Letter | Published:

The contribution of outdoor air pollution sources to premature mortality on a global scale

Nature volume 525, pages 367371 (17 September 2015) | Download Citation


Assessment of the global burden of disease is based on epidemiological cohort studies that connect premature mortality to a wide range of causes1,2,3,4,5, including the long-term health impacts of ozone and fine particulate matter with a diameter smaller than 2.5 micrometres (PM2.5)3,4,5,6,7,8,9. It has proved difficult to quantify premature mortality related to air pollution, notably in regions where air quality is not monitored, and also because the toxicity of particles from various sources may vary10. Here we use a global atmospheric chemistry model to investigate the link between premature mortality and seven emission source categories in urban and rural environments. In accord with the global burden of disease for 2010 (ref. 5), we calculate that outdoor air pollution, mostly by PM2.5, leads to 3.3 (95 per cent confidence interval 1.61–4.81) million premature deaths per year worldwide, predominantly in Asia. We primarily assume that all particles are equally toxic5, but also include a sensitivity study that accounts for differential toxicity. We find that emissions from residential energy use such as heating and cooking, prevalent in India and China, have the largest impact on premature mortality globally, being even more dominant if carbonaceous particles are assumed to be most toxic. Whereas in much of the USA and in a few other countries emissions from traffic and power generation are important, in eastern USA, Europe, Russia and East Asia agricultural emissions make the largest relative contribution to PM2.5, with the estimate of overall health impact depending on assumptions regarding particle toxicity. Model projections based on a business-as-usual emission scenario indicate that the contribution of outdoor air pollution to premature mortality could double by 2050.

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  1. 1.

    & The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected in 2020 (Harvard Univ. Press, 1996)

  2. 2.

    et al. Selected major risk factors and global and regional burden of disease. Lancet 360, 1347–1360 (2002)

  3. 3.

    Outdoor Air Pollution: Assessing the Environmental Burden of Disease at National and Local Levels (World Health Organization Environmental Burden of Disease Series No. 5, WHO, Geneva, 2004)

  4. 4.

    et al. The global burden of disease due to outdoor air pollution. J. Toxicol. Environ. Health A 68, 1301–1307 (2005)

  5. 5.

    et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2224–2260 (2012); correction 381, 628 (2013)

  6. 6.

    & Health effects of fine particulate air pollution: lines that connect. J. Air Waste Manag. Assoc. 56, 709–742 (2006)

  7. 7.

    et al. Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet 383, 785–795 (2014)

  8. 8.

    et al. An integrated risk function for estimating the Global Burden of Disease attributable to ambient fine particulate matter exposure. Environ. Health Perspect. 122, 397–403 (2014)

  9. 9.

    et al. Long-term ozone exposure and mortality. N. Engl. J. Med. 360, 1085–1095 (2009)

  10. 10.

    , , & Uncertainty in mortality response to airborne fine particulate matter: combining European air pollution experts. Reliab. Eng. Syst. Saf. 93, 732–744 (2008)

  11. 11.

    et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. J. Am. Med. Assoc. 287, 1132–1141 (2002)

  12. 12.

    , & The impact of the environment on health by country: a meta-synthesis. Environ. Health 7, (2008)

  13. 13.

    & A focus on particulate matter and health. Environ. Sci. Technol. 43, 4620–4625 (2009)

  14. 14.

    et al. Human health risks in megacities due to air pollution. Atmos. Environ. 44, 4606–4613 (2010)

  15. 15.

    , , & Global health benefits of mitigating ozone pollution with methane emission controls. Proc. Natl Acad. Sci. USA 103, 3988–3993 (2006)

  16. 16.

    et al. The influence of European pollution on ozone in the Near East and northern Africa. Atmos. Chem. Phys. 8, 2267–2283 (2008)

  17. 17.

    , & Evaluating inter-continental transport of fine aerosols: (2) Global health impact. Atmos. Environ. 43, 4339–4347 (2009)

  18. 18.

    , , & An estimate of the global burden of anthropogenic ozone and fine particulate matter on premature human mortality using atmospheric modeling. Environ. Health Perspect. 118, 1189–1195 (2010)

  19. 19.

    et al. Estimating the national public health burden associated with exposure to ambient PM2.5 and ozone. Risk Anal. 32, 81–95 (2012)

  20. 20.

    et al. Global premature mortality due to anthropogenic outdoor air pollution and the contribution of past climate change. Environ. Res. Lett. 8, (2013)

  21. 21.

    , , & Model calculated global, regional and megacity premature mortality due to air pollution by ozone and fine particulate matter. Atmos. Chem. Phys. 13, 7023–7037 (2013)

  22. 22.

    , & Modeled global effects of airborne desert dust on air quality and premature mortality. Atmos. Chem. Phys. 14, 957–968 (2014)

  23. 23.

    et al. Global estimates of ambient fine particulate matter concentrations from satellite-based aerosol optical depth: development and application. Environ. Health Perspect. 118, 847–855 (2010)

  24. 24.

    et al. Exposure assessment for estimation of the Global Burden of Disease attributable to outdoor air pollution. Environ. Sci. Technol. 46, 652–660 (2012)

  25. 25.

    et al. in National Particle Component Toxicity (NPACT) Initiative: Integrated Epidemiologic and Toxicologic Studies of the Health Effects of Particulate Matter Components (eds et al.) 127–166 (Health Effects Institute Research Report 177, Boston, 2013)

  26. 26.

    , et al. (eds) National Particle Component Toxicity (NPACT) Initiative: Integrated Epidemiologic and Toxicologic Studies of the Health Effects of Particulate Matter Components (Health Effects Institute Research Report 177, Boston, 2013)

  27. 27.

    et al. National Particle Component Toxicity (NPACT) Initiative: Report on Cardiovascular Effects (Health Effects Institute Research Report 178, Boston, 2013)

  28. 28.

    et al. Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 381, 1987–2015 (2013)

  29. 29.

    , , , & Response of fine particulate matter concentrations to changes of emissions and temperature in Europe. Atmos. Chem. Phys. 13, 3423–3443 (2013)

  30. 30.

    , , , & Global-scale attribution of anthropogenic and natural dust sources and their emission rates based on MODIS Deep Blue aerosol products. Rev. Geophys. 50, RG3005 (2012)

  31. 31.

    et al. Traffic-related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and Health Effects (Health Effects Institute Special Report 17, Boston, 2010)

  32. 32.

    et al. Effects of business-as-usual anthropogenic emissions on air quality. Atmos. Chem. Phys. 12, 6915–6937 (2012)

  33. 33.

    et al. Sensitivity of simulated climate to horizontal and vertical resolution in the ECHAM5 atmosphere model. J. Clim. 19, 3771–3791 (2006)

  34. 34.

    et al. Technical Note: The Modular Earth Submodel System (MESSy) – a new approach towards earth system modeling. Atmos. Chem. Phys. 5, 433–444 (2005)

  35. 35.

    et al. The atmospheric chemistry general circulation model ECHAM5/MESSy: Consistent simulation of ozone from the surface to the mesosphere. Atmos. Chem. Phys. 6, 5067–5104 (2006)

  36. 36.

    , , & The atmosphere-ocean general circulation model EMAC-MPIOM. Geosci. Model Dev. 4, 771–784 (2011)

  37. 37.

    , , & Technical note: The new comprehensive atmospheric chemistry module MECCA. Atmos. Chem. Phys. 5, 445–450 (2005)

  38. 38.

    et al. Technical Note: An implementation of the dry removal processes DRY DEPosition and SEDImentation in the Modular Earth Submodel System (MESSy). Atmos. Chem. Phys. 6, 4617–4632 (2006)

  39. 39.

    et al. Technical note: A new comprehensive SCAVenging submodel for global atmospheric chemistry modeling. Atmos. Chem. Phys. 6, 565–574 (2006)

  40. 40.

    et al. Global cloud and precipitation chemistry and wet deposition: tropospheric model simulations with ECHAM5/MESSy1. Atmos. Chem. Phys. 7, 2733–2757 (2007)

  41. 41.

    et al. Technical Note: The MESSy-submodel AIRSEA calculating the air-sea exchange of chemical species. Atmos. Chem. Phys. 6, 5435–5444 (2006)

  42. 42.

    et al. Simulating organic species with the global atmospheric chemistry general circulation model ECHAM5/MESSy1: a comparison of model results with observations. Atmos. Chem. Phys. 7, 2527–2550 (2007)

  43. 43.

    , & The influence of the vertical distribution of emissions on tropospheric chemistry. Atmos. Chem. Phys. 9, 9417–9432 (2009)

  44. 44.

    et al. Distributions and regional budgets of aerosols and their precursors simulated with the EMAC chemistry-climate model. Atmos. Chem. Phys. 12, 961–987 (2012)

  45. 45.

    et al. Parameterization of dust emissions in the global atmospheric chemistry-climate model EMAC: impact of nudging and soil properties. Atmos. Chem. Phys. 12, 11057–11083 (2012)

  46. 46.

    et al. Description and evaluation of GMXe: A new aerosol submodel for global simulations (v1). Geosci. Model Dev. 3, 391–412 (2010)

  47. 47.

    et al. Global distribution of the effective aerosol hygroscopicity parameter for CCN activation. Atmos. Chem. Phys. 10, 5241–5255 (2010)

  48. 48.

    et al. EMAC model evaluation and analysis of atmospheric aerosol properties and distribution. Atmos. Res. 114-115, 38–69 (2012)

  49. 49.

    & Modelling the global atmospheric transport and deposition of radionuclides from the Fukushima Dai-ichi nuclear accident. Atmos. Chem. Phys. 13, 1425–1438 (2013)

  50. 50.

    , , & Climate Change and Impact Research in the Mediterranean Environment: Scenarios of Future Climate Change. JRC Tech. Note 62957 (Joint Research Centre, Ispra, 2010)

  51. 51.

    et al. Climate and Air Quality Impacts of Combined Climate Change and Air Pollution Policy Scenarios. JRC Sci. Tech. Rep. 61281 (Joint Research Centre, Ispra, 2010)

  52. 52.

    et al. Simultaneously mitigating near-term climate change and improving human health and food security. Science 335, 183–189 (2012)

  53. 53.

    et al. (eds) Climate Change 2013: The Physical Science Basis (Cambridge Univ. Press, 2013)

  54. 54.

    , , & Global Climate Policy Scenarios for 2030 and Beyond. Analysis of Greenhouse Gas Emission Reduction Pathway Scenarios with the POLES and GEM-E3 models. JRC Ref. Rep. EUR 23032 EN, (Joint Research Centre, Ispra, 2007)

  55. 55.

    , , , eds. Integrated Modelling of Global Environmental change. An Overview of IMAGE 2.4 (Netherlands Environmental Assessment Agency (MNP), Bilthoven, 2006)

  56. 56.

    , & The Sea Surface Temperature and Sea Ice Concentration Boundary Conditions for AMIP II Simulations. PCMDI Tech. Rep. 60 (Program for Climate Model Diagnosis and Intercomparison, Lawrence Livermore National Laboratory, Livermore, California, 2000)

  57. 57.

    et al. A new sea surface temperature and sea ice boundary dataset for the Community Atmosphere Model. J. Clim. 21, 5145–5153 (2008)

  58. 58.

    & Effect of climate change on air quality. Atmos. Environ. 43, 51–63 (2009)

  59. 59.

    et al. Effect of changes in climate and emissions on future sulfate-nitrate-ammonium aerosol levels in the United States. J. Geophys. Res. 114 D01205, (2009)

  60. 60.

    , & The relative importance of impacts from climate change vs. emissions change on air pollution levels in the 21st century. Atmos. Chem. Phys. 13, 3569–3585 (2013)

  61. 61.

    et al. Preindustrial to present-day changes in tropospheric hydroxyl radical and methane lifetime from the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP). Atmos. Chem. Phys. 13, 5277–5298 (2013)

  62. 62.

    et al. Impacts of 21st century climate change on global air pollution-related premature mortality. Clim. Change 121, 239–253 (2013)

  63. 63.

    , & The weekday–weekend difference and the estimation of the non-vehicle contributions to the urban increment of airborne particulate matter. Atmos. Environ. 42, 4467–4479 (2008)

  64. 64.

    , , & Processes affecting concentrations of fine particulate matter (PM2.5) in the UK atmosphere. Atmos. Environ. 46, 115–124 (2012)

  65. 65.

    et al. An approach for determining urban concentration increments. Int. J. Environ. Pollut. 50, 376–385 (2012)

  66. 66.

    et al. Quantification of the urban air pollution increment and its dependency on the use of down-scaled and bottom-up city emission inventories. Urban Clim. 6, 44–62 (2013)

  67. 67.

    et al. Chemical characterization and source apportionment of PM2.5 in Beijing: seasonal perspective. Atmos. Chem. Phys. 13, 7053-7074 (2013); Atmos. Chem. Phys. 14, 175 (2014)

  68. 68.

    , & Differences between weekday and weekend air pollutant levels in Atlanta; Baltimore; Chicago; Dallas–Fort Worth; Denver; Houston; New York; Phoenix; Washington, DC; and surrounding areas. J. Air Waste Manag. Assoc. 58, 1598–1615 (2008)

  69. 69.

    World Health Organization. World Health Organization Statistical Information System (WHOSIS), Detailed Data Files of the WHO Mortality Database (WHO, Geneva, 2012)

  70. 70.

    United Nations Department of Economic and Social Affairs/Population Division. World Population Prospects: the 2004 Revision. E.05.XIII.12 (United Nations, 2005)

  71. 71.

    et al. On the use of expert judgment to characterize uncertainties in the health benefits of regulatory controls of particulate matter. Environ. Sci. Policy 13, 434–443 (2010)

  72. 72.

    et al. Expert judgment assessment of the mortality impact of changes in ambient fine particulate matter in the U.S. Environ. Sci. Technol. 42, 2268–2274 (2008)

  73. 73.

    et al. Association between long-term exposure to outdoor air pollution and mortality in China: A cohort study. J. Hazard. Mater. 186, 1594–1600 (2011)

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We are grateful to the EDGAR team of the Joint Research Centre in Ispra, Italy, for the emission data. We acknowledge support from the Distinguished Scientist Fellowship Program at the King Saud University, Riyadh. The research leading to these results has received funding from the European Research Council under the European Union’s Seventh Framework Programme (FP7/2007-2013)/ERC grant agreement no. 226144.

Author information


  1. Max Planck Institute for Chemistry, Atmospheric Chemistry Department, 55128 Mainz, Germany

    • J. Lelieveld
    •  & A. Pozzer
  2. The Cyprus Institute, Energy, Environment and Water Research Center, 1645 Nicosia, Cyprus

    • J. Lelieveld
    •  & D. Giannadaki
  3. Harvard School of Public Health, Boston, Massachusetts 02215, USA

    • J. S. Evans
  4. Cyprus International Institute for Environment and Public Health, Cyprus University of Technology, 3041 Limassol, Cyprus

    • J. S. Evans
  5. King Saud University, College of Science, Riyadh 11451, Saudi Arabia

    • M. Fnais


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J.L., A.P. and M.F. planned the research, A.P. performed the model calculations, J.L., A.P., D.G. and J.S.E. analysed the results, and J.L. and J.S.E. wrote the paper. All authors contributed to the manuscript.

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The authors declare no competing financial interests.

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Correspondence to J. Lelieveld.

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