PM_2.5-attributable mortality and economic burden in Can Tho City: evidence from Vietnam's Mekong Delta

Ambient fine particulate matter (PM_2.5) was responsible for approximately 4.9 million deaths globally in 2023; however, empirical evidence on PM_2.5-attributable health impacts remains sparse in Vietnam's Mekong Delta. This study quantified PM_2.5 concentrations and estimated attributable mortality and economic burden in Can Tho City, Vietnam, for 2023. The study utilized satellite-derived PM_2.5 estimates at 1 × 1 km resolution combined with local mortality data. Attributable deaths were calculated using the Global Exposure Mortality Model across six health endpoints, including ischemic heart disease (IHD), stroke, chronic obstructive pulmonary disease (COPD), lung cancer, lower respiratory infections (LRI), and non-communicable diseases plus lower respiratory infections (NCD + LRI). Economic losses were monetized using a Vietnam-specific Value of Statistical Life (VSL) derived through benefit transfer from the U.S. Environmental Protection Agency and the Organization for Economic Co-operation and Development, yielding VSL estimates of 10.4 and 6.8 billion VND, respectively. The annual mean PM_2.5 concentration was 27.7 μg/m³, 5.5-fold higher than the World Health Organization guideline (5 μg/m³) and exceeding the Vietnamese national standard (25 μg/m³). Among 3417 NCD + LRI deaths in adults aged 25+ in 2023, 705 (95% CI: 546-828) were attributable to PM_2.5, representing more than one in five deaths (20.6%) in this category (88 deaths per 100,000 population). Economic losses ranged from 3713 to 8611 billion VND, accounting for 3-7% of Can Tho City's gross regional domestic product. These findings demonstrate that PM_2.5 pollution imposes a substantial health and economic burden on Can Tho City and provide robust quantitative evidence to support air quality management strategies in the Mekong Delta region.