Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions

Eur Heart J. 2019 May 21;40(20):1590-1596. doi: 10.1093/eurheartj/ehz135.


Aims: Ambient air pollution is a major health risk, leading to respiratory and cardiovascular mortality. A recent Global Exposure Mortality Model, based on an unmatched number of cohort studies in many countries, provides new hazard ratio functions, calling for re-evaluation of the disease burden. Accordingly, we estimated excess cardiovascular mortality attributed to air pollution in Europe.

Methods and results: The new hazard ratio functions have been combined with ambient air pollution exposure data to estimate the impacts in Europe and the 28 countries of the European Union (EU-28). The annual excess mortality rate from ambient air pollution in Europe is 790 000 [95% confidence interval (95% CI) 645 000-934 000], and 659 000 (95% CI 537 000-775 000) in the EU-28. Between 40% and 80% are due to cardiovascular events, which dominate health outcomes. The upper limit includes events attributed to other non-communicable diseases, which are currently not specified. These estimates exceed recent analyses, such as the Global Burden of Disease for 2015, by more than a factor of two. We estimate that air pollution reduces the mean life expectancy in Europe by about 2.2 years with an annual, attributable per capita mortality rate in Europe of 133/100 000 per year.

Conclusion: We provide new data based on novel hazard ratio functions suggesting that the health impacts attributable to ambient air pollution in Europe are substantially higher than previously assumed, though subject to considerable uncertainty. Our results imply that replacing fossil fuels by clean, renewable energy sources could substantially reduce the loss of life expectancy from air pollution.

Keywords: Air pollution; Cardiovascular risk; Excess mortality rate; Fine particulate matter; Health promotion intervention; Loss of life expectancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollution* / adverse effects
  • Air Pollution* / statistics & numerical data
  • Cardiovascular Diseases* / etiology
  • Cardiovascular Diseases* / mortality
  • Environmental Exposure* / adverse effects
  • Environmental Exposure* / statistics & numerical data
  • Europe
  • Humans
  • Proportional Hazards Models