Xue Tao, Tong Mingkun, Wang Meng, Yang Xinyue, Wang Yanying, Lin Huan, Liu Hengyi, Li Jiajianghui, Huang Conghong, Meng Xia, Zheng Yixuan, Tong Dan, Gong Jicheng, Zhang Shiqiu, Zhu Tong
Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing 100191, China.
Center for Environment and Health, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China.
Environ Sci Technol. 2023 Apr 4;57(13):5349-5357. doi: 10.1021/acs.est.2c08022. Epub 2023 Mar 23.
Nitrogen dioxide (NO) is associated with mortality and many other adverse health outcomes. In 2021, the World Health Organization established a new NO air quality guideline (AQG) (annual average <10 μg/m). However, the burden of diseases attributable to long-term NO exposure above the AQG is unknown in China. Nitrogen oxide is a major air pollutant in populous cities, which are disproportionately impacted by NO; this represents a form of environmental inequality. We conducted a nationwide risk assessment of premature deaths attributable to long-term NO exposure from 2013 to 2020 based on the exposure-response relationship, high-resolution annual NO concentrations, and gridded population data (considering sex, age, and residence [urban vs rural]). We calculated health metrics including attributable deaths, years of life lost (YLL), and loss of life expectancy (LLE). Inequality in the distribution of attributable deaths and YLLs was evaluated by the Lorenz curve and Gini index. According to the health impact assessments, in 2013, long-term NO exposure contributed to 315,847 (95% confidence interval [CI]: 306,709-319,269) premature deaths, 7.90 (7.68-7.99) million YLLs, and an LLE of 0.51 (0.50-0.52) years. The high-risk subgroup (top 20%) accounted for 85.7% of all NO-related deaths and 85.2% of YLLs, resulting in Gini index values of 0.81 and 0.67, respectively. From 2013 to 2020, the estimated health impact from NO exposure was significantly reduced, but inequality displayed a slightly increasing trend. Our study revealed a considerable burden of NO-related deaths in China, which were disproportionally frequent in a small high-risk subgroup. Future clean air initiatives should focus not only on reducing the average level of NO exposure but also minimizing inequality.
二氧化氮（NO）与死亡率及许多其他不良健康后果相关。2021年，世界卫生组织制定了新的NO空气质量指南（AQG）（年平均<10μg/m³）。然而，在中国，长期暴露于高于AQG水平的NO导致的疾病负担尚不清楚。氮氧化物是人口众多城市的主要空气污染物，这些城市受到NO的影响尤为严重；这代表了一种环境不平等形式。我们基于暴露-反应关系、高分辨率年度NO浓度和网格化人口数据（考虑性别、年龄和居住地[城市与农村]），对2013年至2020年长期NO暴露导致的过早死亡进行了全国范围的风险评估。我们计算了包括归因死亡数、寿命损失年数（YLL）和预期寿命损失（LLE）在内的健康指标。通过洛伦兹曲线和基尼系数评估归因死亡数和YLL分布的不平等情况。根据健康影响评估，2013年，长期NO暴露导致315,847例（95%置信区间[CI]：306,709 - 319,269）过早死亡、790万（768 - 799万）寿命损失年数以及0.51年（0.50 - 0.52年）的预期寿命损失。高风险亚组（前20%）占所有与NO相关死亡数的85.7%和YLL的85.2%，基尼系数分别为0.81和0.67。从2013年到2020年，NO暴露对健康的估计影响显著降低，但不平等呈现出略有上升的趋势。我们的研究揭示了中国与NO相关死亡的相当大负担，这些死亡在一个小的高风险亚组中尤为频繁。未来的清洁空气倡议不仅应侧重于降低NO暴露的平均水平，还应尽量减少不平等。
