All-Cause NO-Attributable Mortality Burden and Associated Racial and Ethnic Disparities in the United States.

Nitrogen dioxide (NO) is a regulated pollutant that is associated with numerous health impacts. Recent advances in epidemiology indicate high confidence linking NO exposure with increased mortality, an association that recent studies suggest persists even at concentrations below regulatory thresholds. While large disparities in NO exposure among population subgroups have been reported, U.S. NO-attributable mortality rates and their disparities remain unquantified. Here we provide the first estimate of NO-attributable all-cause mortality across the contiguous U.S. (CONUS) at the census tract-level. We leverage fine-scale, satellite-informed, land use regression model NO concentrations and census tract-level baseline mortality data to characterize the associated disparities among different racial/ethnic subgroups. Across CONUS, we estimate that the NO-attributable all-cause mortality is ∼170,850 (95% confidence interval: 43,970, 251,330) premature deaths yr with large variability across census tracts and within individual cities. Additionally, we find that higher NO concentrations and underlying susceptibilities for predominately Black communities lead to NO-attributable mortality rates that are ∼47% higher compared to CONUS-wide average rates. Our results highlight the substantial U.S. NO mortality burden, particularly in marginalized communities, and motivate adoption of more stringent standards to protect public health.