Global, regional, and national burden of household air pollution, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
GBD 2021 HAP Collaborators (2025-03-18)
Fiona B Bennitt, Sarah Wozniak, Kate Causey, Sandra Spearman, Chukwuma Okereke, Vanessa Garcia, Nadim Hashmeh, Charlie Ashbaugh, Atef Abdelkader, Meriem Abdoun, Muhammed Jemal Abdurebi, Armita Abedi, Roberto Ariel Abeldaño Zuñiga, Richard Gyan Aboagye, Bilyaminu Abubakar, Ahmed Abu-Zaid, Mesafint Molla Adane, Oyelola A Adegboye, Victor Adekanmbi, Abiola Victor Adepoju, Temitayo Esther Adeyeoluwa, Olorunsola Israel Adeyomoye, Rishan Adha, Muhammad Sohail Afzal, Saira Afzal, Feleke Doyore Agide, Aqeel Ahmad, Danish Ahmad, Muayyad M Ahmad, Sajjad Ahmad, Ali Ahmadi, Sepideh Ahmadi, Anisuddin Ahmed, Ayman Ahmed, Haroon Ahmed, Marjan Ajami, Rufus Olusola Akinyemi, Salah Al Awaidy, Hanadi Al Hamad, Muaaz M Alajlani, Mulubirhan Assefa Alemayohu, Adel Ali Saeed Al-Gheethi, Abid Ali, Waad Ali, Sheikh Mohammad Alif, Sami Almustanyir, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Hany Aly, Hubert Amu, Ganiyu Adeniyi Amusa, Tadele Fentabel Anagaw, Boluwatife Stephen Anuoluwa, Iyadunni Adesola Anuoluwa, Saeid Anvari, Ekenedilichukwu Emmanuel Anyabolo, Geminn Louis Carace Apostol, Aleksandr Y Aravkin, Demelash Areda, Brhane Berhe Aregawi, Olatunde Aremu, Akeza Awealom Asgedom, Mubarek Yesse Ashemo, Tahira Ashraf, Seyyed Shamsadin Athari, Sina Azadnajafabad, Ahmed Y Azzam, Giridhara Rathnaiah Babu, Saeed Bahramian, Kiran Bam, Maciej Banach, Biswajit Banik, Mehmet Firat Baran, Francesco Barone-Adesi, Sandra Barteit, Hameed Akande Bashiru, Pritish Baskaran, Mohammad-Mahdi Bastan, Sanjay Basu, Saurav Basu, Sefealem Assefa Belay, Melesse Belayneh, Apostolos Beloukas, Derrick A Bennett, Devidas S Bhagat, Dinesh Bhandari, Pankaj Bhardwaj, Sonu Bhaskar, Ajay Nagesh Bhat, Priyadarshini Bhattacharjee, Gurjit Kaur Bhatti, Manpreet S Singh Bhatti, Cem Bilgin, Mary Sefa Boampong, Sri Harsha Boppana, Samuel Adolf Bosoka, Sofiane Boudalia, Fan Cao, Rama Mohan Chandika, Gashaw Sisay Chanie, Vijay Kumar Chattu, Anis Ahmad Chaudhary, Akhilanand Chaurasia, Guangjin Chen, Yifan Chen, Ritesh Chimoriya, Bryan Chong, Devasahayam J Christopher, Isaac Sunday Chukwu, Aaron J Cohen, Natalia Cruz-Martins, Omid Dadras, Xiaochen Dai, Patience Unekwuojo Daikwo, Samuel Demissie Darcho, Saswati Das, Juana Maria Delgado-Saborit, Belay Desye, Sagnik Dey, Meghnath Dhimal, Daniel Diaz, Thanh Chi Do, Ojas Prakashbhai Doshi, Abdel Rahman E'mar, Alireza Ebrahimi, Hisham Atan Edinur, Aziz Eftekharimehrabad, Temitope Cyrus Ekundayo, Ibrahim Farahat El Bayoumy, Syed Emdadul Haque, Theophilus I Emeto, Habtamu Demelash Enyew, Ayesha Fahim, Adekunle Gregory Fakunle, Sasan Faridi, Timur Fazylov, Alireza Feizkhah, Florian Fischer, Morenike Oluwatoyin Folayan, Sridevi G, Muktar A Gadanya, Xiang Gao, Miglas Welay Gebregergis, Mesfin Gebrehiwot, Teferi Gebru Gebremeskel, Afsaneh Ghasemzadeh, Nermin Ghith, Mahaveer Golechha, Davide Golinelli, Shi-Yang Guan, Zhifeng Guo, Bhawna Gupta, Lalit Gupta, Rabih Halwani, Ahmed I Hasaballah, Md Saquib Hasnain, Simon I Hay, Demisu Zenbaba Heyi, Kamal Hezam, Nguyen Quoc Hoan, Ramesh Holla, Hassan Hosseinzadeh, Chengxi Hu, Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Oluwatope Olaniyi Idowu, Adalia Ikiroma, Mustapha Immurana, Arit Inok, Muhammad Iqhrammullah, Rakibul M Islam, Sheikh Mohammed Shariful Islam, Vinothini J, Ammar Abdulrahman Jairoun, Abhishek Jaiswal, Mihajlo Jakovljevic, Reza Jalilzadeh Yengejeh, Manthan Dilipkumar Janodia, Shubha Jayaram, Alelign Tasew Jema, Ravi Prakash Jha, Jost B Jonas, Nitin Joseph, Vidya Kadashetti, Kehinde Kazeem Kanmodi, Sushil Kumar Kansal, Ibraheem M Karaye, Gbenga A Kayode, Himanshu Khajuria, Amirmohammad Khalaji, Vishnu Khanal, Khaled Khatab, Khalid A Kheirallah, Atulya Aman Khosla, Majid Khosravi, Shivakumar KM, Luke D Knibbs, Gerbrand Koren, Parvaiz A Koul, Kewal Krishan, Barthelemy Kuate Defo, Mohammed Kuddus, Mukhtar Kulimbet, Vishnutheertha Kulkarni, Ashish Kumar, Dewesh Kumar, Nithin Kumar, Om P Kurmi, Chandrakant Lahariya, Hanpeng Lai, Tuo Lan, Paolo Lauriola, Nhi Huu Hanh Le, Munjae Lee, Seung Won Lee, Stephen S Lim, Gang Liu, Shuke Liu, Wei Liu, José Francisco López-Gil, Jay B Lusk, Sandeep B Maharaj, Kashish Malhotra, Ahmad Azam Malik, Iram Malik, Lesibana Anthony Malinga, Alexander G Mathioudakis, Rita Mattiello, Andrea Maugeri, Tesfahun Mekene Meto, Hadush Negash Meles, Ritesh G Menezes, Sultan Ayoub Meo, Seid Tiku Mereta, Tuomo J Meretoja, Tomislav Mestrovic, Laurette Mhlanga, Ted R Miller, Andreea Mirica, Erkin M Mirrakhimov, Moonis Mirza, Awoke Misganaw, Prasanna Mithra, Jama Mohamed, Nouh Saad Mohamed, Abdollah Mohammadian-Hafshejani, Mustapha Mohammed, Shafiu Mohammed, Ali H Mokdad, Shaher Momani, Himel Mondal, Lidia Morawska, Rohith Motappa, Sumaira Mubarik, Kavita Munjal, Yanjinlkham Munkhsaikhan, Christopher J L Murray, Woojae Myung, Sanjeev Nair, Vinay Nangia, Muhammad Naveed, Nawsherwan, Rawlance Ndejjo, Dang Nguyen, Hien Quang Nguyen, Van Thanh Nguyen, Taxiarchis Konstantinos Nikolouzakis, Vikram Niranjan, Efaq Ali Noman, Syed Toukir Ahmed Noor, Abbas Norouzian Baghani, Jean Jacques Noubiap, Ogochukwu Janet Nzoputam, Bogdan Oancea, Ismail A Odetokun, Daniel Bogale Odo, Akinyemi O D Ofakunrin, Onome Bright Oghenetega, Osaretin Christabel Okonji, Andrew T Olagunju, Tosin Abiola Olasehinde, Isaac Iyinoluwa Olufadewa, Gideon Olamilekan Oluwatunase, Ahmed Omar Bali, Mohammad Mehdi Ommati, Abiodun Olusola Omotayo, Maureene Auma Ondayo, Adrian Otoiu, Mayowa O Owolabi, Mahesh Padukudru P A, Jagadish Rao Padubidri, Ioannis Pantazopoulos, Shahina Pardhan, Pragyan Paramita Parija, Romil R Parikh, Eun-Kee Park, Ashwaghosha Parthasarathi, Jay Patel, Siddhartha Pati, Shrikant Pawar, Prince Peprah, Gavin Pereira, Arokiasamy Perianayagam, Hoang Tran Pham, Ramesh Poluru, Akram Pourshams, Jalandhar Pradhan, Elton Junio Sady Prates, Dimas Ria Angga Pribadi, Jagadeesh Puvvula, Ata Rafiee, Pankaja Raghav, Fakher Rahim, Mohammad Hifz Ur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Mohammad Rahmanian, Sathish Rajaa, Rayan Rajabi, Prashant Rajput, Mahmoud Mohammed Ramadan, Juwel Rana, Kritika Rana, Chhabi Lal Ranabhat, Drona Prakash Rasali, Santosh Kumar Rauniyar, Salman Rawaf, Elrashdy M Moustafa Mohamed Redwan, Nazila Rezaei, Jefferson Antonio Buendia Rodriguez, Susanne Röhr, Gholamreza Roshandel, Himanshu Sekhar Rout, Priyanka Roy, Michele Russo, Cameron John Sabet, Basema Ahmad Saddik, Umar Saeed, Narjes Saheb Sharif-Askari, Amirhossein Sahebkar, Pragyan Monalisa Sahoo, Afeez Abolarinwa Salami, Dauda Salihu, Abdallah M Samy, Milena M Santric-Milicevic, Tanmay Sarkar, Maheswar Satpathy, Ganesh Kumar Saya, Md Abu Sayeed, Austin E Schumacher, Mihretu Tagesse Sergindo, Yashendra Sethi, Allen Seylani, Samiah Shahid, Sunder Sham, Muhammad Aaqib Shamim, Anas Shamsi, Aziz Sheikh, Pavanchand H Shetty, Aminu Shittu, Ivy Shiue, Emmanuel Edwar Siddig, Paramdeep Singh, Surjit Singh, Md Shahjahan Siraj, Jeffrey D Stanaway, Leo Stockfelt, Kurt Straif, Chandan Kumar Swain, Berwin Singh Swami Vetha, Seyyed Mohammad Tabatabaei, Mircea Tampa, Haosu Tang, Manoj Tanwar, Elvis Enowbeyang Tarkang, Yibekal Manaye Tefera, Mohamad-Hani Temsah, Reem Mohamad Hani Temsah, Ramna Thakur, Friedrich Thienemann, Nigusie Selomon Tibebu, Krishna Tiwari, Marcos Roberto Tovani-Palone, Jaya Prasad Tripathy, Aristidis Tsatsakis, Munkhtuya Tumurkhuu, Aniefiok John Udoakang, Sana Ullah, Sanaz Vahdati, Siavash Vaziri, Madhur Verma, Simone Vidale, Simona Villani, Karn Vohra, Theo Vos, Gizachew Tadesse Wassie, Haftom Legese Weldetinsaa, Adhena Ayaliew Werkneh, Nuwan Darshana Wickramasinghe, Marcin W Wojewodzic, Tewodros Eshete Wonde, Felicia Wu, Zenghong Wu, Hong Xiao, Suowen Xu, Mukesh Kumar Yadav, Saba Yahoo Syed, Sanni Yaya, Arzu Yiğit, Vahit Yiğit, Dehui Yin, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Leila Zaki, Mohammed G M Zeariya, Youjie Zeng, Chunxia Zhai, Haijun Zhang, Zhiqiang Zhang, Bin Zhu, Sa'ed H Zyoud, Samer H Zyoud, Michael Brauer, Katrin Burkart, Global, regional, and national burden of household air pollution, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021, The Lancet, Volume 405, Issue 10485, 2025, Pages 1167-1181, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(24)02840-X
© 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.
https://creativecommons.org/licenses/by/4.0/
https://urn.fi/URN:NBN:fi:oulu-202503272243
Tiivistelmä
Background:
Despite a substantial reduction in the use of solid fuels for cooking worldwide, exposure to household air pollution (HAP) remains a leading global risk factor, contributing considerably to the burden of disease. We present a comprehensive analysis of spatial patterns and temporal trends in exposure and attributable disease from 1990 to 2021, featuring substantial methodological updates compared with previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study, including improved exposure estimations accounting for specific fuel types.
Methods:
We estimated HAP exposure and trends and attributable burden for cataract, chronic obstructive pulmonary disease, ischaemic heart disease, lower respiratory infections, tracheal cancer, bronchus cancer, lung cancer, stroke, type 2 diabetes, and causes mediated via adverse reproductive outcomes for 204 countries and territories from 1990 to 2021. We first estimated the mean fuel type-specific concentrations (in μg/m3) of fine particulate matter (PM2·5) pollution to which individuals using solid fuels for cooking were exposed, categorised by fuel type, location, year, age, and sex. Using a systematic review of the epidemiological literature and a newly developed meta-regression tool (meta-regression: Bayesian, regularised, trimmed), we derived disease-specific, non-parametric exposure–response curves to estimate relative risk as a function of PM2·5 concentration. We combined our exposure estimates and relative risks to estimate population attributable fractions and attributable burden for each cause by sex, age, location, and year.
Findings:
In 2021, 2·67 billion (95% uncertainty interval [UI] 2·63–2·71) people, 33·8% (95% UI 33·2–34·3) of the global population, were exposed to HAP from all sources at a mean concentration of 84·2 μg/m3. Although these figures show a notable reduction in the percentage of the global population exposed in 1990 (56·7%, 56·4–57·1), in absolute terms, there has been only a decline of 0·35 billion (10%) from the 3·02 billion people exposed to HAP in 1990. In 2021, 111 million (95% UI 75·1–164) global disability-adjusted life-years (DALYs) were attributable to HAP, accounting for 3·9% (95% UI 2·6–5·7) of all DALYs. The rate of global, HAP-attributable DALYs in 2021 was 1500·3 (95% UI 1028·4–2195·6) age-standardised DALYs per 100 000 population, a decline of 63·8% since 1990, when HAP-attributable DALYs comprised 4147·7 (3101·4–5104·6) age-standardised DALYs per 100 000 population. HAP-attributable burden remained highest in sub-Saharan Africa and south Asia, with 4044·1 (3103·4–5219·7) and 3213·5 (2165·4–4409·4) age-standardised DALYs per 100 000 population, respectively. The rate of HAP-attributable DALYs was higher for males (1530·5, 1023·4–2263·6) than for females (1318·5, 866·1–1977·2). Approximately one-third of the HAP-attributable burden (518·1, 410·1–641·7) was mediated via short gestation and low birthweight. Decomposition of trends and drivers behind changes in the HAP-attributable burden highlighted that declines in exposures were counteracted by population growth in most regions of the world, especially sub-Saharan Africa.
Interpretation:
Although the burden attributable to HAP has decreased considerably, HAP remains a substantial risk factor, especially in sub-Saharan Africa and south Asia. Our comprehensive estimates of HAP exposure and attributable burden offer a robust and reliable resource for health policy makers and practitioners to precisely target and tailor health interventions. Given the persistent and substantial impact of HAP in many regions and countries, it is imperative to accelerate efforts to transition under-resourced communities to cleaner household energy sources. Such initiatives are crucial for mitigating health risks and promoting sustainable development, ultimately improving the quality of life and health outcomes for millions of people.
Funding:
Bill & Melinda Gates Foundation.
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