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Cited by 289Air Quality and Health ImpactsEnergy and Environment ImpactsCOVID-19 impact on air quality

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Air pollution deaths attributable to fossil fuels: observational and modelling study

Open access
Lelieveld, Jos, Haines, Andy, Burnett, Richard, Tonne, Cathryn, Klingmüller, Klaus, Münzel, Thomas, Pozzer, Andrea·2023·BMJ
DOI 10.1136/bmj-2023-077784PMC PMC10686100
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Abstract

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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Fig 1 Annual all cause deaths attributable to fine particulate matter (PM2.5) and ozone (O3) in 2019. Units are numbers per area of 10 km×10 km
Fig 1 Annual all cause deaths attributable to fine particulate matter (PM2.5) and ozone (O3) in 2019. Units are numbers per area of 10 km×10 kmCC BY-NC · PubMed Central
Fig 2 Country average, all cause deaths per 100 000 population per year attributable to fine particulate matter (PM2.5) and ozone (O3), and with fossil fuel related and all anthropogenic emissions removed
Fig 2 Country average, all cause deaths per 100 000 population per year attributable to fine particulate matter (PM2.5) and ozone (O3), and with fossil fuel related and all anthropogenic emissions removedCC BY-NC · PubMed Central
Fig 3 Percentage reductions in annual deaths attributable to air pollution from removing fossil fuel related and all anthropogenic emissions of PM2.5 and O3 for seven macro-regions and the world. The yellow bars depict the “half way” scenario by assuming that 50% of the fossil fuel phase-out is achieved and the purple bars indicate the “quarter way” scenario by assuming that 25% is achieved. The error bars indicate the 95% CI
Fig 3 Percentage reductions in annual deaths attributable to air pollution from removing fossil fuel related and all anthropogenic emissions of PM2.5 and O3 for seven macro-regions and the world. The yellow bars depict the “half way” scenario by assuming that 50% of the fossil fuel phase-out is achieved and the purple bars indicate the “quarter way” scenario by assuming that 25% is achieved. The error bars indicate the 95% CICC BY-NC · PubMed Central

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Metadata

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)
DOI
10.1136/bmj-2023-077784
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
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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