Designing health impact functions to assess marginal changes in outdoor fine particulate matter

A systematic review with a Burden of Proof meta-analysis of health effects of long-term ambient fine particulate matter (PM2.5) exposure on dementia

Previous studies have indicated increased dementia risk associated with fine particulate matter (PM2.5) exposure; however, the findings are inconsistent. In this systematic review, we assessed the association between long-term PM2.5 exposure and dementia outcomes using the Burden of Proof meta-analytic framework, which relaxes log-linear assumptions to better characterize relative risk functions and quantify unexplained between-study heterogeneity (PROSPERO, ID CRD42023421869). Here we report a meta-analysis of 28 longitudinal cohort studies published up to June 2023 that investigated long-term PM2.5 exposure and dementia outcomes. We derived risk-outcome scores (ROSs), highly conservative measures of effect size and evidence strength, mapped onto a 1-5-star rating from 'weak and/or inconsistent evidence' to 'very strong and/or consistent evidence'. We identified a significant nonlinear relationship between PM2.5 exposure and dementia, with a minimum 14% increased risk averaged across PM2.5 levels between 4.5 and 26.9 µg m-3 (the 15th to 85th percentile exposure range across included studies), relative to a reference of 2.0 µg m-3 (n = 49, ROS = 0.13, two stars). We found a significant association of PM2.5 with Alzheimer's disease (n = 12, ROS = 0.32, three stars) but not with vascular dementia. Our findings highlight the potential impact of air pollution on brain aging.

Emission reduction strategies and health: a systematic review on the tools and methods to assess co-benefits

OBJECTIVE

The objective of this study is to review the current literature on the health co-benefits of emission reduction strategies and the methods and tools available to assess them.

DESIGN

Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

PubMed, Scopus, Web of Science, ScienceDirect and GreenFILE were searched from January of 2017 to March of 2023.

ELIGIBILITY CRITERIA

We included original, peer-reviewed journal articles that described emission (ambient air pollutant and greenhouse gases) reduction strategies and assessed their health co-benefits.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers employed standardised methods to search, screen and code the included studies, documenting their findings in an Excel spreadsheet.

RESULTS

From 6687 articles, 82 were included. Most studies show that emissions reduction strategies improve air quality, reducing mortality and morbidity. Health risk assessment and health impact assessment are common, though procedures may cause confusion. About 33% used established models like the integrated exposure-response and global exposure mortality model. Out of all studies, 16% of them used Environmental Benefits Mapping and Analysis Program-Community Edition. Only 17.8% carried out cost-benefit analyses, but these show economic worth in investing in emission reduction strategies.

CONCLUSIONS

Emission reduction strategies significantly enhance human health, with potential co-benefits offsetting intervention costs, which can be an incentive for action in low and middle-income countries. This review emphasises investing in cost-benefit analyses and research, particularly in regions with limited studies on emission reduction and health co-benefits. It provides decision-makers insights into selecting assessment methods and underscores the ongoing need for model and tool evaluation.

PROSPERO REGISTRATION NUMBER

CRD42022332480.

The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action

Despite the initial hope inspired by the 2015 Paris Agreement, the world is now dangerously close to breaching its target of limiting global multiyear mean heating to 1·5°C. Annual mean surface temperature reached a record high of 1·45°C above the pre-industrial baseline in 2023, and new temperature highs were recorded throughout 2024. The resulting climatic extremes are increasingly claiming lives and livelihoods worldwide.

The Lancet Countdown: tracking progress on health and climate change was established the same year the Paris Agreement entered into force, to monitor the health impacts and opportunities of the world’s response to this landmark agreement. Supported through strategic core funding from Wellcome, the collaboration brings together over 300 multidisciplinary researchers and health professionals from around the world to take stock annually of the evolving links between health and climate change at global, regional, and national levels.

The 2024 report of the Lancet Countdown, building on the expertise of 122 leading researchers from UN agencies and academic institutions worldwide, reveals the most concerning findings yet in the collaboration’s 8 years of monitoring.

Atmospheric health burden across the century and the accelerating impact of temperature compared to pollution

Anthropogenic emissions alter atmospheric composition and therefore the climate, with implications for air pollution- and climate-related human health. Mortality attributable to air pollution and non-optimal temperature is a major concern, expected to shift under future climate change and socioeconomic scenarios. In this work, results from numerical simulations are used to assess future changes in mortality attributable to long-term exposure to both non-optimal temperature and air pollution simultaneously. Here we show that under a realistic scenario, end-of-century mortality could quadruple from present-day values to around 30 (95% confidence level:12-53) million people/year. While pollution-related mortality is projected to increase five-fold, temperature-related mortality will experience a seven-fold rise, making it a more important health risk factor than air pollution for at least 20% of the world's population. These findings highlight the urgent need to implement stronger climate policies to prevent future loss of life, outweighing the benefits of air quality improvements alone.

Assessing Adverse Health Effects of Long-Term Exposure to Low Levels of Ambient Air Pollution: The HEI Experience and What's Next?

Although concentrations of ambient air pollution continue to decline in high-income regions, epidemiological studies document adverse health effects at levels below current standards in many countries. The Health Effects Institute (HEI) recently completed a comprehensive research initiative to investigate the health effects of long-term exposure to low levels of air pollution in the United States (U.S.), Canada, and Europe. We provide an overview and synthesis of the results of this initiative along with other key research, the strengths and limitations of the research, and remaining research needs. The three studies funded through the HEI initiative estimated the effects of long-term ambient exposure to fine particulate matter (PM2.5), nitrogen dioxide, ozone, and other pollutants on a broad range of health outcomes, including cause-specific mortality and cardiovascular and respiratory morbidity. To ensure high quality research and comparability across studies, HEI worked actively with the study teams and engaged independent expert panels for project oversight and review. All three studies documented positive associations between mortality and exposure to PM2.5 below the U.S. National Ambient Air Quality Standards and current and proposed European Union limit values. Furthermore, the studies observed nonthreshold linear (U.S.), or supra-linear (Canada and Europe) exposure-response functions for PM2.5 and mortality. Heterogeneity was found in both the magnitude and shape of this association within and across studies. Strengths of the studies included the large populations (7-69 million), state-of-the-art exposure assessment methods, and thorough statistical analyses that applied novel methods. Future work is needed to better understand potential sources of heterogeneity in the findings across studies and regions. Other areas of future work include the changing and evolving nature of PM components and sources, including wildfires, and the role of indoor environments. This research initiative provided important new evidence of the adverse effects of long-term exposures to low levels of air pollution at and below current standards, suggesting that further reductions could yield larger benefits than previously anticipated.

Global health costs of ambient PM2·5 from combustion sources: a modelling study supporting air pollution control strategies

BACKGROUND

Climate actions targeting combustion sources can generate large ancillary health benefits via associated air-quality improvements. Therefore, understanding the health costs associated with ambient fine particulate matter (PM2·5) from combustion sources can guide policy design for both air pollution and climate mitigation efforts.

METHODS

In this modelling study, we estimated the health costs attributable to ambient PM2·5 from six major combustion sources across 204 countries using updated concentration-response models and an age-adjusted valuation method. We defined major combustion sources as the sum of total coal, liquid fuel and natural gas, solid biofuel, agricultural waste burning, other fires, and 50% of the anthropogenic fugitive, combustion, and industrial dust source.

FINDINGS

Global long-term exposure to ambient PM2·5 from combustion sources imposed US$1·1 (95% uncertainty interval 0·8-1·5) trillion in health costs in 2019, accounting for 56% of the total health costs from all PM2·5 sources. Comparing source contributions to PM2·5 concentrations and health costs, we observed a higher share of health costs from combustion sources compared to their contribution to population-weighted PM2·5 concentration across 134 countries, accounting for more than 87% of the global population. This disparity was primarily attributed to the non-linear relationship between PM2·5 concentration and its associated health costs. Globally, phasing out fossil fuels can generate 23% higher relative health benefits compared to their share of PM2·5 reductions. Specifically, the share of health costs for total coal was 36% higher than the source's contributions to corresponding PM2·5 concentrations and the share of health costs for liquid fuel and natural gas was 12% higher. Other than fossil fuels, South Asia was expected to show 16% greater relative health benefits than the percentage reduction in PM2·5 from the abatement of solid biofuel emissions.

INTERPRETATION

In most countries, targeting combustion sources might offer greater health benefits than non-combustion sources. This finding provides additional rationale for climate actions aimed at phasing out combustion sources, especially those related to fossil fuels and solid biofuel. Mitigation efforts designed according to source-specific health costs can more effectively avoid health costs than strategies that depend solely on the source contributions to overall PM2·5 concentration.

FUNDING

The Health Effects Institute, the National Natural Science Foundation of China, and NASA.

Substantially reducing global PM2.5-related deaths under SDG3.9 requires better air pollution control and healthcare

The United Nations' Sustainable Development Goal (SDG) 3.9 calls for a substantial reduction in deaths attributable to PM2.5 pollution (DAPP). However, DAPP projections vary greatly and the likelihood of meeting SDG3.9 depends on complex interactions among environmental, socio-economic, and healthcare parameters. We project potential future trends in global DAPP considering the joint effects of each driver (PM2.5 concentration, death rate of diseases, population size, and age structure) and assess the likelihood of achieving SDG3.9 under the Shared Socioeconomic Pathways (SSPs) as quantified by the Scenario Model Intercomparison Project (ScenarioMIP) framework with simulated PM2.5 concentrations from 11 models. We find that a substantial reduction in DAPP would not be achieved under all but the most optimistic scenario settings. Even the development aligned with the Sustainability scenario (SSP1-2.6), in which DAPP was reduced by 19%, still falls just short of achieving a substantial (≥20%) reduction by 2030. Meeting SDG3.9 calls for additional efforts in air pollution control and healthcare to more aggressively reduce DAPP.

Air pollution deaths attributable to fossil fuels: observational and modelling study

OBJECTIVES

To estimate all cause and cause specific deaths that are attributable to fossil fuel related air pollution and to assess potential health benefits from policies that replace fossil fuels with clean, renewable energy sources.

DESIGN

Observational and modelling study.

METHODS

An updated atmospheric composition model, a newly developed relative risk model, and satellite based data were used to determine exposure to ambient air pollution, estimate all cause and disease specific mortality, and attribute them to emission categories.

DATA SOURCES

Data from the global burden of disease 2019 study, observational fine particulate matter and population data from National Aeronautics and Space Administration (NASA) satellites, and atmospheric chemistry, aerosol, and relative risk modelling for 2019.

RESULTS

Globally, all cause excess deaths due to fine particulate and ozone air pollution are estimated at 8.34 million (95% confidence interval 5.63 to 11.19) deaths per year. Most (52%) of the mortality burden is related to cardiometabolic conditions, particularly ischaemic heart disease (30%). Stroke and chronic obstructive pulmonary disease both account for 16% of mortality burden. About 20% of all cause mortality is undefined, with arterial hypertension and neurodegenerative diseases possibly implicated. An estimated 5.13 million (3.63 to 6.32) excess deaths per year globally are attributable to ambient air pollution from fossil fuel use and therefore could potentially be avoided by phasing out fossil fuels. This figure corresponds to 82% of the maximum number of air pollution deaths that could be averted by controlling all anthropogenic emissions. Smaller reductions, rather than a complete phase-out, indicate that the responses are not strongly non-linear. Reductions in emission related to fossil fuels at all levels of air pollution can decrease the number of attributable deaths substantially. Estimates of avoidable excess deaths are markedly higher in this study than most previous studies for these reasons: the new relative risk model has implications for high income (largely fossil fuel intensive) countries and for low and middle income countries where the use of fossil fuels is increasing; this study accounts for all cause mortality in addition to disease specific mortality; and the large reduction in air pollution from a fossil fuel phase-out can greatly reduce exposure.

CONCLUSION

Phasing out fossil fuels is deemed to be an effective intervention to improve health and save lives as part the United Nations' goal of climate neutrality by 2050. Ambient air pollution would no longer be a leading, environmental health risk factor if the use of fossil fuels were superseded by equitable access to clean sources of renewable energy.

Impact of Legislated and Best Available Emission Control Measures on UK Particulate Matter Pollution, Premature Mortality, and Nitrogen-Sensitive Habitats

Past emission controls in the UK have substantially reduced precursor emissions of health-hazardous fine particles (PM2.5) and nitrogen pollution detrimental to ecosystems. Still, 79% of the UK exceeds the World Health Organization (WHO) guideline for annual mean PM2.5 of 5 μg m-3 and there is no enforcement of controls on agricultural sources of ammonia (NH3). NH3 is a phytotoxin and an increasingly large contributor to PM2.5 and nitrogen deposited to sensitive habitats. Here we use emissions projections, the GEOS-Chem model, high-resolution data sets, and contemporary exposure-risk relationships to assess potential human and ecosystem health co-benefits in 2030 relative to the present day of adopting legislated or best available emission control measures. We estimate that present-day annual adult premature mortality attributable to exposure to PM2.5 is 48,625 (95% confidence interval: 45,188-52,595), that harmful amounts of reactive nitrogen deposit to almost all (95%) sensitive habitat areas, and that 75% of ambient NH3 exceeds levels safe for bryophytes and lichens. Legal measures decrease the extent of the UK above the WHO guideline to 58% and avoid 6,800 premature deaths by 2030. This improves with best available measures to 36% of the UK and 13,300 avoided deaths. Both legal and best available measures are insufficient at reducing the extent of damage of nitrogen pollution to sensitive habitats. Far more ambitious reductions in nitrogen emissions (>80%) than is achievable with best available measures (34%) are required to halve the amount of excess nitrogen deposited to sensitive habitats.

Reversal of trends in global fine particulate matter air pollution

Ambient fine particulate matter (PM2.5) is the world's leading environmental health risk factor. Quantification is needed of regional contributions to changes in global PM2.5 exposure. Here we interpret satellite-derived PM2.5 estimates over 1998-2019 and find a reversal of previous growth in global PM2.5 air pollution, which is quantitatively attributed to contributions from 13 regions. Global population-weighted (PW) PM2.5 exposure, related to both pollution levels and population size, increased from 1998 (28.3 μg/m3) to a peak in 2011 (38.9 μg/m3) and decreased steadily afterwards (34.7 μg/m3 in 2019). Post-2011 change was related to exposure reduction in China and slowed exposure growth in other regions (especially South Asia, the Middle East and Africa). The post-2011 exposure reduction contributes to stagnation of growth in global PM2.5-attributable mortality and increasing health benefits per µg/m3 marginal reduction in exposure, implying increasing urgency and benefits of PM2.5 mitigation with aging population and cleaner air.

The Air Pollution Human Health Burden in Different Future Scenarios That Involve the Mitigation of Near-Term Climate Forcers, Climate and Land-Use

Elevated surface concentrations of ozone and fine particulate matter (PM2.5) can lead to poor air quality and detrimental impacts on human health. These pollutants are also termed Near-Term Climate Forcers (NTCFs) as they can also influence the Earth's radiative balance on timescales shorter than long-lived greenhouse gases. Here we use the Earth system model, UKESM1, to simulate the change in surface ozone and PM2.5 concentrations from different NTCF mitigation scenarios, conducted as part of the Aerosol and Chemistry Model Intercomparison Project (AerChemMIP). These are then combined with relative risk estimates and projected changes in population demographics, to estimate the mortality burden attributable to long-term exposure to ambient air pollution. Scenarios that involve the strong mitigation of air pollutant emissions yield large future benefits to human health (25%), particularly across Asia for black carbon (7%), when compared to the future reference pathway. However, if anthropogenic emissions follow the reference pathway, then impacts to human health worsen over South Asia in the short term (11%) and across Africa (20%) in the longer term. Future climate change impacts on air pollutants can offset some of the health benefits achieved by emission mitigation measures over Europe for PM2.5 and East Asia for ozone. In addition, differences in the future chemical environment over regions are important considerations for mitigation measures to achieve the largest benefit to human health. Future policy measures to mitigate climate warming need to also consider the impact on air quality and human health across different regions to achieve the maximum co-benefits.

Noise and Air Pollution as Risk Factors for Hypertension: Part I-Epidemiology

Traffic noise and air pollution are 2 major environmental health risk factors in urbanized societies that often occur together. Despite cooccurrence in urban settings, noise and air pollution have generally been studied independently, with many studies reporting a consistent effect on blood pressure for individual exposures. In the present reviews, we will discuss the epidemiology of air pollution and noise effects on arterial hypertension and cardiovascular disease (part I) and the underlying pathophysiology (part II). Both environmental stressors have been found to cause endothelial dysfunction, oxidative stress, vascular inflammation, circadian dysfunction, and activation of the autonomic nervous system, thereby facilitating the development of hypertension. We also discuss the effects of interventions, current gaps in knowledge, and future research tasks. From a societal and policy perspective, the health effects of both air pollution and traffic noise are observed well below the current guideline recommendations. To this end, an important goal for the future is to increase the acceptance of environmental risk factors as important modifiable cardiovascular risk factors, given their substantial impact on the burden of cardiovascular disease.

Mortality Attributable to Ambient Air Pollution: A Review of Global Estimates

Since the publication of the first epidemiological study to establish the connection between long-term exposure to atmospheric pollution and effects on human health, major efforts have been dedicated to estimate the attributable mortality burden, especially in the context of the Global Burden of Disease (GBD). In this work, we review the estimates of excess mortality attributable to outdoor air pollution at the global scale, by comparing studies available in the literature. We find large differences between the estimates, which are related to the exposure response functions as well as the number of health outcomes included in the calculations, aspects where further improvements are necessary. Furthermore, we show that despite the considerable advancements in our understanding of health impacts of air pollution and the consequent improvement in the accuracy of the global estimates, their precision has not increased in the last decades. We offer recommendations for future measurements and research directions, which will help to improve our understanding and quantification of air pollution-health relationships.

Comparison of the Application of Three Methods for the Determination of Outdoor PM2.5 Design Concentrations for Fresh Air Filtration Systems in China

With the increasing popularity of fresh-air filtration systems, the methods of determining the outdoor PM_2.5 design concentration have become more important. However, the monitoring of atmospheric fine particles in China started relatively late, and there are relatively few cities with complete data, with obvious regional differences, which led to many problems in the selection of air filters for fresh-air filtration systems. In this paper, three methods of determining outdoor PM_2.5 design concentration were analyzed using the daily average concentration of PM_2.5 in 31 provincial capital cities from 2016 to 2020. Six typical cities in different regions were also taken as examples. The advantages and disadvantages of the three existing statistical methods were compared and analyzed, as well as the corresponding differences in the selection of outdoor PM_2.5 concentration value on the filter systems. The results showed that the method of mathematical induction was more accurate and reasonable for the calculation of outdoor PM_2.5 design concentrations. The local outdoor PM_2.5 design concentration could be quickly calculated using the recommended coefficient K and annual average PM_2.5 concentration of the region, especially for small and medium-sized cities without monitoring data. However, the recommended coefficient K should be provided based on the specific region, and should be divided into values for strict conditions and normal conditions during use. This would provide a simple and effective way to select the correct air filters for practical engineering.

How low can you go? Air pollution affects mortality at very low levels

The World Health Organization (WHO) recently released new guidelines for outdoor fine particulate air pollution (PM_2.5) recommending an annual average concentration of 5 μg/m³. Yet, our understanding of the concentration-response relationship between outdoor PM_2.5 and mortality in this range of near-background concentrations remains incomplete. To address this uncertainty, we conducted a population-based cohort study of 7.1 million adults in one of the world's lowest exposure environments. Our findings reveal a supralinear concentration-response relationship between outdoor PM_2.5 and mortality at very low (<5 μg/m³) concentrations. Our updated global concentration-response function incorporating this new information suggests an additional 1.5 million deaths globally attributable to outdoor PM_2.5 annually compared to previous estimates. The global health benefits of meeting the new WHO guideline for outdoor PM_2.5 are greater than previously assumed and indicate a need for continued reductions in outdoor air pollution around the world.

Assessment of PM2.5-related health effects: A comparative study using multiple methods and multi-source data in China

In China, PM_2.5 pollution has caused extensive death and economic loss. Thus, an accurate assessment of the spatial distribution of these losses is crucial for delineating priority areas for air pollution control in China. In this study, we assessed the PM_2.5 exposure-related health effects according to the integrated exposure risk function and non-linear power law (NLP) function in 338 prefecture-level cities in China by utilizing online monitoring data and the PM_2.5 Hindcast Database (PHD). Our results revealed no significant difference between the monitoring data and PHD (p value = 0.66 > 0.05). The number of deaths caused by PM_2.5-related Stroke (cerebrovascular disease), ischemic heart disease, chronic obstructive pulmonary disease, and lung cancer at the national level estimated through the NLP function was 0.27 million (95% CI: 0.06-0.50), 0.23 million (95% CI: 0.08-0.38), 0.31 million (95% CI: 0.04-0.57), and 0.31 million (95% CI: 0.16-0.40), respectively. The total economic cost at the national level in 2016 was approximately US$80.25 billion (95% CI: 24.46-132.25). Based on a comparison of Z statistics, we propose that the evaluation results obtained using the NLP function and monitoring data are accurate. Additionally, according to scenario simulations, Beijing, Chongqing, Tianjin, and other cities should be priority areas for PM_2.5 pollution control to achieve considerable health benefits. Our statistics can help improve the accuracy of PM_2.5-related health effect assessments in China.