Supplementary Material for “Characterizing the long-term PM2.5 concentration
response function: Comparing the strengths and weaknesses of alternate research
synthesis approaches” by Neal Fann, Elisabeth Gilmore and Katherine Walker
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
diagram (Supplemental Figure 1) summarizes the steps we followed to identify studies
appropriate for the quantitative meta-analysis. The three sources yielded a total of 107
articles. 101 of these studies specified PM2.5 as the indicator; we excluded six studies
specifying total suspended particulates, sulfate or PM10. Of these 101 studies, 32 reported
the risks of premature all-cause mortality from long-term exposure to PM2.5; the remaining
69 studies assessed impacts other than premature mortality, assessed impacts from shortterm changes in PM2.5 or did not report an all-cause mortality risk estimate. Of the 32
studies, 29 assessed risks among adults; the remaining 3 characterized risks among
children. Many of the 29 remaining studies report risk estimates from a single cohort (e.g.
the ACS). To avoid over-weighting the meta-analysis toward one cohort, we selected the
latest published study of each cohort. Supplemental Table 1 identifies the sets of studies
incorporated into the first and second meta-analyses described above and summarizes
some of the key characteristics including the cohort attributes, geographic scope, follow-up
period, and hazard ratios. In certain cases, we included study results in both meta-analyses
(e.g. for the ACS and H6C cohorts) to ensure that our analysis was as representative of the
literature as possible. However, we also took care to select only one risk estimate from
studies of each cohort, to reduce the risk of over-weighting any given cohort.
Figure S1: PRISMA Diagram
Identification
0 records identified
through literature
Screening
107 records identified
through alternate sources
101 records including PM2.5 as
the air pollution indicator
101 of records screened
69 of records excluded
Eligibility
32 full text articles
assessed for eligibility
3 full text articles excluded
Included
29 studies included in quantitative analysis
11 studies included in quantitative synthesis (meta-analysis)
Table SI: Summary of Studies included in Meta-Analysis
Study
Cohort
(population age)
Study period
Hazard Ratio
(per 10 ug/m3,
95% confidence
Stage of
metaanalysis
interval)
Studies considered in 2006 Expert Elicitation
Dockery et
al. (1993)
Six Cities (age >24)
Enstrom et
11 California counties (>42)
al. (2005)
Jerrett et al.
ACS/Los Angeles (>29)
(2005)
Lipfert et
32 veterans clinics (>48)
al. (2006)
McDonnell
et al.
Adventist California (>26)
(2000)
Pope et al.
ACS/51 cities (>29)
(2002)
Studies published after 2006 Expert Elicitation
Eftim et al.
Medicare/ACS 50 cities
(2008)
Krewski et
al. (2009)A
Lepeule et
al. (2012)
Ostro et al.
(2010)B
Zeger et al.
(2008)
Puett et al.
(2009)
Puett et al.
(2011)
1975-1989
1973-2002
1982-2000
1989-1996
1.13
(1.04—1.23)
1.007
0.991—1.023)
1.11
(0.99—1.25)
1.15
(1.05—1.26)
Stage 1
Stage 1 & 2
Stage 1
Stage 1 & 2
1997-1992
1.09
(0.98—1.2)
Stage 1 & 2
1979-2000
1.06
(1.02—1.11)
Stage 1
2000-2002
1.08
(1.05—1.18)
Stage 2
ACS/151 cities (>29)
1979-2000
Six Cities (>24)
1974-2009
California teachers (>29)
2002-2007
Medicare (>64)
2000-2005
Nurses/11 US states (>54)
1992-2002
Health professionals (40-75)
1986-2010
1.06
(1.04—1.08)
1.14
(1.07—1.22)
1.1
(0.93—1.28)
0.989 to 1.132C
1.26
(1.02—1.54)
0.86
(0.7—1.05)
Stage 2
Stage 2
Stage 2
Stage 2
Stage 2
Stage 2
Selected results from model that accounted for 44 individual and 7 community-level variables
Selected results from erratum
C Range reflects results from Western U.S. (low end) and Eastern U.S. (high end)
A
B
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