Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions

TLDR

Ambient air pollution remains a major health risk, and recent Global Exposure Mortality Model hazard ratio functions necessitate a re‑evaluation of its cardiovascular disease burden. The study aimed to estimate excess cardiovascular mortality attributable to air pollution in Europe by combining the new hazard ratio functions with ambient exposure data for Europe and the EU‑28. Using these functions and exposure data, the authors calculated the impacts across Europe and the EU‑28, producing estimates of excess deaths and life‑expectancy loss. They found that ambient air pollution causes roughly 790 000 excess cardiovascular deaths per year in Europe (659 000 in the EU‑28), represents 40–80 % of cardiovascular events, exceeds the 2015 Global Burden of Disease estimate by more than a factor of two, reduces life expectancy by about 2.2 years, and that replacing fossil fuels with clean energy could substantially reduce this loss.

Abstract

Ambient air pollution is a major health risk, leading to respiratory and cardiovascular mortality. A recent Global Exposure Mortality Model, based on an unmatched number of cohort studies in many countries, provides new hazard ratio functions, calling for re-evaluation of the disease burden. Accordingly, we estimated excess cardiovascular mortality attributed to air pollution in Europe.The new hazard ratio functions have been combined with ambient air pollution exposure data to estimate the impacts in Europe and the 28 countries of the European Union (EU-28). The annual excess mortality rate from ambient air pollution in Europe is 790 000 [95% confidence interval (95% CI) 645 000-934 000], and 659 000 (95% CI 537 000-775 000) in the EU-28. Between 40% and 80% are due to cardiovascular events, which dominate health outcomes. The upper limit includes events attributed to other non-communicable diseases, which are currently not specified. These estimates exceed recent analyses, such as the Global Burden of Disease for 2015, by more than a factor of two. We estimate that air pollution reduces the mean life expectancy in Europe by about 2.2 years with an annual, attributable per capita mortality rate in Europe of 133/100 000 per year.We provide new data based on novel hazard ratio functions suggesting that the health impacts attributable to ambient air pollution in Europe are substantially higher than previously assumed, though subject to considerable uncertainty. Our results imply that replacing fossil fuels by clean, renewable energy sources could substantially reduce the loss of life expectancy from air pollution.