Air Pollution from Open Waste Burning and Respiratory Health Outcomes: A Systematic Review and Meta-Analysis

Abstract

Background: Open waste burning, a widespread but poorly regulated source of ambient air pollution in many urban, peri-urban, and crisis-affected settings, is an important source of contamination. In contrast to engineered incineration, uncontrolled combustion of mixed waste generates complex emissions, which may include fine particulate matter, carbon monoxide, volatile organic compounds, polycyclic aromatic hydrocarbons, and chlorinated toxicants. Although respiratory harm has been reported in exposed communities and occupational groups, the epidemiological literature remains fragmented across exposure scenarios and study designs.

Objective: To systematically review and quantitatively synthesize evidence on the association between air pollution related to open waste burning and respiratory health outcomes in human populations.

Methods: A systematic review and meta-analysis with a number of sources from the beginning to 2026-03-17 were searched in PubMed, Embase, Scopus, Web of Science, PsycINFO, Cochrane CENTRAL and grey literature databases. Eligible studies were observational human studies evaluating open waste burning, dumpsite and landfill fire exposure, or the presence of comparable burn-pit exposure in association with respiratory complaints or respiratory illness. Both screening and data isolation procedures were developed according to the process being repeated in duplicate and subject under third-reviewer review. Risk of bias was evaluated using Newcastle–Ottawa Scale–based tools and ROBINS-I, respectively. Effect estimates were corrected for odds ratios and pooled with random-effects models.

Results: Eighteen studies fulfilled the qualitative inclusion criteria and five studies contributed to quantitative synthesis. Exposed populations reported higher rates of cough, wheeze, dyspnea, throat irritation, rhinitis, asthma-related outcomes, and chronic respiratory disease than comparator populations overall across the included literature. The pooled estimate of random-effects found greater odds of having an adverse respiratory outcome that was more common in exposed groups (odds ratio 2.77, 95% confidence interval 1.30–5.92), with significant heterogeneity noted (I² 91.7%). Sensitivity analysis with restricted maximum likelihood returned an equivalent effect estimate. Subgroup analyses indicated relatively stronger associations in civilian community and occupational studies than in military burn-pit cohorts, but that military burn-pit cohorts demonstrated high chronic respiratory risk, too.

Conclusion: Recent data indicate that exposure to air pollution in the form of open waste burning is associated with significantly worse respiratory health. However, the degree of uncertainty concerning evidence is constrained by observational methodology, differential exposure evaluation, and enormous heterogeneity; however, the agreement upon a certain direction of harmful direction among contexts supports precautionary public health measures and stringent waste-management controls.