Summary of included studies.
| Study | Location | Design | Population | Key findings | Quality score |
|---|---|---|---|---|---|
| Hystad et al., 2013 [3] | Canada | Cohort | General population | 29% increased lung cancer risk associated with long-term PM2.5 exposure in Canadian cohorts (OR 1.29, 95% CI 0.95–1.76 per 10 μg/m³) | High |
| Aguilera et al., 2021 [2] | Global | Review | General population | PM2.5 exacerbates respiratory conditions, with potential synergy with radiation | Moderate |
| Palma et al., 2013 [4] | Global | Meta-analysis | Lung cancer patients | Radiation pneumonitis in 30% of thoracic radiotherapy patients | High |
| Cui et al., 2015 [5] | Global | Meta-analysis | Lung cancer patients | PM2.5 linked to increased mortality and complications in lung cancer (OR 1.15, 95% CI 1.05–1.26) | High |
| Ohri et al., 2015 [6] | USA | Cohort | Lung cancer patients | Interruptions in radiation therapy, such as those from evacuations, are associated with reduced local control and increased mortality risk, with noncompliance linked to higher recurrence (16% vs. 7%) | High |
| Black et al., 2017 [8] | USA | Cohort | Adolescents | Early life wildfire smoke exposure is associated with lung function decrements (reduced lung volumes) detectable in adolescence | High |
| Xu et al., 2020 [9] | Global | Review | General population | PM2.5 causes systemic inflammation, impairs immune response | High |
| To et al., 2021 [10] | Global | Scoping review | General population | Wildfire smoke linked to 10–15% increase in anxiety/depression | Moderate |
| Hahn et al., 2021 [12] | USA | Review | General population | Increased respiratory hospitalizations and ED visits (e.g., up to 2.4-fold increases in asthma ED visits in some studies) | High |
| Kulig et al., 2009 [13] | Canada | Qualitative | Rural communities | Limited rural healthcare infrastructure during crises | High |
| Landrigan et al., 2018 [14] | Global | Review | General population | Air pollution, including PM2.5, is linked to chronic respiratory diseases | High |
| Ohri et al., 2016 [15] | USA | Cohort | Lung cancer patients | Radiation therapy interruptions increase mortality risk (HR 1.14, 95% CI 1.03–1.26) | High |
| Aguilera et al., 2021 [2] | USA | Observational | General population | Wildfire smoke worsens respiratory outcomes more than other PM2.5 sources | High |