Lin Kaibin, Quan Junxian, Liao Jiafen, Chen Yiyue, Zhou Bing, Xu Xi
School of Computer Science, Hunan First Normal University, Changsha, China.
Department of Rheumatology and Immunology, The Second Xiangya Hospital of Central South University, Changsha, China.
Front Public Health. 2025 Jul 23;13:1636544. doi: 10.3389/fpubh.2025.1636544. eCollection 2025.
Ambient air pollution persists as a critical global health threat, ranking fourth among risk factors for premature mortality. Despite decades of air quality improvements in the U.S. through regulatory measures, persistent health impacts remain, driven primarily by particulate matter (PM.5) and ozone.
This study aimed to quantify long-term trends (1990-2021) in air pollution-attributable disease burdens across U.S. states, evaluate the effectiveness of existing policies, and identify priorities for future public health strategies to address persistent and emerging risks.
Using the Global Burden of Disease (GBD) 2021 dataset, we analyzed age-standardized mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) attributable to PM.5, ozone, and household air pollution. Disease burdens were assessed for chronic obstructive pulmonary disease (COPD), diabetes mellitus, ischemic heart disease (IHD), lower respiratory infections, stroke, and lung cancer. Data were standardized to the GBD reference population for comparability over time.
From 1990 to 2021, PM.5-attributable mortality declined by 80.5%, with IHD deaths falling by 70.6% (79,684-23,433 deaths) and associated DALYs by 71.2%. However, diabetes-related YLDs surged 97.4% nationally, reflecting interactions with obesity and lifestyle factors. Formerly high-pollution states (e.g., Indiana, Tennessee) achieved substantial (30%-40%) reductions in PM.5-linked DALYs for IHD and COPD, while California saw a 12.3% rise in diabetes DALYs. In 2021, residual burdens disproportionately affected older adults and males, with IHD mortality rates 1.8 times higher in men. Ozone-related COPD deaths showed minimal decline despite falling ozone levels.
环境空气污染仍然是全球重大的健康威胁，在过早死亡的风险因素中排名第四。尽管美国通过监管措施在空气质量改善方面历经数十年，但主要由细颗粒物（PM2.5）和臭氧导致的持续性健康影响依然存在。
本研究旨在量化美国各州空气污染所致疾病负担的长期趋势（1990 - 2021年），评估现有政策的有效性，并确定未来公共卫生策略应对持续性和新出现风险的重点。
利用全球疾病负担（GBD）2021数据集，我们分析了归因于PM2.5、臭氧和家庭空气污染的年龄标准化死亡率、伤残调整生命年（DALYs）、寿命损失年数（YLLs）和伤残生存年数（YLDs）。对慢性阻塞性肺疾病（COPD）、糖尿病、缺血性心脏病（IHD）、下呼吸道感染、中风和肺癌的疾病负担进行了评估。数据按照GBD参考人群进行标准化处理，以便随时间进行比较。
1990年至2021年，PM2.5所致死亡率下降了80.5%，其中IHD死亡人数下降了70.6%（从79,684例降至23,433例），相关DALYs下降了71.2%。然而，全国范围内与糖尿病相关的YLDs激增了97.4%，这反映了与肥胖和生活方式因素的相互作用。以前污染严重的州（如印第安纳州、田纳西州）在IHD和COPD的PM2.5相关DALYs方面实现了大幅（30% - 40%）降低，而加利福尼亚州糖尿病DALYs上升了12.3%。2021年，残余负担对老年人和男性的影响尤为严重，男性的IHD死亡率高出1.8倍。尽管臭氧水平下降，但与臭氧相关的COPD死亡人数降幅极小。
