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      Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective

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          Abstract

          Aims

          Long-term exposure of humans to air pollution enhances the risk of cardiovascular and respiratory diseases. A novel Global Exposure Mortality Model (GEMM) has been derived from many cohort studies, providing much-improved coverage of the exposure to fine particulate matter (PM 2.5). We applied the GEMM to assess excess mortality attributable to ambient air pollution on a global scale and compare to other risk factors.

          Methods and results

          We used a data-informed atmospheric model to calculate worldwide exposure to PM 2.5 and ozone pollution, which was combined with the GEMM to estimate disease-specific excess mortality and loss of life expectancy (LLE) in 2015. Using this model, we investigated the effects of different pollution sources, distinguishing between natural (wildfires, aeolian dust) and anthropogenic emissions, including fossil fuel use. Global excess mortality from all ambient air pollution is estimated at 8.8 (7.11–10.41) million/year, with an LLE of 2.9 (2.3–3.5) years, being a factor of two higher than earlier estimates, and exceeding that of tobacco smoking. The global mean mortality rate of about 120 per 100 000 people/year is much exceeded in East Asia (196 per 100 000/year) and Europe (133 per 100 000/year). Without fossil fuel emissions, the global mean life expectancy would increase by 1.1 (0.9–1.2) years and 1.7 (1.4–2.0) years by removing all potentially controllable anthropogenic emissions. Because aeolian dust and wildfire emission control is impracticable, significant LLE is unavoidable.

          Conclusion

          Ambient air pollution is one of the main global health risks, causing significant excess mortality and LLE, especially through cardiovascular diseases. It causes an LLE that rivals that of tobacco smoking. The global mean LLE from air pollution strongly exceeds that by violence (all forms together), i.e. by an order of magnitude (LLE being 2.9 and 0.3 years, respectively).

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          Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter

          Richard Burnett, Hong Chen, Mieczysław Szyszkowicz … (2018)
          Significance Exposure to outdoor concentrations of fine particulate matter is considered a leading global health concern, largely based on estimates of excess deaths using information integrating exposure and risk from several particle sources (outdoor and indoor air pollution and passive/active smoking). Such integration requires strong assumptions about equal toxicity per total inhaled dose. We relax these assumptions to build risk models examining exposure and risk information restricted to cohort studies of outdoor air pollution, now covering much of the global concentration range. Our estimates are severalfold larger than previous calculations, suggesting that outdoor particulate air pollution is an even more important population health risk factor than previously thought.
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            Long-term ozone exposure and mortality.

            Michael Jerrett, Richard Burnett, C. Pope … (2009)
            Although many studies have linked elevations in tropospheric ozone to adverse health outcomes, the effect of long-term exposure to ozone on air pollution-related mortality remains uncertain. We examined the potential contribution of exposure to ozone to the risk of death from cardiopulmonary causes and specifically to death from respiratory causes. Data from the study cohort of the American Cancer Society Cancer Prevention Study II were correlated with air-pollution data from 96 metropolitan statistical areas in the United States. Data were analyzed from 448,850 subjects, with 118,777 deaths in an 18-year follow-up period. Data on daily maximum ozone concentrations were obtained from April 1 to September 30 for the years 1977 through 2000. Data on concentrations of fine particulate matter (particles that are < or = 2.5 microm in aerodynamic diameter [PM(2.5)]) were obtained for the years 1999 and 2000. Associations between ozone concentrations and the risk of death were evaluated with the use of standard and multilevel Cox regression models. In single-pollutant models, increased concentrations of either PM(2.5) or ozone were significantly associated with an increased risk of death from cardiopulmonary causes. In two-pollutant models, PM(2.5) was associated with the risk of death from cardiovascular causes, whereas ozone was associated with the risk of death from respiratory causes. The estimated relative risk of death from respiratory causes that was associated with an increment in ozone concentration of 10 ppb was 1.040 (95% confidence interval, 1.010 to 1.067). The association of ozone with the risk of death from respiratory causes was insensitive to adjustment for confounders and to the type of statistical model used. In this large study, we were not able to detect an effect of ozone on the risk of death from cardiovascular causes when the concentration of PM(2.5) was taken into account. We did, however, demonstrate a significant increase in the risk of death from respiratory causes in association with an increase in ozone concentration. 2009 Massachusetts Medical Society
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              Air Pollution and Cardiovascular Disease

              Sanjay Rajagopalan, Sadeer G Al-Kindi, Robert D Brook (2018)
              Fine particulate matter <2.5 μm (PM2.5) air pollution is the most important environmental risk factor contributing to global cardiovascular (CV) mortality and disability. Short-term elevations in PM2.5 increase the relative risk of acute CV events by 1% to 3% within a few days. Longer-term exposures over several years increase this risk by a larger magnitude (∼10%), which is partially attributable to the development of cardiometabolic conditions (e.g., hypertension and diabetes mellitus). As such, ambient PM2.5 poses a major threat to global public health. In this review, the authors provide an overview of air pollution and health, including assessment of exposure, impact on CV outcomes, mechanistic underpinnings, and impact of air pollution reduction strategies to mitigate CV risk. The review concludes with future challenges, including the inextricable link between air pollution and climate change, and calls for large-scale trials to allow the promulgation of formal evidence-based recommendations to lower air pollution-induced health risks.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cardiovasc Res
                Journal ID (iso-abbrev): Cardiovasc. Res
                Journal ID (publisher-id): cardiovascres
                Title: Cardiovascular Research
                Publisher: Oxford University Press
                ISSN (Print): 0008-6363
                ISSN (Electronic): 1755-3245
                Publication date (Print): 01 September 2020
                Publication date (Electronic): 03 March 2020
                Publication date PMC-release: 03 March 2020
                Volume: 116
                Issue: 11
                Pages: 1910-1917
                Affiliations
                [c1 ] Atmospheric Chemistry Department, Max Planck Institute for Chemistry , Mainz, Germany
                [c2 ] Climate and Atmosphere Research Center, The Cyprus Institute , Nicosia, Cyprus
                [c3 ] College of Science, King Saud University , Riyadh, Saudi Arabia
                [c4 ] Department of Public Health, Environments and Society , London School of Hygiene and Tropical Medicine, London, UK
                [c5 ] University Medical Center of the Johannes Gutenberg University , Mainz, Germany
                [c6 ] German Center for Cardiovascular Research , Mainz, Germany
                Author notes
                Corresponding authors. Tel: +49 6131 3054000; fax: +49 6131 3054019, E-mail: jos.lelieveld@ 123456mpic.de (J.L.); Tel: +49 6131 177250; fax: +49 6131 176615, E-mail: tmuenzel@ 123456uni-mainz.de (T.M.)
                Author information
                http://orcid.org/0000-0001-6307-3846
                Article
                Publisher ID: cvaa025
                DOI: 10.1093/cvr/cvaa025
                PMC ID: 7449554
                PubMed ID: 32123898
                SO-VID: 19b007ea-def2-4956-b0f8-51dba17972d2
                Copyright © © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 10 January 2020
                Date revision received : 20 January 2020
                Date accepted : 24 January 2020
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                Page count
                Pages: 8
                Categories
                Subject: Review Series from the Naples 2019 Joint Meeting of the Escworking Groups on Myocardial Function and Cellular Biology of the Heart
                Subject: Original Articles
                Subject: Risk in Cardiovascular Disease
                Subject: Editor's Choice
                Subject: AcademicSubjects/MED00200

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: air pollution,fine particulate matter,public health risks,loss of life expectancy,anthropogenic emissions,fossil fuel emissions,natural emissions
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: air pollution, fine particulate matter, public health risks, loss of life expectancy, anthropogenic emissions, fossil fuel emissions, natural emissions

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