The health and social implications of household air pollution and respiratory diseases

Suzanne M Simkovich,Robert A Wise,Dina Goodman,Mary E Crocker,Gonzalo E Gianella,Christian Roa,William Checkley,Bruce J Kirenga

doi:10.1038/s41533-019-0126-x

Abstract

Approximately three billion individuals are exposed to household air pollution (HAP) from the burning of biomass fuels worldwide. Household air pollution is responsible for 2.9 million annual deaths and causes significant health, economic and social consequences, particularly in low- and middle-income countries. Although there is biological plausibility to draw an association between HAP exposure and respiratory diseases, existing evidence is either lacking or conflicting. We abstracted systematic reviews and meta-analyses for summaries available for common respiratory diseases in any age group and performed a literature search to complement these reviews with newly published studies. Based on the literature summarized in this review, HAP exposure has been associated with acute respiratory infections, tuberculosis, asthma, chronic obstructive pulmonary disease, pneumoconiosis, head and neck cancers, and lung cancer. No study, however, has established a causal link between HAP exposure and respiratory disease. Furthermore, few studies have controlled for tobacco smoke exposure and outdoor air pollution. More studies with consistent diagnostic criteria and exposure monitoring are needed to accurately document the association between household air pollution exposure and respiratory disease. Better environmental exposure monitoring is critical to better separate the contributions of household air pollution from that of other exposures, including ambient air pollution and tobacco smoking. Clinicians should be aware that patients with current or past HAP exposure are at increased risk for respiratory diseases or malignancies and may want to consider earlier screening in this population.

Highlights

Respiratory diseases are responsible for a significant burden worldwide from direct healthcare costs, significant disability, premature mortality, lost productivity and social consequences
Based on our scoping review, household air pollution (HAP) exposure may be associated with acute lower respiratory infections (ALRI), chronic obstructive pulmonary disease (COPD), tuberculosis, pneumoconiosis, head and neck cancer, and lung cancer
None of the systematic reviews had an objective measure of HAP exposure, instead exposure was often based on proxies and selfreporting

Summary

Introduction

Respiratory diseases are responsible for a significant burden worldwide from direct healthcare costs, significant disability, premature mortality, lost productivity and social consequences. Chronic respiratory diseases are estimated to result in. 92.5 million disability-adjusted life years (DALYs) lost in 2016 worldwide.[1]. There is limited published data on the health expenditures for respiratory disease outside of the United States (US) and the European Union (EU).[2]. Available statistics grossly underestimate health costs due to widespread underdiagnoses of respiratory disease.[2]. For the 28 countries in the EU, lung disease is estimated to cost €379.6 billion and results in an annual loss of 5.2 million DALYs, valued at an additional €300 billion.[2]. In the US, lung diseases cost an estimated $129 billion, with $106 billion of this attributed to chronic obstructive pulmonary disease (COPD), asthma, and pneumonia.[3]

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