The Global Burden of Disease from Air Pollution

Air pollution is a major global health concern, with substantial impacts in high, middle and low income countries throughout the world. More than 85% of the world’s population lives in areas where the World Health Organization (WHO) Air Quality Guideline is exceeded. In China and India less than 1% of the population lives in areas meeting the WHO Guideline. In the context of the Global Burden of Disease 2013, air pollution levels and attributable health impacts were quantified for 188 countries for the period 1990-2013. In 2013 there were 2.9 million deaths (5.3 % of all global deaths) caused by outdoor fine particulate air pollution and an additional 215,000 deaths from exposure to ozone. Further, indoor exposure to household air pollution from the use of solid fuels for cooking and heating was responsible for 2.9 million deaths in 2013. Taken together, air pollution caused 5.5 million deaths in 2013 and was the 4^th highest-ranking risk factor for death in the world. Outdoor particulate air pollution specifically was the 7^thleading risk factor for death globally, with cardiovascular disease (ischemic heart disease and stroke) accounting for the majority of these deaths.  Additional deaths from air pollution were from lung cancer, chronic lung disease and respiratory infections. Of these 2.9 million deaths, 64% were in Asia, especially China and India.  Even in the U.S., where air pollution levels are considerably lower than the global average, ambient air pollution was the 13th highest ranked risk factor for deaths with 79,000 estimated in 2013.

Between 1990 and 2013, global exposure to particulate matter air pollution increased by 20%, driven by increases in South Asia, Southeast Asia, and China. These increases, combined with population growth, aging and increasing prevalence of diseases impacted by air pollution led to increases in both total deaths from air pollution and the rate of attributable deaths. These trends are expected to continue unless air pollution levels are decreased substantially throughout Asia. Decreases in air pollution from 1990-2013 were evident in most high income countries, with consequent decreases in attributable mortality, indicating the widespread population health benefits of clean air policies.  Important opportunities exist to reduce air pollution and its health impacts in the near-term while at the same time reducing emissions of climate-forcing pollutants.