Global estimates of mortality associated with longterm exposure to outdoor fine particulate matter

Richard Burnett, Hong Chen, Mieczyslaw Szyszkowicz, Neal Fann, Bryan Hubbell, C. Arden Pope, Joshua S. Apte, Michael Brauer, Aaron Cohen, Scott Weichenthal, Jay Coggins, Qian Di, Bert Brunekreef, Joseph Frostad, Stephen S. Lim, Haidong Kan, Katherine D. Walker, George D. Thurston, Richard B. Hayes, Chris C. LimMichelle C. Turner, Michael Jerrett, Daniel Krewski, Susan M. Gapstur, W. Ryan Diver, Bart Ostro, Debbie Goldberg, Daniel L. Crouse, Randall V. Martin, Paul Peters, Lauren Pinault, Michael Tjepkema, Aaron Van Donkelaar, Paul J. Villeneuve, Anthony B. Miller, Peng Yin, Maigeng Zhou, Lijun Wang, Nicole A.H. Janssen, Marten Marra, Richard W. Atkinson, Hilda Tsang, Thuan Quoc Thach, John B. Cannon, Ryan T. Allen, Jaime E. Hart, Francine Laden, Giulia Cesaroni, Francesco Forastiere, Gudrun Weinmayr, Andrea Jaensch, Gabriele Nagel, Hans Concin, Joseph V. Spadaro

Research output: Contribution to journalArticle

144 Citations (Scopus)

Abstract

Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries-the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9-8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.

Original languageEnglish (US)
Pages (from-to)9592-9597
Number of pages6
JournalProceedings of the National Academy of Sciences of the United States of America
Volume115
Issue number38
DOIs
StatePublished - Sep 18 2018

Fingerprint

Particulate Matter
Mortality
Confidence Intervals
Cause of Death
Indoor Air Pollution
Tobacco Smoke Pollution
Air Pollution
Proportional Hazards Models
Cohort Studies
Global Burden of Disease

Keywords

  • Concentration
  • Exposure
  • Fine particulate matter
  • Mortality
  • Risk

Cite this

Global estimates of mortality associated with longterm exposure to outdoor fine particulate matter. / Burnett, Richard; Chen, Hong; Szyszkowicz, Mieczyslaw; Fann, Neal; Hubbell, Bryan; Pope, C. Arden; Apte, Joshua S.; Brauer, Michael; Cohen, Aaron; Weichenthal, Scott; Coggins, Jay; Di, Qian; Brunekreef, Bert; Frostad, Joseph; Lim, Stephen S.; Kan, Haidong; Walker, Katherine D.; Thurston, George D.; Hayes, Richard B.; Lim, Chris C.; Turner, Michelle C.; Jerrett, Michael; Krewski, Daniel; Gapstur, Susan M.; Diver, W. Ryan; Ostro, Bart; Goldberg, Debbie; Crouse, Daniel L.; Martin, Randall V.; Peters, Paul; Pinault, Lauren; Tjepkema, Michael; Van Donkelaar, Aaron; Villeneuve, Paul J.; Miller, Anthony B.; Yin, Peng; Zhou, Maigeng; Wang, Lijun; Janssen, Nicole A.H.; Marra, Marten; Atkinson, Richard W.; Tsang, Hilda; Thach, Thuan Quoc; Cannon, John B.; Allen, Ryan T.; Hart, Jaime E.; Laden, Francine; Cesaroni, Giulia; Forastiere, Francesco; Weinmayr, Gudrun; Jaensch, Andrea; Nagel, Gabriele; Concin, Hans; Spadaro, Joseph V.

In: Proceedings of the National Academy of Sciences of the United States of America, Vol. 115, No. 38, 18.09.2018, p. 9592-9597.

Research output: Contribution to journalArticle

Burnett, R, Chen, H, Szyszkowicz, M, Fann, N, Hubbell, B, Pope, CA, Apte, JS, Brauer, M, Cohen, A, Weichenthal, S, Coggins, J, Di, Q, Brunekreef, B, Frostad, J, Lim, SS, Kan, H, Walker, KD, Thurston, GD, Hayes, RB, Lim, CC, Turner, MC, Jerrett, M, Krewski, D, Gapstur, SM, Diver, WR, Ostro, B, Goldberg, D, Crouse, DL, Martin, RV, Peters, P, Pinault, L, Tjepkema, M, Van Donkelaar, A, Villeneuve, PJ, Miller, AB, Yin, P, Zhou, M, Wang, L, Janssen, NAH, Marra, M, Atkinson, RW, Tsang, H, Thach, TQ, Cannon, JB, Allen, RT, Hart, JE, Laden, F, Cesaroni, G, Forastiere, F, Weinmayr, G, Jaensch, A, Nagel, G, Concin, H & Spadaro, JV 2018, 'Global estimates of mortality associated with longterm exposure to outdoor fine particulate matter', Proceedings of the National Academy of Sciences of the United States of America, vol. 115, no. 38, pp. 9592-9597. https://doi.org/10.1073/pnas.1803222115
Burnett, Richard ; Chen, Hong ; Szyszkowicz, Mieczyslaw ; Fann, Neal ; Hubbell, Bryan ; Pope, C. Arden ; Apte, Joshua S. ; Brauer, Michael ; Cohen, Aaron ; Weichenthal, Scott ; Coggins, Jay ; Di, Qian ; Brunekreef, Bert ; Frostad, Joseph ; Lim, Stephen S. ; Kan, Haidong ; Walker, Katherine D. ; Thurston, George D. ; Hayes, Richard B. ; Lim, Chris C. ; Turner, Michelle C. ; Jerrett, Michael ; Krewski, Daniel ; Gapstur, Susan M. ; Diver, W. Ryan ; Ostro, Bart ; Goldberg, Debbie ; Crouse, Daniel L. ; Martin, Randall V. ; Peters, Paul ; Pinault, Lauren ; Tjepkema, Michael ; Van Donkelaar, Aaron ; Villeneuve, Paul J. ; Miller, Anthony B. ; Yin, Peng ; Zhou, Maigeng ; Wang, Lijun ; Janssen, Nicole A.H. ; Marra, Marten ; Atkinson, Richard W. ; Tsang, Hilda ; Thach, Thuan Quoc ; Cannon, John B. ; Allen, Ryan T. ; Hart, Jaime E. ; Laden, Francine ; Cesaroni, Giulia ; Forastiere, Francesco ; Weinmayr, Gudrun ; Jaensch, Andrea ; Nagel, Gabriele ; Concin, Hans ; Spadaro, Joseph V. / Global estimates of mortality associated with longterm exposure to outdoor fine particulate matter. In: Proceedings of the National Academy of Sciences of the United States of America. 2018 ; Vol. 115, No. 38. pp. 9592-9597.
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T1 - Global estimates of mortality associated with longterm exposure to outdoor fine particulate matter

AU - Burnett, Richard

AU - Chen, Hong

AU - Szyszkowicz, Mieczyslaw

AU - Fann, Neal

AU - Hubbell, Bryan

AU - Pope, C. Arden

AU - Apte, Joshua S.

AU - Brauer, Michael

AU - Cohen, Aaron

AU - Weichenthal, Scott

AU - Coggins, Jay

AU - Di, Qian

AU - Brunekreef, Bert

AU - Frostad, Joseph

AU - Lim, Stephen S.

AU - Kan, Haidong

AU - Walker, Katherine D.

AU - Thurston, George D.

AU - Hayes, Richard B.

AU - Lim, Chris C.

AU - Turner, Michelle C.

AU - Jerrett, Michael

AU - Krewski, Daniel

AU - Gapstur, Susan M.

AU - Diver, W. Ryan

AU - Ostro, Bart

AU - Goldberg, Debbie

AU - Crouse, Daniel L.

AU - Martin, Randall V.

AU - Peters, Paul

AU - Pinault, Lauren

AU - Tjepkema, Michael

AU - Van Donkelaar, Aaron

AU - Villeneuve, Paul J.

AU - Miller, Anthony B.

AU - Yin, Peng

AU - Zhou, Maigeng

AU - Wang, Lijun

AU - Janssen, Nicole A.H.

AU - Marra, Marten

AU - Atkinson, Richard W.

AU - Tsang, Hilda

AU - Thach, Thuan Quoc

AU - Cannon, John B.

AU - Allen, Ryan T.

AU - Hart, Jaime E.

AU - Laden, Francine

AU - Cesaroni, Giulia

AU - Forastiere, Francesco

AU - Weinmayr, Gudrun

AU - Jaensch, Andrea

AU - Nagel, Gabriele

AU - Concin, Hans

AU - Spadaro, Joseph V.

PY - 2018/9/18

Y1 - 2018/9/18

N2 - Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries-the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9-8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.

AB - Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries-the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95% CI: 4.9-8.5) and 120% larger than the risk function used in the GBD (4.0; 95% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20% reduction in concentrations, with the GEMM predicting 220% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.

KW - Concentration

KW - Exposure

KW - Fine particulate matter

KW - Mortality

KW - Risk

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