Quantification of life expectancy loss from air pollution in Slovakia

Abstract This study estimates municipality-level life expectancy loss (ΔLE) attributable to PM2.5 and benzo(a)pyrene (B(a)P) air pollution across Slovakia. We conducted a cross-sectional ecological analysis of 2924 municipalities, combining modelled and monitored air pollution data with demographic, healthcare, and mortality records. Exposure was defined using an air quality model for 2020–2024, complemented by long-term monitoring and historical reconstruction dating back to 1990, and categorized into quantiles. Life expectancy at birth was calculated from mortality data for 2008–2024. Associations were assessed using multivariable regression with socioeconomic and healthcare-related covariates. In parallel, WHO and SCHIF exposure response functions were applied within life tables to estimate ΔLE under a counterfactual PM2.5 concentration of 5 μg/m³. The combined IVW estimate indicated a mean national ΔLE of 1.03 years. Municipalities in the highest PM2.5 exposure category showed substantially lower life expectancy (Q20 vs Q1: −1.96 years; 95% CI: −2.51 to −1.41), with a clear monotonic gradient. SCHIF produced a steeper exposure-response gradient, whereas the WHO HRAPIE framework produced higher but more uniform estimates. Results were robust to covariate adjustments. Air pollution effects exceeded those associated with healthcare accessibility indicators and were most pronounced in rural areas dominated by solid-fuel combustion. Results suggest that air pollution explains a substantial, though partial, share of life expectancy differences in Slovakia.