Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China; Clinical Research Center of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA.
Ecotoxicol Environ Saf. 2022 Jun 15;238:113588. doi: 10.1016/j.ecoenv.2022.113588. Epub 2022 May 5.
Understanding the spatio-temporal patterns of the disease burden attributable to ambient PM2.5 across the world is essential for the prevention of related diseases, as well as ambient PM2.5 control. Following the framework and methodology of the Global Burden of Disease Study (GBD) in 2019, the global, regional, and national data on ambient PM2.5-attributable death and disability-adjusted life years (DALYs), and the age-standardized rates of mortality (ASMR) and disability-adjusted life years (ASDR) were summarized based on age, gender, year, location and specific diseases. We calculated the average annual percentage change (AAPC) to depict the secular trends of ASMR and ASDR from 1990 to 2019. In 2019, the global ambient PM2.5-related deaths and DALYs were 4,140,970 and 118.2 million, respectively, with 1,702,150 deaths and 47.5 million DALYs for females and 2,438,820 deaths and 70.7 million DALYs for male. In the 13 level-three causes, ischemic heart disease, stroke, chronic obstructive and pulmonary disease (COPD) were the leading three causes of deaths and DALYs attributable to ambient PM2.5. The number of global deaths and DALYs attributable to ambient PM2.5 has increased by 102.3% and 67.7% from 1990 to 2019, respectively. However, ASMR and ASDR showed little change. In the 13 level-three diseases, ischemic heart disease, stroke, COPD, diabetes mellitus, and lung cancer were the top five contributors to the increase of global deaths or DALYs, among which diabetes mellitus had the fastest increase of ASMR and ASDR, with AAPC of 1.5 (95% CI: 1.43, 1.58) and 2.21 (95% CI: 2.15, 2.27), respectively. The population attributable fractions (PAF) of causes in ASMR or ASDR varied significantly across regions, of which PAF of COPD, stroke and lung cancer were the top three. Regarding the GBD region, high PAF mainly occurred in North Africa and Middle East, South Asia, and East Asia. The age-specific PAFs of ischemic heart disease and stroke deaths and DALYs due to ambient PM2.5 were negatively correlated with age. ASMR and ASDR of overall PM2.5 related-burden showed an inverted "V/U" relationship with the socio-demographic index (SDI). The AAPC of ASMR and ASDR of the overall causes showed a strong negative correlation with SDI in 2019, especially at the SDI larger than 0.5. The deaths and DALYs attributable to ambient PM2.5 continued to increase under the context of population growth and aging. Decision-makers should consider controlling the PM2.5 emission when developing the economy.
了解全球环境 PM2.5 造成的疾病负担的时空模式对于预防相关疾病以及环境 PM2.5 控制至关重要。本研究遵循 2019 年全球疾病负担研究（GBD）的框架和方法，总结了全球、区域和国家环境 PM2.5 相关死亡和伤残调整生命年（DALYs）以及死亡率（ASMR）和伤残调整生命年（ASDR）的年龄标准化率，基于年龄、性别、年份、位置和特定疾病。我们计算了平均年变化百分比（AAPC），以描绘 1990 年至 2019 年 ASMR 和 ASDR 的趋势。2019 年，全球环境 PM2.5 相关死亡和 DALYs 分别为 4140970 人和 118.2 百万，女性死亡和 DALYs 分别为 1702150 人和 47.5 百万，男性死亡和 DALYs 分别为 2438820 人和 70.7 百万。在 13 个三级原因中，缺血性心脏病、中风和慢性阻塞性肺疾病（COPD）是环境 PM2.5 造成的死亡和 DALYs 的前三个主要原因。1990 年至 2019 年，全球环境 PM2.5 造成的死亡和 DALYs 分别增加了 102.3%和 67.7%。然而，ASMR 和 ASDR 变化不大。在 13 种三级疾病中，缺血性心脏病、中风、COPD、糖尿病和肺癌是全球死亡或 DALYs 增加的前五种原因，其中糖尿病的 ASMR 和 ASDR 增长最快，AAPC 分别为 1.5（95%CI：1.43，1.58）和 2.21（95%CI：2.15，2.27）。各原因在 ASMR 或 ASDR 中的人群归因分数（PAF）在各区域差异显著，其中 COPD、中风和肺癌的 PAF 最高。在 GBD 区域中，北非和中东、南亚和东亚的 PAF 较高。与环境 PM2.5 相关的缺血性心脏病和中风死亡和 DALYs 的年龄特异性 PAF 与年龄呈负相关。总 PM2.5 相关负担的 ASMR 和 ASDR 与社会人口指数（SDI）呈倒“U”型关系。2019 年，ASMR 和 ASDR 的 AAPC 与 SDI 呈强负相关，尤其是在 SDI 大于 0.5 时。在人口增长和老龄化的背景下，环境 PM2.5 造成的死亡和 DALYs 持续增加。决策者在制定经济发展政策时应考虑控制 PM2.5 的排放。
