Background Ambient air pollution is the largest environmental risk factor for morbidity and premature mortality worldwide. Studies that have quantified the health effects of air pollution typically use single-pollutant models and do not account for concurrent population exposure to other air pollutants. We compare and provide estimates of single and multi-pollutant attributable mortality for 824 European cites. Methods We conducted quantitative single and multi-pollutant health impact assessment (HIA) to estimate the attributable mortality to PM 2.5 and NO 2 on adult residents (aged ≥ 20 years) in 824 European cities, in 2018. Exposure response functions from PM 2.5 and NO 2 single-pollutant models were adjusted by a coefficient difference approach in a multi-pollutant HIA. We quantified pollutant dominance and identified intra-city pollutant distribution patterns in relation to potential double counting and multi-pollutant burden. Findings Non-compliance with the WHO 2021 guidelines resulted in a total of 213 889 deaths 95% CI: 89 224 – 344 223 jointly attributable to PM 2.5 and NO 2 . This was 76 833 less deaths than the sum of single-pollutant attributable estimates (PM 2.5 : 145 747 95% CI: 104 999 – 189 535; NO 2 : 143 646 95% CI: 87 398 – 198 313). Cities with the highest multi-pollutant age-standardised attributable mortality were PM 2.5 dominant, and mostly found in Eastern Europe. The majority of cities were NO 2 dominant, however varied by intra-city pollutant profiles and magnitude of multi-pollutant burden. Interpretation Quantifying attributable burden in a multi-pollutant HIA provides interpretable burden estimates for policy-makers and minimises potential double counting. Our findings provide critical evidence for tailoring urban and transport planning policies to city-specific contexts.
Dyer et al. (Mon,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: