Quantitative and distributive measurement of ambient air pollution 4 for global burden of disease

Air quality impacts human health from multiple perspectives. Ambient air pollution 25 (AAP) exposure poses a great contribution to the global burden of disease (BoD). The 26 United Nations launched the Sustainable Development Goals (SDGs) to evaluate 27 sustainability levels and improve human living environments. In particular, the two 28 indicators 3.9.1 and 11.6.2, i.e. fine particulate matters (PM2.5 and PM10) and relative 29 disease mortality are listed to illustrate the development goals for the air environment. 30 At present, countries around the world have adopted measures to mitigate AAP, and a 31 quantitative evaluation of the effectiveness is necessary. Thus, statistics for AAP and 32 BoD across the global 183 countries were analyzed to help assess the gap between the 33 status quo and SDGs in this study. We offer a new perspective on BoD estimation 34 research - proportional data (AAP-caused disease burden / total environment-caused 35 disease burden) in grouped global countries (according to their geographical and 36 economic conditions) were adopted to substitute the absolute value in this study, which 37 is more reasonable for comparative analysis. The overlap of economic and geographic 38 distribution shows that the heaviest BoD is concentrated in high-income and Middle 39 Eastern regions. Concerning the type of disease burden, acute lower respiratory 40 infections (ALRI) and ischemic heart disease (IHD) are two major contributors to BoD, 41 and the worldwide deaths and Disability Adjusted Life Years (DALYs) caused by them 42 need to be taken seriously. Generally, this study provides novel evidence for the 43 formulation of air pollution control and management measures to reduce the related 44 disease burden in global regions. To reduce the future BoD, different strategies should 45 be designed depending on the order of driving factors in regions. Even though the 46 triggers of BoD are quite different across the globe, the correlation analysis results 47 inform that reducing emissions along with CO 2 from social operations at the source is 48 the most direct and effective path in areas with a high density of susceptible populations.

Nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), particulate 65 matter with a median aerodynamic diameter <10 μm (PM10), and fine particulate 66 matter <2.5 μm (PM2.5) are typical air pollutants that can cause significant negative 67 influences on our ambient air quality (Committee on Environmental Health 2004). 68 Multiple research evidence from global regions has shown that these air pollution 69 factors are closely related to the incidence of diseases. In Iran, PM10 and SO2 with

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The previous research on the association between ambient particulate matter and 122 the disease burden provides a reliable basis for the further analysis of this study. and ambient air pollution" and "11.6.2 Annual mean levels of fine particulate matter   Table 1). Primary data of WHO and WB are derived

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(2) AAP attributable BoD. The assessment of environment-and AAP-associated BoD 190 is available for 183 countries and regions (see Table 1 Table 1, the linkage between disease burden and AAP is assessed via 216 AAP attributable BoD, and its spatial dynamics are discussed in terms of disease type, 217 geographical regions, and income distributions.

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In the temporal analysis of exposure AAP, Eq.1 shows the dynamic of AAP value     As illustrated in Fig.5, the overall distribution of death and DALY is analogous.

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Nevertheless, the situation of death owing to AAP exposure is more serious than DALY 311 across the world, and the gap between these two proportions is even over 16% in Europe   regions (see Fig.7). In the analysis of DALYs and deaths, it can be seen that their 383 distribution is roughly similar except for the slight difference in proportion. Obviously, 384 the distribution of disease burden is closely related to income (see Fig.8).

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The distribution of the major AAP-caused disease burdens has shown regularity 386 across world economies. and ALRI is the contributor to half of the burden in low-income regions (70% and 48%

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Combining the display of Fig.9  Saudi Arabia, and Lebanon), is still the "worst-hit" region in terms of disease burden. 409 Fig.9(a) and (b) also confirm the changes in Fig.5 and Fig.7, they suggest that AAP-     For the indicator of SGD 3.9.1, the results in Fig.5 and Fig.7 show that the AAP- we should at least attach importance to the factors that have been tested so far that harm 508 air quality, and work to reduce the burden of disease caused by air pollution.

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In conclusion, the global air pollution statistics combined with the relative disease 510 data have been used in this study to analyze the AAP and BoD situation and distribution.

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The results show that the BoD caused by AAP (including ALRI, lung cancer, COPD, 512 stroke, and IHD) is related to geography and income distribution. ALRI and IHD are 513 two main AAP-caused diseases that contribute to BoD around the world. Generally, the 514 burden of the disease tends to increase in affluent areas, but the reason is complex, it 515 might include the level of CO2 emissions, forest coverage rate, population density 516 government policies, etc. These negative circumstances show that there is still a 517 distance to reach the SDGs and fully protect human health from the adverse effects of 518 air pollution, lots further studies need to be developed in the near future.