title: The health burden and economic costs averted by ambient PM2.5pollution reductions in Nagpur, India.
abstract: National estimates of the health and economic burdens of exposure to ambient fine particulate matter (PM2.5) in India reveal substantial impacts. This information, often lacking at the local level, can justify and drive mitigation interventions. Here, we assess the health and economic gains resulting from attainment of WHO guidelines for PM2.5concentrations - including interim target 2 (IT-2), interim target 3 (IT-3), and the WHO air quality guideline (AQG) - in Nagpur district to inform policy decision making for mitigation. We conducted a detailed assessment of concentrations of PM2.5in 9 areas, covering urban, peri-urban and rural environments, from February 2013 to June 2014. We used a combination of hazard and survival analyses based on the life table method to calculate attributed annual number of premature deaths and disability-adjusted life years (DALYs) for five health outcomes linked to PM2.5exposure: acute lower respiratory infection for children <5years, ischemic heart disease, chronic obstructive pulmonary disease, stroke and lung cancer in adults ≥25years. We used GBD 2013 data on deaths and DALYs for these diseases. We calculated averted deaths, DALYs and economic loss resulting from planned reductions in average PM2.5concentration from current level to IT-2, IT-3 and AQG by the years 2023, 2033 and 2043, respectively. The economic cost for premature mortality was estimated as the product of attributed deaths and value of statistical life for India, while morbidity was assumed to be 10% of the mortality cost. The annual average PM2.5concentration in Nagpur district is 34±17μgm-3and results in 3.3 (95% confidence interval [CI]: 2.6, 4.2) thousand premature deaths and 91 (95% CI: 68, 116) thousand DALYs in 2013 with economic loss of USD 2.2 (95% CI: 1.7, 2.8) billion in that year. It is estimated that interventions that achieve IT-2, IT-3 and AQG by 2023, 2033 and 2043, would avert, respectively, 15, 30 and 36%, of the attributed health and economic loss in those years, translating into an impressively large health and economic gain. To achieve this, we recommend an exposure-integrated source reduction approach.
authors.affiliation: The International Clinical Epidemiology Network (INCLEN) Trust, New Delhi, India.
authors.forename: Tunde O
authors.initials: TO
authors.lastname: Etchie
authors.affiliation: National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India. Electronic address: ss_devi@neeri.res.in.
authors.forename: Saravanadevi
authors.initials: S
authors.lastname: Sivanesan
authors.affiliation: Department of Chemistry, University of Ibadan, Ibadan, Nigeria.
authors.forename: Gregory O
authors.initials: GO
authors.lastname: Adewuyi
authors.affiliation: National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India. Electronic address: k_krishnamurthi@neeri.res.in.
authors.forename: Kannan
authors.initials: K
authors.lastname: Krishnamurthi
authors.affiliation: National Environmental Engineering Research Institute, Council of Scientific and Industrial Research (CSIR-NEERI), Nagpur, India. Electronic address: ps_rao@neeri.res.in.
authors.forename: Padma S
authors.initials: PS
authors.lastname: Rao
authors.affiliation: Independent Researcher, Ibadan, Nigeria.
authors.forename: Ayotunde T
authors.initials: AT
authors.lastname: Etchie
authors.affiliation: School of Public Health, University of California, Berkeley, California, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Pillarisetti
authors.affiliation: The International Clinical Epidemiology Network (INCLEN) Trust, New Delhi, India. Electronic address: nkarora@inclentrust.org.
authors.forename: Narendra K
authors.initials: NK
authors.lastname: Arora
authors.affiliation: School of Public Health, University of California, Berkeley, California, USA. Electronic address: krksmith@berkeley.edu.
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Smith
mesh_terms: D000393:Air Pollutants / Q000009:adverse effects / Q000032:analysis; D000397:Air Pollution / Q000032:analysis / Q000191:economics* / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000191:economics* / Q000401:mortality; D004777:Environment; D004784:Environmental Monitoring; D007194:India / Q000453:epidemiology; D061213:Mortality, Premature; D010316:Particle Size; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis; D019057:Quality-Adjusted Life Years; D012140:Respiratory Tract Diseases / Q000191:economics* / Q000401:mortality
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
keywords: Burden of disease assessment; Disability-adjusted life years (DALYs); Hazard and survival analyses; Life table; Urban, rural and peri-urban