Health Effects Institute, Boston, MA, USA.
University of British Columbia, Vancouver, BC, Canada.
Lancet. 2017 May 13;389(10082):1907-1918. doi: 10.1016/S0140-6736(17)30505-6. Epub 2017 Apr 10.
BACKGROUND: Exposure to ambient air pollution increases morbidity and mortality, and is a leading contributor to global disease burden. We explored spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015 at global, regional, and country levels. METHODS: We estimated global population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2·5 μm (PM) and ozone at an approximate 11 km × 11 km resolution with satellite-based estimates, chemical transport models, and ground-level measurements. Using integrated exposure-response functions for each cause of death, we estimated the relative risk of mortality from ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infections from epidemiological studies using non-linear exposure-response functions spanning the global range of exposure. FINDINGS: Ambient PM was the fifth-ranking mortality risk factor in 2015. Exposure to PM caused 4·2 million (95% uncertainty interval [UI] 3·7 million to 4·8 million) deaths and 103·1 million (90·8 million 115·1 million) disability-adjusted life-years (DALYs) in 2015, representing 7·6% of total global deaths and 4·2% of global DALYs, 59% of these in east and south Asia. Deaths attributable to ambient PM increased from 3·5 million (95% UI 3·0 million to 4·0 million) in 1990 to 4·2 million (3·7 million to 4·8 million) in 2015. Exposure to ozone caused an additional 254 000 (95% UI 97 000-422 000) deaths and a loss of 4·1 million (1·6 million to 6·8 million) DALYs from chronic obstructive pulmonary disease in 2015. INTERPRETATION: Ambient air pollution contributed substantially to the global burden of disease in 2015, which increased over the past 25 years, due to population ageing, changes in non-communicable disease rates, and increasing air pollution in low-income and middle-income countries. Modest reductions in burden will occur in the most polluted countries unless PM values are decreased substantially, but there is potential for substantial health benefits from exposure reduction. FUNDING: Bill & Melinda Gates Foundation and Health Effects Institute.
背景：暴露于环境空气污染会增加发病率和死亡率，是导致全球疾病负担的主要因素。我们在全球、区域和国家层面上探讨了 1990 年至 2015 年期间归因于环境空气污染的死亡率和疾病负担的时空趋势。
方法：我们使用卫星估计、化学传输模型和地面测量来估计全球人口加权平均浓度的直径小于 2.5μm 的颗粒物质量（PM）和臭氧，分辨率约为 11km×11km。使用每个死因的综合暴露-反应函数，我们使用非线性暴露-反应函数来估计来自流行病学研究的缺血性心脏病、脑血管疾病、慢性阻塞性肺疾病、肺癌和下呼吸道感染的死亡率的相对风险，这些函数跨越了全球暴露范围。
结果：2015 年，环境 PM 是第五大死亡风险因素。PM 暴露导致 420 万人（95%置信区间[95%UI]370 万至 480 万）死亡和 1031 万人（908 万至 1151 万）伤残调整生命年（DALY），占全球总死亡人数的 7.6%和全球 DALY 的 4.2%，其中 59%发生在东亚和南亚。1990 年，归因于环境 PM 的死亡人数从 350 万（95%UI 300 万至 400 万）增加到 2015 年的 420 万（370 万至 480 万）。臭氧暴露导致 2015 年慢性阻塞性肺病额外死亡 25.4 万人（95%UI 9.7 万至 42.2 万）和损失 410 万人（160 万至 680 万）伤残调整生命年。
解释：环境空气污染在 2015 年对全球疾病负担有很大贡献，由于人口老龄化、非传染性疾病发病率的变化以及中低收入国家空气污染的增加，过去 25 年来，这一负担有所增加。除非 PM 值大幅下降，否则污染最严重的国家的负担将有所减轻，但从减少暴露中获得巨大健康益处的潜力是存在的。
资金来源：比尔和梅琳达·盖茨基金会以及健康影响研究所。
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