Mainz, March 12, 2019 Air pollution is clearly underestimated as a health hazard, even though there is currently a heated discussion about nitrogen oxides, particulate matter and diesel driving bans. A team of scientists led by Jos Lelieveld, Director at the Max Planck Institute for Chemistry, and Thomas Münzel, Professor at the University Medical Center Mainz, has now determined that air pollution reduces the average life expectancy of Europeans by around 2 years. Worldwide, about 120 people per 100,000 inhabitants die prematurely each year as a result of polluted air, according to the study, and in Europe as many as 133, which is higher than the global average. In at least half of the cases, cardiovascular diseases are the cause of death.
Bad air, especially air polluted with particulate matter, leads to respiratory and cardiovascular diseases and apparently poses a greater health risk than previously assumed. With their study, which is published in the current issue of the European Heart Journal, the Mainz researchers updated recent calculations of the Global Burden of Disease (GBD), a worldwide health study, and also results of their own earlier investigations: Until recently, they assumed a global mortality rate due to air pollution of around 4.5 million people per year. The newly calculated figure is 8.8 million per year. In Europe alone, almost 800,000 people die prematurely each year as a result of air pollution.
The update of the calculations became necessary because a recently published study puts the disease-specific hazard rates significantly higher than the values of the GBD. "Since the GBD study takes into account 41 comprehensive case group studies from 16 countries, including China, it provides the best data basis currently available," says Jos Lelieveld, Director at the Max Planck Institute for Chemistry.
Polluted outdoor air claims more victims than smoking
According to the recalculation by the Mainz researchers, bad air thus joins the list of the most significant health risks such as high blood pressure, diabetes, obesity and smoking. By way of comparison, the World Health Organization (WHO) estimates the mortality rate from tobacco smoke at 7.2 million people per year - including passive smoking. Thus, polluted outdoor air is a similarly large risk factor. However, smoking is individually preventable, whereas air pollution is not.
The researchers emphasize that fine dust particles smaller than 2.5 micrometers in diameter (PM2.5) are the main cause of respiratory and cardiovascular diseases, which explains the high mortality rates attributed to bad air. "Our results show that the European limit value for particulate matter, which is 25 micrograms per cubic meter of air for the annual average, is far too high," said Thomas Münzel, director of the Center for Cardiology at the University Medical Center Mainz. The value is far above the WHO guideline of 10 micrograms per cubic meter.
For their calculations, the scientists from Mainz first determined the regional exposure to pollutants such as particulate matter and ozone using an established, data-based atmospheric chemistry model. They linked these exposure values with disease-specific hazard rates from epidemiological data, as well as population density and causes of death in individual countries.
Fine dust pollution should be reduced
"Our results show a much higher disease burden from air pollution than previously thought," says Münzel, who is also the initiator of the Mainz Heart Foundation. "Air pollution must be recognized as an important cardiovascular risk factor, as it causes additional damage in the body through diabetes, high blood pressure and high levels of cholersterol . Now it has become even more urgent to further reduce exposure to particulate matter and to adjust limit values. In addition, particulate matter needs to be given greater prominence in the European Society of Cardiology guidelines as a causative factor in cardiovascular disease."
Replacing fossil fuels with clean energy sources can cut mortality rates by more than half
Since much of the particulate matter and other air pollutants come from burning fossil fuels, the scientists advocate replacing fossil fuels for energy production. "If we use clean, renewable energy, we not only meet the agreements made in Paris to mitigate the effects of climate change," says Jos Lelieveld, who is also a professor at Johannes Gutenberg University in Mainz and the Cyprus Institute in Nicosia. "We can also use it to reduce the mortality rate in Europe caused by air pollution by up to 55 percent."
1 Age-dependent health risk from ambient air pollution: a modelling study of childhood mortality in middle and low-income countries
Jos Lelieveld, Andy Haines, Andrea Pozzer; The Lancet Planetary Health, 2 July 2018; pre-publication 29 June 2018.
2 Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter
Burnett et al: Proceedings of the National Academy U S A. 115(38):9592-9597, doi: 10.1073/pnas.1803222115, 
2018
3 Effects of gaseous and solid constituents of air pollution on endothelial function.
Munzel T, Gori T, Al-Kindi S, Deanfield J, Lelieveld J, Daiber A, Rajagopalan S. Eur Heart J 2018;39(38):3543-3550.
Original publication
Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions.
J. Lelieveld, K. Klingmüller, A. Pozzer, U. Pöschl, M. Fnais, A. Daiber and T. Münzel
European Heart Journal (2019), 00, 1-7
DOI: 10.1093/eurheartj/ehz135
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