Burden of disease attributable to ambient fine particulate matter exposure in Taiwan

There is compelling epidemiological evidence that links air pollution to increased risk of mortality from cardiopulmonary disease and lung cancer. We quantified the burden of mortality attributable to ambient fine particulate matter (PM_2.5) among the Taiwanese population in 2014 at the national and subnational levels.

Subnational PM_2.5 exposure levels were obtained from Taiwan Air Quality Monitoring Network. Relative risks were derived from a previously developed exposure-response model. Population attributable fraction for cause-specific mortality was estimated at the county level using the estimated ambient PM_2.5 concentrations and the relative risk functions.

In 2014, PM_2.5 accounted for 6282 deaths [95% confidence interval (CI), 5716-6847], from ischemic heart disease (2244 deaths; 95% CI, 2015-2473), stroke (2140 deaths; 95% CI, 1760-2520), lung cancer (1252 deaths; 95% CI, 995-1509), and chronic obstructive pulmonary disease (645 deaths; 95% CI, 418-872). Nationally, the population attributable mortality fraction of PM_2.5 for the four disease causes was 18.6% (95% CI, 16.9-20.3%). Substantial geographic variation in PM_2.5 attributable mortality fraction was found; the percentage of deaths attributable to PM_2.5 ranged from 8.7% in Hualian County to 21.8% in Yunlin County. In terms of absolute number of deaths, New Taipei and Kaohsiung cities had the largest number of deaths associated with PM_2.5 (874 and 829 deaths, respectively) among all cities and counties.

Ambient PM_2.5 pollution is a major mortality risk factor in Taiwan. Aggressive and multisectorial intervention strategies are urgently needed to bring down the impact of air pollution on environment and health.