Air pollution deaths attributable to fossil fuels: observational and modelling study
Open accessAbstract
OBJECTIVES: To estimate all cause and cause specific deaths that are attributable to fossil fuel related air pollution and to assess potential health benefits from policies that replace fossil fuels with clean, renewable energy sources. DESIGN: Observational and modelling study. METHODS: An updated atmospheric composition model, a newly developed relative risk model, and satellite based data were used to determine exposure to ambient air pollution, estimate all cause and disease specific mortality, and attribute them to emission categories. DATA SOURCES: Data from the global burden of disease 2019 study, observational fine particulate matter and population data from National Aeronautics and Space Administration (NASA) satellites, and atmospheric chemistry, aerosol, and relative risk modelling for 2019. RESULTS: Globally, all cause excess deaths due to fine particulate and ozone air pollution are estimated at 8.34 million (95% confidence interval 5.63 to 11.19) deaths per year. Most (52%) of the mortality burden is related to cardiometabolic conditions, particularly ischaemic heart disease (30%). Stroke and chronic obstructive pulmonary disease both account for 16% of mortality burden. About 20% of all cause mortality is undefined, with arterial hypertension and neurodegenerative diseases possibly implicated. An estimated 5.13 million (3.63 to 6.32) excess deaths per year globally are attributable to ambient air pollution from fossil fuel use and therefore could potentially be avoided by phasing out fossil fuels. This figure corresponds to 82% of the maximum number of air pollution deaths that could be averted by controlling all anthropogenic emissions. Smaller reductions, rather than a complete phase-out, indicate that the responses are not strongly non-linear. Reductions in emission related to fossil fuels at all levels of air pollution can decrease the number of attributable deaths substantially. Estimates of avoidable excess deaths are markedly higher in this study than most previous studies for these reasons: the new relative risk model has implications for high income (largely fossil fuel intensive) countries and for low and middle income countries where the use of fossil fuels is increasing; this study accounts for all cause mortality in addition to disease specific mortality; and the large reduction in air pollution from a fossil fuel phase-out can greatly reduce exposure. CONCLUSION: Phasing out fossil fuels is deemed to be an effective intervention to improve health and save lives as part the United Nations' goal of climate neutrality by 2050. Ambient air pollution would no longer be a leading, environmental health risk factor if the use of fossil fuels were superseded by equitable access to clean sources of renewable energy.
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Exposure to fossil fuel-derived outdoor PM2.5 pollution contributed to 2.09 million deaths in 2021.
“The extensively validated model used in this indicator suggests that exposure to fossil fuel-derived outdoor PM2·5 pollution contributed to 2·09 million of these deaths, with coal burning accounting for nearly 980 000 deaths.273”
From The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action (2024) · cites this paper as [273]
The Methods (Study design and data sources) say the model results are for 2019, not 2021. The Results (Mortality related to fossil fuels) estimate 5.13 million annual deaths attributable to fossil-fuel-related emissions, not 2.09 million. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredCoal burning accounted for nearly 980,000 deaths in 2021.
“The extensively validated model used in this indicator suggests that exposure to fossil fuel-derived outdoor PM2·5 pollution contributed to 2·09 million of these deaths, with coal burning accounting for nearly 980 000 deaths.273”
From The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action (2024) · cites this paper as [273]
The Results section ('Mortality related to fossil fuels'; page unavailable) estimates deaths from fossil fuels overall and says coal combustion contributes more than half of the emissions, but gives no coal-specific death count. The Methods ('Study design and data sources'; page unavailable) says the model results are for 2019, not 2021. Searches for 980,000 coal-burning deaths and a 2021 coal-specific estimate found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Lelieveld, J., Haines, A., Burnett, R., Tonne, C., Klingmüller, K., Münzel, T., & Pozzer, A.
- Affiliations
- Cyprus Institute (CY)
- London School of Hygiene & Tropical Medicine (GB)
- University of Washington (US)
- Universitat Pompeu Fabra (ES)
- Max Planck Institute for Chemistry (DE)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Lelieveld, Jos
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2023-11-29
- Volume
- 383
- Pages
- e077784
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC10686100
- OpenAlex
- W4389154806
- Cited by
- 289
- References
- 44
- Citations by year
- 2026: 82 · 2025: 120 · 2024: 83 · 2023: 4
- FWCI
- 33.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion, other-oa)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, cc-by-nc-nd)
- HighWire Press Open Archive (submittedVersion)
- Funders
- European Union Agency for Cybersecurity
- Oak Foundation
- Wellcome Trust
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Physical Sciences › Environmental Science › Global and Planetary Change › COVID-19 impact on air quality
- Keywords
- air pollution mortality, fossil fuel phase-out, PM2.5, ozone, ischemic heart disease, stroke, chronic obstructive pulmonary disease, relative risk model, anthropogenic emissions, renewable energy transition, climate neutrality, global health burden, atmospheric chemistry modeling, low- and middle-income countries
- MeSH terms
- Air Pollutants, Air Pollution, Fossil Fuels, Humans, Income, Ozone, Particulate Matter
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