Human exposure risk assessment for infectious diseases due to temperature and air pollution: an overview of reviews

Air pollution and global temperature change are expected to affect infectious diseases. Yet to date overview of systematic reviews assessing the exposure risk of air pollutants and temperature on infectious diseases is unavailable. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature were searched. Systematic reviews and meta-analyses investigated the exposure risk of pollutants or temperature on infectious diseases were included. Two investigators screened literature, extracted data and performed the risk of bias assessments independently. A total of 23 articles met the inclusion criteria, which 3 (13%) were "low" quality and 20 (87%) were "critically low" quality. COVID-19 morbidity was associated with long-term exposure PM 2.5 (RR = 1.056 per 1μg/m 3 , 95% CI: 1.039-1.072) and NO 2 (RR = 1.042 per 1 μg/m 3 , 95% CI: 1.017-1.068). In addition, for each 1°C increase in temperature, the risk of dengue fever morbidity increased 13% (RR = 1.130 per 1°C, 95% CI: 1.120-1.150), infectious diarrhea morbidity increased 8% (RR =1.080 per 1°C, 95% CI: 1.050-1.200), and hand, foot and mouth disease (HFMD) morbidity increased 5% (RR = 1.050 per 1 °C, 95% CI: 1.020-1.080). In conclusion, PM 2.5 and NO 2 increased the risk of COVID-19 and temperatures were associated with dengue, infectious diarrhoea and HFMD morbidity. Moreover, the exposure risk of temperature on COVID-19 need to be further explored.