ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1636544
Comprehensive Insights into the Disease Burden Linked to Air Pollution Exposure Across U.S. States: Findings from the 2021 Global Burden of Disease Study
Provisionally accepted
- 1Second Xiangya Hospital, Central South University, Changsha, China
- 2Hunan First Normal University, Changsha, China
- 3Hunan University of Technology, Zhuzhou, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background Ambient air pollution persists as a critical global health threat, ranking fourth among risk factors for premature mortality. Despite decades of air quality improvements in the U.S. through regulatory measures, persistent health impacts remain, driven primarily by particulate matter (PM₂.₅) and ozone. Objective This study aimed to quantify long-term trends (1990-2021) in air pollution-attributable disease burdens across U.S. states, evaluate the effectiveness of existing policies, and identify priorities for future public health strategies to address persistent and emerging risks. Methods Using the Global Burden of Disease (GBD) 2021 dataset, we analyzed age-standardized mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) attributable to PM₂.₅, ozone, and household air pollution. Disease burdens were assessed for chronic obstructive pulmonary disease (COPD), diabetes mellitus, ischemic heart disease (IHD), lower respiratory infections, stroke, and lung cancer. Data were standardized to the GBD reference population for comparability over time. Results From 1990 to 2021, PM₂.₅-attributable mortality declined by 80.5%, with IHD deaths falling by 70.6% (79,684 to 23,433 deaths) and associated DALYs by 71.2%. However, diabetes-related YLDs surged 97.4% nationally, reflecting interactions with obesity and lifestyle factors. Formerly high-pollution states (e.g., Indiana, Tennessee) achieved substantial (30–40%) reductions in PM₂.₅-linked DALYs for IHD and COPD, while California saw a 12.3% rise in diabetes DALYs. In 2021, residual burdens disproportionately affected older adults and males, with IHD mortality rates 1.8 times higher in men. Ozone-related COPD deaths showed minimal decline despite falling ozone levels.
Keywords: GBD 2021, Air Pollution, disease burden, PM2.5, Ozone
Received: 28 May 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Zhou, Lin, Quan, Liao, Chen and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bing Zhou, Second Xiangya Hospital, Central South University, Changsha, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.