There’s a global calamity that’s causing more premature deaths than smoking, HIV/AIDS, parasitic and vector-borne diseases, and wars and other forms of violence, according to the authors of a recent study published in Cardiovascular Research.

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It’s air pollution.

“Since the impact of air pollution on public health overall is much larger than expected, and is a worldwide phenomenon, we believe our results show there is an ‘air pollution pandemic.Policy-makers and the medical community should be paying much more attention to this."

- Study co-leader Thomas Münzel, MD, cardiology clinic director, University Medical Center of the Johannes Gutenberg University, Mainz, Germany

Air pollution particularly aggravates chronic health risks, and the extended exposure takes its toll later in life, the authors noted. For instance, about 75% of deaths attributed to air pollution globally occurred in people aged 60 years and older.

The study co-leader Jos Lelieveld, PhD, director, Atmospheric Chemistry Department, Max Planck Institute for Chemistry, Mainz, Germany said, “When we looked at how pollution played a role in several diseases, its effect on cardiovascular disease was by far the largest—very similar to the effect of smoking. Air pollution causes damage to the blood vessels through increased oxidative stress, which then leads to increases in blood pressure, diabetes, stroke, heart attacks, and heart failure.”

Globally, non-communicable diseases are the major cause of death, associated with hypertension, smoking, diabetes, and high cholesterol—and air pollution is likewise a leading risk factor, the authors noted.

Dr. Münzel said, “It is important that policy-makers and the medical community realize that air pollution is an important risk factor for heart and blood vessel disease. It should be included as a risk factor, along with smoking, diabetes, and high blood pressure and cholesterol, in the guidelines of the European Society of Cardiology and the American Heart Association on the prevention of acute and chronic heart syndromes and heart failure."

Air pollution is worse than smoking

Both air pollution and smoking are preventable, but over the past decades much less attention has been paid to air pollution than to smoking, especially among cardiologists, Dr. Münzel noted.

Dr. Lelieveld said, “It is remarkable that both the number of deaths and the loss in life expectancy from air pollution rival the effect of tobacco smoking and are much higher than other causes of death. Air pollution exceeds malaria as a global cause of premature death by a factor of 19; it exceeds violence by a factor of 16, HIV/AIDS by a factor of 9, alcohol by a factor of 45, and drug abuse by a factor of 60.”

If all man-made emissions could be removed from the atmosphere, the global loss of life expectancy of 3 years could be reduced by 1.7 years. It could be reduced by 1.1 years through the removal of fossil fuel-related emissions alone. “This corroborates that fossil fuel-generated air pollution qualifies as a major global health risk factor by itself,” the researchers wrote.

Avoidable vs unavoidable air pollution

For this study, the researchers used a data-driven atmospheric model to calculate exposure to fine particulate matter and ozone pollution throughout different continents and global regions. This they combined with a novel Global Exposure Mortality Model—which was derived from data from 41 cohort studies in 16 countries—to estimate disease-specific excess mortality rates and loss of life expectancy.

Using this information, they investigated the effects of different pollution sources on life expectancy. They distinguished between avoidable man-made air pollution (including fossil fuel use) and unavoidable natural pollution (desert dust and wildfire emissions).

This is the first study to show the effects of air pollution on life expectancy according to age and type of disease at the level of individual countries and regions, according to the authors.

“We show that about two-thirds of premature deaths are attributable to human-made air pollution, mainly from fossil fuel use; this goes up to 80% in high-income countries. Five and a half million deaths worldwide a year are potentially avoidable,” Dr. Münzel said.

Air pollution around the world

Due to the diversity of emissions, large differences in loss of life expectancy occurred between regions.

“In Africa, air pollution represents a health risk that is comparable to HIV/AIDS and malaria. However, in most of the rest of the world, air pollution is a much greater health risk,” said Dr. Lelieveld.

Pollution from dust predominates in Africa, where only 0.7 of 3.1 years lost could be prevented. Compare that to East Asia, which has the highest loss of life expectancy due to avoidable air pollution, where 3 of the average of 4 years of lost life expectancy could be prevented by the removal of human-made emissions.

Similarly, in Europe, where there is an average of 2.2 years of lost life expectancy, 1.7 years could be prevented. And North America has an average of 1.4 years of lost life expectancy, of which 1.1 could be prevented, mostly by phasing out fossil fuels.

The lowest mortality rates and loss of life expectancy were found in Australia, the nation with the strictest air-quality standards worldwide.

This story is contributed by John Murphy and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.