Ningrui Liu PhD , Wei Liu PhD , Prof Furong Deng MD , Yumeng Liu PhD , Xuehuan Gao MM , Lin Fang PhD , Zhuoru Chen MPH , Hao Tang MPH , Shijie Hong MSc , Minyi Pan MSc , Wei Liu MSc , Xinyue Huo PhD , Kangqi Guo MSc , Fangfang Ruan PhD , Wenlou Zhang MSc , Prof Bin Zhao PhD , Prof Jinhan Mo PhD , Prof Chen Huang PhD , Chunxiao Su PhD , Chanjuan Sun PhD , Prof Yinping Zhang PhD
{"title":"The burden of disease attributable to indoor air pollutants in China from 2000 to 2017","authors":"Ningrui Liu PhD , Wei Liu PhD , Prof Furong Deng MD , Yumeng Liu PhD , Xuehuan Gao MM , Lin Fang PhD , Zhuoru Chen MPH , Hao Tang MPH , Shijie Hong MSc , Minyi Pan MSc , Wei Liu MSc , Xinyue Huo PhD , Kangqi Guo MSc , Fangfang Ruan PhD , Wenlou Zhang MSc , Prof Bin Zhao PhD , Prof Jinhan Mo PhD , Prof Chen Huang PhD , Chunxiao Su PhD , Chanjuan Sun PhD , Prof Yinping Zhang PhD","doi":"10.1016/S2542-5196(23)00215-2","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>High-level exposure to indoor air pollutants (IAPs) and their corresponding adverse health effects have become a public concern in China in the past 10 years. However, neither national nor provincial level burden of disease attributable to multiple IAPs has been reported for China. This is the first study to estimate and rank the annual burden of disease and the financial costs attributable to targeted residential IAPs at the national and provincial level in China from 2000 to 2017.</p></div><div><h3>Methods</h3><p>We first did a systematic review and meta-analysis of 117 articles from 37 231 articles identified in major databases, and obtained exposure–response relationships for the candidate IAPs. The exposure levels to these IAPs were then collected by another systematic review of 1864 articles selected from 52 351 articles. After the systematic review, ten IAPs with significant and robust exposure–response relationships and sufficient exposure data were finally targeted: PM<sub>2·5</sub>, nitrogen dioxide, sulphur dioxide, ozone, carbon monoxide, radon, formaldehyde, benzene, toluene, and p-dichlorobenzene. The annual exposure levels in residences were then evaluated in all 31 provinces in mainland China continuously from 2000 to 2017, using the spatiotemporal Gaussian process regression model to analyse indoor originating IAPs, and the infiltration factor method to analyse outdoor originating IAPs. The disability-adjusted life-years (DALYs) attributable to the targeted IAPs were estimated at both national and provincial levels in China, using the population attributable fraction method. Financial costs were estimated by an adapted human capital approach.</p></div><div><h3>Findings</h3><p>From 2000 to 2017, annual DALYs attributable to the ten IAPs in mainland China decreased from 4620 (95% CI 4070–5040) to 3700 (3210–4090) per 100 000. Nevertheless, in 2017, IAPs still ranked third among all risk factors, and their DALYs and financial costs accounted for 14·1% (95% CI 12·3–15·6) of total DALYs and 3·45% (3·01–3·82) of the gross domestic product. Specifically, the rank of ten targeted IAPs in order of their contribution to DALYs in 2017 was PM<sub>2·5</sub>, carbon monoxide, radon, benzene, nitrogen dioxide, ozone, sulphur dioxide, formaldehyde, toluene, and p-dichlorobenzene. The DALYs attributable to IAPs were 9·50% higher than those attributable to outdoor air pollution in 2017. For the leading IAP, PM<sub>2·5</sub>, the DALYs attributable to indoor origins are 18·3% higher than those of outdoor origins.</p></div><div><h3>Interpretation</h3><p>DALYs attributed to IAPs in China have decreased by 20·0% over the past two decades. Even so, they are still much higher than those in the USA and European countries. This study can provide a basis for determining which IAPs to target in various indoor air quality standards and for estimating the health and economic benefits of various indoor air quality control approaches, which will help to reduce the adverse health effects of IAPs in China.</p></div><div><h3>Funding</h3><p>The National Key Research and Development Program of China and the National Natural Science Foundation of China.</p></div>","PeriodicalId":48548,"journal":{"name":"Lancet Planetary Health","volume":"7 11","pages":"Pages e900-e911"},"PeriodicalIF":24.1000,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Planetary Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2542519623002152","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENVIRONMENTAL SCIENCES","Score":null,"Total":0}
引用次数: 1
Abstract
Background
High-level exposure to indoor air pollutants (IAPs) and their corresponding adverse health effects have become a public concern in China in the past 10 years. However, neither national nor provincial level burden of disease attributable to multiple IAPs has been reported for China. This is the first study to estimate and rank the annual burden of disease and the financial costs attributable to targeted residential IAPs at the national and provincial level in China from 2000 to 2017.
Methods
We first did a systematic review and meta-analysis of 117 articles from 37 231 articles identified in major databases, and obtained exposure–response relationships for the candidate IAPs. The exposure levels to these IAPs were then collected by another systematic review of 1864 articles selected from 52 351 articles. After the systematic review, ten IAPs with significant and robust exposure–response relationships and sufficient exposure data were finally targeted: PM2·5, nitrogen dioxide, sulphur dioxide, ozone, carbon monoxide, radon, formaldehyde, benzene, toluene, and p-dichlorobenzene. The annual exposure levels in residences were then evaluated in all 31 provinces in mainland China continuously from 2000 to 2017, using the spatiotemporal Gaussian process regression model to analyse indoor originating IAPs, and the infiltration factor method to analyse outdoor originating IAPs. The disability-adjusted life-years (DALYs) attributable to the targeted IAPs were estimated at both national and provincial levels in China, using the population attributable fraction method. Financial costs were estimated by an adapted human capital approach.
Findings
From 2000 to 2017, annual DALYs attributable to the ten IAPs in mainland China decreased from 4620 (95% CI 4070–5040) to 3700 (3210–4090) per 100 000. Nevertheless, in 2017, IAPs still ranked third among all risk factors, and their DALYs and financial costs accounted for 14·1% (95% CI 12·3–15·6) of total DALYs and 3·45% (3·01–3·82) of the gross domestic product. Specifically, the rank of ten targeted IAPs in order of their contribution to DALYs in 2017 was PM2·5, carbon monoxide, radon, benzene, nitrogen dioxide, ozone, sulphur dioxide, formaldehyde, toluene, and p-dichlorobenzene. The DALYs attributable to IAPs were 9·50% higher than those attributable to outdoor air pollution in 2017. For the leading IAP, PM2·5, the DALYs attributable to indoor origins are 18·3% higher than those of outdoor origins.
Interpretation
DALYs attributed to IAPs in China have decreased by 20·0% over the past two decades. Even so, they are still much higher than those in the USA and European countries. This study can provide a basis for determining which IAPs to target in various indoor air quality standards and for estimating the health and economic benefits of various indoor air quality control approaches, which will help to reduce the adverse health effects of IAPs in China.
Funding
The National Key Research and Development Program of China and the National Natural Science Foundation of China.
期刊介绍：
The Lancet Planetary Health is a gold Open Access journal dedicated to investigating and addressing the multifaceted determinants of healthy human civilizations and their impact on natural systems. Positioned as a key player in sustainable development, the journal covers a broad, interdisciplinary scope, encompassing areas such as poverty, nutrition, gender equity, water and sanitation, energy, economic growth, industrialization, inequality, urbanization, human consumption and production, climate change, ocean health, land use, peace, and justice.
With a commitment to publishing high-quality research, comment, and correspondence, it aims to be the leading journal for sustainable development in the face of unprecedented dangers and threats.
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