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Global Burden of Lower Respiratory Infections from Air Pollution: GBD 2017 Estimates

This study provides estimates of the global burden of lower respiratory infections (LRI) attributable to ambient and household air pollution. It describes mortality and morbidity from major diseases, injuries, and risk factors worldwide. The study reveals the significant impact of PM2.5 air pollution on LRI mortality, especially in children and older adults in low- and middle-income countries. Reductions in burden require policy action to reduce exposure to PM2.5 and other LRI risk factors. Future research questions include understanding the separate risk functions for different age groups and identifying the major sources of PM2.5 responsible for LRI burden.

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Global Burden of Lower Respiratory Infections from Air Pollution: GBD 2017 Estimates

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  1. The Global Burden of Lower Respiratory Infections Attributable to Ambient and Household Air Pollution: estimates from GBD 2017 National Academy of Sciences Workshop Washington, DC January 15, 2019 Aaron J Cohen Health Effects Institute / Institute for Health Metrics and Evaluation

  2. What is the Global Burden of Disease? • The most comprehensive worldwide observational epidemiological study to date. It describes mortality and morbidity from major diseases, injuries and risk factors to health at global, national and regional levels • Disease, injury, & risk burden estimates for 1990 – 2017 using comparable methods for 195 countries and territories and sub-national analyses for selected countries • Mortality from 264 specific causes and incidence and prevalence of diseases and injuries and relevant disabling sequelae, stratified by sex and 20 age groups • Burden measured as deaths in a given year and Disability Adjusted Life Years” (DALYs) – lost years of healthy life • Burden attributable to of 84 risk factors • Global collaboration coordinated by Institute for Health Metrics and Evaluation and involves > 3,000 collaborators • GBD 2017 updates previous GBD estimates with new data, methods • Major GBD 2017 were published in The Lancet November 2018 • Estimates updated annually http://www.healthdata.org/gbd

  3. Changes in Life-Expectancy at Birth 1970-2017 GBD 2017 Mortality Collaborators The Lancet 2018

  4. Trends in Global LRI Mortality 1990-2017 GBD 2017 Cause of Death Collaborators The Lancet 2018

  5. Leading causes of death 2017 GBD 2017 Cause of Death Collaborators The Lancet 2018

  6. Age-Standardized LRI Mortality 2017 GBD 2017 Cause of Death Collaborators The Lancet 2018

  7. GBD 2017 DALYs and HALE Collaborators The Lancet 2018

  8. General approach Worldwide Health Evidence Country- Specific Mortality, Disease Exposure to Ambient Air Pollution Concentration –Response Relationships Global Burden, DALYs, Mortality Baseline Incidence

  9. PM2.5 Exposure 2017 Global Burden of Disease Study 2017. IHME, 2018 PRELIMINARY ESTIMATES

  10. GBD 2017 LRI Integrated Exposure Response Function TMREL (counterfactual) ~4 μg/m3 midpoint of a uniform distribution bounded by the minimum and fifth percentiles of exposure distributions from ambient air pollution epidemiologic studies (2.4-5.9 μg/m3 ) GBD Risk Factor Collaborators The Lancet 2018

  11. Global Mortality Risk Factor Ranking 2017 • 2.9 million (UI 2.5-3.4) deaths attributable to ambient PM2.5 • 5.2 % of global deaths • 8th ranking risk factor • 432 K (UI 343-527) LRI deaths • 1.6 million (UI 1.4-1.9) deaths attributable to Household Air Pollution • 2.9% of global deaths • 13th ranking risk factor • 459 K (UI 367-553) LRI deaths • PM2.5 air pollution contributed to 4.9 million deaths in 2016 (UI 4.4-5.4) • 8.7 % of global mortality • 5th leading global risk factor • 0.89 million (UI 0.75-1.04) LRI deaths GBD 2017 Risk Factor Collaborators The Lancet 2018

  12. Source: J Apte U Texas Austin Personal Communication

  13. LRI Mortality Risk Factors 2017 GBD 2017 Risk Factor Collaborators The Lancet 2018

  14. PM2.5-attributable LRI death rates 1990-2017 GBD 2017 Risk Factor Collaborators The Lancet 2018

  15. Looking ahead GBD MAPS Working Group. 2018. Burden of Disease Attributable to Major Air Pollution Sources in India. Special Report 21. Boston, MA: Health Effects Institute. Foreman KJ et al. The Lancet 2018

  16. Summary and Future Research Questions • Mortality from LRI has declined since 1990, especially in children under 5 yr. but remained the 4th leading global cause of death in 2017 and the 2nd leading cause in children under 5 yr. • PM2.5 air pollution is the leading global risk factor for LRI mortality, largely due to high rates of PM-attributable mortality in both children under 5 yr. and adults > 70 yr. with the highest rates in low- and middle-income countries in Asia and Sub-Saharan Africa. • LRI mortality from ambient and household exposure to PM2.5 has declined but a considerable burden of disease remains. LRI will remain a leading cause of death in the future, especially due to ambient exposure in older adults. • Reductions in burden will require concerted policy action to reduce exposure to PM2.5 air pollution from major sources and to other LRI risk factors • Research questions: • Is the LRI exposure-response relationship the same for children and adults? Can we develop separate risk functions? • Does exposure to PM2.5 cause increased TB mortality ? If so, what is the attributable burden? • Are the effects of exposure to PM2.5 and other major LRI risk factors additive, or are there joint, interactive effects? • Which sources of PM2.5 are most responsible for the LRI PM-attributable burden?

  17. Thank You! acohen@healtheffects.org For more information on the GBD Collaboration http://www.healthdata.org/gbd For all data and estimates https://www.stateofglobalair.org/ http://vizhub.healthdata.org/gbd-compare/

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