Air Pollution Control Legislation and Respiratory Health: A Systematic Review and Meta-analysis
Keywords:
Air Pollution, Legal Services, Legislation as Topic, Public Nondiscrimination Policies, Respiratory System AgentsAbstract
Air pollution is one of the most significant environmental factors threatening public health, associated with an increased incidence of respiratory diseases and premature mortality. The present study aimed to evaluate the effect of air pollution control legislation on respiratory health. The international databases PubMed/Scopus, MEDLINE (Ovid), Cochrane Library, and Embase were searched using keywords aligned with the study objective as of September 2025. Two blinded, independent authors reviewed all articles. STATA/MP.v17 (College Station, Texas, USA) was used to perform the analyses. Fifteen eligible studies were included in the study after reviewing the title, abstract, and full text by independent and blinded researchers. An overall reduction in pollutants was estimated to be 20% (ES 0.20; 95% CI: 0.10-0.31). Meta-regression with a random-effects model revealed a significant inverse relationship (-0.0846, P = 0.032) between air pollution reduction and policy type. The impact of implementing pollution reduction laws on asthma was significant (HR: 0.86, 95% CI: 0.80-0.92). Strengthening legal frameworks, promoting evidence-based policy making, and enforcing regulations can help reduce emissions, thereby improving public health and reducing the burden of air pollution-related diseases.
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1. Kumar R, Gupta P. Air pollution control policies and regulations. Plant responses to air pollution: Springer; 2016. p. 133-49.
2. Valavanidis A. Indoor air pollution causes around 4 million premature deaths worldwide per year. 2023.
3. Fuller R, Landrigan PJ, Balakrishnan K, Bathan G, Bose-O'Reilly S, Brauer M, et al. Pollution and health: a progress update. The Lancet Planetary Health. 2022;6(6):e535-e47. doi: https://doi.org/10.1016/S2542-5196(22)00090-0.
4. Ioannou A, Papadopoulos E, Qaderi M. The Impact of Air Pollution on Chronic Respiratory Diseases. International journal of medical and applied health science. 2025;1(1):14-20.
5. Utami P. Systematic Review: The Impact of Particulate Matter 2.5 (PM2. 5) Exposure on Public Health Around Coal Mines. SEHATMAS: Jurnal Ilmiah Kesehatan Masyarakat. 2025;4(3):938-52. doi: https://doi.org/10.55123/sehatmas.v4i3.6060.
6. Balakrishnan K, Steenland K, Clasen T, Chang H, Johnson M, Pillarisetti A, et al. Exposure–response relationships for personal exposure to fine particulate matter (PM2· 5), carbon monoxide, and black carbon and birthweight: an observational analysis of the multicountry Household Air Pollution Intervention Network (HAPIN) trial. The Lancet Planetary Health. 2023;7(5):e387-e96. doi: https://doi.org/10.1016/S2542-5196(23)00052-9.
7. Krismanuel H, Hairunisa N. The effects of air pollution on respiratory problems: a literature review. Poltekita: Jurnal Ilmu Kesehatan. 2024;18(1):1-15. doi: https://doi.org/10.33860/jik.v18i1.3151.
8. Patel J, Song W. A review of the Health Impacts of Air Pollutants. Authorea Preprints. 2023. doi: https://doi.org/10.22541/au.170379723.34512305/v1.
9. Henning RJ. Particulate matter air pollution is a significant risk factor for cardiovascular disease. Current Problems in Cardiology. 2024;49(1):102094. doi: https://doi.org/10.1016/j.cpcardiol.2023.102094.
10. Feng L, Liao W. Legislation, plans, and policies for prevention and control of air pollution in China: achievements, challenges, and improvements. Journal of Cleaner Production. 2016;112:1549-58. doi: https://doi.org/10.1016/j.jclepro.2015.08.013.
11. Ozymy J, Ozymy MJ. Environmental criminal enforcement and environmental justice in the United States. Handbook on Inequality and the Environment: Edward Elgar Publishing; 2023. p. 365-82.
12. Khanam Z, Sultana FM, Mushtaq F. Environmental pollution control measures and strategies: an overview of recent developments. Geospatial Analytics for Environmental Pollution Modeling: Analysis, Control and Management. 2023:385-414. doi: https://doi.org/10.1007/978-3-031-45300-7_15.
13. Al-Thani HG, Isaifan RJ. Policies and Regulations for Sustainable. Sustainable Strategies for Air Pollution Mitigation: Development, Economics, and Technologies. 2024;133:409. doi: https://doi.org/10.1007/698_2024_1093.
14. Al-Thani HG, Isaifan RJ. Policies and regulations for sustainable clean air: an overview. Sustainable Strategies for Air Pollution Mitigation: Development, Economics, and Technologies. 2024:409-37. doi: https://doi.org/10.1007/698_2024_1093.
15. Charlier D, Legendre B. Fuel poverty in industrialized countries: Definition, measures and policy implications a review. Energy. 2021;236:121557. doi: https://doi.org/10.1016/j.energy.2021.121557.
16. Jonidi Jafari A, Charkhloo E, Pasalari H. Urban air pollution control policies and strategies: a systematic review. Journal of Environmental Health Science and Engineering. 2021;19(2):1911-40. doi: https://doi.org/10.1007/s40201-021-00744-4.
17. Awewomom J, Dzeble F, Takyi YD, Ashie WB, Ettey ENYO, Afua PE, et al. Addressing global environmental pollution using environmental control techniques: a focus on environmental policy and preventive environmental management. Discover Environment. 2024;2(1):8. doi: https://doi.org/10.1007/s44274-024-00033-5.
18. Liu Z, Tang Y, Wilson J, Tao X, Lv B, Wang Z, et al. Influence of government attention on environmental quality: An analysis of 30 provinces in China. Environmental Impact Assessment Review. 2023;100:107084. doi: https://doi.org/10.1016/j.eiar.2023.107084.
19. Organization WH. WHO global air quality guidelines: particulate matter (PM2. 5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide: World Health Organization; 2021.
20. Wang P, Liu D, Mukherjee A, Agrawal M, Zhang H, Agathokleous E, et al. Air pollution governance in China and India: Comparison and implications. Environmental Science & Policy. 2023;142:112-20. doi: https://doi.org/10.1016/j.envsci.2023.02.006.
21. Pai AU. Urban Planning: A Review of Delhi's Draft Master Plan, 2041. Available at SSRN 5315218. 2025. doi: https://doi.org/10.2139/ssrn.5315218.
22. Barton MG, Henderson I, Border JA, Siriwardena G. A review of the impacts of air pollution on terrestrial birds. Science of the total environment. 2023;873:162136. doi: https://doi.org/10.1016/j.scitotenv.2023.162136.
23. Gul H, Das BK. The impacts of air pollution on human health and well-being: A comprehensive review. Journal of Environmental Impact and Management Policy. 2023;36:1-11. doi: https://doi.org/10.55529/jeimp.36.1.11.
24. Li B, Sun Y, Zheng W, Zhang H, Jurasz J, Du T, et al. Evaluating the role of clean heating technologies in rural areas in improving the air quality. Applied Energy. 2021;289:116693. doi: https://doi.org/10.1016/j.apenergy.2021.116693.
25. Taghizadeh F, Mokhtarani B, Rahmanian N. Air pollution in Iran: The current status and potential solutions. Environmental Monitoring and Assessment. 2023;195(6):737. doi: https://doi.org/10.1007/s10661-023-11296-5.
26. Sundaram A. The Enforcement Of Environmental Laws In Developing Countries: Challenges And Opportunities. Library of Progress-Library Science, Information Technology & Computer. 2024;44(3).
27. Tugwell P, Tovey D. PRISMA 2020. Elsevier; 2021. p. A5-A6.
28. Alkhanani MF. Assessing the impact of air quality and socioeconomic conditions on respiratory disease incidence. Tropical Medicine and Infectious Disease. 2025;10(2):56. doi: https://doi.org/10.3390/tropicalmed10020056.
29. Zarate-Gonzalez G, Brown P, Cisneros R. Assessing public support for air pollution mitigation and control policies: health, socioeconomic, and ideological predictors in an overburdened and vulnerable region of the US. BMC Public Health. 2025;25(1):263. doi: https://doi.org/10.1186/s12889-025-21366-7.
30. Chi Y, Zhang Y, Zhang X, Liu B. Potential and health impact assessment of air pollutant emission reduction: a case study of China. Clean Technologies and Environmental Policy. 2025;27(3):1053-66. doi: https://doi.org/10.1007/s10098-024-02880-5.
31. Nie T, Chen J, Ji Y, Lin T, Wang J. Impact of air pollution on respiratory diseases in typical industrial city in the North China Plain. Sustainability. 2023;15(14):11198. doi: https://doi.org/10.3390/su151411198.
32. Zhang Z, Zhang G, Li L. The spatial impact of atmospheric environmental policy on public health based on the mediation effect of air pollution in China. Environmental Science and Pollution Research. 2023;30(55):116584-600. doi: https://doi.org/10.1007/s11356-022-21501-6.
33. Yang J, Zhao Y, Cao J, Nielsen CP. Co-benefits of carbon and pollution control policies on air quality and health till 2030 in China. Environment International. 2021;152:106482. doi: https://doi.org/10.1016/j.envint.2021.106482.
34. Han C, Xu R, Zhang Y, Yu W, Zhang Z, Morawska L, et al. Air pollution control efficacy and health impacts: a global observational study from 2000 to 2016. Environmental Pollution. 2021;287:117211. doi: https://doi.org/10.1016/j.envpol.2021.117211.
35. Jaafari S, Shabani AA, Moeinaddini M, Danehkar A, Sakieh Y. Applying landscape metrics and structural equation modeling to predict the effect of urban green space on air pollution and respiratory mortality in Tehran. Environmental Monitoring and Assessment. 2020;192(7):412. doi: https://doi.org/10.1007/s10661-020-08377-0.
36. Ma Z, Liu R, Liu Y, Bi J. Effects of air pollution control policies on PM< sub> 2.5 pollution improvement in China from 2005 to 2017: a satellite-based perspective. Atmospheric Chemistry and Physics. 2019;19(10):6861-77. doi: https://doi.org/10.5194/acp-19-6861-2019.
37. Croft DP, Zhang W, Lin S, Thurston SW, Hopke PK, Masiol M, et al. The association between respiratory infection and air pollution in the setting of air quality policy and economic change. Annals of the American Thoracic Society. 2019;16(3):321-30. doi: https://doi.org/10.1513/AnnalsATS.201810-691OC.
38. Huang J, Pan X, Guo X, Li G. Health impact of China's Air Pollution Prevention and Control Action Plan: an analysis of national air quality monitoring and mortality data. The Lancet Planetary Health. 2018;2(7):e313-e23. doi: https://doi.org/10.1016/S2542-5196(18)30141-4.
39. Ghorani-Azam A, Riahi-Zanjani B, Balali-Mood M. Effects of air pollution on human health and practical measures for prevention in Iran. Journal of research in medical sciences. 2016;21(1):65. doi: https://doi.org/10.4103/1735-1995.189646.
40. Guan W-J, Zheng X-Y, Chung KF, Zhong N-S. Impact of air pollution on the burden of chronic respiratory diseases in China: time for urgent action. The Lancet. 2016;388(10054):1939-51. doi: https://doi.org/10.1016/S0140-6736(16)31597-5.
41. Chen R, Wang X, Meng X, Hua J, Zhou Z, Chen B, et al. Communicating air pollution-related health risks to the public: An application of the Air Quality Health Index in Shanghai, China. Environment international. 2013;51:168-73. doi: https://doi.org/10.1016/j.envint.2012.11.008.
42. Karakatsani A, Analitis A, Perifanou D, Ayres JG, Harrison RM, Kotronarou A, et al. Particulate matter air pollution and respiratory symptoms in individuals having either asthma or chronic obstructive pulmonary disease: a European multicentre panel study. Environmental Health. 2012;11(1):75. doi: https://doi.org/10.1186/1476-069X-11-75.
43. Hospido L, Sanz C, Villanueva E. Air pollution: a review of its economic effects and policies to mitigate them. Banco de Espana Occasionally Paper. 2023(2301). doi: https://doi.org/10.53479/27332.
44. Guerra E, Reyes A. Examining behavioral responses to Mexico City's driving restriction: A mixed methods approach. Transportation research part D: transport and environment. 2022;104:103191. doi: https://doi.org/10.1016/j.trd.2022.103191.
45. Carvalho VSB, Freitas ED, Martins LD, Martins JA, Mazzoli CR, de Fátima Andrade M. Air quality status and trends over the Metropolitan Area of São Paulo, Brazil as a result of emission control policies. Environmental Science & Policy. 2015;47:68-79. doi: https://doi.org/10.1016/j.envsci.2014.11.001.
46. Ribeiro AKC, Galvão ES, Albuquerque TTdA. Air quality characterization and trend analysis in a Brazilian industrialized metropolitan area in the period from 1995 to 2022. Atmosphere. 2023;14(12):1792. doi: https://doi.org/10.3390/atmos14121792.
47. Schlutow A, Scheuschner T. Determination of critical loads for eutrophying and acidifying air pollutant inputs for the protection of near-natural ecosystems in Germany. Atmosphere. 2023;14(2):383. doi: https://doi.org/10.3390/atmos14020383.
48. Trnka D. Policies, regulatory framework and enforcement for air quality management: The case of Korea. OECD Environment Working Papers. 2020(158):0_1-59.
49. Hong SJ, Kim Y. Dread and unknown characteristics of particulate matter pollution: cognitive and affective routes to air pollution prevention. Journal of risk research. 2023;26(10):1085-100. doi: https://doi.org/10.1080/13669877.2023.2259399.
50. Yuan T, Tai AP, Fu T-M, Zhang A, Yung DH, Wu J, et al. Impacts of irrigation on ozone and fine particulate matter (PM 2.5) air quality: Implications for emission control strategies for intensively irrigated regions in China. EGUsphere. 2024;2024:1-38. doi: https://doi.org/10.5194/egusphere-2024-1557-supplement.
51. Zhao B, Wang S, Wang J, Fu JS, Liu T, Xu J, et al. Impact of national NOx and SO2 control policies on particulate matter pollution in China. Atmospheric Environment. 2013;77:453-63. doi: https://doi.org/10.1016/j.atmosenv.2013.05.012.
52. Carnell E, Vieno M, Vardoulakis S, Beck R, Heaviside C, Tomlinson S, et al. Modelling public health improvements as a result of air pollution control policies in the UK over four decades—1970 to 2010. Environmental Research Letters. 2019;14(7):074001.
53. Zhai M, Wolff H. Air pollution and urban road transport: Evidence from the world’s largest low-emission zone in London. Environmental Economics and Policy Studies. 2021;23(4):721-48. doi: https://doi.org/10.1007/s10018-021-00307-9.
54. Damayanti S, Harrison RM, Pope F, Beddows DC. Limited impact of diesel particle filters on road traffic emissions of ultrafine particles. Environment International. 2023;174:107888. doi: https://doi.org/10.1016/j.envint.2023.107888.
55. Daneshpajooh N, Arhami M, Azoji H. PM dispersion during stable winter episodes in tehran and effect of governmental emission regulations. Atmospheric Pollution Research. 2020;11(8):1316-28. doi: https://doi.org/10.1016/j.apr.2020.05.008.
56. Ali-Taleshi MS, Bakhtiari AR, Liu N, Hopke PK. Characterization and Transport Pathways of High PM2. 5 Pollution Episodes During 2015–2021 in Tehran, Iran. Aerosol and Air Quality Research. 2025;25(5):18. doi: https://doi.org/10.1007/s44408-025-00016-y.
57. Liu X-y, Xu L-x, Wu X-q, Wen H-x. Can China’s vehicular emissions regulation reduce air pollution?—a quasi-natural experiment based on the latest National Vehicular Emissions Standard (stage-VI). Environmental Science and Pollution Research. 2023;30(52):112474-89. doi: https://doi.org/10.1007/s11356-023-30105-7.
58. Delgado-Lindeman M, Cordera R, Moura JL, Rodriguez A. Characteristics and effects of low emission zones in Europe. A systematic literature review. European Transport Research Review. 2025;17(1):54. doi: https://doi.org/10.1186/s12544-025-00749-2.
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