Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015

Aaron J Cohen, Michael Brauer, Richard Burnett, H Ross Anderson, Joseph Frostad, Kara Estep, Kalpana Balakrishnan, Bert Brunekreef, Lalit Dandona, Rakhi Dandona, Valery Feigin, Greg Freedman, Bryan Hubbell, Amelia Jobling, Haidong Kan, Luke Knibbs, Yang Liu, Randall Martin, Lidia Morawska, C Arden Pope 3rd, Hwashin Shin, Kurt Straif, Gavin Shaddick, Matthew Thomas, Rita van Dingenen, Aaron van Donkelaar, Theo Vos, Christopher J L Murray, Mohammad H Forouzanfar, Aaron J Cohen, Michael Brauer, Richard Burnett, H Ross Anderson, Joseph Frostad, Kara Estep, Kalpana Balakrishnan, Bert Brunekreef, Lalit Dandona, Rakhi Dandona, Valery Feigin, Greg Freedman, Bryan Hubbell, Amelia Jobling, Haidong Kan, Luke Knibbs, Yang Liu, Randall Martin, Lidia Morawska, C Arden Pope 3rd, Hwashin Shin, Kurt Straif, Gavin Shaddick, Matthew Thomas, Rita van Dingenen, Aaron van Donkelaar, Theo Vos, Christopher J L Murray, Mohammad H Forouzanfar

Abstract

Background: Exposure to ambient air pollution increases morbidity and mortality, and is a leading contributor to global disease burden. We explored spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015 at global, regional, and country levels.

Methods: We estimated global population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2·5 μm (PM2·5) and ozone at an approximate 11 km × 11 km resolution with satellite-based estimates, chemical transport models, and ground-level measurements. Using integrated exposure-response functions for each cause of death, we estimated the relative risk of mortality from ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infections from epidemiological studies using non-linear exposure-response functions spanning the global range of exposure.

Findings: Ambient PM2·5 was the fifth-ranking mortality risk factor in 2015. Exposure to PM2·5 caused 4·2 million (95% uncertainty interval [UI] 3·7 million to 4·8 million) deaths and 103·1 million (90·8 million 115·1 million) disability-adjusted life-years (DALYs) in 2015, representing 7·6% of total global deaths and 4·2% of global DALYs, 59% of these in east and south Asia. Deaths attributable to ambient PM2·5 increased from 3·5 million (95% UI 3·0 million to 4·0 million) in 1990 to 4·2 million (3·7 million to 4·8 million) in 2015. Exposure to ozone caused an additional 254 000 (95% UI 97 000-422 000) deaths and a loss of 4·1 million (1·6 million to 6·8 million) DALYs from chronic obstructive pulmonary disease in 2015.

Interpretation: Ambient air pollution contributed substantially to the global burden of disease in 2015, which increased over the past 25 years, due to population ageing, changes in non-communicable disease rates, and increasing air pollution in low-income and middle-income countries. Modest reductions in burden will occur in the most polluted countries unless PM2·5 values are decreased substantially, but there is potential for substantial health benefits from exposure reduction.

Funding: Bill & Melinda Gates Foundation and Health Effects Institute.

Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Integrated exposure–response functions Curves show the central estimate of the integrated exposure–response (solid lines) and their 95% uncertainty intervals (shaded areas). The relative risk equals 1 for PM2·5 concentrations of 0–2·4 μg/m3 (ie, lower bound of the theoretical minimum risk exposure level uncertainty distribution). Additional details are provided in the appendix (pp 7–15). PM2·5=particle mass with aerodynamic diameter less than 2·5 μm.
Figure 2
Figure 2
Trends in population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2·5 μm Global data and data from the ten most populous countries are shown. Shaded areas are 95% uncertainty intervals. PM2·5=particle mass with aerodynamic diameter less than 2·5 μm.
Figure 3
Figure 3
Leading level 3 Global Burden of Diseases global risk factors for deaths (A) and disability-adjusted life-years (B), 1990 and 2015 Risks are connected by lines between years; solid lines show risks that have stayed the same or moved higher in the ranking and dashed lines show risks that have moved lower.
Figure 4
Figure 4
Deaths attributable to ambient particulate matter pollution by year and cause PM2·5=particle mass with aerodynamic diameter less than 2·5 μm.
Figure 5
Figure 5
Deaths attributable to ambient particulate matter pollution in 2015 ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Isl=Island. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.
Figure 6
Figure 6
Changes in mortality attributable to ambient particulate matter pollution according to population-level determinants by country from 1990 to 2015 PM2·5=particle mass with aerodynamic diameter less than 2·5 μm.
Figure 7
Figure 7
Proportion of deaths attributable to ozone (A) in 2015 and percentage change from 1990 (B) ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. Isl=Island. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.

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