Global, regional, and national burden of household air pollution, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Fiona B Bennitt, Sarah Wozniak, Kate Causey, Sandra Spearman, Chukwuma Okereke, Vanessa Garcia, Nadim Hashmeh, Charlie Ashbaugh, Atef Abdelkader, Meriem Abdoun, Muhammed Jemal Abdurebi, Armita Abedi, Roberto Ariel Abeldaño Zúñiga, Richard Gyan Aboagye, Bilyaminu Abubakar, Ahmed Abu‐Zaid, Mesafint Molla Adane, Oyelola A. Adegboye, Victor Adekanmbi, Victor Abiola Adepoju, Temitayo Esther Adeyeoluwa, Olorunsola Adeyomoye, Rishan Adha, Muhammad Sohail Afzal, Saira Afzal, Feleke Doyore Agide, Aqeel Ahmad, Danish Ahmad, Muayyad Ahmad, Sajjad Ahmad, Ali Ahmadi, Sepideh Ahmadi, Anisuddin Ahmed, Ayman Ahmed, Haroon Ahmed, Marjan Ajami, Rufus Akinyemi, Salah Al Awaidy, Hanadi Al Hamad, Muaaz Alajlani, Mulubirhan Assefa Alemayohu, Adel Al‐Gheethi, Abid Ali, Waad Ali, Sheikh Mohammad Alif, Sami Almustanyir, Nelson Alvis‐Guzmán, Nelson J Alvis-Zakzuk, Hany Aly, Hubert Amu, Ganiyu Adeniyi Amusa, Tadele Fentabil Anagaw, Boluwatife Stephen Anuoluwa, Iyadunni Adesola Anuoluwa, Saeid Anvari, Ekenedilichukwu Emmanuel Anyabolo, Geminn Louis Carace Apostol, Aleksandr Y. Aravkin, Demelash Areda, Brhane Berhe Aregawi, Olatunde Aremu, Akeza Awealom Asgedom, Mubarek Yesse Ashemo, Tahira Ashraf, Seyyed Shamsadin Athari, Sina Azadnajafabad, Ahmed Y. Azzam, Giridhara R. Babu, Saeed Bahramian, Kiran Bam, Maciej Banach, Biswajit Banik, Mehmet Fırat Baran, Francesco Barone‐Adesi, Sandra Barteit, Hameed Akande Bashiru, Pritish Baskaran, Mohammad‐Mahdi Bastan, Sanjay Basu, Saurav Basu, Sefealem Assefa Belay, Melesse Belayneh, Apostolos Beloukas, Derrick Bennett, Devidas S. Bhagat, Dinesh Bhandari, Pankaj Bhardwaj, Sonu Bhaskar, Ajay Nagesh Bhat, Priyadarshini Bhattacharjee, Gurjit Kaur Bhatti, Manpreet S. Bhatti, Cem Bilgin, Mary Sefa Boampong, Sri Harsha Boppana, Samuel Adolf Bosoka, Sofiane Boudalia, Fan Cao, Rama Mohan Chandika, Gashaw Sisay Chanie
Abstract
BACKGROUND: Despite a substantial reduction in the use of solid fuels for cooking worldwide, exposure to household air pollution (HAP) remains a leading global risk factor, contributing considerably to the burden of disease. We present a comprehensive analysis of spatial patterns and temporal trends in exposure and attributable disease from 1990 to 2021, featuring substantial methodological updates compared with previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study, including improved exposure estimations accounting for specific fuel types. METHODS: concentration. We combined our exposure estimates and relative risks to estimate population attributable fractions and attributable burden for each cause by sex, age, location, and year. FINDINGS: . Although these figures show a notable reduction in the percentage of the global population exposed in 1990 (56·7%, 56·4-57·1), in absolute terms, there has been only a decline of 0·35 billion (10%) from the 3·02 billion people exposed to HAP in 1990. In 2021, 111 million (95% UI 75·1-164) global disability-adjusted life-years (DALYs) were attributable to HAP, accounting for 3·9% (95% UI 2·6-5·7) of all DALYs. The rate of global, HAP-attributable DALYs in 2021 was 1500·3 (95% UI 1028·4-2195·6) age-standardised DALYs per 100 000 population, a decline of 63·8% since 1990, when HAP-attributable DALYs comprised 4147·7 (3101·4-5104·6) age-standardised DALYs per 100 000 population. HAP-attributable burden remained highest in sub-Saharan Africa and south Asia, with 4044·1 (3103·4-5219·7) and 3213·5 (2165·4-4409·4) age-standardised DALYs per 100 000 population, respectively. The rate of HAP-attributable DALYs was higher for males (1530·5, 1023·4-2263·6) than for females (1318·5, 866·1-1977·2). Approximately one-third of the HAP-attributable burden (518·1, 410·1-641·7) was mediated via short gestation and low birthweight. Decomposition of trends and drivers behind changes in the HAP-attributable burden highlighted that declines in exposures were counteracted by population growth in most regions of the world, especially sub-Saharan Africa. INTERPRETATION: Although the burden attributable to HAP has decreased considerably, HAP remains a substantial risk factor, especially in sub-Saharan Africa and south Asia. Our comprehensive estimates of HAP exposure and attributable burden offer a robust and reliable resource for health policy makers and practitioners to precisely target and tailor health interventions. Given the persistent and substantial impact of HAP in many regions and countries, it is imperative to accelerate efforts to transition under-resourced communities to cleaner household energy sources. Such initiatives are crucial for mitigating health risks and promoting sustainable development, ultimately improving the quality of life and health outcomes for millions of people. FUNDING: Bill & Melinda Gates Foundation.