Association between air pollution, multimorbidity and polypharmacy: a systematic review and meta-analysis.

Authors

Hanbin Zhang, Abiola Rodemade, Siyu Wang, Xinyi Zhang, Shawn Y Lee, Dimitris Evangelopoulos, Maoyi Tian, Zixuan Wang

Published in

BMJ public health. Volume 4. Issue 3. Pages e004782. Epub Sep 03, 2026.

Abstract

To comprehensively examine the existing literature investigating the association between air pollution exposure and multimorbidity and/or polypharmacy.
Systematic review and meta-analysis.
PubMed, Web of Science, EMBASE and the Cochrane Library.
Observational studies assessed the association between air pollution and the risk of multimorbidity and/or polypharmacy among the general population were searched. Only full-text original human studies written in English up to 1 April 2026 were included.
Data was extracted using a standardised data extraction template and analysed using Stata SE V.19. Estimates were pooled using a random effects model, with the I ² statistic used to estimate heterogeneity of results (PROSPERO registration: CRD42024613048).
In total, 22 studies met the inclusion criteria in our systematic review and 21 of 22 were included for meta-analysis. After excluding incompatible effect estimates (increment other than per 5 µg/m³, 10 µg/m³ or IQR increase) and studies using overlapping datasets, four, three, two and four were included in the main meta-analysis, respectively, with a pooled adjusted risk ratio (aRR) of 1.15 (95% CI 1.08 to 1.23; I ² =93.0%) per 5 µg/m³ particulate matter (PM)_2.5 increase, a pooled aRR of 1.27 (95% CI 1.11 to 1.47; I ² =99.5%) per 5 µg/m³ PM₁₀ increase, a pooled aRR of 1.07 (95% CI 1.05 to 1.09; I ² =0.0%) per 5 µg/m³ PM₁ increase and a pooled aRR of 1.12 (95% CI 1.00 to 1.26; I ² =96.6%) per 5 µg/m³ nitrogen dioxide (NO₂) increase. There was no evidence of associations between other air pollutants (nitrogen oxides (N=3), black carbon (N=1), sulphur dioxide (N=3), ozone (N=4), carbon monoxide (N=3)) and multimorbidity. No eligible studies on polypharmacy, indoor air pollution, older adults, American and Oceanian populations were identified.
Long-term exposure to ambient PM_2.5 and NO₂ may elevate the risk of multimorbidity. Future research should prioritise household air pollution, rural areas, older populations as a target group, continents other than Europe and Asia and polypharmacy.

PMID:
42707885
Bibliographic data and abstract were imported from PubMed on 08 Sep 2026.

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