The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017
The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017
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DOI：
10.1016/s2542-5196(18)30261-4
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发表时间：
2019-01-01
影响因子：
25.7
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中科院分区：
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背景空气污染是一个主要的地球健康风险，印度估计有一些全球最严重的水平。为了在印度地方一级采取行动，我们估计了2017年印度每个邦的空气污染暴露及其对死亡，疾病负担和预期寿命的影响。方法我们估计了空气污染暴露，包括环境颗粒物污染，定义为PM2.5的年平均网格浓度，以及家庭空气污染，定义为使用固体烹饪燃料的家庭百分比以及相应的PM2.5暴露，使用来自多个来源的可访问数据，作为2017年全球疾病，伤害和风险因素研究（GBD）的一部分。这些州被分为三个社会人口指数（SDI）水平，由GBD 2017根据滞后分布的人均收入，15岁或以上人口的平均教育程度以及25岁以下人口的总生育率计算。我们根据GBD 2017中评估的已发表文献中的因果关系，估计了空气污染暴露导致的死亡和残疾调整生命年（DDEs）;印度占全球空气污染DDEs的比例;以及如果空气污染水平低于造成健康损失的最低水平，印度每个邦的预期寿命是多少。2017年，印度环境颗粒物PM2.5的人口加权平均暴露量为89.9 μ g/m3（95%不确定性区间[UI] 67.0-112.0）。大多数邦和印度76.8%的人口暴露于年人口加权平均PM2.5大于40 μ g/m（3），这是印度国家环境空气质量标准推荐的限值。2017年，德里的年度人口加权平均PM2.5最高，其次是印度北部的北方邦、比哈尔邦和哈里亚纳邦，所有这些地区的平均值都大于125 μ g/m。2017年，印度使用固体燃料的人口比例为55.5%（54.8-56.2），在SDI较低的比哈尔邦、贾坎德和奥里萨邦超过75%。1.24 2017年，印度有100万（1.09-1.39）人死亡，占总死亡人数的12.5%，可归因于空气污染，其中67万（0.55-0.79）人死于环境颗粒物污染，48万（0.39-0.58）人死于家庭空气污染。在这些可归因于空气污染的死亡中，51.4%是70岁以下的人。印度占全球人口的18.1%，但在2017年占全球空气污染的26.2%。在印度北部的北方邦、哈里亚纳邦、德里、旁遮普和拉贾斯坦邦，环境颗粒物污染DALY率最高，分布在三个SDI州组，而在印度北部和东北部的恰蒂斯加尔邦、拉贾斯坦邦、中央邦和阿萨姆邦，家庭空气污染DALY率最高。我们估计，如果印度的空气污染水平低于造成健康损失的最低水平，则2017年的平均预期寿命将增加1.7年（1.6-1.9年），在印度北部的拉贾斯坦邦，北方邦和哈里亚纳邦，这一增长超过2年。解释印度由于空气污染而具有不成比例的高死亡率和疾病负担。在印度北部SDI较低的邦，这种负担通常最高。减少这一重大环境风险造成的大量可避免的死亡和疾病负担取决于在印度各地迅速部署有效的多部门政策，这些政策与每个邦的空气污染程度相称。版权所有（C）2018作者。爱思唯尔有限公司出版
Background Air pollution is a major planetary health risk, with India estimated to have some of the worst levels globally. To inform action at subnational levels in India, we estimated the exposure to air pollution and its impact on deaths, disease burden, and life expectancy in every state of India in 2017.Methods We estimated exposure to air pollution, including ambient particulate matter pollution, defined as the annual average gridded concentration of PM2.5, and household air pollution, defined as percentage of households using solid cooking fuels and the corresponding exposure to PM2.5, across the states of India using accessible data from multiple sources as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. The states were categorised into three Socio-demographic Index (SDI) levels as calculated by GBD 2017 on the basis of lag-distributed per-capita income, mean education in people aged 15 years or older, and total fertility rate in people younger than 25 years. We estimated deaths and disability-adjusted life-years (DALYs) attributable to air pollution exposure, on the basis of exposureresponse relationships from the published literature, as assessed in GBD 2017; the proportion of total global air pollution DALYs in India; and what the life expectancy would have been in each state of India if air pollution levels had been less than the minimum level causing health loss.Findings The annual population-weighted mean exposure to ambient particulate matter PM2.5 in India was 89.9 mu g/m(3) (95% uncertainty interval [UI] 67.0-112.0) in 2017. Most states, and 76.8% of the population of India, were exposed to annual population-weighted mean PM2.5 greater than 40 mu g/m(3), which is the limit recommended by the National Ambient Air Quality Standards in India. Delhi had the highest annual population-weighted mean PM2.5 in 2017, followed by Uttar Pradesh, Bihar, and Haryana in north India, all with mean values greater than 125 mu g/m(3). The proportion of population using solid fuels in India was 55.5% (54.8-56.2) in 2017, which exceeded 75% in the low SDI states of Bihar, Jharkhand, and Odisha. 1.24 million (1.09-1.39) deaths in India in 2017, which were 12.5% of the total deaths, were attributable to air pollution, including 0.67 million (0.55-0.79) from ambient particulate matter pollution and 0.48 million (0.39-0.58) from household air pollution. Of these deaths attributable to air pollution, 51.4% were in people younger than 70 years. India contributed 18.1% of the global population but had 26.2% of the global air pollution DALYs in 2017. The ambient particulate matter pollution DALY rate was highest in the north Indian states of Uttar Pradesh, Haryana, Delhi, Punjab, and Rajasthan, spread across the three SDI state groups, and the household air pollution DALY rate was highest in the low SDI states of Chhattisgarh, Rajasthan, Madhya Pradesh, and Assam in north and northeast India. We estimated that if the air pollution level in India were less than the minimum causing health loss, the average life expectancy in 2017 would have been higher by 1.7 years (1.6-1.9), with this increase exceeding 2 years in the north Indian states of Rajasthan, Uttar Pradesh, and Haryana.Interpretation India has disproportionately high mortality and disease burden due to air pollution. This burden is generally highest in the low SDI states of north India. Reducing the substantial avoidable deaths and disease burden from this major environmental risk is dependent on rapid deployment of effective multisectoral policies throughout India that are commensurate with the magnitude of air pollution in each state. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.