Department of Neurobiology, Harvard Medical School, 220 Longwood Avenue, Boston, MA, 02115, USA.
School of Medicine, University of Split, Šoltanska 2, 21 000, Split, Croatia.
Sci Rep. 2021 Nov 18;11(1):22516. doi: 10.1038/s41598-021-01802-5.
Air pollution is the fourth greatest overall risk factor for human health. Despite declining levels in Europe, air pollution still represents a major health and economic burden. We collected data from the Global Burden of Disease Study 2019 regarding overall, as well as ischemic heart disease (IHD), stroke, and tracheal, bronchus and lung cancer-specific disability adjusted life years (DALYs), years of life lost (YLL) and mortality attributable to air pollution for 43 European countries between 1990 and 2019. Concentrations of ambient particulate matter (aPM), ozone, and household air pollution from solid fuels were obtained from State of Global Air 2020. We analysed changes in air pollution parameters, as well as DALYs, YLL, and mortality related to air pollution, also taking into account gross national income (GNI) and socio-demographic index (SDI). Using a novel calculation, aPM ratio (PMR) change and DALY rate ratio (DARR) change were used to assess each country's ability to decrease its aPM pollution and DALYs to at least the extent of the European median decrease within the analysed period. Finally, we created a multiple regression model for reliably predicting YLL using aPM and household air pollution. The average annual population-weighted aPM exposure in Europe in 1990 was 20.8 μg/m (95% confidence interval (CI) 18.3-23.2), while in 2019 it was 33.7% lower at 13.8 μg/m (95% CI 12.0-15.6). There were in total 368 006 estimated deaths in Europe in 2019 attributable to air pollution, a 42.4% decrease compared to 639 052 in 1990. The majority (90.4%) of all deaths were associated with aPM. IHD was the primary cause of death making up 44.6% of all deaths attributable to air pollution. The age-standardised DALY rate and YLL rate attributable to air pollution were more than 60% lower in 2019 compared to 1990. There was a strong positive correlation (r = 0.911) between YLL rate and aPM pollution in 2019 in Europe. Our multiple regression model predicts that for 10% increase in aPM, YLL increases by 16.7%. Furthermore, 26 of 43 European countries had a positive DARR change. 31 of 43 European countries had a negative PMR change, thus not keeping up with the European median aPM concentration decrease. When categorising countries by SDI and GNI, countries in the higher brackets had significantly lower aPM concentration and DALY rate for IHD and stroke. Overall, air pollution levels, air pollution-related morbidity and mortality have decreased considerably in Europe in the last three decades. However, with the growing European population, air pollution remains an important public health and economic issue. Policies targeting air pollution reduction should continue to be strongly enforced to further reduce one of the greatest risk factors for human health.
空气污染是人类健康的第四大主要风险因素。尽管欧洲的空气污染水平有所下降，但它仍然是一个主要的健康和经济负担。我们收集了 2019 年全球疾病负担研究中有关欧洲 43 个国家在 1990 年至 2019 年期间的总体以及缺血性心脏病 (IHD)、中风、气管、支气管和肺癌特定残疾调整生命年 (DALY)、预期寿命损失 (YLL) 和归因于空气污染的死亡率的数据。环境空气中的颗粒物 (aPM)、臭氧和来自固体燃料的家用空气污染浓度从 2020 年全球空气质量状况中获得。我们分析了空气污染参数的变化，以及与空气污染相关的 DALY、YLL 和死亡率，同时还考虑了国民总收入 (GNI) 和社会人口指数 (SDI)。使用一种新的计算方法，aPM 比值 (PMR) 变化和 DALY 率比值 (DARR) 变化用于评估每个国家降低其 aPM 污染和 DALY 的能力，使其至少达到分析期间欧洲中位数降低的程度。最后，我们创建了一个多元回归模型，用于可靠地预测使用 aPM 和家用空气污染的 YLL。1990 年欧洲的年平均人口加权 aPM 暴露量为 20.8μg/m（95%置信区间[CI]为 18.3-23.2），而 2019 年则降低了 33.7%，为 13.8μg/m（95% CI 为 12.0-15.6）。2019 年欧洲共有 368006 人因空气污染而死亡，与 1990 年的 639052 人相比下降了 42.4%。其中 90.4%的死亡与 aPM 有关。IHD 是主要的死亡原因，占所有归因于空气污染的死亡人数的 44.6%。与 1990 年相比，2019 年欧洲归因于空气污染的年龄标准化 DALY 率和 YLL 率降低了 60%以上。2019 年欧洲的 YLL 率与 aPM 污染之间存在很强的正相关关系（r=0.911）。我们的多元回归模型预测，aPM 增加 10%，YLL 增加 16.7%。此外，43 个欧洲国家中有 26 个国家的 DARR 变化为正。31 个欧洲国家的 PMR 变化为负，因此未能跟上欧洲平均 aPM 浓度的下降。按 SDI 和 GNI 对国家进行分类，较高分组的国家的 aPM 浓度和 IHD 和中风的 DALY 率显著降低。总体而言，过去三十年来，欧洲的空气污染水平、与空气污染相关的发病率和死亡率已大幅下降。然而，随着欧洲人口的增长，空气污染仍然是一个重要的公共卫生和经济问题。应继续大力执行针对减少空气污染的政策，以进一步降低人类健康的最大风险因素之一。
