Using epidemiology to estimate the impact and burden of exposure to air pollutants: Health effects of air pollution

Alison M. Gowers*, Heather Walton, Karen Exley, J. Fintan Hurley

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)


This paper focuses on the use of results of epidemiological studies to quantify the effects on health, particularly on mortality, of long-term exposure to air pollutants. It introduces health impact assessment methods, used to predict the benefits that can be expected from implementation of interventions to reduce emissions of pollutants. It also explains the estimation of annual mortality burdens attributable to current levels of pollution. Burden estimates are intended to meet the need to communicate the size of the effect of air pollution on public health to policy makers and others. The implications, for the interpretation of the estimates, of the assumptions and approximations underlying the methods are discussed. The paper starts with quantification based on results obtained from studies of the association of mortality risk with long-term average concentrations of particulate air pollution. It then tackles the additional methodological considerations that need to be addressed when also considering the mortality effects of other pollutants such as nitrogen dioxide (NO 2). Finally, approaches that could be used to integrate morbidity and mortality endpoints in the same assessment are touched upon. This article is part of a discussion meeting issue 'Air quality, past present and future'.

Original languageEnglish
Article number20190321
JournalPhilosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences
Issue number2183
Publication statusPublished - 30 Oct 2020

Bibliographical note

Funding Information:
Data accessibility. This article has no additional data. Authors’ contributions. A.G. and K.E. provided Scientific Secretariat support to COMEAP during the development of the reports and statements described in the paper, and A.G. drafted the manuscript. J.F.H. and H.W. are previous and current Chairs of the Quantification Sub-group of COMEAP and contributed to the development of the reports and statements described in the paper. All authors read, revised and approved the manuscript. Competing interests. The authors declare that they have no competing interests. Funding. H.W.’s post was part funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Health Impact of Environmental Hazards at King’s College London in partnership with Public Health England (PHE) and Imperial College London (now the NIHR HPRU on Environmental Exposures and Health at Imperial College, London in partnership with Public Health England (PHE), King’s College London and the MRC Toxicology Unit, Cambridge. Acknowledgements. The authors would like to acknowledge the contributions of previous and current Members of COMEAP and the COMEAP Scientific Secretariat, in particular Dr Brian Miller, the NO2 working group and its Chair Professor Roy Harrison, the cardiovascular epidemiology and quantification working group and its Chair Professor Paul Wilkinson, and the COMEAP Chair Professor Frank Kelly. The systematic review and meta-analysis of cohort studies on NO2 and mortality was undertaken by Professor Richard Atkinson and Barbara Butland. The systematic review and meta-analysis of studies on cardiovascular morbidity was undertaken by Professor Paul Wilkinson and Drs Ai Milojevic and Emma Hutchinson. The development of models integrating mortality and morbidity was undertaken by Dr Phil Symonds and Dr James Milner. Dr Dimitris Evangelopoulos provided comment on the manuscript. We are grateful to all of these. Disclaimer. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health & Social Care or Public Health England.

Publisher Copyright:
© 2020 The Author(s)

Copyright 2020 Elsevier B.V., All rights reserved.


  • health impact assessment
  • morbidity
  • mortality burden
  • nitrogen dioxide
  • particulate air pollution
  • two-pollutant models


Dive into the research topics of 'Using epidemiology to estimate the impact and burden of exposure to air pollutants: Health effects of air pollution'. Together they form a unique fingerprint.

Cite this