Estimates, temporal evolution, and drivers of the global burden of cardiovascular disease attributable to particulate matter air pollution, 1990-2021: A systematic analysis from the global burden of disease study 2021

Shuailing Liu; Huajie Yang; Mingzheng Li; Yinchu Guo; Zhaoqi Zhang; Wei Liu; Shuo Wu; Tong Liu; Shenghang Li; Juexin Zhang; Yuejia Wang; Luoxin Li; Peng Shi

doi:10.1016/j.ecoenv.2025.118584

Estimates, temporal evolution, and drivers of the global burden of cardiovascular disease attributable to particulate matter air pollution, 1990-2021: A systematic analysis from the global burden of disease study 2021

Ecotoxicol Environ Saf. 2025 Jun 26:302:118584. doi: 10.1016/j.ecoenv.2025.118584. Online ahead of print.

Authors

Shuailing Liu¹, Huajie Yang², Mingzheng Li³, Yinchu Guo⁴, Zhaoqi Zhang³, Wei Liu⁵, Shuo Wu⁴, Tong Liu⁶, Shenghang Li⁷, Juexin Zhang⁶, Yuejia Wang⁶, Luoxin Li⁴, Peng Shi⁸

Affiliations

¹ College of Health Management, China Medical University, Shenyang 110122, China.
² Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China; Tianjin Key Laboratory of Environment Nutrition and Public Health and Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, Tianjin Medical University, Tianjin 300070, China; Center for International Collaborative Research on Environment Nutrition and Public Health, Tianjin 300070, China.
³ Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China.
⁴ Department of Epidemiology, School of Public Health, China Medical University, Shenyang 110122, China.
⁵ Department of Biomedical-Engineering, School of Intelligent Medicine, China Medical University, Shenyang 110122, China.
⁶ Department of Clinical Medicine, the Fourth Clinical Medical School, China Medical University, Shenyang 110122, China.
⁷ Department of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang 110122, China.
⁸ Department of Epidemiology, School of Public Health, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, China. Electronic address: pshi@cmu.edu.cn.

PMID: 40577924
DOI: 10.1016/j.ecoenv.2025.118584

Abstract

Cardiovascular diseases (CVDs) are the most common non-communicable diseases worldwide. Fine particulate matter (PM_2.5) has emerged as a significant modifiable risk factor contributing to the burden of CVDs. This study examines the global burden of CVDs attributable to PM_2.5 pollution from 1990 to 2021. Using data from the Global Burden of Disease (GBD) study. We calculated the estimated annual percentage change (EAPC) via log-linear regression and assessed age-standardized rates (ASRs, per 100,000 population) for deaths and disability-adjusted life years (DALYs). While global ASRs for PM_2.5-related DALYs declined from 2009.92 to 1161.77 per 100,000, these reductions were unequal: high-income regions, such as North America and Western Europe, achieved substantial progress, whereas low-income regions, particularly Sub-Saharan Africa and South Asia, faced rising burdens from PM_2.5 exposure. The study highlights the shift from household to ambient sources of PM_2.5 as the main contributor to CVDs, particularly in rapidly industrializing regions, with the total DALYs attributable to PM_2.5 increasing from 78.87 million in 1990-99.64 million in 2021. Decomposition analysis identifies population growth, aging, and epidemiological changes as key drivers of the global trends. This study provides evidence-based guidance for the CVDs prevention and PM_2.5 air pollution policy.

Keywords: Cardiovascular diseases; Disease burden; Global trends; Mortality; Particulate matter air pollution.