The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study

Benjamin Bowe; Elena Artimovich; Yan Xie; Yan Yan; Miao Cai; Ziyad Al-Aly

doi:10.1136/bmjgh-2019-002063

The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study

BMJ Glob Health. 2020 Mar 25;5(3):e002063. doi: 10.1136/bmjgh-2019-002063. eCollection 2020.

Authors

Benjamin Bowe^{1

2}, Elena Artimovich¹, Yan Xie^{1

2}, Yan Yan^{1

3}, Miao Cai^{1

2}, Ziyad Al-Aly^{1

4

5

6}

Affiliations

¹ Clinical Epidemiology Center, VA Saint Louis Health Care System, Saint Louis, Missouri, USA.
² Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA.
³ Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
⁴ Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA.
⁵ Nephrology Section, Medicine Service, VA Saint Louis Helath Care System, Saint Louis, Missouri, USA.
⁶ Institute for Public Health, Washington University in Saint Louis, Saint Louis, Missouri, USA.

Abstract

Introduction: We aimed to integrate all available epidemiological evidence to characterise an exposure-response model of ambient fine particulate matter (PM_2.5) and the risk of chronic kidney disease (CKD) across the spectrum of PM_2.5 concentrations experienced by humans. We then estimated the global and national burden of CKD attributable to PM_2.5.

Methods: We collected data from prior studies on the association of PM_2.5 with CKD and used an integrative meta-regression approach to build non-linear exposure-response models of the risk of CKD associated with PM_2.5 exposure. We then estimated the 2017 global and national incidence, prevalence, disability-adjusted life-years (DALYs) and deaths due to CKD attributable to PM_2.5 in 194 countries and territories. Burden estimates were generated by linkage of risk estimates to Global Burden of Disease study datasets.

Results: The exposure-response function exhibited evidence of an increase in risk with increasing PM_2.5 concentrations, where the rate of risk increase gradually attenuated at higher PM_2.5 concentrations. Globally, in 2017, there were 3 284 358.2 (95% UI 2 800 710.5 to 3 747 046.1) incident and 122 409 460.2 (108 142 312.2 to 136 424 137.9) prevalent cases of CKD attributable to PM_2.5, and 6 593 134.6 (5 705 180.4 to 7 479 818.4) DALYs and 211 019.2 (184 292.5 to 236 520.4) deaths due to CKD attributable to PM_2.5. The burden was disproportionately borne by low income and lower middle income countries and exhibited substantial geographic variability, even among countries with similar levels of sociodemographic development. Globally, 72.8% of prevalent cases of CKD attributable to PM_2.5 and 74.2% of DALYs due to CKD attributable to PM_2.5 were due to concentrations above 10 µg/m³, the WHO air quality guidelines.

Conclusion: The global burden of CKD attributable to PM_2.5 is substantial, varies by geography and is disproportionally borne by disadvantaged countries. Most of the burden is associated with PM_2.5 levels above the WHO guidelines, suggesting that achieving those targets may yield reduction in CKD burden.

Keywords: environmental health; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollution* / adverse effects
Humans
Incidence
Particulate Matter / adverse effects
Quality-Adjusted Life Years
Renal Insufficiency, Chronic* / chemically induced
Renal Insufficiency, Chronic* / epidemiology

Substances

Particulate Matter