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Proc Natl Acad Sci U S A. 2018 Sep 18;115(38):9592-9597. doi: 10.1073/pnas.1803222115. Epub 2018 Sep 4.

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

Author information

1
Population Studies Division, Health Canada, Ottawa, ON K1A 0K9, Canada.
2
Department of Environmental and Occupational Health, Public Health Ontario, Toronto, ON M5G 1V2, Canada.
3
Population Studies Division, Health Canada, Ottawa, ON K1A 0K9, Canada; mietek.szyszkowicz@canada.ca.
4
Risk and Benefits Group, Office of Air Quality Planning and Standards, US Environmental Protection Agency, Washington, DC 20460.
5
Office of Research and Development, US Environmental Protection Agency, Washington, DC 20460.
6
Department of Economics, Brigham Young University, Provo, UT 84602.
7
Department of Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX 78712.
8
School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
9
Health Effects Institute, Boston, MA 02110-1817.
10
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 0G4, Canada.
11
Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada.
12
Department of Applied Economics, University of Minnesota, Minneapolis, MN 55455.
13
Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115.
14
Institute for Risk Assessment Sciences, Universiteit Utrecht, 3512 JE Utrecht, The Netherlands.
15
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195.
16
School of Public Health, Fudan University, Shanghai 200433, China.
17
Environmental Medicine and Population Health, Program in Human Exposures and Health Effects, New York University School of Medicine, New York, NY 10016.
18
Department of Population Health, NYU Langone Medical Center, New York, NY 10016.
19
Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016.
20
ISGlobal, Barcelona Institute for Global Health, 08036 Barcelona, Spain.
21
Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA 90095.
22
McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
23
Epidemiology Research Program, American Cancer Society, Inc., Atlanta, GA 30303.
24
Department of Civil and Environmental Engineering, University of California, Davis, CA 95616.
25
Cancer Prevention Institute of California, Fremont, CA 94538.
26
Department of Sociology, University of New Brunswick, Fredericton, NB E3B 5A3, Canada.
27
Department of Physics and Atmospheric Science, Dalhousie University, Halifax, NS B3H 4R2, Canada.
28
Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada.
29
Department of Geography and Environment, Carleton University, Ottawa, ON K1S 5B6, Canada.
30
New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, NB E3B 5A3, Canada.
31
Health Analysis Division, Statistics Canada, Ottawa, ON K1A 0T6, Canada.
32
Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada.
33
National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
34
National Institute for Public Health and the Environment, 3720 BA Bilthoven, The Netherlands.
35
Population Health Research Institute, St. George's, University of London, London SW17 0RE, United Kingdom.
36
MRC-PHE Centre for Environment and Health, St. George's, University of London, London SW17 0RE, United Kingdom.
37
School of Public Health, University of Hong Kong, Hong Kong, China.
38
Department of Environmental Health, Harvard C.T. Channing School of Public Health, Harvard University, Boston, MA 02115.
39
Department of Epidemiology, Regional Health Service, ASL Roma 1, 00147 Rome, Italy.
40
Institute of Epidemiology and Medical Biometry, Ulm University, 89081 Ulm, Germany.
41
Agency for Preventive and Social Medicine, 6900 Bregenz, Austria.
42
Spadaro Environmental Research Consultants (SERC), Philadelphia, PA 19142.

Abstract

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.

KEYWORDS:

concentration; exposure; fine particulate matter; mortality; risk

PMID:
30181279
PMCID:
PMC6156628
DOI:
10.1073/pnas.1803222115
[Indexed for MEDLINE]
Free PMC Article

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