Global Estimates of Mortality Associated with Long-Term Exposure to Outdoor Fine Particulate Matter. Burnett, R.; Chen, H.; Szyszkowicz, M.; Fann, N.; Hubbell, B.; Pope, C. A.; Apte, J. S.; Brauer, M.; Cohen, A.; Weichenthal, S.; Coggins, J.; Di, Q.; Brunekreef, B.; Frostad, J.; Lim, S. S.; Kan, H.; Walker, K. D.; Thurston, G. D.; Hayes, R. B.; Lim, C. C.; Turner, M. C.; Jerrett, M.; Krewski, D.; Gapstur, S. M.; Diver, W. R.; Ostro, B.; Goldberg, D.; Crouse, D. L.; Martin, R. V.; Peters, P.; Pinault, L.; Tjepkema, M.; van Donkelaar, A.; Villeneuve, P. J.; Miller, A. B.; Yin, P.; Zhou, M.; Wang, L.; Janssen, N. A. H.; Marra, M.; Atkinson, R. W.; Tsang, H.; Quoc Thach, T.; Cannon, J. B.; Allen, R. T.; Hart, J. E.; Laden, F.; Cesaroni, G.; Forastiere, F.; Weinmayr, G.; Jaensch, A.; Nagel, G.; Concin, H.; and Spadaro, J. V. 115(38):9592–9597.
Global Estimates of Mortality Associated with Long-Term Exposure to Outdoor Fine Particulate Matter [link]Paper  doi  abstract   bibtex   
[Significance] Exposure to outdoor concentrations of fine particulate matter is considered a leading global health concern, largely based on estimates of excess deaths using information integrating exposure and risk from several particle sources (outdoor and indoor air pollution and passive/active smoking). Such integration requires strong assumptions about equal toxicity per total inhaled dose. We relax these assumptions to build risk models examining exposure and risk information restricted to cohort studies of outdoor air pollution, now covering much of the global concentration range. Our estimates are severalfold larger than previous calculations, suggesting that outdoor particulate air pollution is an even more important population health risk factor than previously thought. [Abstract] Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries – the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95\,% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30\,% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95\,% CI: 4.9-8.5) and 120\,% larger than the risk function used in the GBD (4.0; 95\,% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20\,% reduction in concentrations, with the GEMM predicting 220\,% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.
@article{burnettGlobalEstimatesMortality2018,
  title = {Global Estimates of Mortality Associated with Long-Term Exposure to Outdoor Fine Particulate Matter},
  author = {Burnett, Richard and Chen, Hong and Szyszkowicz, Mieczysław and Fann, Neal and Hubbell, Bryan and Pope, C. Arden and Apte, Joshua S. and Brauer, Michael and Cohen, Aaron and Weichenthal, Scott and Coggins, Jay and Di, Qian and Brunekreef, Bert and Frostad, Joseph and Lim, Stephen S. and Kan, Haidong and Walker, Katherine D. and Thurston, George D. and Hayes, Richard B. and Lim, Chris C. and Turner, Michelle C. and Jerrett, Michael and Krewski, Daniel and Gapstur, Susan M. and Diver, W. Ryan and Ostro, Bart and Goldberg, Debbie and Crouse, Daniel L. and Martin, Randall V. and Peters, Paul and Pinault, Lauren and Tjepkema, Michael and van Donkelaar, Aaron and Villeneuve, Paul J. and Miller, Anthony B. and Yin, Peng and Zhou, Maigeng and Wang, Lijun and Janssen, Nicole A. H. and Marra, Marten and Atkinson, Richard W. and Tsang, Hilda and Quoc Thach, Thuan and Cannon, John B. and Allen, Ryan T. and Hart, Jaime E. and Laden, Francine and Cesaroni, Giulia and Forastiere, Francesco and Weinmayr, Gudrun and Jaensch, Andrea and Nagel, Gabriele and Concin, Hans and Spadaro, Joseph V.},
  date = {2018-09},
  journaltitle = {Proceedings of the National Academy of Sciences},
  volume = {115},
  pages = {9592--9597},
  issn = {1091-6490},
  doi = {10.1073/pnas.1803222115},
  url = {https://doi.org/10.1073/pnas.1803222115},
  abstract = {[Significance] Exposure to outdoor concentrations of fine particulate matter is considered a leading global health concern, largely based on estimates of excess deaths using information integrating exposure and risk from several particle sources (outdoor and indoor air pollution and passive/active smoking). Such integration requires strong assumptions about equal toxicity per total inhaled dose. We relax these assumptions to build risk models examining exposure and risk information restricted to cohort studies of outdoor air pollution, now covering much of the global concentration range. Our estimates are severalfold larger than previous calculations, suggesting that outdoor particulate air pollution is an even more important population health risk factor than previously thought.

[Abstract] Exposure to ambient fine particulate matter (PM2.5) is a major global health concern. Quantitative estimates of attributable mortality are based on disease-specific hazard ratio models that incorporate risk information from multiple PM2.5 sources (outdoor and indoor air pollution from use of solid fuels and secondhand and active smoking), requiring assumptions about equivalent exposure and toxicity. We relax these contentious assumptions by constructing a PM2.5-mortality hazard ratio function based only on cohort studies of outdoor air pollution that covers the global exposure range. We modeled the shape of the association between PM2.5 and nonaccidental mortality using data from 41 cohorts from 16 countries -- the Global Exposure Mortality Model (GEMM). We then constructed GEMMs for five specific causes of death examined by the global burden of disease (GBD). The GEMM predicts 8.9 million [95\,\% confidence interval (CI): 7.5-10.3] deaths in 2015, a figure 30\,\% larger than that predicted by the sum of deaths among the five specific causes (6.9; 95\,\% CI: 4.9-8.5) and 120\,\% larger than the risk function used in the GBD (4.0; 95\,\% CI: 3.3-4.8). Differences between the GEMM and GBD risk functions are larger for a 20\,\% reduction in concentrations, with the GEMM predicting 220\,\% higher excess deaths. These results suggest that PM2.5 exposure may be related to additional causes of death than the five considered by the GBD and that incorporation of risk information from other, nonoutdoor, particle sources leads to underestimation of disease burden, especially at higher concentrations.},
  keywords = {*imported-from-citeulike-INRMM,~INRMM-MiD:c-14637878,air-pollution,empirical-equation,human-health,mortality,particulate-matter,smoke},
  number = {38},
  options = {useprefix=true}
}
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