Ministry of Education Key Laboratory for Earth System modeling, Department of Earth System Science, Tsinghua University, Beijing, China; School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada; Energy and Resources Group, University of California, Berkeley, CA, USA.
School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USAxs.
Lancet Planet Health. 2021 Jun;5(6):e356-e367. doi: 10.1016/S2542-5196(21)00131-5.
BACKGROUND: The health impacts of ambient air pollution impose large costs on society. Although all people are exposed to air pollution, the older population (ie, those aged ≥60 years) tends to be disproportionally affected. As a result, there is growing concern about the health impacts of air pollution as many countries undergo rapid population ageing. We investigated the spatial and temporal variation in the economic cost of deaths attributable to ambient air pollution and its interaction with population ageing from 2000 to 2016 at global and regional levels. METHODS: In this global analysis, we developed an age-adjusted measure of the value of a statistical life-year (VSLY) to estimate the economic cost of deaths attributable to ambient PM pollution using Global Burden of Diseases, Injuries, and Risk Factors Study 2017 data and country-level socioeconomic information. First, we estimated the global age-specific and cause-specific mortality and years of life lost (YLLs) attributable to PM pollution using the global exposure mortality model and global estimates of exposure at 0·1° × 0·1° (about 11 km × 11 km at the equator) resolution. Second, for each year between 2000 and 2016, we translated the YLLs within each age group into a health-related cost using a country-specific, age-adjusted measure of VSLY. Third, we decomposed the major driving factors that contributed to the temporal change in health costs related to PM. Finally, we did a sensitivity test to analyse the variability of the estimated health costs to four alternative valuation measures. We identified the uncertainty intervals (UIs) from 1000 draws of the parameters and concentration-response functions by age, cause, country, and year. All economic values are reported in 2011 purchasing power parity-adjusted US dollars. All simulations were done with R, version 3.6.0. FINDINGS: Globally, in 2016, PM was estimated to have caused 8·42 million (95% UI 6·50-10·52) attributable deaths, which was associated with 163·68 million (116·03-219·44) YLLs. In 2016, the global economic cost of deaths attributable to ambient PM pollution for the older population was US$2·40 trillion (1·89-2·93) accounting for 59% (59-60) of the cost for the total population ($4·09 trillion [3·19-5·05]). The economic cost per capita for the older population was $2739 (2160-3345) in 2016, which was 10 times that of the younger population (ie, those aged <60 years). By assessing the factors that contributed to economic costs, we found that increases in these factors changed the total economic cost by 77% for gross domestic product (GDP) per capita, 21% for population ageing, 16% for population growth, -41% for age-specific mortality, and -0·4% for PM exposure. INTERPRETATION: The economic cost of ambient PM borne by the older population almost doubled between 2000 and 2016, driven primarily by GDP growth, population ageing, and population growth. Compared with younger people, air pollution leads to disproportionately higher health costs among older people, even after accounting for their relatively shorter life expectancy and increased disability. As the world's population is ageing, the disproportionate health cost attributable to ambient PM pollution potentially widens the health inequities for older people. Countries with severe air pollution and rapid ageing rates need to take immediate actions to improve air quality. In addition, strategies aimed at enhancing health-care services, especially targeting the older population, could be beneficial for reducing the health costs of ambient air pollution. FUNDING: National Natural Science Foundation of China, China Postdoctoral Science Foundation, and Qiushi Foundation.
背景: 大气污染对健康的影响给社会带来了巨大的成本。尽管所有人都暴露在空气污染中,但老年人口(即≥60 岁的人群)往往受到不成比例的影响。因此,随着许多国家快速人口老龄化,人们越来越关注空气污染对健康的影响。我们研究了 2000 年至 2016 年期间,全球和区域层面上,归因于大气污染的死亡人数的经济成本及其与人口老龄化的时空变化。
方法: 在这项全球分析中,我们开发了一种经过年龄调整的统计生命年(VSLY)价值衡量标准,以使用全球疾病、伤害和危险因素研究 2017 年数据和国家层面的社会经济信息来估计归因于 PM 污染的死亡人数的经济成本。首先,我们使用全球暴露死亡率模型和全球 0.1°×0.1°(在赤道处约为 11km×11km)分辨率的暴露估计值,估计了 PM 污染导致的全球特定年龄和特定原因的死亡率和寿命损失年(YLL)。其次,对于 2000 年至 2016 年的每一年,我们使用特定国家的经过年龄调整的 VSLY 衡量标准,将每个年龄组的 YLL 转化为健康相关的成本。第三,我们分解了导致与 PM 相关的健康成本随时间变化的主要驱动因素。最后,我们进行了一项敏感性测试,以分析四个替代估值衡量标准对估计健康成本的可变性。我们通过年龄、死因、国家和年份的 1000 次参数和浓度反应函数的随机抽样,确定了不确定性区间(UI)。所有经济价值均以 2011 年购买力平价调整后的美元报告。所有模拟均使用 R 版本 3.6.0 进行。
结果: 在全球范围内,2016 年 PM 估计导致了 842 万人(95%置信区间 650-1052)归因死亡,这与 1636.8 万人(1160.3-2194.4)的寿命损失年有关。2016 年,归因于大气 PM 污染的老年人口死亡的全球经济成本为 2.40 万亿美元(1.89-2.93),占总人口(4.09 万亿美元[3.19-5.05])成本的 59%(59-60)。2016 年,老年人口的人均经济成本为 2739 美元(2160-3345),是年轻人口(即<60 岁的人口)的 10 倍。通过评估导致经济成本的因素,我们发现这些因素的变化使人均国内生产总值(GDP)增长 77%、人口老龄化 21%、人口增长 16%、特定年龄死亡率下降-41%和 PM 暴露下降 0.4%,从而改变了总经济成本。
解释: 2000 年至 2016 年间,归因于大气 PM 的老年人口的经济成本几乎翻了一番,主要由 GDP 增长、人口老龄化和人口增长驱动。与年轻人相比,即使考虑到他们相对较短的预期寿命和增加的残疾,空气污染也会导致老年人的健康成本不成比例地更高。随着世界人口老龄化,归因于大气 PM 污染的不成比例的健康成本可能会扩大老年人的健康不平等。空气污染严重和人口老龄化速度较快的国家需要立即采取行动,改善空气质量。此外,旨在加强医疗保健服务的战略,特别是针对老年人口的战略,可能有助于降低大气空气污染的健康成本。
资助: 国家自然科学基金、中国博士后科学基金会和求是基金会。
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