Assessing the disease burden from air pollution in Europe: Insights from the ETC HE and EEA

Abstract Ambient air pollution remains the leading environmental health risk in Europe. According to the European Environment Agency (EEA), 96% of the urban population in the EU was exposed to annual PM2.5 levels exceeding WHO guidelines in 2022. The environmental burden of disease (EBD) method is widely used to assess population health impacts. In collaboration with the European Topic Centre “Human Health and the Environment” (ETC HE), the EEA conducted EBD assessments for PM2.5, nitrogen dioxide (NO2), and ozone. Here we present the disease burden attributable to long-term PM2.5 and NO2 exposure in Europe for the year 2022. Using WHO's EBD framework, cause-specific mortality and morbidity burden was estimated. Nine risk-outcome pairs were selected based on available evidence for causality. Burden indicators included years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). Concentration-response functions were extracted from relevant sources for the risk-outcome pairs, while exposure data (annual mean) were provided by ETC HE partners. Health data (e.g., cause-specific mortality and prevalence) were mainly obtained from Eurostat and the European Health Interview Survey. In 2022, the disease burden attributable to PM2.5 was considerably higher compared to the one due to NO2: 2,703,827 vs. 580,847 DALY. For both pollutants, YLL contributed most to total DALY - 84% for PM2.5 and 58% for NO2. The highest burden due to PM2.5 resulted from ischemic heart disease in adults (764,479 DALY), and the lowest from asthma in children (37,768 DALY). For NO2, the highest attributable burden resulted from diabetes in adults (313,491 DALYs), and the lowest from adult asthma (74,717 DALY). Despite improvements in air quality, these findings highlight air pollution as a major public health concern in Europe. PM2.5 has the highest disease burden, warranting further national and European coordinated action to reduce exposures and protect human health. Key messages • Air pollution caused over 2.7 million DALY in Europe in 2022, with PM2.5 as the leading contributor to the disease burden. • While air quality improvements are evident, air pollution remains a major health risk that necessitates more comprehensive actions throughout Europe.