Global attributed burden of death for air pollution: Demographic decomposition and birth cohort effect

Background: To identify the high-risk pollutants and evolving patterns of attributed mortality burden, more detailed evidence is needed to examine the contribution of different air pollutants to death across the disease spectrum, partic-ularly considering population change as well as the context of the era. Methods: We explored the evolving patterns of all-cause and disease-specific deaths attributed to overall air pollution and its main subcategories by using the estimated annual percentage change and additionally assessing the contribu-tion of population growth and ageing to death burden using the decomposition method. Age-period-cohort model and Joinpoint analysis were used to evaluate birth cohort effects specific-disease death burden owing to high-risk air pol-lution subcategories. Findings: The number of deaths caused by air pollution increased by 2.62 %, which was driven by ambient particulate matter pollution and ambient ozone pollution, whereas household air pollution decreased. Population ageing contrib-uted 28.88 % of the deaths increase change for air pollution. Compared with other subcategories, the age-standardized mortality rate (ASMR) attributed to ambient particulate matter pollution remained the heaviest attributed death burden, comprehensively considering of bivariate burden. In 2019, ischemic heart disease attributed to ambient par-ticulate matter pollution exhibited the highest ASMR, which may be impacted by a rapid increase era from 1950 to 1980 birth cohort in woman and 1970 to 1990 birth cohort in man. Diabetes mellitus attributed to ambient particulate matter pollution showed the largest increase for ASMR, which was driven primarily by men born 1910-1975 and women born 1950-1975.Uzbekistan showed the highest ASMR for ischemic heart disease, with Equatorial Guinea showing the fastest increase for diabetes mellitus. Conclusion: Priority intervention targets for air pollution and health should emphasize the susceptibility of the elderly population as well as the structural factors of the era, in particular sensitive diseases to the ambient particulate matter pollution.