{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:17:20Z","timestamp":1788445040921,"version":"build-2803163510"},"reference-count":75,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"unspecified","delay-in-days":64,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,7,23]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"\n Objectives<\/jats:title>\n To comprehensively examine the existing literature investigating the association between air pollution exposure and multimorbidity and\/or polypharmacy.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Systematic review and meta-analysis.<\/jats:p>\n <\/jats:sec>\n \n Data sources<\/jats:title>\n PubMed, Web of Science, EMBASE and the Cochrane Library.<\/jats:p>\n <\/jats:sec>\n \n Eligibility criteria<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Data extraction and synthesis<\/jats:title>\n \n 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\n I<\/jats:italic>\n \n 2<\/jats:italic>\n <\/jats:sup>\n statistic used to estimate heterogeneity of results (PROSPERO registration: CRD42024613048).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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\u2009\u00b5g\/m\n 3<\/jats:sup>\n , 10\u2009\u00b5g\/m\n 3<\/jats:sup>\n 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;\n I<\/jats:italic>\n \n 2<\/jats:italic>\n <\/jats:sup>\n =93.0%) per 5\u2009\u00b5g\/m\u00b3 particulate matter (PM)\n 2.5<\/jats:sub>\n increase, a pooled aRR of 1.27 (95% CI 1.11 to 1.47;\n I<\/jats:italic>\n \n 2<\/jats:italic>\n <\/jats:sup>\n =99.5%) per 5\u2009\u00b5g\/m\u00b3 PM\n 10<\/jats:sub>\n increase, a pooled aRR of 1.07 (95% CI 1.05 to 1.09;\n I<\/jats:italic>\n \n 2<\/jats:italic>\n <\/jats:sup>\n =0.0%) per 5\u2009\u00b5g\/m\u00b3 PM\n 1<\/jats:sub>\n increase and a pooled aRR of 1.12 (95% CI 1.00 to 1.26;\n I<\/jats:italic>\n \n 2<\/jats:italic>\n <\/jats:sup>\n =96.6%) per 5\u2009\u00b5g\/m\u00b3 nitrogen dioxide (NO\n 2<\/jats:sub>\n ) 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Long-term exposure to ambient PM\n 2.5<\/jats:sub>\n and NO\n 2<\/jats:sub>\n 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.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004782","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:50:23Z","timestamp":1788443423000},"page":"e004782","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association between air pollution, multimorbidity and polypharmacy: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2228-7981","authenticated-orcid":false,"given":"Hanbin","family":"Zhang","sequence":"first","affiliation":[{"name":"European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK"},{"name":"Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abiola","family":"Rodemade","sequence":"additional","affiliation":[{"name":"School of Pharmacy, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK"},{"name":"Essex Partnership University NHS Foundation Trust, Wickford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyu","family":"Wang","sequence":"additional","affiliation":[{"name":"European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health, Harbin Medical University, Harbin, China"},{"name":"Division of General Practice, Second Affiliated Hospital of Harbin Medical University, Harbin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn Y","family":"Lee","sequence":"additional","affiliation":[{"name":"Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitris","family":"Evangelopoulos","sequence":"additional","affiliation":[{"name":"Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5660-8571","authenticated-orcid":false,"given":"Maoyi","family":"Tian","sequence":"additional","affiliation":[{"name":"School of Public Health, Harbin Medical University, Harbin, China"},{"name":"Division of General Practice, Second Affiliated Hospital of Harbin Medical University, Harbin, China"},{"name":"Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Harbin, China"},{"name":"National Health Commission Key Laboratory of Etiology and Epidemiology, Harbin Medical University, Harbin, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zixuan","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Pharmacy, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK"},{"name":"Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"2026090306501767000_4.3.e004782.1","unstructured":"World Health Organization . 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