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Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use

Hanna M. Ollila Orcid Logo, Markku Partinen, Jukka Koskela, John Borghi Orcid Logo, Riikka Savolainen Orcid Logo, Anna Rotkirch, Liisa T. Laine

PLOS ONE, Volume: 17, Issue: 12, Start page: e0271517

Swansea University Author: Riikka Savolainen Orcid Logo

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DOI (Published version): 10.1371/journal.pone.0271517

Abstract

ObjectivesTo examine the use of face mask intervention in mitigating the risk of spreading respiratory infections and whether the effect of face mask intervention differs in different exposure settings and age groups.DesignSystematic review and meta-analysis. We evaluated the risk of bias using the...

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Published in: PLOS ONE
ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2022
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fullrecord <?xml version="1.0" encoding="utf-8"?><rfc1807 xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema"><bib-version>v2</bib-version><id>62124</id><entry>2022-12-06</entry><title>Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use</title><swanseaauthors><author><sid>ebbf9320052d317dbd373b3999c398f7</sid><ORCID>0000-0002-0651-6548</ORCID><firstname>Riikka</firstname><surname>Savolainen</surname><name>Riikka Savolainen</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-12-06</date><deptcode>ECON</deptcode><abstract>ObjectivesTo examine the use of face mask intervention in mitigating the risk of spreading respiratory infections and whether the effect of face mask intervention differs in different exposure settings and age groups.DesignSystematic review and meta-analysis. We evaluated the risk of bias using the Cochrane Risk of Bias 2 tool (ROB2).Data sourcesWe searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials investigating the effect of face masks on respiratory infections published between 1981 and February 9, 2022. We followed the PRISMA 2020 guidelines.Eligibility criteria for selecting studiesWe included randomized controlled trials investigating the use of face mask intervention in mitigating the risk of spreading respiratory infections across different exposure settings.ResultsWe identified 2,400 articles for screening. 18 articles passed the inclusion criteria for both evidence synthesis and meta-analysis. There were N = 189,145 individuals in the face mask intervention arm and N = 173,536 in the control arm, and the follow-up times ranged from 4 days to 19 months. Our results showed between-study heterogeneity (p &lt; 0.0001). While there was no statistically significant association over all studies when the covariate unadjusted intervention effect estimates were used (RR = 0.977 [0.858–1.113], p = 0.728), our subgroup analyses revealed that a face mask intervention reduced respiratory infections in the adult subgroup (RR = 0.8795 [0.7861–0.9839], p = 0.0249) and in a community setting (RR = 0.890 [0.812–0.975], p = 0.0125). Furthermore, our leave-one-out analysis found that one study biased the results towards a null effect. Consequently, when using covariate adjusted odds ratio estimates to have a more precise effect estimates of the intervention effect to account for differences at the baseline, the results showed that a face mask intervention did reduce respiratory infections when the biasing study was excluded from the analysis (OR = 0.8892 [0.8061–0.9810], p = 0.0192).ConclusionOur findings support the use of face masks particularly in a community setting and for adults. We also observed substantial between-study heterogeneity and varying adherence to protocol. Notably, many studies were subject to contamination bias thus affecting the efficacy of the intervention, that is when also some controls used masks or when the intervention group did not comply with mask use leading to a downward biased effect of treatment receipt and efficacy.</abstract><type>Journal Article</type><journal>PLOS ONE</journal><volume>17</volume><journalNumber>12</journalNumber><paginationStart>e0271517</paginationStart><paginationEnd/><publisher>Public Library of Science (PLoS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1932-6203</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-12-01</publishedDate><doi>10.1371/journal.pone.0271517</doi><url/><notes>Data Availability Statement: Data are shared in the Supporting Information files along with the code that is used to perform the analyses.</notes><college>COLLEGE NANME</college><department>Economics</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>ECON</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>The Strategic Research Council, Academy of Finland, 340551, LL. The Strategic Research Council, Academy of Finland, 340539, HMO.</funders><projectreference/><lastEdited>2023-08-30T12:05:39.0394775</lastEdited><Created>2022-12-06T09:36:04.7772318</Created><path><level id="1">Faculty of Humanities and Social Sciences</level><level id="2"/></path><authors><author><firstname>Hanna M.</firstname><surname>Ollila</surname><orcid>0000-0002-5302-6429</orcid><order>1</order></author><author><firstname>Markku</firstname><surname>Partinen</surname><order>2</order></author><author><firstname>Jukka</firstname><surname>Koskela</surname><order>3</order></author><author><firstname>John</firstname><surname>Borghi</surname><orcid>0000-0001-9570-4163</orcid><order>4</order></author><author><firstname>Riikka</firstname><surname>Savolainen</surname><orcid>0000-0002-0651-6548</orcid><order>5</order></author><author><firstname>Anna</firstname><surname>Rotkirch</surname><order>6</order></author><author><firstname>Liisa T.</firstname><surname>Laine</surname><order>7</order></author></authors><documents><document><filename>62124__26021__b65f57f4eef44fc4b04ed2ca03f0ae65.pdf</filename><originalFilename>62124.pdf</originalFilename><uploaded>2022-12-06T09:39:26.5893869</uploaded><type>Output</type><contentLength>2286655</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2022 Ollila et al. 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spelling v2 62124 2022-12-06 Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use ebbf9320052d317dbd373b3999c398f7 0000-0002-0651-6548 Riikka Savolainen Riikka Savolainen true false 2022-12-06 ECON ObjectivesTo examine the use of face mask intervention in mitigating the risk of spreading respiratory infections and whether the effect of face mask intervention differs in different exposure settings and age groups.DesignSystematic review and meta-analysis. We evaluated the risk of bias using the Cochrane Risk of Bias 2 tool (ROB2).Data sourcesWe searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials investigating the effect of face masks on respiratory infections published between 1981 and February 9, 2022. We followed the PRISMA 2020 guidelines.Eligibility criteria for selecting studiesWe included randomized controlled trials investigating the use of face mask intervention in mitigating the risk of spreading respiratory infections across different exposure settings.ResultsWe identified 2,400 articles for screening. 18 articles passed the inclusion criteria for both evidence synthesis and meta-analysis. There were N = 189,145 individuals in the face mask intervention arm and N = 173,536 in the control arm, and the follow-up times ranged from 4 days to 19 months. Our results showed between-study heterogeneity (p < 0.0001). While there was no statistically significant association over all studies when the covariate unadjusted intervention effect estimates were used (RR = 0.977 [0.858–1.113], p = 0.728), our subgroup analyses revealed that a face mask intervention reduced respiratory infections in the adult subgroup (RR = 0.8795 [0.7861–0.9839], p = 0.0249) and in a community setting (RR = 0.890 [0.812–0.975], p = 0.0125). Furthermore, our leave-one-out analysis found that one study biased the results towards a null effect. Consequently, when using covariate adjusted odds ratio estimates to have a more precise effect estimates of the intervention effect to account for differences at the baseline, the results showed that a face mask intervention did reduce respiratory infections when the biasing study was excluded from the analysis (OR = 0.8892 [0.8061–0.9810], p = 0.0192).ConclusionOur findings support the use of face masks particularly in a community setting and for adults. We also observed substantial between-study heterogeneity and varying adherence to protocol. Notably, many studies were subject to contamination bias thus affecting the efficacy of the intervention, that is when also some controls used masks or when the intervention group did not comply with mask use leading to a downward biased effect of treatment receipt and efficacy. Journal Article PLOS ONE 17 12 e0271517 Public Library of Science (PLoS) 1932-6203 1 12 2022 2022-12-01 10.1371/journal.pone.0271517 Data Availability Statement: Data are shared in the Supporting Information files along with the code that is used to perform the analyses. COLLEGE NANME Economics COLLEGE CODE ECON Swansea University The Strategic Research Council, Academy of Finland, 340551, LL. The Strategic Research Council, Academy of Finland, 340539, HMO. 2023-08-30T12:05:39.0394775 2022-12-06T09:36:04.7772318 Faculty of Humanities and Social Sciences Hanna M. Ollila 0000-0002-5302-6429 1 Markku Partinen 2 Jukka Koskela 3 John Borghi 0000-0001-9570-4163 4 Riikka Savolainen 0000-0002-0651-6548 5 Anna Rotkirch 6 Liisa T. Laine 7 62124__26021__b65f57f4eef44fc4b04ed2ca03f0ae65.pdf 62124.pdf 2022-12-06T09:39:26.5893869 Output 2286655 application/pdf Version of Record true © 2022 Ollila et al. This is an open access article distributed under the terms of the Creative Commons Attribution License true eng http://creativecommons.org/licenses/by/4.0/
title Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use
spellingShingle Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use
Riikka Savolainen
title_short Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use
title_full Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use
title_fullStr Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use
title_full_unstemmed Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use
title_sort Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use
author_id_str_mv ebbf9320052d317dbd373b3999c398f7
author_id_fullname_str_mv ebbf9320052d317dbd373b3999c398f7_***_Riikka Savolainen
author Riikka Savolainen
author2 Hanna M. Ollila
Markku Partinen
Jukka Koskela
John Borghi
Riikka Savolainen
Anna Rotkirch
Liisa T. Laine
format Journal article
container_title PLOS ONE
container_volume 17
container_issue 12
container_start_page e0271517
publishDate 2022
institution Swansea University
issn 1932-6203
doi_str_mv 10.1371/journal.pone.0271517
publisher Public Library of Science (PLoS)
college_str Faculty of Humanities and Social Sciences
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hierarchy_top_id facultyofhumanitiesandsocialsciences
hierarchy_top_title Faculty of Humanities and Social Sciences
hierarchy_parent_id facultyofhumanitiesandsocialsciences
hierarchy_parent_title Faculty of Humanities and Social Sciences
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description ObjectivesTo examine the use of face mask intervention in mitigating the risk of spreading respiratory infections and whether the effect of face mask intervention differs in different exposure settings and age groups.DesignSystematic review and meta-analysis. We evaluated the risk of bias using the Cochrane Risk of Bias 2 tool (ROB2).Data sourcesWe searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials investigating the effect of face masks on respiratory infections published between 1981 and February 9, 2022. We followed the PRISMA 2020 guidelines.Eligibility criteria for selecting studiesWe included randomized controlled trials investigating the use of face mask intervention in mitigating the risk of spreading respiratory infections across different exposure settings.ResultsWe identified 2,400 articles for screening. 18 articles passed the inclusion criteria for both evidence synthesis and meta-analysis. There were N = 189,145 individuals in the face mask intervention arm and N = 173,536 in the control arm, and the follow-up times ranged from 4 days to 19 months. Our results showed between-study heterogeneity (p < 0.0001). While there was no statistically significant association over all studies when the covariate unadjusted intervention effect estimates were used (RR = 0.977 [0.858–1.113], p = 0.728), our subgroup analyses revealed that a face mask intervention reduced respiratory infections in the adult subgroup (RR = 0.8795 [0.7861–0.9839], p = 0.0249) and in a community setting (RR = 0.890 [0.812–0.975], p = 0.0125). Furthermore, our leave-one-out analysis found that one study biased the results towards a null effect. Consequently, when using covariate adjusted odds ratio estimates to have a more precise effect estimates of the intervention effect to account for differences at the baseline, the results showed that a face mask intervention did reduce respiratory infections when the biasing study was excluded from the analysis (OR = 0.8892 [0.8061–0.9810], p = 0.0192).ConclusionOur findings support the use of face masks particularly in a community setting and for adults. We also observed substantial between-study heterogeneity and varying adherence to protocol. Notably, many studies were subject to contamination bias thus affecting the efficacy of the intervention, that is when also some controls used masks or when the intervention group did not comply with mask use leading to a downward biased effect of treatment receipt and efficacy.
published_date 2022-12-01T12:05:39Z
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