Mapping landscape fire-sourced air pollution-related mortality across 2288 local communities in Australia: a nationwide health impact assessment.

Background: Landscape fire-sourced (LFS) air pollution has been linked to increased mortality, which is especially concerning in fire-prone regions such as Australia. However, there is little evidence on how this increased mortality and associated economic burden might vary by region in Australia or on the factors driving such regional differences. To address this gap, we aimed to estimate the community-level mortality burden and economic loss from LFS air pollution and examine the socioeconomic factors contributing to regional health disparities across 2288 communities in Australia.

Methods: We obtained individual death records and community characteristics from the Australian Bureau of Statistics, together with community-level population-weighted average daily and annual estimates of LFS fine particulate matter (PM_2.5) and surface ozone (O₃) during 2009-19 from a validated dataset. We used two-stage time series analyses to derive relative risks for the short-term mortality risks of LFS PM_2·5 and O₃. By integrating recent evidence on long-term mortality impacts of all-source PM_2·5 and O₃, we calculated the total LFS air pollution-related mortality burden (including both short-term and long-term burdens) and economic loss for each of the 2288 communities (statistical area level 2) in Australia. Mortality burden was expressed as attributable deaths, attributable fractions, and attributable mortality rates. Economic loss was quantified with the value of statistical life approach on the basis of willingness-to-pay estimates.

Findings: Between 2016 and 2019, LFS air pollution was responsible for 22 809 (95% CI 19 276-26 435) all-cause deaths in Australia, valued at AU$138·41 billion (95% CI 116·97-160·41). Communities in the Northern Territory had the highest LFS air pollution-related excess mortality rate, at 33·97 (95% CI 29·12-39·20) per 100 000 residents per year, followed by communities in New South Wales and Queensland, whereas Southern Australia had the lowest burden, at 12·25 (10·64-14·04) deaths per 100 000 residents per year. Notably, mortality burdens were greater in communities with higher proportions of Indigenous Australian residents or residents of lower socioeconomic status and in communities situated in rural locations.

Interpretation: This study provides a comprehensive analysis of the mortality burden and economic loss associated with LFS air pollution, highlighting a clear socioeconomic inequality in health burdens across Australian communities. The results-presented as community-level mortality burden maps-could inform the development of targeted public health interventions and climate policies at both local and national levels.

Funding: The Australian Research Council, Australian National Health and Medical Research Council, and VicHealth.