The future health burden of air pollution in Greece and the associated drivers

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This study examines the future health burden of air pollution in Greece under different IPCC (Intergovernmental Panel on Climate Change) SSP (Shared Socioeconomic Pathway) scenarios, providing for the first time a decomposition of future air pollution-related mortality changes into key driving factors for the country and its administrative regions. Using bias-corrected CMIP6 (Coupled Model Intercomparison Project Phase 6) simulations from the GFDL-ESM4 model, we assess recent-past and future excess mortality attributable to PM 2.5 and O 3 , taking into account future demographic shifts and air quality changes. Despite projected declines in pollutant concentrations, the associated excess mortality is projected to increase primarily due to population ageing. By 2090, PM 2.5 -related mortality (mortality rate), which is approximately 7,900 (confidence interval (CI): 4,300 to 13,000) deaths per year (76 (CI: 41 to 130) deaths per 100 thousand population per year) in 2000, is expected to double under SSP1-2.6 and SSP2-4.5 and increase by a factor of 1.7 (2.7) under SSP3-7.0. O 3 -related deaths surpass 1,000 per year (10 deaths per 100 thousand population per year) under SSP2-4.5 and SSP3-7.0 but decline to near zero under the strong mitigation SSP1-2.6 due to strict air quality measures. The country’s most populous administrative regions, Attica and Central Macedonia, experience the highest health burden, with PM 2.5 -related mortality in Attica increasing by 6,000 deaths per year (increase > 200%), reaching a total of 8,800 (CI: 3,600 to 18,000) deaths per year by 2090 under SSP1-2.6. Our findings highlight the crucial role of demographic changes in shaping future air pollution health burden emphasizing the need for integrated air quality and public health policies to control these adverse health effects. • Pollution-related mortality change is decomposed to reveal key contributing factors. • Population ageing is the dominant driver of future air pollution mortality in Greece. • Future PM 2.5 -related mortality rises despite declining pollution levels. • Future O 3 -related mortality declines only under strong air quality mitigation policies. • Regional disparities highlight the need for targeted pollution control measures.