gms | German Medical Science

Introduction: Ambient air pollution is considered the most relevant environmental health risk in Europe and a leading cause of attributable deaths and losses of healthy life years. In 2021, the European Environment Agency (EEA) reported that 97% of the urban population in the European Union was exposed to ambient particulate matter concentrations (PM_2.5) above the World Health Organization (WHO) annual guideline value. To measure the impact of air pollutants on population health, the Environmental Burden of Disease (EBD) methodology is widely used. At the European level, the EEA and the European Topic Centre ‘Human Health and the Environment’ have been conducting joint EBD assessments for three air pollutants: PM_2.5, nitrogen dioxide (NO₂), and ozone. Here, the results of the cause-specific disease burden attributable to long-term PM_2.5 and NO₂ exposure in Europe 2021 will be presented.

Methods: The EBD methodology, developed by the WHO, was used to quantify the cause-specific mortality and morbidity disease burden attributable to PM_2.5 and NO₂ in Europe in 2021. Nine risk-outcome pairs were considered in the analyses, which were selected on the basis of available evidence assessments on causality. Various EBD indicators, including years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) were calculated. Concentration-response functions were extracted from relevant sources for each of the selected risk-outcome pairs. The European population-related exposure data (PM_2.5/NO₂ annual mean) were created by ETC HE consortium partners and provided for the EBD estimations. Cause-specific health data, including causes of death and prevalence, were mostly gathered from European data bases such as Eurostat or obtained from the European Health Interview Survey (EHIS).

Results: In 2021, the burden of disease attributable to PM_2.5 was significantly higher than that attributable for NO₂ in Europe. The respective figures were 2,528,363 and 634,721 DALYs. For both air pollutants, the ratio of mortality to morbidity demonstrated that the contribution of YLLs to the overall DALYs was higher, accounting for 82% and 54% of the total burden, respectively. Ischemic heart disease in adults aged 25 years or older had the greatest share of the overall burden due to PM_2.5, contributing to 759,303 DALYs in Europe. The lowest burden was related to asthma in children younger than 15 years, with 25,932 DALYs. Regarding NO₂, diabetes mellitus in adults aged 25 years or older was associated with the highest disease burden (314,574 DALYs), while asthma in adults aged 15 years or older was associated with the lowest (115,425 DALYs).

Conclusions: Although there have been overall improvements in air quality, the results of the EBD assessment indicate that air pollution remains an important environmental risk factor for the health of the European population. Comparing the impact of PM_2.5 and NO₂, PM_2.5 is clearly the pollutant with the highest burden of disease. Further concerted action is required throughout Europe to improve air quality and to protect population health.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.