The International Clinical Epidemiology Network (INCLEN) Trust, New Delhi, India.
National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India.
Environ Int. 2017 May;102:145-156. doi: 10.1016/j.envint.2017.02.010. Epub 2017 Mar 11.
National estimates of the health and economic burdens of exposure to ambient fine particulate matter (PM) in India reveal substantial impacts. This information, often lacking at the local level, can justify and drive mitigation interventions. Here, we assess the health and economic gains resulting from attainment of WHO guidelines for PM concentrations - including interim target 2 (IT-2), interim target 3 (IT-3), and the WHO air quality guideline (AQG) - in Nagpur district to inform policy decision making for mitigation. We conducted a detailed assessment of concentrations of PM in 9 areas, covering urban, peri-urban and rural environments, from February 2013 to June 2014. We used a combination of hazard and survival analyses based on the life table method to calculate attributed annual number of premature deaths and disability-adjusted life years (DALYs) for five health outcomes linked to PM exposure: acute lower respiratory infection for children <5years, ischemic heart disease, chronic obstructive pulmonary disease, stroke and lung cancer in adults ≥25years. We used GBD 2013 data on deaths and DALYs for these diseases. We calculated averted deaths, DALYs and economic loss resulting from planned reductions in average PM concentration from current level to IT-2, IT-3 and AQG by the years 2023, 2033 and 2043, respectively. The economic cost for premature mortality was estimated as the product of attributed deaths and value of statistical life for India, while morbidity was assumed to be 10% of the mortality cost. The annual average PM concentration in Nagpur district is 34±17μgm and results in 3.3 (95% confidence interval [CI]: 2.6, 4.2) thousand premature deaths and 91 (95% CI: 68, 116) thousand DALYs in 2013 with economic loss of USD 2.2 (95% CI: 1.7, 2.8) billion in that year. It is estimated that interventions that achieve IT-2, IT-3 and AQG by 2023, 2033 and 2043, would avert, respectively, 15, 30 and 36%, of the attributed health and economic loss in those years, translating into an impressively large health and economic gain. To achieve this, we recommend an exposure-integrated source reduction approach.
国家估算显示，印度因接触环境细颗粒物（PM）而导致的健康和经济负担巨大。这些信息在地方层面往往缺乏，可作为减轻污染干预措施的理由和推动力。本研究旨在评估实现世界卫生组织（WHO）PM 浓度指南（包括临时目标 2（IT-2）、临时目标 3（IT-3）和 WHO 空气质量准则（AQG））在那格浦尔区所带来的健康和经济效益，以为减轻污染的决策提供信息。我们于 2013 年 2 月至 2014 年 6 月期间在 9 个地区（包括城市、城郊和农村地区）进行了 PM 浓度的详细评估。我们结合危害和生存分析，基于生命表法计算了与 PM 暴露相关的 5 种健康结果（5 岁以下儿童急性下呼吸道感染、缺血性心脏病、慢性阻塞性肺疾病、中风和成人 25 岁以上肺癌）的归因于 PM 的年过早死亡人数和伤残调整生命年（DALY）。我们使用了 GBD 2013 年关于这些疾病的死亡和 DALY 数据。我们计算了从当前水平到 2023 年、2033 年和 2043 年分别达到 IT-2、IT-3 和 AQG 时，平均 PM 浓度降低所带来的避免死亡人数、DALY 和经济损失。过早死亡率的经济成本估计为归因于死亡人数乘以印度的统计生命价值，而发病率则假定为死亡率成本的 10%。2013 年，那格浦尔区的年平均 PM 浓度为 34±17μg/m3，导致 3300（95%置信区间[CI]：2600，4100）例过早死亡和 910000（95%CI：680000，1160000）伤残调整生命年（DALY），当年的经济损失为 22 亿美元（95%CI：17 亿至 28 亿美元）。据估计，到 2023 年、2033 年和 2043 年分别实现 IT-2、IT-3 和 AQG，将分别避免当年归因于健康和经济损失的 15%、30%和 36%，这将带来巨大的健康和经济效益。为了实现这一目标，我们建议采取一种以暴露为基础的综合污染源减排方法。
