The recognized importance of ambient fine particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) on human health has prompted the world to enact increasingly strict regulations on anthropogenic nitrogen oxides (NOx) emissions. However, the health concerns from soil NOx, potentially driven by fertilizer input but conventionally categorized as natural sources, remain less studied. Here, we emphasize the underappreciated roles of soil NOx emissions on health burden attributable to short-term PM2.5, O3, and NO2 exposure. Globally, we quantify acute health effects using machine-learning-based daily exposure estimates and identify influences of soil NOx emissions based on chemical transport model simulations. We find that 72.3% of the globe is affected by soil NOx emissions, whose contributions to short-term PM2.5, O3, and NO2 pollution lead to 13.9 (95% Confidence Interval [CI]: 9.1-18.8), 26.0 (18.2-34.2), and 13.9 (10.3-17.5) thousand premature mortality, respectively, in 2019. With distinct variations in regions, seasons, and pollutants, soil NOx-originated air pollution poses a global health concern, particularly for developing regions and intensively agricultural areas. In response to the intensive fertilizer use, South Asia, Southern Sub-Saharan Africa, and Central Europe witness the largest soil NOx-related health burden of up to 1.6 (95% CI: 1.1-2.1) mortality per 100k population. The overall health risk peaks in May, with O3 pollution typically dominating the soil NOx-attributable health burden during warm seasons and NO2 or PM2.5 during cold months. Our study highlights the necessity of dynamically adapted agricultural strategies for health-oriented multi-pollutant control, among which the improved use of synthetic fertilizers deserves priority under the ever-changing climate.
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