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Geographic distribution of attributable mortality rate across Europe. Credit: Nature Health (2026). DOI: 10.1038/s44360-026-00124-y
Fine particles (PM₂.₅) were associated with around 79,000 preventable deaths, followed by nitrogen dioxide (NO₂), ozone (O₃) and coarser particles (PM₂.₅-₁₀, particles with a diameter between 2.5 and 10 micrometers). These are among the findings of a new study conducted by the Barcelona Institute for Global Health (ISGlobal), in collaboration with the Barcelona Supercomputing Center–Centro Nacional de Supercomputación (BSC-CNS), which provides the first Europe-wide estimate of short-term mortality associated with the combined effects of multiple pollutants across 31 European countries. The findings, published in Nature Health, support the development of impact-based early warning systems to help protect the population from the health effects of air pollution.
Although the overall health burden is dominated by long-term exposure, short-term air pollution can trigger acute physiological responses, such as systemic inflammation, autonomic imbalance and increased blood clotting, that elevate mortality risk over the following days. Recent studies have shown that daily pollution levels are linked to daily short-term increases in mortality, but important limitations remain.
Most research focuses only on cities, overlooking peri-urban and rural areas; and they often fail to account for regional differences in vulnerability (such as age, baseline health, socioeconomic status or environment) and air pollution toxicity. In addition, pollutants are usually analyzed separately, making it difficult to understand their combined effects.
“Our study addressed these limitations by combining daily data on major air pollutants across Europe with the new mortality database from the EARLY-ADAPT project of the European Research Council (ERC), which covers the whole population in 31 countries representing over 530 million people,” explains Zhao-Yue Chen, researcher at ISGlobal and first author of the study. “This allows a more precise analysis of how short-term exposure to the major pollutants affects people differently depending on age, sex and cause of death.” The study analyzed nearly 89 million deaths recorded between 2003 and 2019 across 653 European regions.
“To assess exposure to air pollution, daily levels of several pollutants were estimated across Europe using data from monitoring stations, satellites, land use and meteorological variables, and then adjusted at the regional level, giving more weight to areas where more people live,” explains Carlos Pérez García-Pando, ICREA and AXA Professor at BSC-CNS.
PM₂.₅, the most harmful pollutant
An estimated 146,500 premature deaths per year were associated with short-term exposure to overall air pollution when all pollutants are considered together. When each pollutant was analyzed separately, the greatest impact was attributed to PM₂.₅ (around 79,000 deaths), followed by NO₂ (69,000), O₃ (31,000) and PM2.5-10 (29,000). These figures cannot simply be added together; pollutants often occur simultaneously, so their effects overlap.
PM2.5 is the most harmful pollutant because it penetrates deep into the lungs and can enter the bloodstream, causing inflammation and other rapid effects on the body. By contrast, PM2.5-10 mainly affects the upper airways due to its larger size, while gases such as NO₂ and O₃ irritate the lungs and increase vulnerability to respiratory diseases.
Most earlier large studies focused only on fine particles (PM₂.₅) when estimating the short-term health burden of air pollution, leaving the impact of other pollutants in Europe largely unknown. This new study considers several pollutants together, providing a more complete and realistic picture of health risks. It also suggests that previous global estimates based solely on PM₂.₅ may have somewhat overestimated the burden in Europe, potentially reflecting biases from evidence derived in other regions.
Young men are more vulnerable than young women, but the pattern reverses with increasing age
Air pollution does not affect everyone in the same way. Young men showed greater vulnerability to ambient air pollutants than young women, likely due to higher exposure (outdoor work, traffic, smoking, etc.) or to the earlier appearance of comorbidities in men at young ages. However, this pattern changes with age: at older ages (especially from 85 years onward), the highest risk is observed in women.
For specific causes of death, particulate matter was more strongly associated with cardiovascular risks in women, while O₃ had a greater impact on men. These findings highlight the need for tailored protection measures, in contrast to one-size-fits-all approaches.
“Our findings are highly relevant for policymakers and public health professionals, as they support the use of epidemiological models fitted with data by sex, age and comorbidities to create a new generation of impact-based early warning systems (for example, the platform Forecaster.Health), which specifically target vulnerable groups,” explains Joan Ballester, researcher at ISGlobal and coordinator of the study.
In a context where new daily air quality standards are being introduced across Europe, these results provide practical insights to help protect the population more effectively.
Publication details
Zhao-Yue Chen et al, Mortality from short-term exposure to particulate matter, nitrogen dioxide and ozone across Europe, Nature Health (2026). DOI: 10.1038/s44360-026-00124-y
Breathing polluted air significantly increases the risk of developing and dying from multiple cancers – including liver and breast cancer – according to a new report calling for stricter air quality standards.
Air pollution is linked to increased overall risk of developing cancer, beyond its impact on the lungs, according to a new report by The Union for International Cancer Control (UICC) and supported by the Clean Air Fund.
The report, which synthesised data from 42 meta-analyses and systematic reviews published between 2019 and 2024, found that air pollution is not only a driver of lung cancer but also significantly increases the risk of multiple other cancers and raises the likelihood of dying from the disease.
“Clean air is not a luxury, it is a fundamental human right – one that underpins health, equity, and sustainable development. Tackling air pollution is not only an environmental priority; it is a cancer prevention strategy, an economic investment, and an act of social justice,” Helen Clark, former Prime Minister of New Zealand and co-chair of Our Common Air, wrote in the publication.
The report found that particulate matter posed the greatest risk. Populations exposed to high levels of PM2.5, compared to those in less polluted environments, face an 11% increase in the overall risk of developing cancer, with the sharpest rises for liver and colorectal, kidney, lung, and bladder cancers.
Long-term exposure to high levels of PM2.5 was also associated with a 12% increase in the overall risk of dying from cancer by 12%, and specifically a 20% higher risk from breast cancer, 14% from liver cancer, and 12% from lung cancer.
Exposure to larger air pollutants (PM10) was linked to a 10% higher overall cancer risk, a 13% increased risk of dying from lung cancer, and 11% increased risk of dying from breast cancer.
Not everyone is affected equally
The report also found that these risks are not shared equally. Women and children are generally more exposed to smoke from solid fuels used for cooking and heating. Women exposed to household air pollution face a 69% higher risk of lung cancer, alongside increased risks of cervical cancer, the authors found.
People living in low- and middle-income countries bear the greatest burden, as they are exposed to higher pollution levels with limited resources to reduce pollution or access to timely cancer care, the report noted.
And the inequality is not limited to lower-income countries. In Europe, a recent study found that the poorest regions are also the most affected by pollution.
“We have made huge strides in reducing deaths from cancer, but polluted air is silently undermining that progress. It is a risk people cannot opt out of, and one that disproportionately affects women, children, and people living in poverty,” said Cary Adams, CEO of UICC.
Need for stronger action
While there is a growing recognition of the link between air pollution and many cancers, the authors called for further coordinated action.
“Further research is still needed to better quantify risks beyond the respiratory system, to understand the impacts of non-particulate pollutants, and biological processes by which air pollution acts on the human body,” Elisabete Weiderpass, executive director at the International Agency for Research on Cancer (IARC ), wrote in the report.
She added that the cancer community cannot afford to wait for perfect evidence before acting.
“The harms of air pollution are already clear, and the benefits of reducing exposure are well documented across a wide range of health outcomes, including lung cancer, cardiovascular and respiratory disease, children’s health, and neurocognitive conditions such as dementia,” Weiderpass said.
The report calls for expanding the scientific evidence of air pollution’s impact beyond lung cancer, and for establishing more robust air quality monitoring and standards.
Nationwide study of 270,000 patients shows pandemic-era behavior changes significantly lowered PM2.5-associated risk of MINOCA, a non-obstructive type of heart attack
Researchers at Kumamoto University have discovered that behavioral changes during the COVID-19 pandemic—particularly widespread mask-wearing—may have reduced the risk of certain types of heart attacks triggered by air pollution.
The study, led by Dr. Masanobu Ishii and colleagues, was published in the European Society of Cardiology’s flagship journal, European Heart Journal.
Air pollution and heart attacks
Fine particulate matter known as PM2.5—tiny airborne particles small enough to penetrate deep into the lungs—has long been recognized as a major environmental risk factor for cardiovascular disease. Exposure can trigger inflammation, oxidative stress, and blood vessel dysfunction, potentially leading to acute myocardial infarction (AMI), commonly known as a heart attack.
Using Japan’s nationwide cardiovascular database (JROAD-DPC), the research team analyzed data from 270,091 patients hospitalized for AMI between 2012 and 2022. They examined short-term exposure to PM2.5 and compared risks before and during the COVID-19 pandemic, which brought dramatic shifts in public behavior, including mask use and reduced mobility.
Striking decline in a specific heart attack subtype
The researchers found that short-term exposure to PM2.5 significantly increased the risk of all types of AMI. However, one subtype—MINOCA (myocardial infarction with non-obstructive coronary arteries), a heart attack without coronary artery obstruction—showed a particularly strong association with air pollution.
Most notably, after the onset of the pandemic, the PM2.5-related risk of MINOCA significantly declined. In contrast, the risk of the more typical heart attack with coronary artery obstruction (MI-CAD) remained largely unchanged.
The findings suggest that pandemic-related preventive behaviors—especially mask-wearing—may have reduced individual exposure to harmful particulate matter, thereby lowering the risk of pollution-triggered vascular dysfunction such as coronary spasm or microvascular impairment.
Implications for public health
This study provides real-world evidence that simple protective measures can mitigate cardiovascular risks associated with unavoidable environmental exposures. Even in Japan, where no strict lockdowns were imposed, voluntary public health practices appear to have delivered measurable cardiovascular benefits.
The researchers emphasize that improving air quality remains a long-term priority. However, the findings also highlight the potential of accessible interventions—such as mask use during high-pollution periods—to protect vulnerable populations.
As societies confront ongoing environmental challenges, these insights may help shape future preventive cardiology and public health strategies worldwide.
Graphical overview of a nationwide Japanese study (2012–2022) showing that short-term PM2.5 exposure increased hospitalization risk for acute myocardial infarction (AMI), particularly MINOCA. After the onset of the COVID-19 pandemic, the PM2.5-related risk of MINOCA significantly declined, suggesting that behavioral changes such as mask-wearing may have reduced pollution-triggered heart events. Image from Ishii et al., “Air pollution before and during the COVID-19 pandemic: changes in risk of acute myocardial infarction,” European Heart Journal (2026). Licensed under CC BY 4.0.
Just over 180,000 deaths in the European Union were attributable to exposure to fine particulate matter (PM2.5) concentrations above World Health Organization WHO guideline levels in 2023, according to the latest European Environment Agency (EEA) air quality health impact assessment published today.
The EEA briefing ‘Harm to human health from air pollution in Europe: burden of disease status, 2025’ confirms the nineteen-year trend that the estimated impact on health attributable to long-term exposure to three key air pollutants (fine particulate matter, nitrogen dioxide and ozone) continues to drop. However, almost everyone living in European cities (95%) is exposed to air pollution levels considerably above recommended WHO levels.
Premature deaths attributable to fine particulate matter fell by 57% in the EU between 2005 and 2023. This indicates that the EU’s zero-pollution action plan’s target of a 55% reduction in impact, was achieved for 2023.
This year’s assessment is being published to coincide with the EU Clean Air Forum being held on 1-2 December in Bonn, Germany. The event draws policymakers, scientists, and civil society from across Europe to discuss efforts to improve air quality.
Premature deaths can be avoided
Reducing air pollution to WHO guideline levels could have prevented 182,000 deaths attributable to fine particulate matter exposure, 63,000 to ozone (O3) exposure and 34,000 to nitrogen dioxide (NO2) exposure in the EU in 2023, according to EEA estimates.
Eastern and south-eastern European countries suffer the most significant health impacts from air pollution due to high pollution levels.
Key information for each country is included in a separate factsheet annex to this press release, including information on national level health impacts.
Quality of life suffers significantly
In addition to premature deaths, the impacts from living with diseases related to air pollution are significant. For some diseases caused and/or aggravated by air pollution, such as asthma, the main impact is poorer health. For others, such as ischemic heart disease and lung cancer, it is premature death. New evidence suggests that air pollution may also cause dementia. Dementia’s disease burden is estimated to be higher than that of other relevant diseases, the EEA briefing says.
New EU air quality rules in place
The revised ambient air quality directive, which entered into force last year, brings the EU air quality standards closer to the WHO recommendations, supporting further reductions in the health impacts of air pollution over the coming years. Still, air pollution continues to be the top environmental health risk to Europeans (followed by other factors such as exposure to noise, chemicals and the increasing effects of climate-related heatwaves on health), causing chronic illness and attributable deaths, especially in cities and urban areas.
Background
The EEA analysis covers 41 European countries, including the 27 EU Member States, other EEA member and cooperating countries and additional European microstates. Türkiye is not included in the PM2.5 estimations as the number of background monitoring stations from which data are available was too low to produce concentration maps for fine particulate matter. Consequently, PM2.5 estimations were made for 40 countries.
The EEA has been estimating number of deaths attributable to exposure to air pollution since 2014. The EEA uses the recommendations for health impacts set out in the 2021 WHO air quality guidelines. As with previous years, the health impacts of different air pollutants should not be added together to avoid double counting due to some overlaps in data. This is the case for both mortality and illness.
Annual survey by IQAir based on toxic PM2.5 particles reveals some progress in pollution levels in India and China
Nearly every country on Earth has dirtier air than doctors recommend breathing, a report has found.
Only seven countries met the World Health Organization’s guidelines for tiny toxic particles known as PM2.5 last year, according to analysis from the Swiss air quality technology company IQAir.
Australia, New Zealand and Estonia were among the handful of countries with a yearly average of no more than 5µg of PM2.5 per cubic metre, along with Iceland and some small island states.
The most polluted countries were Chad, Bangladesh, Pakistan, the Democratic Republic of the Congo and India. PM2.5 levels in all five countries were at least 10 times higher than guideline limits in 2024, the report found, stretching as much as 18 times higher than recommended levels in Chad.
Doctors say there are no safe levels of PM2.5, which is small enough to slip into the bloodstream and damage organs throughout the body, but have estimated millions of lives could be saved each year by following their guidelines. Dirty air is the second-biggest risk factor for dying after high blood pressure.
“Air pollution doesn’t kill us immediately – it takes maybe two to three decades before we see the impacts on health, unless it’s very extreme,” said Frank Hammes, CEO of IQAir. “[Avoiding it] is one of those preventative things people don’t think about till too late in their lives.”
The annual report, which is in its seventh year, highlighted some areas of progress. It found the share of cities meeting the PM2.5 standards rose from 9% in 2023 to 17% in 2024.
Air pollution in India, which is home to six of the 10 dirtiest cities in the world, fell by 7% between 2023 and 2024. China’s air quality also improved, part of a long-running trend that saw the country’s extreme PM2.5 pollution fall by almost half between 2013 and 2020.
The air quality in Beijing is now almost the same as in Sarajevo, the capital of Bosnia and Herzegovina. The latter was the most polluted city in Europe for the second year running, the report found.
Zorana Jovanovic Andersen, an environmental epidemiologist at the University of Copenhagen, who was not involved in the report, said the results highlighted some chilling facts about air pollution.
“Huge disparities are seen even within one of the cleanest continents,” she said. “Citizens of eastern European and non-EU Balkan countries breathe the most polluted air in Europe, and there is a 20-fold difference in PM2.5 levels between the most and least polluted cities.”
Governments could clean their air with policies such as funding renewable energy projects and public transport; building infrastructure to encourage walking and cycling; and banning people from burning farm waste.
To create the ranking, the researchers averaged real-time data on air pollution, measured at ground level, over the course of the calendar year. About one-third of the units were run by governments and two-thirds by non-profits, schools and universities, and private citizens with sensors.
Air quality monitoring is worse in parts of Africa and west Asia, where several countries were excluded from the analysis. Poor countries tend to have dirtier air than rich ones but often lack measuring stations to inform their citizens or spur policy changes.
Roel Vermeulen, an environmental epidemiologist at Utrecht University, who was not involved in the report, said biases were most likely in data-poor areas with few regulated monitoring stations – particularly as satellite measurements were not used for the analysis – but that the values presented for Europe were in line with previous research.
“Virtually everyone globally is breathing bad air,” he said. “What brings it home is that there are such large disparities in the levels of exposure.”
Brief exposure to high concentrations of particulate matter may impair a person’s ability to focus on tasks.
People’s ability to interpret emotions or focus on performing a task is reduced by short-term exposure to particulate matter (PM) air pollution, potentially making everyday activities, such as the weekly supermarket shop, more challenging, a new study reveals.
Scientists discovered that even brief exposure to high concentrations of PM may impair a person’s ability to focus on tasks, avoid distractions, and behave in a socially acceptable manner.
Researchers exposed study participants to either high levels of air pollution – using candle smoke – or clean air, testing cognitive abilities before and four hours after exposure. The tests measured working memory, selective attention, emotion recognition, psychomotor speed, and sustained attention.
“Our study provides compelling evidence that even short-term exposure to particulate matter can have immediate negative effects on brain functions essential for daily activities, such as doing the weekly supermarket shop.” Dr Thomas Faherty – University of Birmingham
Publishing their findings in Nature Communications, researchers from the Universities of Birmingham and Manchester reveal that selective attention and emotion recognition were negatively affected by air pollution – regardless of whether subjects breathed normally or only through their mouths.
The experts suggest that inflammation caused by pollution may be responsible for these deficits noting that while selective attention and emotion recognition were affected, working memory was not. This indicates that some brain functions are more resilient to short-term pollution exposure.
Co-author Dr Thomas Faherty, from the University of Birmingham, commented: “Our study provides compelling evidence that even short-term exposure to particulate matter can have immediate negative effects on brain functions essential for daily activities, such as doing the weekly supermarket shop.”
Co-author Professor Francis Pope, from the University of Birmingham, commented: “Poor air quality undermines intellectual development and worker productivity, with significant societal and economic implications in a high-tech world reliant on cognitive excellence.
“Reduced productivity impacts economic growth, further highlighting the urgent need for stricter air quality regulations and public health measures to combat the harmful effects of pollution on brain health, particularly in highly polluted urban areas.”
Cognitive functioning encompasses a diverse array of mental processes crucial for everyday tasks. Selective attention, for example, helps decision-making and goal-directed behaviour, such as prioritising items on your shopping list in the supermarket, while ignoring other products and resisting impulse buys.
Working memory serves as a temporary workspace for holding and manipulating information, vital for tasks requiring simultaneous processing and storage, essential for tasks that require multitasking, such as planning a schedule or juggling multiple conversations.
Socio-emotional cognition, which involves detecting and interpreting emotions in oneself and others, helps guide socially acceptable behaviour. Although these are separate cognitive skills, they work together to enable the successful completion of tasks both at work in other aspects of life.
Overall, the study highlights the need for further research to understand the pathways through which air pollution affects cognitive functions and to explore the long-term impacts, especially on vulnerable populations like children and older adults.
Co-author Professor Gordon McFiggans, from the University of Manchester, commented: “This study shows the importance of understanding the impacts of air pollution on cognitive function and the need to study the influences of different sources of pollution on brain health in vulnerable older members of society.”
The study is the first to experimentally manipulate inhalation routes of PM air pollution, providing valuable insights into how different pathways affect cognitive functions. Researchers emphasise the need for further investigation into long-term impacts and potential protective measures.
Globally, air pollution is the leading environmental risk factor to human health, increasing premature mortality. The detrimental impacts of poor air quality on cardiovascular and respiratory systems are widely acknowledged, with links to neurodegenerative conditions such as multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease.
PM2.5 is the air pollutant most responsible for human health effects with some 4.2 million deaths attributed to this size of particle alone in 2015. The World Health Organization (WHO) recommends that 24-hour and annual limits are below 15 μg m3 and 5 μg m3 respectively.
New UNICEF analysis reveals staggering impact of toxic air on millions of children, urging immediate action to protect their health and future
As Thailand’s capital, Bangkok, grapples with unhealthy levels of air pollution, leading to school closures and widespread health concerns, UNICEF’s latest analysis sheds light on the devastating impact of toxic air on children across East Asia and the Pacific. Air pollution, which peaks in many parts of the region during the dry season from now until April, is linked to over 100 deaths in children under five every day.
The analysis reveals that all children in East Asia and the Pacific – 500 million children in total – live in countries with unhealthy levels of air pollution. Household air pollution, caused by solid fuels used for cooking and heating, is linked to more than half of all air pollution-related deaths in children under five. Meanwhile, 325 million children live in countries where average annual particulate matter (PM2.5) levels exceed World Health Organization (WHO) guideline levels by more than five times, and 373 million live in countries with unhealthy levels if nitrogen dioxide (NO₂). Additionally, 91 percent of children in the region – 453 million – live in countries where ozone pollution exceeds WHO guideline levels. Nearly half of the PM2.5 in countries with the highest levels of this pollutant, came from the burning of fossil fuel, biomass fuel, and agriculture waste, which also generate the greenhouse gases driving climate change.
“Every breath matters, but for too many children every breath can bring harm,” said June Kunugi, UNICEF Regional Director for East Asia and the Pacific. “The air they breathe, at a time when their bodies and minds are still developing, too often contains unhealthy levels of pollution that can comprise their growth, harm their lungs, and impair their cognitive development.”
Air pollution is linked to nearly one in four deaths of children under five in East Asia and the Pacific, and can impact every stage of a child’s life. It begins in the womb with risks of premature delivery and low birth weight. The harm continues into early childhood, as young children breathe more rapidly and are closer to ground-level pollutants like vehicle exhaust, making them more vulnerable to asthma, lung damage, and developmental delays. The threat is often worse for low-income children living near factories or highways, where exposure to pollution is higher. Over time, air pollution can silently fuel chronic illnesses such as diabetes and cardiovascular disease, jeopardizing children’s futures.
Air pollution’s toll goes far beyond children’s health – it strains already overwhelmed healthcare systems, drives up costs, and disrupts learning and productivity. School absences due to illness, hindered brain development, and the risk of school closures limit children’s potential, while parents caring for sick children lose income. The economic fallout is staggering: the World Bank estimated that in 2019, air pollution from PM2.5 caused premature deaths and illnesses that cost East Asia and the Pacific 9.3 per cent of its gross domestic product (GDP), equivalent to more than $2.5 trillion.
UNICEF urges governments, businesses, the health sector, parents and educators to urgently address air pollution’s impact on children for children in East Asia and the Pacific, more specifically:
Governments must lead by strengthening climate and environmental policies, transitioning to clean energy, and enforcing WHO-aligned air quality standards to protect children’s health.
Businesses should adopt clean technologies, reduce emissions, and ensure their practices and products prioritize the safety and well-being of children.
The health sector should take measures to improve detection and treatment, and adopt sustainable, net-zero operations.
Parents and educators should play a crucial role in raising awareness, advocating for cleaner environments, and empowering young people to take action.
UNICEF is partnering with governments, businesses, health systems, and communities across East Asia and the Pacific to protect children from the devastating effects of air pollution. Key initiatives include:
Advocating for climate and environmental policies that create a cleaner, more sustainable world for children.
Implementing programmes that reduce children’s exposure to household air pollution with solutions like chimney ventilation and cleaner heating systems.
Improving air quality monitoring and public reporting through initiatives like installing affordable sensors.
Strengthening healthcare systems to address pollution-related illnesses and investing in cleaner medical waste management systems.
Collaborating with communities and empowering young people as clean air advocates to raise awareness, monitor air quality, and push for stronger policies.
“Addressing air pollution will lead to enormous improvements in children’s health, education, and well-being, with ripple effects across entire societies and economies,” Kunugi emphasized. “The solutions exist, and our collective future depends on implementing them.”
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