, a systematic literature search and meta-analysis using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline were conducted to examine the association between long-term exposure to ambient air pollution for the LC and COPD mortalities in China. Two databases (PubMed and Scopus) were systematically searched and a total of eight research papers were finally included in this study with the risk of bias assessed by Newcastle-Ottawa Scale (NOS). A total of 409,945 participants were included in the analysis based on four individual Chinese cohorts during the follow-up periods between 1991 and 2011. The pooled risk ratios for LC and COPD mortalities were 1.08 (95% CI: 1.02–1.16) and 1.12 (95% CI: 1.11–1.13), respectively, for each 10 μg/m3 increase in the concentrations of PM2.5. Furthermore, the results of the meta-analysis were examined using a case study in the Yangtze River Delta region in 2015. A comparison of the estimated LC and COPD mortality risks between the current study and the previous relative risk model demonstrated that the result of cohort studies could provide more accurate relative risk values and estimated mortalities for the population in China. Although only limited cohort studies have been conducted in China, they provide significant evidence of the long-term effects of ambient air pollution on LC and COPD mortalities in the population of the more polluted regions. It is also recommended to develop a more suitable relative risk model using the results of meta-analysis for the estimation of air pollution-related mortality in the more polluted regions.

Ambient air pollution, lifestyle, and genetic predisposition associated with type 2 diabetes: findings from a national prospective cohort study

BackgroundThe combined effects of ambient air pollution, lifestyle, and genetic predisposition on incident Type 2 Diabetes (T2D) have not been well documented. MethodsA total of 263,733 participants without T2D at baseline were identified from the UK Biobank. Annual concentrations of five air pollutants were estimated using Land Use Regression, while a healthy lifestyle score (HLS) was constructed using 7 major lifestyle factors, and polygenic risk score (PRS) was generated using 73 genetic variants. Cox regression was used to determine the association between air pollution and incident T2D for different HLS/PRS categories. Potential HLS/PRS interactions and population attributable fraction (PAF) were also examined. ResultsDuring a median follow-up of 11.94 years, 7827 (2.97 %) incident T2D cases were identified. Association between air pollution and incident T2D was stronger among those with higher HLS/PRS in a dose-response fashion. In addition, synergistic interactions between lifestyles and air pollution were observed. Lifestyle was the leading risk factor of T2D with a weighted PAF of 25.54 % (95 % CI: 19.22 %, 27.77 %) for intermediate HLS and 24.24 % (18.24 %, 26.36 %) due to unhealthy HLS. Overall, we estimated that about 25 % of T2D cases could be attributable to air pollution and associated interactions. ConclusionsAssociations between air pollution and T2D were stronger among individuals with unhealthier lifestyle on an additive interaction scale. Public health interventions that address both reduction of exposure to high levels of air pollution in addition to lifestyle changes may have more benefit on reducing T2D risk than focusing on lifestyle changes alone.

The diverse life-course cohort (DLCC): protocol of a large-scale prospective study in China

The Diverse Life-Course Cohort (DLCC) is a large-scale prospective study including around 130,000 participants in mainland China. The primary aims of DLCC include contributing to knowledge on noncommunicable chronic disease determinants, particularly cardiometabolic diseases, and exploring the long-term effect of ambient air pollutants or other environmental risk factors on health among all-age populations. The cohort consists of several sub-populations that cover the whole life-course and diverse resources: from premarital to adolescents, adults from workplace and communities ranged from 18 to 93 years old. Baseline assessment (2017–2021) included face-to-face standardized questionnaire interview and measurements to assess social and biological factors of health. Blood samples were collected from each participant (except for children younger than 6) to establish the biobank. DLCC consists of two visits. Visit 1 was conducted from 2017, and 114850 individuals from one of the world-class urban agglomerations: Beijing, Tianjin, and Hebei area were recruited. By the end of 2021, at least one follow-up was carried out, with an overall follow-up rate of 92.33%. In 2021, we initiated Visit 2, newly recruited 9,866 adults from Guangdong province (South China) and Hebei province (Central China), with research focuses on the comparations on ambient pollution hazards and other unique dietary or environmental risks for health. The baseline survey of Visit 2 was finished in July 2021. DLCC is still ongoing with a long-term follow-up design, and not limited by the current funding period. With reliable data and the well-established biobank which consists of over 120,000 individuals’ blood samples, DLCC will provide invaluable resources for scientific research.

Short-Term Effects of Ambient Air Pollutants on Outpatient Visits for Childhood Allergic Diseases in Shanghai, China

Short-Term Effects of Ambient Air Pollutants on Outpatient Visits for Childhood Allergic Diseases in Shanghai, China

Effect of ambient air pollution and meteorological factors on the potential transmission of COVID-19 in Turkey

There is a need to improve the understanding of air quality parameters and meteorological conditions on the transmission of SARS-CoV-2 in different regions of the world. In this preliminary study, we explore the relationship between short-term air quality (nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and particulate matter (PM2.5, PM10)) exposure, temperature, humidity, and wind speed on SARS-CoV-2 transmission in 41 cities of Turkey with reported weekly cases from February 8 to April 2, 2021. Both linear and non-linear relationships were explored. The nonlinear association between weekly confirmed cases and short-term exposure to predictor factors was investigated using a generalized additive model (GAM).The preliminary results indicate that there was a significant association between humidity and weekly confirmed COVID-19 cases. The cooler temperatures had a positive correlation with the occurrence of new confirmed cases. The low PM2.5 concentrations had a negative correlation with the number of new cases, while reducing SO2 concentrations may help decrease the number of new cases. This is the first study investigating the relationship between measured air pollutants, meteorological factors, and the number of weekly confirmed COVID-19 cases across Turkey. There are several limitations of the presented study, however, the preliminary results show that there is a need to understand the impacts of regional air quality parameters and meteorological factors on the transmission of the virus.

Ambient Air Pollution Associated with Body Fat Percentages at Different Body Compartments: A Cohort Study of UK Biobank Participants.

Ambient Air Pollution Associated with Body Fat Percentages at Different Body Compartments: A Cohort Study of UK Biobank Participants.

Effects of ambient air pollution on glycosylated hemoglobin: a systematic review and meta-analysis.

Air pollution is one of the biggest environmental health problems in the world; accumulative studies have shown that air pollution was closely related to metabolism disorders. HbA1c is a stable indicator for blood glucose level monitoring. However, studies on the impact of ambient air pollution on HbA1c have inconsistent conclusions. The objective of the study is to explore the influence of ambient air pollution on HbA1c. By searching keywords, a systematic literature retrieval was carried out on PubMed, Cochrane Library, Web of Science, and Embase databases up to April 2022. Pooled percentage change (%-change) and 95% confidence intervals (95% CI) were estimated using random effect models for particulate matter (PM) and nitrogen dioxide (NO2). A subgroup analysis of body mass index (BMI), study region, exposure period, sample size, sensitivity analysis, and publication bias detection was also performed. There were 8, 12, and 6 studies included in this meta-analysis to explore the association between PM10, PM2.5, NO2, and HbA1c, respectively. The results showed that for every increase of 10μg/m3 in PM10, PM2.5, and NO2, the %-changes in HbA1c were 0.13%, 0.814%, and 0.02%, respectively. The subgroup analysis showed that exposure period, sample size, and BMI were associated with HbA1c in response to air pollution. PM10, PM2.5, and NO2 exposure were significantly associated with increased HbA1c levels.

Effects of ambient air pollution, fresh fruit and vegetable intakes as well as maternal psychosocial stress on the outcome of newborn otoacoustic emission hearing screening

BackgroundNewborn hearing screening results indicated that more than 40% of the detected infants had no recognized risk factors. To determine whether maternal exposure to ambient air pollutants and experience of stressful life event, as well as lack of fresh fruit and vegetable during pregnancy are associated with the abnormal hearing development among newborns.MethodsA total of 1193 newborns and their mothers were recruited in this study. Personal information and covariates were collected by face to face interview. Medical examination results of newborns and their mothers were extracted from medical record. We estimated personal air pollutant exposure level through inverse distance weighted method based on data from air quality monitoring stations and assessed the auditory development of newborns via distortion product otoacoustic emission (DPOAE). Unconditional logistic regression model was used to estimate the relationship between DPOAE screening result and the potential influential factors as well as the combined effect.ResultsThe results indicated that PM10 exposure during the second trimester and stressful life event during the third trimester could increase the risk of not passing DPOAE test among newborns. However, frequent intakes of fruit and vegetable significantly reduced the risk. There was a synergetic interaction between PM10 exposure and stressful life event on neonatal hearing development.ConclusionsTo alleviate abnormal auditory development among fetus, pregnant woman should decrease the exposures to ambient air pollutant and negative life event and at the same time, intake sufficient fresh fruit and vegetable.

Combining multiple regression and principal component analysis to evaluate the effects of ambient air pollution on children’s respiratory diseases

Combining multiple regression and principal component analysis to evaluate the effects of ambient air pollution on children’s respiratory diseases

Association between ambient air pollution and daily hospital visits for cardiovascular diseases in Wuhan, China: a time-series analysis based on medical insurance data

ABSTRACT Although evidence showed the adverse effects of air pollution on cardiovascular disease (CVDs), few studies were based on medically insured populations. We applied a generalized additive Poisson model (GAM) to estimate the short-term effects of ambient air pollution on a group of medically insured population in Wuhan, China. We extracted daily air pollution data, meteorological data, and daily hospital visits for CVDs. We found that the ambient air pollutants sulfur dioxide (SO2), nitrogen dioxide (NO2), ground-level ozone (O3) particulate matter (PM) with an aerodynamic diameter ≤10 μm (PM10), and those ≤2.5 μm (PM2.5) all increased the risk of daily hospital visits for CVDs. We also found that the effect of air pollution on daily hospital visits for CVDs is greater in the cold season than in the warm season. Our findings can be used as evidence that supports the formulation of policies for air pollution and CVDs.

Effects of sulfur dioxide, ozone, and ambient air pollution on lung histopathology, oxidative-stress biomarkers, and apoptosis-related gene expressions in rats

Purpose of the Study Ambient air pollution (AAP) has become an important health problem globally. Besides, several pieces of evidence indicate that air pollutants such as sulfur dioxide (SO2) and ozone (O3) are major contributors to a wide range of non-communicable diseases. The present study investigated the effects of AAP, sulfur dioxide, and ozone on oxidative stress, histopathology, and some apoptosis-related genes expressions of lung tissue in a rat model. Materials and Methods Thirty-two Wistar rats were randomly divided into the control, AAP, sulfur dioxide (10 ppm), and ozone (0.6 ppm) groups. After five consecutive weeks’ exposure to the selected pollutants (3 h/day), lung tissues were harvested and immediately fixed with formalin. The samples were routinely processed, sectioned, stained with hematoxylin and eosin (H&E), and finally assessed for presence of pathological changes. Expression changes of BAX, p-53, EGFR, caspase-3, caspase-8 and caspase-9 were assayed using the RT-qPCR method. One hundred milligrams of lung tissues were extracted and the supernatants were used for assaying malondialdehyde (MDA), total antioxidant capacity (TAC), superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase activities. Results GPx activity was increased in the ozone (P = 0.05) and AAP (P < 0.001) groups and also MDA level in sulfur dioxide group (P = 0.008). Pathological lesions were mild, moderate, and severe in the sulfur dioxide, ozone, and AAP groups, respectively, as compared to control group (P ˂ 0.05). Exposure to AAP and sulfur dioxide enhanced BAX (P = 0.002) and caspase-8 (P < 0.001) mRNA expression, respectively. Caspases-3 and −8 mRNA expressions were elevated in ozone group (P < 0.001). Conclusions The results indicated induction of oxidative stress. Our results suggest the apoptosis stimuli effect of AAP and also the extrinsic apoptotic pathway trigger effect of sulfur dioxide and ozone in the lung tissue in the concentrations used in the present study. The histopathological and the genes expression changes may be a result of the induced oxidative stress in the lung tissues.

Ambient air pollution and cardiovascular diseases: An umbrella review of systematic reviews and meta-analyses.

The available evidence on the effects of ambient air pollution on cardiovascular diseases (CVDs) has increased substantially. In this umbrella review, we summarized the current epidemiological evidence from systematic reviews and meta‐analyses linking ambient air pollution and CVDs, with a focus on geographical differences and vulnerable subpopulations. We performed a search strategy through multiple databases including articles between 2010 and 31 January 2021. We performed a quality assessment and evaluated the strength of evidence. Of the 56 included reviews, the most studied outcomes were stroke (22 reviews), all‐cause CVD mortality, and morbidity (19). The strongest evidence was found between higher short‐ and long‐term ambient air pollution exposure and all‐cause CVD mortality and morbidity, stroke, blood pressure, and ischemic heart diseases (IHD). Short‐term exposures to particulate matter <2.5 μm (PM2.5), <10 μm (PM10), and nitrogen oxides (NO x ) were consistently associated with increased risks of hypertension and triggering of myocardial infarction (MI), and stroke (fatal and nonfatal). Long‐term exposures of PM2.5 were largely associated with increased risk of atherosclerosis, incident MI, hypertension, and incident stroke and stroke mortality. Few reviews evaluated other CVD outcomes including arrhythmias, atrial fibrillation, or heart failure but they generally reported positive statistical associations. Stronger associations were found in Asian countries and vulnerable subpopulations, especially among the elderly, cardiac patients, and people with higher weight status. Consistent with experimental data, this comprehensive umbrella review found strong evidence that higher levels of ambient air pollution increase the risk of CVDs, especially all‐cause CVD mortality, stroke, and IHD. These results emphasize the importance of reducing the alarming levels of air pollution across the globe, especially in Asia, and among vulnerable subpopulations.