The burden of disease attributable to indoor air pollutants in China from 2000 to 2017

Ningrui Liu; Wei Liu; Furong Deng; Yumeng Liu; Xuehuan Gao; Lin Fang; Zhuoru Chen; Hao Tang; Shijie Hong; Minyi Pan; Wei Liu; Xinyue Huo; Kangqi Guo; Fangfang Ruan; Wenlou Zhang; Bin Zhao; Jinhan Mo; Chen Huang; Chunxiao Su; Chanjuan Sun; Zhijun Zou; Hao Li; Yuexia Sun; Hua Qian; Xiaohong Zheng; Xiangang Zeng; Jianguo Guo; Zhongming Bu; Corinne Mandin; Otto Hänninen; John S Ji; Louise B Weschler; Haidong Kan; Zhuohui Zhao; Yinping Zhang

doi:10.1016/S2542-5196(23)00215-2

The burden of disease attributable to indoor air pollutants in China from 2000 to 2017

Lancet Planet Health. 2023 Nov;7(11):e900-e911. doi: 10.1016/S2542-5196(23)00215-2.

Authors

Ningrui Liu¹, Wei Liu², Furong Deng³, Yumeng Liu⁴, Xuehuan Gao⁵, Lin Fang¹, Zhuoru Chen⁶, Hao Tang⁶, Shijie Hong⁷, Minyi Pan⁷, Wei Liu⁸, Xinyue Huo⁸, Kangqi Guo⁹, Fangfang Ruan¹⁰, Wenlou Zhang³, Bin Zhao⁴, Jinhan Mo¹, Chen Huang⁷, Chunxiao Su⁷, Chanjuan Sun⁷, Zhijun Zou⁷, Hao Li⁷, Yuexia Sun⁸, Hua Qian⁹, Xiaohong Zheng⁹, Xiangang Zeng¹⁰, Jianguo Guo¹¹, Zhongming Bu¹², Corinne Mandin¹³, Otto Hänninen¹⁴, John S Ji¹⁵, Louise B Weschler¹⁶, Haidong Kan¹⁷, Zhuohui Zhao¹⁸, Yinping Zhang¹⁹

Affiliations

¹ Department of Building Science, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China.
² Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China.
³ School of Public Health, Peking University, Beijing, China.
⁴ Department of Building Science, Tsinghua University, Beijing, China.
⁵ Anhui Provincial Center for Disease Control and Prevention, Hefei, China.
⁶ School of Public Health, Fudan University, Shanghai, China.
⁷ School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China.
⁸ School of Environmental Science and Engineering, Tianjin University, Tianjin, China.
⁹ School of Energy and Environment, Southeast University, Nanjing, China.
¹⁰ School of Environment and Natural Resources, Renmin University of China, Beijing, China.
¹¹ Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
¹² Department of Energy and Environmental System Engineering, Zhejiang University of Science and Technology, Hangzhou, China.
¹³ Institute for Radiation Protection and Nuclear Safety, Fontenay-aux-Roses Cedex, Marne-la-Vallée, France.
¹⁴ Finnish Institute for Health and Welfare, Department of Health Security, Kuopio, Finland.
¹⁵ Vanke School of Public Health, Tsinghua University, Beijing, China.
¹⁶ Colts Neck, NJ, USA.
¹⁷ School of Public Health, Fudan University, Shanghai, China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai, China. Electronic address: kanh@fudan.edu.cn.
¹⁸ School of Public Health, Fudan University, Shanghai, China; Key Laboratory of Public Health Safety of the Ministry of Education, NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, China; IRDR International Center of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai China; WMO/IGAC MAP-AQ Asian Office Shanghai, Fudan University, Shanghai, China. Electronic address: zhzhao@fudan.edu.cn.
¹⁹ Department of Building Science, Tsinghua University, Beijing, China; Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China. Electronic address: zhangyp@tsinghua.edu.cn.

PMID: 37940210
DOI: 10.1016/S2542-5196(23)00215-2

Abstract

Background: High-level exposure to indoor air pollutants (IAPs) and their corresponding adverse health effects have become a public concern in China in the past 10 years. However, neither national nor provincial level burden of disease attributable to multiple IAPs has been reported for China. This is the first study to estimate and rank the annual burden of disease and the financial costs attributable to targeted residential IAPs at the national and provincial level in China from 2000 to 2017.

Methods: We first did a systematic review and meta-analysis of 117 articles from 37 231 articles identified in major databases, and obtained exposure-response relationships for the candidate IAPs. The exposure levels to these IAPs were then collected by another systematic review of 1864 articles selected from 52 351 articles. After the systematic review, ten IAPs with significant and robust exposure-response relationships and sufficient exposure data were finally targeted: PM_2·5, nitrogen dioxide, sulphur dioxide, ozone, carbon monoxide, radon, formaldehyde, benzene, toluene, and p-dichlorobenzene. The annual exposure levels in residences were then evaluated in all 31 provinces in mainland China continuously from 2000 to 2017, using the spatiotemporal Gaussian process regression model to analyse indoor originating IAPs, and the infiltration factor method to analyse outdoor originating IAPs. The disability-adjusted life-years (DALYs) attributable to the targeted IAPs were estimated at both national and provincial levels in China, using the population attributable fraction method. Financial costs were estimated by an adapted human capital approach.

Findings: From 2000 to 2017, annual DALYs attributable to the ten IAPs in mainland China decreased from 4620 (95% CI 4070-5040) to 3700 (3210-4090) per 100 000. Nevertheless, in 2017, IAPs still ranked third among all risk factors, and their DALYs and financial costs accounted for 14·1% (95% CI 12·3-15·6) of total DALYs and 3·45% (3·01-3·82) of the gross domestic product. Specifically, the rank of ten targeted IAPs in order of their contribution to DALYs in 2017 was PM_2·5, carbon monoxide, radon, benzene, nitrogen dioxide, ozone, sulphur dioxide, formaldehyde, toluene, and p-dichlorobenzene. The DALYs attributable to IAPs were 9·50% higher than those attributable to outdoor air pollution in 2017. For the leading IAP, PM_2·5, the DALYs attributable to indoor origins are 18·3% higher than those of outdoor origins.

Interpretation: DALYs attributed to IAPs in China have decreased by 20·0% over the past two decades. Even so, they are still much higher than those in the USA and European countries. This study can provide a basis for determining which IAPs to target in various indoor air quality standards and for estimating the health and economic benefits of various indoor air quality control approaches, which will help to reduce the adverse health effects of IAPs in China.

Funding: The National Key Research and Development Program of China and the National Natural Science Foundation of China.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / adverse effects
Air Pollutants* / analysis
Benzene / adverse effects
Benzene / analysis
Carbon Monoxide / analysis
Cost of Illness
Formaldehyde / analysis
Humans
Nitrogen Dioxide / adverse effects
Nitrogen Dioxide / analysis
Ozone* / analysis
Particulate Matter / analysis
Radon* / analysis
Sulfur Dioxide / analysis
Toluene / analysis

Substances

Air Pollutants
4-dichlorobenzene
Carbon Monoxide
Sulfur Dioxide
Benzene
Nitrogen Dioxide
Formaldehyde
Particulate Matter
Radon
Ozone
Toluene