全球家庭空气污染（以 PM 计）的城乡差距及其归因于健康的负担估计。
Urban-rural disparity in global estimation of PM household air pollution and its attributable health burden.
机构信息
Institute of Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, UK.
Energy Institute, University College London, London, UK.
出版信息
Lancet Planet Health. 2023 Aug;7(8):e660-e672. doi: 10.1016/S2542-5196(23)00133-X.
BACKGROUND
Polluting fuels and inefficient stove technologies are still a leading cause of premature deaths worldwide, particularly in low-income and middle-income countries. Previous studies of global household air pollution (HAP) have neither considered the estimation of PM at national level nor the corresponding attributable mortality burden. Additionally, the effects of climate and ambient air pollution on the global estimation of HAP-PM exposure for different urban and rural settings remain largely unknown. In this study, we include climatic effects to estimate the HAP-PM exposure from different fuel types and stove technologies in rural and urban settings separately and the related attributable global mortality burden.
METHODS
Bayesian hierarchical models were developed to estimate an annual average HAP-PM personal exposure and HAP-PM indoor concentration (including both outdoor and indoor sources). Model variables were selected from sample data in 282 peer-reviewed studies drawn and updated from the WHO Global HAP dataset. The PM exposure coefficients from the developed model were applied to the external datasets to predict the HAP-PM exposure globally (personal exposure in 62 countries and indoor concentration in 69 countries). Attributable mortality rate was estimated using a comparative risk assessment approach. Using weighted averages, the national level 24 h average HAP-PM exposure due to polluting and clean fuels and related death rate per 100 000 population were estimated.
FINDINGS
In 2020, household use of polluting solid fuels for cooking and heating led to a national-level average personal exposure of 151 μg/m (95% CI 133-169), with rural households having an average of 171 μg/m (153-189) and urban households an average of 92 μg/m (77-106). Use of clean fuels gave rise to a national-level average personal exposure of 69 μg/m (62-76), with a rural average of 76 μg/m (69-83) and an urban average of 49 μg/m (46-53). Personal exposure-attributable premature mortality (per 100 000 population) from the use of polluting solid fuels at national level was on average 78 (95% CI 69-87), with a rural average of 82 (73-90) and an urban average of 66 (57-75). The average attributable premature mortality (per 100 000 population) from the use of clean fuels at the national level is 62 (54-70), with a rural average of 66 (58-74) and an urban average of 52 (47-57). The estimated HAP-PM indoor concentration shows that the use of polluting solid fuels resulted in a national-level average of 412 μg/m (95% CI 353-471), with a rural average of 514 μg/m (446-582) and an urban average of 149 μg/m (126-173). The use of clean fuels (gas and electricity) led to an average PM indoor concentration of 135 μg/m (117-153), with a rural average of 174 μg/m (154-195) and an urban average of 71 μg/m (63-80). Using time-weighted HAP-PM indoor concentrations, the attributable premature death rate (per 100 000 population) from the use of polluting solid fuels at the national level is on average 78 (95% CI 72-84), the rural average being 84 (78-91) and the urban average 60 (54-66). From the use of clean fuels, the average attributable premature death rate (per 100 000 population) at the national level is 59 (53-64), the rural average being 68 (62-74) and the urban average 45 (41-50).
INTERPRETATION
A shift from polluting to clean fuels can reduce the average PM personal exposure by 53% and thereby lower the death rate. For all fuel types, the estimated average HAP-PM personal exposure and indoor concentrations exceed the WHO's Interim Target-1 average annual threshold. Policy interventions are urgently needed to greatly increase the use of clean fuels and stove technologies by 2030 to achieve the goal of affordable clean energy access, as set by the UN in 2015, and address health inequities in urban-rural settings.
FUNDING
Wellcome Trust, The Lancet Countdown, the Engineering and Physical Sciences Research Council, and the Natural Environment Research Council.
背景
污染燃料和低效炉灶技术仍然是导致全球过早死亡的主要原因，尤其是在低收入和中等收入国家。以前的全球家庭空气污染（HAP）研究既没有考虑到国家一级的 PM 估计值，也没有考虑到相应的归因死亡率负担。此外，气候和环境空气污染对不同城乡环境下全球 HAP-PM 暴露的估计影响在很大程度上仍不清楚。在这项研究中，我们将气候影响纳入考虑，分别估算农村和城市地区不同燃料类型和炉灶技术的 HAP-PM 暴露情况以及相关的全球归因死亡率。
方法
我们开发了贝叶斯层次模型来估算年度平均 HAP-PM 个人暴露量和 HAP-PM 室内浓度（包括室外和室内来源）。模型变量是从 282 项经过同行评审的研究中的抽样数据中选择的，并从世界卫生组织全球 HAP 数据集中进行了更新。从开发的模型中得出的 PM 暴露系数被应用于外部数据集，以在全球范围内预测 HAP-PM 暴露情况（在 62 个国家进行个人暴露预测，在 69 个国家进行室内浓度预测）。使用比较风险评估方法估计归因死亡率。使用加权平均值，估算了由于使用污染和清洁燃料而导致的国家 24 小时平均 HAP-PM 暴露量以及每 10 万人口的死亡率。
结果
2020 年，家庭使用污染性固体燃料进行烹饪和取暖导致全国平均个人暴露量为 151μg/m³（95%CI 133-169），农村家庭的平均暴露量为 171μg/m³（153-189），城市家庭的平均暴露量为 92μg/m³（77-106）。使用清洁燃料导致全国平均个人暴露量为 69μg/m³（62-76），农村平均暴露量为 76μg/m³（69-83），城市平均暴露量为 49μg/m³（46-53）。使用污染性固体燃料导致的个人暴露归因于过早死亡（每 10 万人口）的平均水平为 78（95%CI 69-87），农村地区的平均水平为 82（73-90），城市地区的平均水平为 66（57-75）。使用清洁燃料导致的全国平均归因于过早死亡（每 10 万人口）的平均水平为 62（54-70），农村地区的平均水平为 66（58-74），城市地区的平均水平为 52（47-57）。估计的 HAP-PM 室内浓度表明，使用污染性固体燃料导致全国平均室内浓度为 412μg/m³（95%CI 353-471），农村地区的平均室内浓度为 514μg/m³（446-582），城市地区的平均室内浓度为 149μg/m³（126-173）。使用清洁燃料（天然气和电力）导致的 PM 室内浓度平均为 135μg/m³（117-153），农村地区的平均室内浓度为 174μg/m³（154-195），城市地区的平均室内浓度为 71μg/m³（63-80）。使用时间加权的 HAP-PM 室内浓度，使用污染性固体燃料导致的全国归因于过早死亡的平均比率（每 10 万人口）为 78（95%CI 72-84），农村地区的平均比率为 84（78-91），城市地区的平均比率为 60（54-66）。使用清洁燃料，全国归因于过早死亡的平均比率（每 10 万人口）为 59（53-64），农村地区的平均比率为 68（62-74），城市地区的平均比率为 45（41-50）。
解释
从污染性燃料向清洁燃料的转变可以将平均 PM 个人暴露量减少 53%，从而降低死亡率。对于所有燃料类型，估计的平均 HAP-PM 个人暴露量和室内浓度均超过了世界卫生组织临时目标-1 的年均阈值。迫切需要采取政策干预措施，到 2030 年大幅增加清洁燃料和炉灶技术的使用，以实现联合国 2015 年提出的负担得起的清洁能源获取目标，并解决城乡地区的健康不平等问题。
资金
惠康信托基金会、柳叶刀倒计时、工程和物理科学研究理事会以及自然环境研究理事会。
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