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

By R. Burnett, Hong Chen, M. Szyszkowicz, N. Fann, Bryan Hubbell, C. Pope, J. Apte, M. Brauer, A. Cohen, S. Weichenthal and 44 more. Proceedings of the National Academy of Sciences of the United States of America, 2018

2,096 citations recorded by the source corpus.

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. Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries—the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5–10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9–8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3–4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.

Subfields: Health, Toxicology and Mutagenesis, Pollution

View Paper: https://www.semanticscholar.org/paper/b7d275e1f699d5e549a7281b3d078a99deb12971

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Citations in the corpus

Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective (2020, methodology): “The mortality attributable to air pollution can be estimated with disease-specific hazard models, linked to information about exposure to ambient concentrations.(3,6) We used a global atmospheric chemistry model to estimate exposure to ozone (O3) and fine particulate matter (PM2.”
Recent Insights into Particulate Matter (PM2.5)-Mediated Toxicity in Humans: An Overview (2022, background): “5, the inflammation leads to oxidative stress and causes vascular dysfunction [26,27].”
COVID-19 lockdowns cause global air pollution declines (2020, neutral): “Chile 1 [1; 2]* -2 [-1; -4]* 9 [-23; 42]* 8 [6; 9]* -1 [-1; -2]* 3 [1; 3]*”
Drivers of improved PM2.5 air quality in China from 2013 to 2017 (2019, methodology): “9 million deaths globally, among which over a quarter occurred in China (4).”
Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions (2019, methodology): “For additional examples, we refer to Supplementary material online, Figure S1 of Burnett et al.13 While for GBD 2015 the available PM2.”