SynthesisEnvironmental health : a global access science source2020
Synergistic health effects of air pollution, temperature, and pollen exposure: a systematic review of epidemiological evidence.
Synthesis in Environmental health : a global access science source, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
90 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- The public health co-benefits of strategies consistent with net-zero emissions: a systematic review.The Lancet. Planetary health · 2025Pooled it
- Modification of heat-related effects on mortality by air pollution concentration, at small-area level, in the Attica prefecture, Greece.Environmental health : a global access science source · 2024Pooled it
- Joint effect of heat and air pollution on mortality in 620 cities of 36 countries.Environment international · 2023Pooled it
- Global Health Impacts for Economic Models of Climate Change: A Systematic Review and Meta-Analysis.Annals of the American Thoracic Society · 2022Pooled it
- Suicide and Associations with Air Pollution and Ambient Temperature: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2021Pooled it
- Concentration-dependent increase in symptoms due to diesel exhaust in a controlled human exposure study.Particle and fibre toxicology · 2022Trial
- Rising global population coexposure to heatwaves and landscape fire-sourced air pollution.Science advances · 2026Article
- Non optimal temperatures and chronic cardiovascular diseases.Seminars in immunopathology · 2026Review
- Article
- AI-Assisted Literature Mining Reveals Spatiotemporal Heterogeneity and Progression Trajectories of Traditional Chinese Medicine Syndromes in Coronary Heart Disease in China.Journal of evidence-based medicine · 2026Article
- Multi-Tree Model for Precision Environmental Health with Longitudinally Assessed Mixture Exposure.Journal of the Royal Statistical Society. Series C, Applied statistics · 2026Article
- Attributing heatwave mortality to human-induced climate change in Greece: a case-crossover and attribution analysis for 2000-2019.Environmental health : a global access science source · 2026Article
- Spatial Heterogeneity in Synergistic Effects of Extreme Heat and NO 2 Exposures on Cardiorespiratory Hospitalizations in California.Epidemiology (Cambridge, Mass.) · 2026Article
- Joint Associations of Outdoor Nitrogen Dioxide and Temperature with Incident Adult-Onset Asthma in the United States.medRxiv : the preprint server for health sciences · 2026Article
- Article
- Article
- Excess risk of heat-related hospitalization associated with temperature and PMEnvironmental epidemiology (Philadelphia, Pa.) · 2026Article
- Ambient temperature exposure on inflammatory blood proteins-A longitudinal self-sampling survey in young Swedish adults.iScience · 2026Article
- Development and two-city validation of a Temperature-Sensitive Air Quality Health Index incorporating synergistic effects of air pollution and thermal stress.Frontiers in public health · 2026Article
- Aggravated Risks of Emergency Hospitalizations Associated with Temperature amid Elevated Ambient Air Pollution: Evidence from a 20-Year Time-Series Study in Hong Kong.Environmental science & technology · 2025Article
30 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundExposure to heat, air pollution, and pollen are associated with health outcomes, including cardiovascular and respiratory disease. Studies assessing the health impacts of climate change have considered increased exposure to these risk factors separately, though they may be increasing simultaneously for some populations and may act synergistically on health. Our objective is to systematically review epidemiological evidence for interactive effects of multiple exposures to heat, air pollution, and pollen on human health.
methodsWe systematically searched electronic literature databases (last search, April 29, 2019) for studies reporting quantitative measurements of associations between at least two of the exposures and mortality from any cause and cardiovascular and respiratory morbidity and mortality specifically. Following the Navigation Guide systematic review methodology, we evaluated the risk of bias of individual studies and the overall quality and strength of evidence.
resultsWe found 56 studies that met the inclusion criteria. Of these, six measured air pollution, heat, and pollen; 39 measured air pollution and heat; 10 measured air pollution and pollen; and one measured heat and pollen. Nearly all studies were at risk of bias from exposure assessment error. However, consistent exposure-response across studies led us to conclude that there is overall moderate quality and sufficient evidence for synergistic effects of heat and air pollution. We concluded that there is overall low quality and limited evidence for synergistic effects from simultaneous exposure to (1) air pollution, pollen, and heat; and (2) air pollution and pollen. With only one study, we were unable to assess the evidence for synergistic effects of heat and pollen.
conclusionsIf synergistic effects between heat and air pollution are confirmed with additional research, the health impacts from climate change-driven increases in air pollution and heat exposure may be larger than previously estimated in studies that consider these risk factors individually.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.