• Rongbin Xu, Tingting Ye, Wenzhong Huang, Xu Yue, Lidia Morawska, Michael J Abramson, Gongbo Chen, Pei Yu, Yanming Liu, Zhengyu Yang, Yiwen Zhang, Yao Wu, Wenhua Yu, Bo Wen, Yuxi Zhang, Simon Hales, Eric Lavigne, SaldivaPaulo H NPHNDepartment of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil., Micheline S Z S Coelho, Patricia Matus, Dominic Roye, Jochem Klompmaker, Malcolm Mistry, Susanne Breitner, Ariana Zeka, Raanan Raz, Shilu Tong, Fay H Johnston, Joel Schwartz, Antonio Gasparrini, Yuming Guo, Shanshan Li, and Multi-Country Multi-City Collaborative Research Network.
• Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Medicine, Chongqing University, Chongqing, China.
• Lancet. 2024 Dec 14; 404 (10470): 244724592447-2459.

BackgroundLandscape fire-sourced (LFS) air pollution is an increasing public health concern in the context of climate change. However, little is known about the attributable global, regional, and national mortality burden related to LFS air pollution.MethodsWe calculated country-specific population-weighted average daily and annual LFS fine particulate matter (PM2·5) and surface ozone (O3) during 2000-19 from a validated dataset. We obtained the relative risks (RRs) for both short-term and long-term impact of LFS PM2·5 and O3 on all-cause, cardiovascular, and respiratory mortality. The short-term RRs were pooled from community-specific standard time-series regressions in 2267 communities across 59 countries or territories. The long-term RRs were obtained from published meta-analyses of cohort studies on all-source PM2·5 and O3. Annual mortality, population, and socio-demographic data for each country or territory were extracted from the Global Burden of Diseases Study 2019. These data were used to estimate country-specific annual deaths attributable to LFS air pollution using standard algorithms.FindingsGlobally, 1·53 million all-cause deaths per year (95% empirical confidence interval [eCI] 1·24-1·82) were attributable to LFS air pollution during 2000-19, including 0·45 million (0·32-0·57) cardiovascular deaths and 0·22 million respiratory deaths (0·08-0·35). LFS PM2·5 and O3 contributed to 77·6% and 22·4% of the total attributable deaths, respectively. Over 90% of all attributable deaths were in low-income and middle-income countries, particularly in sub-Saharan Africa (606 769 deaths per year), southeast Asia (206 817 deaths), south Asia (170 762 deaths), and east Asia (147 291 deaths). The global cardiovascular attributable deaths saw an average 1·67% increase per year (ptrend <0·001), although the trends for all-cause and respiratory attributable deaths were not statistically significant. The five countries with the largest all-cause attributable deaths were China, the Democratic Republic of the Congo, India, Indonesia, and Nigeria, although the order changed in the second decade. The leading countries with the greatest attributable mortality rates (AMRs) were all in sub-Saharan Africa, despite decreasing trends from 2000 to 2019. North and central America, and countries surrounding the Mediterranean, showed increasing trends of all-cause, cardiovascular, and respiratory AMRs. Increasing cardiovascular AMR was also observed in southeast Asia, south Asia, and east Asia. In 2019, the AMRs in low-income countries remained four times those in high-income countries, though this had reduced from nine times in 2000. AMRs negatively correlated with a country-specific socio-demographic index (Spearman correlation coefficients r around -0·60).InterpretationLFS air pollution induced a substantial global mortality burden, with notable geographical and socioeconomic disparities. Urgent actions are required to address such substantial health impact and the associated environmental injustice in a warming climate.FundingAustralian Research Council, Australian National Health and Medical Research Council.Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.

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