Sex/Gender Differences in Cardiovascular Mortality Associated with Environmental Stressors: Systematic Review and Meta-Analysis

摘要

Epidemiological studies of environmental stressors associated with cardiovascular health often show different effect estimates for males and females, but results are far from being consistent. Furthermore, there is a need to disentangle whether this modification is attributable to the biological sex, to gender including social role or cultural norms or an interplay of both. Our objective is to evaluate the current state of integrating sex/gender into environmental epidemiology and to quantify the sex/gender specific effects of ambient air pollution, air temperature and noise on cardiovascular mortality. We conducted a systematic literature search using the electronic databases PubMed and Web of Science (WOS). Publications in English or German between 2000 and 2017 which provide sex/gender specific effect estimates for short- and long-term associations between particulate matter with a diameter <2.5μm (PM2.5) and <10μm (PM10), nitrogen dioxide (NO2), ozone, air temperature as well as noise and cardiovascular mortality were screened. We will assess studies' integration of sex and gender with regard to conceptualization and operationalization of sex/gender, reporting of male and female specific baseline characteristics, exposure and health data as well as discussion of sex/gender specific results. After study quality rating sex/gender specific effects will be quantified by applying meta-analytic tools. Of 660 and 394 identified articles in PubMed and WOS, respectively, 76 studies met our inclusion criteria. Most studies dealt with PM2.5 (N=29), followed by PM10 (26), NO2 (26), air temperature (25) and Ozone (10). Only one study was found regarding noise. Preliminary results show that studies generally used a dichotomous category "male/female", lacked a clear conceptualization and therefore missed a gainful discussion of results. In the next steps we will continue with the extraction of necessary information and preparation of meta-analysis where possible.