ETC HE Report 2023/7: Version 2; Health Risk Assessment of Air Pollution: assessing the environmental burden of disease in Europe in 2021

This report presents the results of the environmental burden of disease (or health risk) assessment related to air pollution in 2021. The estimates include all-cause mortality and cause-specific mortality and morbidity health outcomes, with ten risk-outcome pairs considered for the cause-specific estimates. Cause-specific mortality and morbidity estimates are combined to allow assessing the overall impact on population health based on a common indicator, the disability-adjusted life year. Using estimates disaggregated by mortality and morbidity components allows for the identification of the related shares across European countries.

13 Jun 2024

Joana Soares (NILU), Dietrich Plass (UBA), Sarah Kienzler (UBA), Alberto González Ortiz (EEA), Artur Gsella (EEA), Jan Horálek (CHMI)

This report presents the results of the environmental burden of disease (EBD) assessment related to air pollution in 2021 for the 27 Member States of the European Union and an additional 14 European countries (Albania, Andorra, Bosnia and Herzegovina, Iceland, Kosovo under UNSCR 1244/99, Liechtenstein, Monaco, Montenegro, North Macedonia, Norway, San Marino, Serbia, Switzerland, and Türkiye). The estimations differentiate the EBD by three individual pollutants, fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3), considering all-cause mortality as well as cause-specific mortality and morbidity. For the analyses, various burden of disease indicators were used, such as attributable deaths (AD), years of life lost (YLL), years lived with disability (YLD), disability-adjusted life years (DALY) and attributable hospitalisation cases.

In 2021, long-term exposure to concentration levels above the WHO Air Quality Guideline levels of PM2.5 and NO2, resulted in 293 000 and 69 000 AD from all natural causes, respectively. There were 27 000 AD related to short-term exposure to O3. For EU27, the number of AD is 253 000, 52 000 and 22 000, respectively. When considering both the number of deaths and the age at which it occurs, the YLL (YLL per 100 000 inhabitants) is 2 936 000 (618) for long-term exposure to PM2.5 and 740 000 (132) to NO2, and 299 000 (54) due to short-term exposure to O3. For EU27, YLL (YLL per 100 000 inhabitants) are 2 584 000 (584), 532 000 (120), 234 000 (53), respectively. When comparing long-term exposure, both all-cause and cause-specific analyses point to PM2.5 as the pollutant with the highest burden. The cause-specific analyses resulted in 2 510 442 DALY in all countries or 2 294 842 DALY in the EU27. The burden attributable to NO2 was considerably lower, with 634 721 DALY and 403 788 DALY in all countries and in the EU27, respectively. Looking at the single disease entities, ischemic heart disease contributed the most to the overall burden of PM2.5, with 741 383 DALY in all countries and 688 979 DALY in the EU27. The lowest burden was related to Asthma (children), with 25 932 and 23 969 DALY in all countries and the EU27, respectively. For NO2, the highest disease burden was associated with diabetes mellitus (314 574 DALY; EU27: 197 031 DALY) and the lowest with asthma (adults) (all countries: 115 425 DALY; EU27: 62 460 DALY). No corresponding indicators were calculated for O3, yet short-term exposure to O3 was associated with 15 986 attributable hospital admissions in the selected European countries. When comparing the results, it is important to note that different age groups (i.e. children, adults, and elderly) were considered in the estimates, according to the relevant concentration-response functions.

This is an updated version of the report originally published on 22/11/2023. It includes a corrigendum to the results for ischaemic heart disease (IHD) related to long-term exposure to PM2.5.