Estimates of the Global Burden of Ambient PM2.5, Ozone, and NO2 on Asthma Incidence and Emergency Room Visits
Open accessAbstract
Background: Asthma is the most prevalent chronic respiratory disease worldwide, affecting 358 million people in 2015. Ambient air pollution exacerbates asthma among populations around the world and may also contribute to new-onset asthma. Objectives: We aimed to estimate the number of asthma emergency room visits and new onset asthma cases globally attributable to fine particulate matter (PM2.5), ozone, and nitrogen dioxide (NO2) concentrations. Methods: We used epidemiological health impact functions combined with data describing population, baseline asthma incidence and prevalence, and pollutant concentrations. We constructed a new dataset of national and regional emergency room visit rates among people with asthma using published survey data. Results: We estimated that 9–23 million and 5–10 million annual asthma emergency room visits globally in 2015 could be attributable to ozone and PM2.5, respectively, representing 8–20% and 4–9% of the annual number of global visits, respectively. The range reflects the application of central risk estimates from different epidemiological meta-analyses. Anthropogenic emissions were responsible for ∼37% and 73% of ozone and PM2.5 impacts, respectively. Remaining impacts were attributable to naturally occurring ozone precursor emissions (e.g., from vegetation, lightning) and PM2.5 (e.g., dust, sea salt), though several of these sources are also influenced by humans. The largest impacts were estimated in China and India. Conclusions: These findings estimate the magnitude of the global asthma burden that could be avoided by reducing ambient air pollution. We also identified key uncertainties and data limitations to be addressed to enable refined estimation. https://doi.org/10.1289/EHP3766
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An estimated 9-23 million (8-20% of total) asthma-related emergency room visits globally were attributable to ozone.
“An estimated 9–23 million (8–20% of total) asthma-related emergency room visits globally were attributable to ozone (74).”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [74]
Worldwide, in 2015, 9-23 million annual asthma emergency room visits have been attributed to outdoor ozone.
“Worldwide, in 2015, 9–23 million and 5–10 million annual asthma emergency room visits have been attributed to the outdoor air pollutants ozone and particulate matter with an aerodynamic diameter <2.5 μm (PM2.5), respectively.”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [121]
Outdoor air pollution almost certainly has a major global impact on asthma for children and adults, especially in China and India.
“Outdoor air pollution almost certainly has a major global impact on asthma for children and adults, especially in China and India (121).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [121]
Worldwide, in 2015, 5-10 million annual asthma emergency room visits have been attributed to PM2.5.
“Worldwide, in 2015, 9–23 million and 5–10 million annual asthma emergency room visits have been attributed to the outdoor air pollutants ozone and particulate matter with an aerodynamic diameter <2.5 μm (PM2.5), respectively.”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [121]
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- Authors
- Anenberg, S. C., Henze, D. K., Tinney, V., Kinney, P. L., Raich, W., Fann, N., Malley, C. S., Roman, H., Lamsal, L., Duncan, B., Martin, R. V., van Donkelaar, A., Brauer, M., Doherty, R., Jonson, J. E., Davila, Y., Sudo, K., & Kuylenstierna, J. C. I.
- Affiliations
- George Washington University (US)
- University of Colorado Boulder (US)
- Boston University (US)
- Industrial Economics, Inc. , Cambridge, Massachusetts,
- Environmental Protection Agency (US)
- Stockholm Environment Institute , York,
- Goddard Space Flight Center (US)
- Dalhousie University (CA)
- Dalhousie University , Halifax, Nova Scotia,
- University of British Columbia (CA)
- University of Edinburgh (GB)
- Norwegian Meteorological Institute (NO)
- Japan Agency for Marine-Earth Science and Technology (JP)
- Stockholm Environment Institute (GB)
- Corresponding author
- Anenberg, Susan C.
- ORCID
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2018-10-01
- Volume
- 126
- Issue
- 10
- Pages
- 107004-107004
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC6371661
- OpenAlex
- W2898247900
- Cited by
- 337
- References
- 71
- Citations by year
- 2026: 19 · 2025: 45 · 2024: 51 · 2023: 38 · 2022: 48 · 2021: 55 · 2020: 47 · 2019: 34
- FWCI
- 16.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- creativecommons.org/licenses/by/4.0/ (vor)
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- CU Scholar (University of Colorado Boulder) (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Funders
- National Aeronautics and Space Administration
- Stockholm Environment Institute
- Institute for Health Metrics and Evaluation
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- asthma, ambient air pollution, PM2.5, ozone, nitrogen dioxide, emergency department visits, new-onset asthma, attributable burden, anthropogenic emissions, respiratory disease burden, China, India
- MeSH terms
- Air Pollution, Asthma, Emergency Service, Hospital, Environmental Exposure, Humans, Nitrogen Dioxide, Ozone, Particle Size, Risk Factors, Incidence, Particulate Matter
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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