TY - JOUR A1 - Bergmann, Marie A1 - Haddad-Thoelke, Pascale A1 - Jeong, Haeran A1 - Kappeler, Ron A1 - Altug, Hicran A1 - Oberwinster, Lukas A1 - Boogaard, Hanna A1 - Pohl, Tobias A1 - Soppa, Vanessa A1 - Ogurtsova, Katherine A1 - Joss, Meltem Kutlar A1 - Andersen, Zorana Jovanovic A1 - Hoffmann, Barbara T1 - Systematic review and meta-analysis on the health effects of long-term exposure to ultrafine particles T2 - European Respiratory Review N2 - Background Ultrafine particles (≤100 nm diameter) may have a higher toxicity than larger particles but are still not regulated nor part of routine air pollution monitoring. So far, health effects of long-term exposure to ambient ultrafine particles are not well understood, owing to a lack of exposure data and epidemiological studies. Methods We conducted a systematic review and meta-analysis on the health effects of long-term exposure to ultrafine particles, including studies published until December 2024. A meta-analysis was conducted for outcomes with at least four available effect estimates. Confidence in the body of evidence was evaluated using the Office of Health Assessment and Translation method. Results We identified 85 studies investigating various mortality, morbidity and subclinical outcomes. In meta-analyses of single-pollutant models, we found positive associations with natural mortality (hazard ratio 1.06, 95% CI 1.04–1.08) and C-reactive protein (10.14% increase (95% CI −0.51–21.99%) per 10 000 pt·cm−3 increase in long-term exposure to ultrafine particles, with low and inadequate levels of evidence, respectively. The remaining studies revealed overall limited evidence for adverse effects on a wide range of outcomes. Less than half of the studies adjusted for co-pollutants. Conclusion The evidence base on long-term health effects of ultrafine particles has increased substantially in the past decade, while the overall evidence for independent effects of long-term ultrafine particle exposure remains inadequate to low. More studies are needed to draw firm conclusions about the independent adverse effects of long-term ultrafine particles on various health end-points, with a special focus on the influence of co-pollutant adjustment. KW - Luftreinhaltung KW - Schadstoffbelastung KW - Luftverunreinigender Stoff KW - Feinstaub KW - Auswirkung Y1 - 2026 UR - https://opus4.kobv.de/opus4-hs-duesseldorf/frontdoor/index/index/docId/6027 UR - https://nbn-resolving.org/urn:nbn:de:hbz:due62-opus-60272 SN - 1600-0617 VL - 35 IS - 179 PB - European Respiratory Society ER -