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Environmental Health Perspectives









Background: Asthma is the most prevalent chronic respiratory disease worldwide, affecting 358 million people in 2015. Ambient air pollution exacerbates asthma among populations around the world and may also contribute to new-onset asthma. Objectives: We aimed to estimate the number of asthma emergency room visits and new onset asthma cases globally attributable to fine particulate matter (P[M.sub.2.5]), ozone, and nitrogen dioxide (N[O.sub.2]) concentrations. Methods: We used epidemiological health impact functions combined with data describing population, baseline asthma incidence and prevalence, and pollutant concentrations. We constructed a new dataset of national and regional emergency room visit rates among people with asthma using published survey data. Results: We estimated that 9-23 million and 5-10 million annual asthma emergency room visits globally in 2015 could be attributable to ozone and P[M.sub.2.5], respectively, representing 8-20% and 4-9% of the annual number of global visits, respectively. The range reflects the application of central risk estimates from different epidemiological meta-analyses. Anthropogenic emissions were responsible for ~37% and 73% of ozone and P[M.sub.2.5] impacts, respectively. Remaining impacts were attributable to naturally occurring ozone precursor emissions (e.g., from vegetation, lightning) and P[M.sub.2.5] (e.g., dust, sea salt), though several of these sources are also influenced by humans. The largest impacts were estimated in China and India. Conclusions: These findings estimate the magnitude of the global asthma burden that could be avoided by reducing ambient air pollution. We also identified key uncertainties and data limitations to be addressed to enable refined estimation.


Susan C. Anenberg1 Daven K. Henze2 Veronica Tinney1 Patrick L. Kinney3 William Raich4 Neal Fann5 Chris S. Malley6 Henry Roman4 Lok Lamsal7 Bryan Duncan7 Randall V. Martin8,9 Aaron van Donkelaar8 Michael Brauer10,11 Ruth Doherty12 Jan Eiof Jonson13 Yanko Davila2 Kengo Sudo14,15 Johan C.I. Kuylenstierna6 1 Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA 2 University of Colorado Boulder, Boulder, Colorado, USA 3 School of Public Health, Boston University, Boston, Massachusetts, USA 4 Industrial Economics, Inc., Cambridge, Massachusetts, USA 5 Office of Air and Radiation, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA 6 Stockholm Environment Institute, York, UK 7 NASA Goddard Space Flight Center, Greenbelt, Maryland, USA 8 Dalhousie University, Halifax, Nova Scotia, Canada 9 Smithsonian Astrophysical Observatory, Cambridge, Massachusetts, USA 10 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada 11 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA 12 University of Edinburgh, Edinburgh, UK 13 Norwegian Meteorological Institute, Oslo, Norway 14 Graduate School of Environmental Studies, Nagoya University, Nagoya, Japan 15 Japan Agency for Marine-Earth Science and Technology (JAMSTEC), Yokohama, Japan