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A health impact study was the first to estimate the mortality rate from air pollution in more than 1,000 European cities. The study, published in The Lancet Planetary Health, ranks the European cities with the highest mortality rates from each of the two air pollutants studied: particulate matter (PM2.5) and nitrogen dioxide (NO2). The research project was led by the Barcelona Institute for Global Health (ISGlobal) in collaboration with researchers from the Swiss Institute for Tropical and Public Health (Swiss TPH) and the University of Utrecht.

The results show that 51,000 and 900 premature deaths, respectively, could be prevented each year if all the cities analyzed achieved the PM2.5 and NO2 levels recommended by the World Health Organization (WHO). However, if all cities matched the air quality levels of the least polluted city on the list, even more deaths could be prevented. In particular, the number of premature deaths that could be prevented each year by lowering PM2.5 and NO2 levels to the lowest recorded levels is 125,000 and 79,000, respectively.

Mortality ranking

After estimating the preventable premature deaths in each city, the research team ranked the cities according to mortality exposure for each of the two pollutants studied.

“We observed large differences in the results for the different cities analyzed,” commented ISGlobal researcher Sasha Khomenko, lead author of the study. “The highest death rates from NO2, a toxic gas primarily associated with motor vehicle traffic, were recorded in major cities in countries such as Spain, Belgium, Italy and France.”

“For PM2.5, the cities with the highest mortality burden were in the Italian Po Valley, southern Poland and the Eastern Czech Republic. This is because particulate matter is emitted not only from automobiles but also from other sources of combustion, including industry, Domestic heating and burning of coal and wood, “added Khomenko.

“The highest percentage of natural mortality attributable to particulate matter was 15% in the city of Brescia. For nitrogen dioxide, the highest percentage – up to 7% of natural mortality – was found in the Madrid metropolitan area,” said Khomenko.

At the other end of the ranking are the cities with the lowest mortality rates from air pollution, a privileged position held by northern European cities in both PM2.5 and NO2 rankings.

“This is the first study to estimate the mortality rate caused by urban air pollution in Europe,” commented Mark Nieuwenhuijsen, lead author of the study and director of the Urban Planning, Environment and Health Initiative at ISGlobal, one of the “la Caixa” Foundation. “Our results support the evidence that there is no safe exposure threshold below which air pollution is harmful. They also suggest that current European legislation is not doing enough to protect human health. Hence the maximum of NO2 and PM2 5 Legally Allowed Levels should be revised. We hope local authorities can use this data to implement urban and transport planning strategies to improve people’s health. “

Online data hub

This study is part of the ISGlobal Ranking of Cities project and the first in a series of analyzes of the health effects of various environmental factors in urban life, including air pollution, noise, access to green spaces, heat island effects, etc. The website http://www.isglobalranking. org was created as a hub for rankings and detailed data for each city. The site is currently available in English, Spanish and Catalan. Data from the project’s other analyzes and rankings will be added to the site as it becomes available.


The study followed the quantitative health impact assessment method, which compares current urban air pollution with two counterfactual scenarios of improved air quality. Based on recent scientific evidence on the relationship between air pollution and mortality, the researchers calculated the impact that both air pollution reduction scenarios would have on mortality. Three mathematical models were combined to determine the average levels of each pollutant in each city. Values ​​from 2015 were taken as a basis and compared with data from 2018.

To make city comparisons, the researchers assigned a mortality burden value to each city. The results were calculated using an algorithm that took into account mortality rates, the percentage of preventable annual premature deaths, and the years of life lost for each air pollutant.

Top 10 cities with the highest mortality burden

The ten cities with the highest mortality from PM2.5:

1. Brescia (Italy)

2. Bergamo (Italy)

3. Karvina (Czech Republic)

4. Vicenza (Italy)

5. Silesian Metropolis (Poland)

6. Ostrava (Czech Republic)

7. Jastrzebie-Zdrój (Poland)

8. Saronno (Italy)

9. Rybnik (Poland)

10. Havírov (Czech Republic)

The ten cities with the highest death rate from NO2:

1. Madrid (metropolitan area) (Spain)

2. Antwerp (Belgium)

3. Turin (Italy)

4. Paris (metropolitan area) (France)

5.Milan (metropolitan area) (Italy)

6. Barcelona (Metropolitan Area) (Spain)

7. Mollet del Vallès (Spain)

8. Brussels (Belgium)

9. Herne (Germany)

10. Argenteuil-Bezons (France)

Top 10 cities with the lowest mortality burden

The ten cities with the lowest death rate from PM2.5:

1. Reykjavík (Iceland)

2. Tromsø (Norway)

3. Umeå (Sweden)

4. Oulu (Finland)

5. Jyväskylä (Finland)

Uppsala (Sweden)

7. Trondheim (Norway)

8. Lahti (Finland)

9. Örebro (Sweden)

10. Tampere (Finland)

The ten cities with the lowest death rate from NO2:

1. Tromso (Norway)

2. Umeå (Sweden)

3. Oulu (Finland)

4. Kristiansand (Norway)

5. Pula (Croatia)

Linköping (Sweden)

7. Galway (Ireland)

8. Jönköping (Sweden)

9. Alytus (Lithuania)

10. Trondheim (Norway)

Almost half of all childhood asthma cases in Barcelona are due to air pollution

More information:
Khomenko S., Cirach M., Pereira-Barboza E., Müller N., Barrera-Gómez J., Rojas-Rueda D., de Hoogh K., Hoek G., Nieuwenhuijsen M. Premature mortality due to air pollution in European cities ; an assessment of the urban burden of disease. The Lancet Planetary Health, 2021. Provided by the Barcelona Institute for Global Health

Quote: Study identifies European cities with the highest mortality from air pollution (2021, January 19), accessed January 19, 2021 from .html

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