Background: Estimating the burden of disease attributable to long-term exposure to fine particulate matter (PM2.5) in ambient air requires knowledge of both the shape and magnitude of the relative risk (RR) function. However, adequate direct evidence to identify the shape of the mortality RR functions at the high ambient concentrations observed in many places in the world is lacking.
Objective: We developed RR functions over the entire global exposure range for causes of mortality in adults: ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), and lung cancer (LC). We also developed RR functions for the incidence of acute lower respiratory infection (ALRI) that can be used to estimate mortality and lost-years of healthy life in children < 5 years of age.
Methods: We fit an integrated exposure–response (IER) model by integrating available RR information from studies of ambient air pollution (AAP), second hand tobacco smoke, household solid cooking fuel, and active smoking (AS). AS exposures were converted to estimated annual PM2.5 exposure equivalents using inhaled doses of particle mass. We derived population attributable fractions (PAFs) for every country based on estimated worldwide ambient PM2.5 concentrations.
Results: The IER model was a superior predictor of RR compared with seven other forms previously used in burden assessments. The percent PAF attributable to AAP exposure varied among countries from 2 to 41 for IHD, 1 to 43 for stroke, < 1 to 21 for COPD, < 1 to 25 for LC, and < 1 to 38 for ALRI.
Conclusions: We developed a fine particulate mass–based RR model that covered the global range of exposure by integrating RR information from different combustion types that generate emissions of particulate matter. The model can be updated as new RR information becomes available.
1Health Canada, Ottawa, Ontario, Canada; 2Brigham Young University, Provo, Utah, USA; 3MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; 4School of Public Health, University of Washington, Seattle, Washington, USA; 5Institute for Health Metrics and Evaluation, Seattle, Washington, USA; 6Global Alliance for Clean Cookstoves, Washington, DC, USA; 7Harvard School of Public Health, Harvard University, Cambridge, Massachusetts, USA; 8U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA; 9School of Population and Public Health, University of British Colombia, Vancouver, British Columbia, Canada; 10MRC-PHE Centre for Environment and Health, King’s College London, London, UK; 11University of California, Berkeley, Berkeley, California, USA; 12School of Medicine, University of California, San Francisco, San Francisco, California, USA; 13School of Medicine, University of California, Berkeley, Berkeley, California, USA; 14Department of Public Health and Policy, University of Liverpool, Liverpool, UK; 15School of Public Health, Fudan University, Shanghai, China; 16Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; 17World Health Organization, Geneva, Switzerland; 18Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada; 19American Cancer Society, Atlanta, Georgia, USA; 20Health Effects Institute, Boston, Massachusetts, USA; *Senior Author
Recommended Citation:
Richard T. Burnett,1 C. Arden Pope III,2 Majid Ezzati,et al. An Integrated Risk Function for Estimating the Global Burden of Disease Attributable to Ambient Fine Particulate Matter Exposure[J]. Environmental Health Perspectives,2014-01-01,Volume 122(Issue 4):397