Grant: Operating Grant

Recent estimates suggest that 3.2 million deaths per year are attributable to outdoor air pollution globally, with 3.5 million deaths attributable to household air pollution from cooking and heating with solid fuels. These estimates place exposures to air pollution among the most important modifiable risk factors for global disease burden; however, they incorporate substantial uncertainty. In particular, the largest health impacts are estimated to occur in developing countries, where outdoor air pollution levels are high and household pollution from cooking and heating is common; however, few air pollution and health studies have been conducted in these countries. We therefore will conduct the first worldwide health study of both outdoor and household air pollution impacts on cardiovascular and respiratory disease, using an existing large international cohort: the Prospective Urban and Rural Epidemiological Study (PURE). This study has recruited 155,000 individuals residing in 628 communities in 17 countries and 5 continents, with current follow-up completed for four years and continuing for a further six years. We will use novel satellite-based approaches to estimate outdoor air pollution levels for all communities and complement this with targeted air pollution monitoring. For household air pollution we will estimate exposures using detailed information already collected on heating and cooking methods, fuel types and ventilation practices within study participants' homes. We will then determine the relationship between outdoor and household air pollution exposures with measures of cardiovascular and respiratory diseases as well as key relevant risk factors such as blood pressure and lung function. Overall, this study will provide an unparalleled worldwide analysis of the relationship between air pollution and cardiovascular and respiratory disease.