title: Burden of disease attributable to ambient fine particulate matter exposure in Taiwan.
abstract: OBJECTIVE
  There is compelling epidemiological evidence that links air pollution to increased risk of mortality from cardiopulmonary disease and lung cancer. We quantified the burden of mortality attributable to ambient fine particulate matter (PM2.5) among the Taiwanese population in 2014 at the national and subnational levels.
  
  
  METHODS
  Subnational PM2.5exposure levels were obtained from Taiwan Air Quality Monitoring Network. Relative risks were derived from a previously developed exposure-response model. Population attributable fraction for cause-specific mortality was estimated at the county level using the estimated ambient PM2.5concentrations and the relative risk functions.
  
  
  RESULTS
  In 2014, PM2.5accounted for 6282 deaths [95% confidence interval (CI), 5716-6847], from ischemic heart disease (2244 deaths; 95% CI, 2015-2473), stroke (2140 deaths; 95% CI, 1760-2520), lung cancer (1252 deaths; 95% CI, 995-1509), and chronic obstructive pulmonary disease (645 deaths; 95% CI, 418-872). Nationally, the population attributable mortality fraction of PM2.5for the four disease causes was 18.6% (95% CI, 16.9-20.3%). Substantial geographic variation in PM2.5attributable mortality fraction was found; the percentage of deaths attributable to PM2.5ranged from 8.7% in Hualian County to 21.8% in Yunlin County. In terms of absolute number of deaths, New Taipei and Kaohsiung cities had the largest number of deaths associated with PM2.5(874 and 829 deaths, respectively) among all cities and counties.
  
  
  CONCLUSIONS
  Ambient PM2.5pollution is a major mortality risk factor in Taiwan. Aggressive and multisectorial intervention strategies are urgently needed to bring down the impact of air pollution on environment and health.
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan.
authors.forename: Wei-Cheng
authors.initials: WC
authors.lastname: Lo
authors.affiliation: Green Energy and Environment Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Ruei-Hao
authors.initials: RH
authors.lastname: Shie
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan; Global Health Center, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: ccchan@ntu.edu.tw.
authors.forename: Chang-Chuan
authors.initials: CC
authors.lastname: Chan
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: hsienho@ntu.edu.tw.
authors.forename: Hsien-Ho
authors.initials: HH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000401:mortality; D017281:Cost of Illness; D003710:Demography; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D052638:Particulate Matter / Q000009:adverse effects*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D013624:Taiwan
chemical_list: D052638:Particulate Matter
keywords: ambient fine particulate matter; burden of disease; subnational analysis