Premature mortality related to United States cross-state air pollution


Outdoor air pollution adversely affects human health and is estimated to be responsible for five to ten per cent of the total annual premature mortality in the contiguous United States1,2,3. Combustion emissions from a variety of sources, such as power generation or road traffic, make a large contribution to harmful air pollutants such as ozone and fine particulate matter (PM2.5)4. Efforts to mitigate air pollution have focused mainly on the relationship between local emission sources and local air quality2. Air quality can also be affected by distant emission sources, however, including emissions from neighbouring federal states5,6. This cross-state exchange of pollution poses additional regulatory challenges. Here we quantify the exchange of air pollution among the contiguous United States, and assess its impact on premature mortality that is linked to increased human exposure to PM2.5 and ozone from seven emission sectors for 2005 to 2018. On average, we find that 41 to 53 per cent of air-quality-related premature mortality resulting from a state’s emissions occurs outside that state. We also find variations in the cross-state contributions of different emission sectors and chemical species to premature mortality, and changes in these variations over time. Emissions from electric power generation have the greatest cross-state impacts as a fraction of their total impacts, whereas commercial/residential emissions have the smallest. However, reductions in emissions from electric power generation since 2005 have meant that, by 2018, cross-state premature mortality associated with the commercial/residential sector was twice that associated with power generation. In terms of the chemical species emitted, nitrogen oxides and sulfur dioxide emissions caused the most cross-state premature deaths in 2005, but by 2018 primary PM2.5 emissions led to cross-state premature deaths equal to three times those associated with sulfur dioxide emissions. These reported shifts in emission sectors and emission species that contribute to premature mortality may help to guide improvements to air quality in the contiguous United States.

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Fig. 1: Early-death source–receptor matrices for 2011.
Fig. 2: Total annual early deaths caused per 10,000 people for 2005, 2011 and 2018.
Fig. 3: Total annual early deaths attributable to emission sector, emission species and in total.

Data availability

The cross-state source–receptor matrices generated and analysed here, together with sector definitions, are available in the 4TU.ResearchData repository at

Code availability

The atmospheric modelling code used is publicly available; instructions for download are given at


  1. 1.

    World Health Organization Health Risks of Particulate Matter from Long-range Transboundary Air Pollution (WHO Regional Office for Europe, 2006).

  2. 2.

    United States Environmental Protection Agency The Benefits and Costs of the Clean Air Act from 1990 to 2020 Final Report of US Environmental Protection Agency (Office of Air and Radiation, 2011).

  3. 3.

    Landrigan, P. J. et al. The Lancet Commission on pollution and health. Lancet 391, 462–512 (2018).

  4. 4.

    Lelieveld, J., Evans, J. S., Fnais, M., Giannadaki, D. & Pozzer, A. The contribution of outdoor air pollution sources to premature mortality on a global scale. Nature 525, 367–371 (2015).

  5. 5.

    United States Environmental Protection Agency Regulatory Impact Analysis for the Federal Implementation Plans to Reduce Interstate Transport of Fine Particulate Matter and Ozone in 27 States; Correction of SIP Approvals for 22 States Report EPA-HQ-OAR-2009-0491 (Office of Air and Radiation, 2011).

  6. 6.

    Goodkind, A. L., Tessum, C. W., Coggins, J. S., Hill, J. D. & Marshall, J. D. Fine-scale damage estimates of particulate matter air pollution reveal opportunities for location-specific mitigation of emissions. Proc. Natl Acad. Sci. USA 116, 8775–8780 (2019).

  7. 7.

    Krewski, D. et al. Extended follow-up and spatial analysis of the American Cancer Society study linking particulate air pollution and mortality. Res. Rep. Health. Eff. Inst. 140, 5–114 (2009).

  8. 8.

    Lim, S. S. 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).

  9. 9.

    Hoek, G. et al. Long-term air pollution exposure and cardio-respiratory mortality: a review. Environ. Health 12, 43 (2013).

  10. 10.

    Burnett, R. T. 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).

  11. 11.

    Forouzanfar, M. H. et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386, 2287–2323 (2015).

  12. 12.

    Burnett, R. et al. Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter. Proc. Natl Acad. Sci. USA 115, 9592–9597 (2018).

  13. 13.

    Caiazzo, F., Ashok, A., Waitz, I. A., Yim, S. H. L. & Barrett, S. R. H. Air pollution and early deaths in the United States. Part I: quantifying the impact of major sectors in 2005. Atmos. Environ. 79, 198–208 (2013).

  14. 14.

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

  15. 15.

    Penn, S. L. et al. Estimating state-specific contributions to PM2.5- and O3-related health burden from residential combustion and electricity generating unit emissions in the United States. Environ. Health Perspect. 125, 324–332 (2017).

  16. 16.

    Turner, M. D. et al. Premature deaths attributed to source-specific BC emissions in six urban US regions. Environ. Res. Lett. 10, 114014 (2015).

  17. 17.

    Tong, D. Q. & Mauzerall, D. L. Summertime state-level source-receptor relationships between nitrogen oxides emissions and surface ozone concentrations over the continental United States. Environ. Sci. Technol. 42, 7976–7984 (2008).

  18. 18.

    Fann, N., Fulcher, C. M. & Baker, K. The recent and future health burden of air pollution apportioned across U.S. sectors. Environ. Sci. Technol. 47, 3580–3589 (2013).

  19. 19.

    Dedoussi, I. C. & Barrett, S. R. H. Air pollution and early deaths in the United States. Part II: attribution of PM2.5 exposure to emissions species, time, location and sector. Atmos. Environ. 99, 610–617 (2014).

  20. 20.

    Pappin, A. J. & Hakami, A. Source attribution of health benefits from air pollution abatement in Canada and the United States: an adjoint sensitivity analysis. Environ. Health Perspect. 121, 572–579 (2013).

  21. 21.

    Fann, N., Kim, S.-Y., Olives, C. & Sheppard, L. Estimated changes in life expectancy and adult mortality resulting from declining PM2.5 exposures in the contiguous United States: 1980–2010. Environ. Health Perspect. 125, 097003 (2017).

  22. 22.

    Henze, D. K., Hakami, A. & Seinfeld, J. H. Development of the adjoint of GEOS-Chem. Atmos. Chem. Phys. 7, 2413–2433 (2007).

  23. 23.

    Holt, J., Selin, N. E. & Solomon, S. Changes in inorganic fine particulate matter sensitivities to precursors due to large-scale US emissions reductions. Environ. Sci. Technol. 49, 4834–4841 (2015).

  24. 24.

    Bureau of Economic Analysis BEA Regions (2004).

  25. 25.

    United States Environmental Protection Agency SMOKE v3.5.1 User’s Manual (Institute for the Environment, University of North Carolina at Chapel Hill, 2013).

  26. 26.

    United States Environmental Protection Agency 2005 National Emissions Inventory (NEI) data. Environmental Protection Agency Air Emissions Inventories. (2008).

  27. 27.

    United States Environmental Protection Agency 2011 National Emissions Inventory. Environmental Protection Agency Air Emissions Inventories. (2014).

  28. 28.

    United States Environmental Protection Agency MOVES and Other Mobile Source Emissions Models (Environmental Protection Agency, 2017).

  29. 29.

    Wilkerson, J. T. et al. Analysis of emission data from global commercial aviation: 2004 and 2006. Atmos. Chem. Phys. 10, 6391–6408 (2010).

  30. 30.

    Yim, S. H. L. et al. Global, regional and local health impacts of civil aviation emissions. Environ. Res. Lett. 10, 034001 (2015).

  31. 31.

    Eastham, S. D. & Barrett, S. R. H. Aviation-attributable ozone as a driver for changes in mortality related to air quality and skin cancer. Atmos. Environ. 144, 17–23 (2016).

  32. 32.

    Thompson, T. M., Saari, R. K. & Selin, N. E. Air quality resolution for health impact assessment: influence of regional characteristics. Atmos. Chem. Phys. 14, 969–978 (2014).

  33. 33.

    Li, Y., Henze, D. K., Jack, D. & Kinney, P. L. The influence of air quality model resolution on health impact assessment for fine particulate matter and its components. Air Qual. Atmos. Health 9, 51–68 (2016).

  34. 34.

    Arunachalam, S., Wang, B., Davis, N., Baek, B. H. & Levy, J. I. Effect of chemistry-transport model scale and resolution on population exposure to PM2.5 from aircraft emissions during landing and takeoff. Atmos. Environ. 45, 3294–3300 (2011).

  35. 35.

    National Oceanic and Atmospheric Administration Climate at a Glance (National Centers for Environmental Information, 2017). 

  36. 36.

    Travis, K. R. et al. Why do models overestimate surface ozone in the Southeast United States? Atmos. Chem. Phys. 16, 13561–13577 (2016).

  37. 37.

    Anderson, D. C. et al. Measured and modeled CO and NOy in DISCOVER-AQ: an evaluation of emissions and chemistry over the eastern US. Atmos. Environ. 96, 78–87 (2014).

  38. 38.

    Olivier, J. G. J. et al. Applications of EDGAR. Including a Description of EDGAR 32 Reference Database with Trend Data for 1970–1995. RIVM Report 773301 001/NRP Report 410200 051 (2002).

  39. 39.

    Guenther, A. B. et al. The model of emissions of gases and aerosols from nature version 2.1 (MEGAN2.1): an extended and updated framework for modeling biogenic emissions. Geosci. Model Dev. 5, 1471–1492 (2012).

  40. 40.

    Murray, L. T., Jacob, D. J., Logan, J. A., Hudman, R. C. & Koshak, W. J. Optimized regional and interannual variability of lightning in a global chemical transport model constrained by LIS/OTD satellite data. J. Geophys. Res. Atmos. 117, D20307 (2012).

  41. 41.

    Barrett, S. R. H. et al. Impact of the Volkswagen emissions control defeat device on US public health. Environ. Res. Lett. 10, 114005 (2015).

  42. 42.

    Lee, C. J. et al. Response of global particulate-matter-related mortality to changes in local precursor emissions. Environ. Sci. Technol. 49, 4335–4344 (2015).

  43. 43.

    Ashok, A. & Barrett, S. R. H. Adjoint-based computation of U.S. nationwide ozone exposure isopleths. Atmos. Environ. 133, 68–80 (2016).

  44. 44.

    Wu, S., Duncan, B. N., Jacob, D. J., Fiore, A. M. & Wild, O. Chemical nonlinearities in relating intercontinental ozone pollution to anthropogenic emissions. Geophys. Res. Lett. 36, L05806 (2009).

  45. 45.

    Pinder, R. W., Adams, P. J. & Pandis, S. N. Ammonia emission controls as a cost-effective strategy for reducing atmospheric particulate matter in the eastern United States. Environ. Sci. Technol. 41, 380–386 (2007).

  46. 46.

    Anenberg, S. C., Horowitz Larry, W., Tong Daniel, Q. & West, J. J. 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).

  47. 47.

    Evans, J. et al. Estimates of global mortality attributable to particulate air pollution using satellite imagery. Environ. Res. 120, 33–42 (2013).

  48. 48.

    Wolfe, P. et al. Monetized health benefits attributable to mobile source emission reductions across the United States in 2025. Sci. Total Environ. 650, 2490–2498 (2019).

  49. 49.

    Lepeule, J., Laden, F., Dockery, D. & Schwartz, J. Chronic exposure to fine particles and mortality: an extended follow-up of the Harvard six cities study from 1974 to 2009. Environ. Health Perspect. 120, 965–970 (2012).

  50. 50.

    Di, Q. et al. Air pollution and mortality in the Medicare population. N. Engl. J. Med. 376, 2513–2522 (2017).

  51. 51.

    Pope, C. A. et al. Mortality risk and PM2.5 air pollution in the USA: an analysis of a national prospective cohort. Air Qual. Atmos. Health 11, 245–252 (2018).

  52. 52.

    Turner, M. C. et al. Long-term ozone exposure and mortality in a large prospective study. Am. J. Respir. Crit. Care Med. 193, 1134–1142 (2016).

  53. 53.

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

  54. 54.

    Balk, D. L. et al. Determining global population distribution: methods, applications and data. Adv. Parasitol. 62, 119–156 (2006).

  55. 55.

    Bright, E. A., Coleman, P. R., Rose, A. N. & Urban, M. L. LandScan 2013 High Resolution Global Population Data Set v.13 (United States Department of Energy Office of Scientific and Technical Information, 2014).

  56. 56.

    United States Census Bureau Annual estimates of the resident population: April 1, 2010 to July 1, 2017 (USCB, 2018).

  57. 57.

    United States Census Bureau. 2007–2011 American community survey 5-year estimates: age and sex. American Fact Finder (2011).

  58. 58.

    World Health Organization Disease and Injury Country Estimates, 2000–2012 (WHO, 2014).

  59. 59.

    Fiore, A. M. et al. Multimodel estimates of intercontinental source-receptor relationships for ozone pollution. J. Geophys. Res. Atmos. 114, D04301 (2009).

  60. 60.

    West, J. J., Naik, V., Horowitz, L. W. & Fiore, A. M. Effect of regional precursor emission controls on long-range ozone transport—part 2: steady-state changes in ozone air quality and impacts on human mortality. Atmos. Chem. Phys. 9, 6095–6107 (2009).

  61. 61.

    Anenberg, S. C. et al. Intercontinental impacts of ozone pollution on human mortality. Environ. Sci. Technol. 43, 6482–6487 (2009).

  62. 62.

    Crippa, M., Janssens-Maenhout, G., Guizzardi, D., Dingenen, R. V. & Dentener, F. Contribution and uncertainty of sectorial and regional emissions to regional and global PM2.5 health impacts. Atmos. Chem. Phys. 19, 5165–5186 (2019).

  63. 63.

    Liu, J., Mauzerall, D. L. & Horowitz, L. W. Evaluating inter-continental transport of fine aerosols: (2) global health impact. Atmos. Environ. 43, 4339–4347 (2009).

  64. 64.

    Anenberg, S. C. et al. Impacts of intercontinental transport of anthropogenic fine particulate matter on human mortality. Air Qual. Atmos. Health 7, 369–379 (2014).

  65. 65.

    Zhang, Q. et al. Transboundary health impacts of transported global air pollution and international trade. Nature 543, 705–709 (2017).

  66. 66.

    Liang, C.-K. et al. HTAP2 multi-model estimates of premature human mortality due to intercontinental transport of air pollution and emission sectors. Atmos. Chem. Phys. 18, 10497–10520 (2018).

  67. 67.

    Lupaşcu, A. & Butler, T. Source attribution of European surface O3 using a tagged O3 mechanism. Atmos. Chem. Phys. 19, 14535–14558 (2019).

  68. 68.

    Fann, N., Coffman, E., Timin, B. & Kelly, J. T. The estimated change in the level and distribution of PM2.5-attributable health impacts in the United States: 2005-2014. Environ. Res. 167, 506–514 (2018).

  69. 69.

    Lelieveld, J. Clean air in the Anthropocene. Faraday Discuss. 200, 693–703 (2017).

  70. 70.

    Cohen, A. J. et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet 389, 1907–1918 (2017).

  71. 71.

    United States Environmental Protection Agency National Air Quality: Status and Trends of Key Air Pollutants (US EPA, 2018).

  72. 72.

    Tong, D. Q. et al. Long-term NOx trends over large cities in the United States during the great recession: comparison of satellite retrievals, ground observations, and emission inventories. Atmos. Environ. 107, 70–84 (2015).

  73. 73.

    Tong, D. Q., Lee, P. & Saylor, R. D. New directions: the need to develop process-based emission forecasting models. Atmos. Environ. 47, 560–561 (2012).

  74. 74.

    Jiang, Z. et al. Unexpected slowdown of US pollutant emission reduction in the past decade. Proc. Natl Acad. Sci. USA 115, 5099–5104 (2018).

  75. 75.

    Heald, C. L. et al. Atmospheric ammonia and particulate inorganic nitrogen over the United States. Atmos. Chem. Phys. 12, 10295–10312 (2012).

  76. 76.

    Zhu, L. et al. Sources and impacts of atmospheric NH3: current understanding and frontiers for modeling, measurements, and remote sensing in North America. Curr. Pollut. Rep. 1, 95–116 (2015).

  77. 77.

    Crouse, D. L. et al. A new method to jointly estimate the mortality risk of long-term exposure to fine particulate matter and its components. Sci. Rep. 6, 18916 (2016).

  78. 78.

    Beelen, R. et al. Natural-cause mortality and long-term exposure to particle components: an analysis of 19 European cohorts within the multi-center ESCAPE project. Environ. Health Perspect. 123, 525–533 (2015).

  79. 79.

    Kioumourtzoglou, M.-A. et al. Long-term PM2.5 exposure and neurological hospital admissions in the northeastern United States. Environ. Health Perspect. 124, 23–29 (2016).

  80. 80.

    Turner, M. C. et al. Ambient air pollution and cancer mortality in the cancer prevention study II. Environ. Health Perspect. 125, 087013 (2017).

  81. 81.

    Rosa, M. J. et al. Prenatal exposure to PM2.5 and birth weight: a pooled analysis from three North American longitudinal pregnancy cohort studies. Environ. Int. 107, 173–180 (2017).

  82. 82.

    Joel, S., Kelvin, F. & Antonella, Z. A national multicity analysis of the causal effect of local pollution, NO2, and PM2.5 on mortality. Environ. Health Perspect. 126, 087004 (2018).

  83. 83.

    Di, Q. et al. association of short-term exposure to air pollution with mortality in older adults. J. Am. Med. Assoc. 318, 2446–2456 (2017).

  84. 84.

    Wang, Y. et al. Doubly robust additive hazards models to estimate effects of a continuous exposure on survival. Epidemiology 28, 771–779 (2017).

  85. 85.

    Kioumourtzoglou, M.-A., Schwartz, J., James, P., Dominici, F. & Zanobetti, A. PM2.5 and mortality in 207 US cities: modification by temperature and city characteristics. Epidemiology 27, 221–227 (2016).

  86. 86.

    Lin, J. et al. China’s international trade and air pollution in the United States. Proc. Natl Acad. Sci. USA 111, 1736–1741 (2014).

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We thank the EPA and K. Travis (Harvard) for providing assistance with the NEI datasets. This publication was made possible by US EPA grant RD-835872-01. Its contents are solely the responsibility of the grantee and do not necessarily represent the official views of the USEPA. Further, USEPA does not endorse the purchase of any commercial products or services mentioned in the publication. I.C.D. was additionally funded through the Massachusetts Institute of Technology (MIT) Martin Family Fellowship for Sustainability and the MIT George and Marie Vergottis Fellowship. We also acknowledge support by the VoLo Foundation.

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I.C.D. and S.R.H.B. planned the research. I.C.D. performed the emissions modelling and the air quality modelling PM2.5 simulations. S.D.E. and E.M. performed the air quality modelling ozone simulations. I.C.D. and S.D.E. performed results analysis. I.C.D. drafted the manuscript with the help of S.D.E. and S.R.H.B. All authors provided feedback on the manuscript.

Correspondence to Steven R. H. Barrett.

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Peer review information Nature thanks Marianthi-Anna Kioumourtzoglou, Enrico Pisoni, Andrea Pozzer and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Extended data figures and tables

Extended Data Fig. 1 Source–receptor matrix showing total impacts in 2011 for the contiguous US.

‘By each state’ indicates sources; ‘in each state’ indicates receptors. The matrix is annotated with state abbreviations and their regional grouping.

Extended Data Fig. 2 Annual early-death source–receptor matrices for 2005, 2011 and 2018 for the contiguous US.

Each matrix comprises 48 × 48 states. a (i), The total source–receptor matrix for 2011. a (ii), Its breakdown to PM2.5-attributable and ozone-attributable impacts for all three years. b, Source–receptor early-death attribution to emission sectors (i) and emission species that lead to the formation of PM2.5 and/or ozone (ii). States are grouped in regions defined by the Bureau of Economic Analysis20 (labelled in a) and ordered from west (left) to east (right). The ordering of individual states is presented in Extended Data Fig. 1. Boxed percentages represent the fraction of impacts that occur out of the state that caused the corresponding emissions. We note that to obtain these summarized source–receptor matrices using conventional modelling approaches (‘forward difference simulations’) would have required around 1,300 simulations.

Extended Data Fig. 3 Origins of New York annual early deaths, for 2005, 2011 and 2018, for five sectors and in total.

Each state is coloured according to the annual early deaths that emissions from that state cause in the state of New York, for each sector–year combination. The total early deaths occurring in New York (that is, the sum of all states’ values) for each sector–year combination is displayed at the bottom left of each panel.

Extended Data Fig. 4 Origins of North Carolina annual early deaths, for 2005, 2011 and 2018, for five sectors and in total.

Each state is coloured according to the annual early deaths that emissions from that state cause in the state of North Carolina, for each sector–year combination. The total early deaths occurring in North Carolina (the sum of all states’ values) for each sector–year combination is displayed at the bottom left of each panel.

Extended Data Fig. 5 Receptors of annual early deaths due to emissions in Indiana for 2005, 2011 and 2018, for five sectors and in total.

Each state is coloured according to the annual early deaths that occur in that state because of emissions in Indiana, for each sector–year combination. The total early deaths caused by Indiana emissions (that is, the sum of all states’ values) for each sector–year combination is displayed at the bottom left of each panel.

Extended Data Fig. 6 Changes in the response of surface-population-weighted PM2.5 and ozone concentrations to US emissions.

Data points show the results of a series of forward simulations, in which the input conditions of the simulation (the total US anthropogenic emissions of all species) are reduced, joined by a cubic spline fit. The ‘average sensitivity’ lines indicate the gradient implied when impacts due to all sectors combined are calculated—that is, when the effects of atmospheric nonlinearity are taken into account—and thus the total results are scaled to match this. The ‘marginal sensitivity’ lines indicate the gradient of the response obtained by our GEOS-Chem adjoint simulation, and are used for calculations of individual sector and species impacts (where individual perturbations are of smaller size). The difference between the zero intercept of the two lines constitutes the ‘interaction’ effect. All values are population-weighted means for 2011.

Extended Data Table 1 Primary PM2.5, NOx and SOx emissions totals for 2005, 2011 and 2018
Extended Data Table 2 Five states with the greatest reduction in annual early deaths between 2005 and 2018
Extended Data Table 3 Early deaths attributable to each sector and species (that lead to PM2.5 and/or ozone formation) for 2005, 2011 and 2018
Extended Data Table 4 Alternative CRF application to 2011 early deaths for all sectors, for PM2.5 and ozone

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Dedoussi, I.C., Eastham, S.D., Monier, E. et al. Premature mortality related to United States cross-state air pollution. Nature 578, 261–265 (2020).

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