Family, neighborhood and psychosocial environmental factors and their associations with asthma in Australia: a systematic review and Meta-analysis.

Various associations between different environmental exposures and asthma have been reported in different countries and populations. We aimed to investigate the associations between family, neighborhood and psychosocial environmental factors and asthma-symptoms in Australia by conducting a systematic review and meta-analysis. We analyzed the primary research studies conducted in Australia across multiple databases, including PubMed, EMBASE and Scopus, published between 2000 and 2020. The reviews and analyses focused on the overall association of different environmental exposures with the exacerbation of asthma-symptoms or asthma-related hospital visits. Quality-effect meta-analysis was done to estimate the pooled odds ratio for different environmental exposures for asthma-symptoms. Among the 4799 unique published articles found, 46 were included here for systematic review and 28 for meta-analysis. Our review found that psychosocial factors, including low socioeconomic condition, maternal depression, mental stress, ethnicity, and discrimination, are associated with asthma-symptoms. Pooled analysis was conducted on family and neighborhood environmental factors and revealed that environmental tobacco smoking (ETS) (OR 1·69, 95% CI 1·19-2·38), synthetic bedding (OR 1·91, 95% CI 1·48-2·47) and gas heaters (OR 1·40, 95% CI 1·12-1·76) had significant overall associations with asthma-symptoms in Australia. Although the studies were heterogeneous, both systematic review and meta-analysis found several psychosocial and family environmental exposures significantly associated with asthma-symptoms. Further study to identify their causal relationship and modification may reduce asthma-symptoms in the Australian population.