科研团队报道了1990-2021年全球、区域和国家家庭空气污染负担。相关论文发表在2025年3月18日出版的《柳叶刀》杂志上。

背景:尽管世界范围内用于烹饪的固体燃料的使用大幅减少，但暴露于家庭空气污染（HAP）仍然是一个主要的全球风险因素，在很大程度上造成了疾病负担。课题组人员对1990年至2021年期间暴露和归因疾病的空间格局和时间趋势进行了全面分析，与之前的全球疾病、伤害和风险因素负担研究相比，方法上进行了大量更新，包括改进了考虑特定燃料类型的暴露估计。

方法:课题组研究人员估计了1990年至2021年间204个国家和地区的白内障、慢性阻塞性肺病、缺血性心脏病、下呼吸道感染、气管癌、支气管癌、肺癌、中风、2型糖尿病以及不良生殖结局介导的原因的HAP暴露、趋势和归因负担。该研究团队首先根据燃料类型、地点、年份、年龄和性别，估算了使用固体燃料做饭的个体所暴露的细颗粒物（PM2·5）污染的平均燃料类型特定浓度（以μg/m³为单位）。通过对流行病学文献的系统回顾和新开发的荟萃回归工具（荟萃回归：贝叶斯、正则化、裁剪），课题组导出了疾病特异性、非参数暴露-反应曲线，以估计相对风险作为PM2.5浓度的函数。小组将暴露估计值和相对风险结合起来，按性别、年龄、地点和年份估计每种原因的人群归因部分和归因负担。

发现:2021年，26.7亿人（95%不确定性区间[UI]2.63-2.71），占全球人口的33.8%（95%UI 33.2-34.3），暴露于各种来源的HAP，平均浓度为84.2μg/m3。尽管这些数字显示，1990年全球暴露于HAP的人口比例显著下降（56.7%，56.4-57.1），但从绝对值来看，与1990年暴露于HAPs的30.2亿人相比，仅下降了0.35亿人（10%）。2021年，全球1.11亿（95%UI 75.1-164）残疾调整生命年（DALYs）归因于HAP，占所有DALYs的3.9%（95%UI 2.6-5.7）。2021年，全球HAP归因的DALYs比率为每100人1500.3（95%UI 1028.4-2195.6）个年龄标准化DALYs 000 人口，自1990年以来下降了63.8%，当时HAP归因的DALYs为每10万人4147.7（3101.4-5104.6）个年龄标准化DALYs。撒哈拉以南非洲和南亚的HAP归因负担仍然最高，每10万人分别有4044.1（3103.4-5219.7）和3213.5（2165.4-4409.4）个年龄标准化伤残调整生命年。男性HAP归因的DALYs发生率（1530.51023.4-2263.6）高于女性（1318.8666.1-1977.2）。大约三分之一的HAP归因负担（518.1410.1-641.7）是通过短妊娠和低出生体重介导的。对HAP归因负担变化背后的趋势和驱动因素的分解强调，世界大多数地区，特别是撒哈拉以南非洲地区的人口增长抵消了暴露量的下降。

研究结果表明，虽然由HAP引起的负担已大大减少，但HAP仍然是一个重要的风险因素，特别是在撒哈拉以南非洲和南亚。该课题组对HAP暴露和可归因负担的综合估计为卫生政策制定者和从业人员精确定位和调整卫生干预措施提供了强有力和可靠的资源。鉴于清洁能源在许多地区和国家持续产生重大影响，必须加快努力，使资源不足的社区转向更清洁的家庭能源。这些举措对于减轻健康风险和促进可持续发展，最终改善数百万人的生活质量和健康成果至关重要。

附：英文原文

Title: Global, regional, and national burden of household air pollution, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Author: 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 Abeldao Zuiga, Richard Gyan Aboagye, Bilyaminu Abubakar, Ahmed Abu-Zaid, Mesafint Molla Adane, Oyelola A Adegboye, Victor Adekanmbi, Abiola Victor Adepoju, Temitayo Esther Adeyeoluwa, Olorunsola Israel Adeyomoye, Rishan Adha, Muhammad Sohail Afzal, Saira Afzal, Feleke Doyore Agide, Aqeel Ahmad, Danish Ahmad, Muayyad M Ahmad, Sajjad Ahmad, Ali Ahmadi, Sepideh Ahmadi, Anisuddin Ahmed, Ayman Ahmed, Haroon Ahmed, Marjan Ajami, Rufus Olusola Akinyemi, Salah Al Awaidy, Hanadi Al Hamad, Muaaz M Alajlani, Mulubirhan Assefa Alemayohu, Adel Ali Saeed Al-Gheethi, Abid Ali, Waad Ali, Sheikh Mohammad Alif, Sami Almustanyir, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Hany Aly, Hubert Amu, Ganiyu Adeniyi Amusa, Tadele Fentabel 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 Rathnaiah Babu, Saeed Bahramian, Kiran Bam, Maciej Banach, Biswajit Banik, Mehmet Firat 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 A Bennett, Devidas S Bhagat, Dinesh Bhandari, Pankaj Bhardwaj, Sonu Bhaskar, Ajay Nagesh Bhat, Priyadarshini Bhattacharjee, Gurjit Kaur Bhatti, Manpreet S Singh Bhatti, Cem Bilgin, Mary Sefa Boampong, Sri Harsha Boppana, Samuel Adolf Bosoka, Sofiane Boudalia, Fan Cao, Rama Mohan Chandika, Gashaw Sisay Chanie, Vijay Kumar Chattu, Anis Ahmad Chaudhary, Akhilanand Chaurasia, Guangjin Chen, Yifan Chen, Ritesh Chimoriya, Bryan Chong, Devasahayam J Christopher, Isaac Sunday Chukwu, Aaron J Cohen, Natalia Cruz-Martins, Omid Dadras, Xiaochen Dai, Patience Unekwuojo Daikwo, Samuel Demissie Darcho, Saswati Das, Juana Maria Delgado-Saborit, Belay Desye, Sagnik Dey, Meghnath Dhimal, Daniel Diaz, Thanh Chi Do, Ojas Prakashbhai Doshi, Abdel Rahman Emar, Alireza Ebrahimi, Hisham Atan Edinur, Aziz Eftekharimehrabad, Temitope Cyrus Ekundayo, Ibrahim Farahat El Bayoumy, Syed Emdadul Haque, Theophilus I Emeto, Habtamu Demelash Enyew, Ayesha Fahim, Adekunle Gregory Fakunle, Sasan Faridi, Timur Fazylov, Alireza Feizkhah, Florian Fischer, Morenike Oluwatoyin Folayan, Sridevi G, Muktar A Gadanya, Xiang Gao, Miglas Welay Gebregergis, Mesfin Gebrehiwot, Teferi Gebru Gebremeskel, Afsaneh Ghasemzadeh, Nermin Ghith, Mahaveer Golechha, Davide Golinelli, Shi-Yang Guan

Issue&Volume: 2025-03-18

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

We estimated HAP exposure and trends and attributable burden for cataract, chronic obstructive pulmonary disease, ischaemic heart disease, lower respiratory infections, tracheal cancer, bronchus cancer, lung cancer, stroke, type 2 diabetes, and causes mediated via adverse reproductive outcomes for 204 countries and territories from 1990 to 2021. We first estimated the mean fuel type-specific concentrations (in μg/m3) of fine particulate matter (PM2·5) pollution to which individuals using solid fuels for cooking were exposed, categorised by fuel type, location, year, age, and sex. Using a systematic review of the epidemiological literature and a newly developed meta-regression tool (meta-regression: Bayesian, regularised, trimmed), we derived disease-specific, non-parametric exposure–response curves to estimate relative risk as a function of PM2·5 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

In 2021, 2·67 billion (95% uncertainty interval [UI] 2·63–2·71) people, 33·8% (95% UI 33·2–34·3) of the global population, were exposed to HAP from all sources at a mean concentration of 84·2 μg/m3. 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 100000 population, a decline of 63·8% since 1990, when HAP-attributable DALYs comprised 4147·7 (3101·4–5104·6) age-standardised DALYs per 100000 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 100000 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.

DOI: 10.1016/S0140-6736(24)02840-X

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02840-X/abstract