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      Millions Dead: How Do We Know and What Does It Mean? Methods Used in the Comparative Risk Assessment of Household Air Pollution

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          Abstract

          In the Comparative Risk Assessment (CRA) done as part of the Global Burden of Disease project (GBD-2010), the global and regional burdens of household air pollution (HAP) due to the use of solid cookfuels, were estimated along with 60+ other risk factors. This article describes how the HAP CRA was framed; how global HAP exposures were modeled; how diseases were judged to have sufficient evidence for inclusion; and how meta-analyses and exposure-response modeling were done to estimate relative risks. We explore relationships with the other air pollution risk factors: ambient air pollution, smoking, and secondhand smoke. We conclude with sensitivity analyses to illustrate some of the major uncertainties and recommendations for future work. We estimate that in 2010 HAP was responsible for 3.9 million premature deaths and ∼4.8% of lost healthy life years (DALYs), ranking it highest among environmental risk factors examined and one of the major risk factors of any type globally.

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          Stephen S Lim, Theo Vos, Abraham D. Flaxman … (2012)
          The Lancet, 380(9859), 2224-2260
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            Solid Fuel Use for Household Cooking: Country and Regional Estimates for 1980–2010

            Sophie Bonjour, Heather Adair-Rohani, Jennyfer Wolf … (2013)
            Background: Exposure to household air pollution from cooking with solid fuels in simple stoves is a major health risk. Modeling reliable estimates of solid fuel use is needed for monitoring trends and informing policy. Objectives: In order to revise the disease burden attributed to household air pollution for the Global Burden of Disease 2010 project and for international reporting purposes, we estimated annual trends in the world population using solid fuels. Methods: We developed a multilevel model based on national survey data on primary cooking fuel. Results: The proportion of households relying mainly on solid fuels for cooking has decreased from 62% (95% CI: 58, 66%) to 41% (95% CI: 37, 44%) between 1980 and 2010. Yet because of population growth, the actual number of persons exposed has remained stable at around 2.8 billion during three decades. Solid fuel use is most prevalent in Africa and Southeast Asia where > 60% of households cook with solid fuels. In other regions, primary solid fuel use ranges from 46% in the Western Pacific, to 35% in the Eastern Mediterranean and < 20% in the Americas and Europe. Conclusion: Multilevel modeling is a suitable technique for deriving reliable solid-fuel use estimates. Worldwide, the proportion of households cooking mainly with solid fuels is decreasing. The absolute number of persons using solid fuels, however, has remained steady globally and is increasing in some regions. Surveys require enhancement to better capture the health implications of new technologies and multiple fuel use.
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              Exposure assessment for estimation of the global burden of disease attributable to outdoor air pollution.

              Michael Brauer, Markus Amann, Rick T. Burnett … (2012)
              Ambient air pollution is associated with numerous adverse health impacts. Previous assessments of global attributable disease burden have been limited to urban areas or by coarse spatial resolution of concentration estimates. Recent developments in remote sensing, global chemical-transport models, and improvements in coverage of surface measurements facilitate virtually complete spatially resolved global air pollutant concentration estimates. We combined these data to generate global estimates of long-term average ambient concentrations of fine particles (PM(2.5)) and ozone at 0.1° × 0.1° spatial resolution for 1990 and 2005. In 2005, 89% of the world's population lived in areas where the World Health Organization Air Quality Guideline of 10 μg/m(3) PM(2.5) (annual average) was exceeded. Globally, 32% of the population lived in areas exceeding the WHO Level 1 Interim Target of 35 μg/m(3), driven by high proportions in East (76%) and South (26%) Asia. The highest seasonal ozone levels were found in North and Latin America, Europe, South and East Asia, and parts of Africa. Between 1990 and 2005 a 6% increase in global population-weighted PM(2.5) and a 1% decrease in global population-weighted ozone concentrations was apparent, highlighted by increased concentrations in East, South, and Southeast Asia and decreases in North America and Europe. Combined with spatially resolved population distributions, these estimates expand the evaluation of the global health burden associated with outdoor air pollution.
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                Author and article information

                Journal
                Title: Annual Review of Public Health
                Abbreviated Title: Annu. Rev. Public Health
                Publisher: Annual Reviews
                ISSN (Print): 0163-7525
                ISSN (Electronic): 1545-2093
                Publication date Created: March 18 2014
                Publication date (Print): March 18 2014
                Volume: 35
                Issue: 1
                Pages: 185-206
                Affiliations
                [1 ]School of Public Health, University of California, Berkeley, California 94720-7360; email: ,
                [2 ]Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom; email: , ,
                [3 ]Department of Environmental Health Engineering, Sri Ramachandra University (SRU), Chennai 600116, India; email:
                [4 ]Pulmonary Medicine, University of California, San Francisco, California 94143; email:
                [5 ]Energy and Resources Group, University of California, Berkeley, California 94720-3050; email:
                [6 ]Division of Epidemiology, Albert Einstein College of Medicine, Bronx, New York 10461; email:
                [7 ]Global Alliance for Clean Cookstoves, Washington, DC 20006; email:
                [8 ]Department of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich 81377, Germany; email:
                Article
                DOI: 10.1146/annurev-publhealth-032013-182356
                PubMed ID: 24641558
                SO-VID: 4afbd79c-5ecc-4aee-be52-e705899e058c
                Copyright © © 2014
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