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Health Effects of Ambient Air Pollution in Developing Countries

Pier Mannuccio Mannucci
1,* and
Massimo Franchini
Scientific Direction, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico and University of Milan, 20100 Milan, Italy
Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, 46100 Mantova, Italy
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2017, 14(9), 1048;
Submission received: 25 July 2017 / Revised: 26 August 2017 / Accepted: 9 September 2017 / Published: 12 September 2017
(This article belongs to the Special Issue Ambient Air Pollution and Health Vulnerability)


The deleterious effects of ambient air pollution on human health have been consistently documented by many epidemiologic studies worldwide, and it has been calculated that globally at least seven million deaths are annually attributable to the effects of air pollution. The major air pollutants emitted into the atmosphere by a number of natural processes and human activities include nitrogen oxides, volatile organic compounds, and particulate matter. In addition to the poor ambient air quality, there is increasing evidence that indoor air pollution also poses a serious threat to human health, especially in low-income countries that still use biomass fuels as an energy resource. This review summarizes the current knowledge on ambient air pollution in financially deprived populations.

1. Introduction

It is well known that air pollution has a number of detrimental effects on human health and is considered a major issue for the global community [1,2,3,4,5,6]. The World Health Organization (WHO) estimated that, in the year 2012, ambient air pollution was responsible for nearly seven million deaths, representing more than 10% of all-cause deaths and more than doubling previous estimates [7,8]. Air pollution accounts worldwide for an estimated 9% of deaths due to lung cancer, 17% due to chronic obstructive pulmonary disease, more than 30% due to ischemic heart disease and stroke, and 9% due to respiratory infections [7]. The Global Burden of Disease report [9] identified in 2012 that air pollution was among the leading risk factors for disease burden, being globally responsible alone for 3.1% of all Disability-Adjusted Life Years (DALYs). All these findings confirm that air pollution is now the world’s largest environmental health risk.
Outdoor air pollution is a mixture of thousands of components. Among them, airborne particulate matter (PM) and the gaseous pollutants ozone, nitrogen dioxide (NO2), volatile organic compounds (including benzene), carbon monoxide (CO), and sulphur dioxide (SO2) are the most important from a health perspective. Primary pollutants such as soot particles and oxides of nitrogen and sulphur are emitted directly into the air by the combustion of fossil fuels [10]. Major sources of primary particles include motorized road traffic, power generation, industrial sources, and residential heating. Secondary pollutants, formed when primary pollutants react or interact in the atmosphere, include mainly ozone (O3) and PM [11]. The latter, primary or secondary in origin, consists of particles that, on the basis of their size, are classified as coarse (diameter < 10 μm; PM10), fine (diameter < 2.5 μm; PM2.5), or ultrafine (<0.1 μm; PM0.1). PM2.5 are contained within the coarse particle fraction, broadly representing approximately 50% of the total mass of PM10. The resuspension of soil and road dust by wind or moving vehicles, as well as construction work and industrial emissions, results in coarse particles (PM10). Fine particles are derived primarily from direct emissions from combustion processes such as gasoline and diesel fuel, wood burning, coal burning for power generation, and industrial processes [11]. Fine particles can travel large distances (more than 100 km), with the potential for high background concentrations over a wide area [12]. As a consequence, their composition may be extremely heterogeneous, depending on the meteorological conditions and human activities in a particular geographical area [12]. Ultrafine particles are fresh emissions from combustion-related sources such as vehicle exhaust and atmospheric photochemical reactions and are recognized as important markers of exposure to traffic exhaust along main roads [13]. Fine and ultrafine particles are those associated with the worst effects on health as they can reach the deepest portions of the airways or even reach the blood stream directly [5,14].
If acute and long-term exposure to ambient air pollution represents a serious threat for health in western industrialized countries, the burden of this problem is even higher in developing countries, where population explosion along with widespread industrialization coupled with urbanization have resulted in dense urban centers with poor air quality [15,16]. In such developing countries, however, huge economic and social disparities coexist; thus, in addition to the poor ambient air quality, people can be also exposed, especially in rural areas, to high concentrations of indoor air pollution due to the use of biomass fuels (coal, wood, and other solid fuels) as an energy resource [17,18]. Worldwide, more than three billion people, largely in developing countries, rely on biomass fuels for their domestic energy needs [8]. As a consequence, household air pollution from solid fuel use has become a serious threat to health and has been estimated to be one of the top five major risk factors for the global burden of disease (4.3% of global DALYs), accounting for 3.9 million premature deaths in 2010 [17]. In this regard, the best example is provided by Asia, which has experienced rapid and disharmonic industrialization, urbanization, and transportation development in the recent decades, with resulting outdoor and indoor air pollution levels that are constantly well above the upper limits indicated by the WHO guidelines [19,20]. China, in particular, the Asian country with the fastest industrial development and population increase, is now facing the worst air pollution problem in the world [21,22]. This review focuses on this particularly vulnerable population living in low- and middle-income countries and highly exposed to both household and outdoor pollutants.

2. Health Effects in Adult Population

A number of studies and meta-analyses have shown that increased mortality is associated with short- and long-term exposure to PM, both in developed and developing countries. The percentage relative risk (RR) increase for all-cause mortality related to short-term PM exposure has been estimated to range from 0.4% to 1.5% per 20 μg/m3 increase in coarser PM10 and from 0.6% to 1.2% per 10 μg/m3 increase in finer PM2.5 [23]. Interestingly, the results of a recent large study conducted in the United States by Di and colleagues [24], including more than 60 million Medicare beneficiaries from 2000 through 2012, found that, for every increase of 10 μg/m3 in PM2.5, there was an associated 7.3% increase in all-cause mortality. This robust association was even more evident when the analysis was restricted to the Medicaid-eligible sub-group, documenting that persons with low socioeconomic status are more likely to be exposed to higher pollutant levels (and thus experience an increased incidence of adverse effects) than the rest of population [24]. As previously mentioned, this association may particularly important in East-Asian countries, which, due to their rapidly developing economies and dense populations, are exposed to very high levels of air pollution [25]. For instance, with urbanization increasing from 26% in 1990 to 50% in 2010, China has undergone dramatic epidemiological transitions [26,27], and, among the risk factors responsible for DALYs, ambient and household air pollution ranked fourth and fifth, respectively [28]. A recent meta-analysis of 33 time-series and case-crossover studies conducted in China to assess the mortality effects of short-term exposure to air pollution observed that each 10 μg/m3 increase in PM2.5 was associated with a 0.38% (95% CI 0.31–0.45) increase in total mortality, a 0.51% increase in respiratory mortality (95% CI 0.30–0.73), and a 0.44% (95% CI 0.33–0.54) increase in cardiovascular mortality [25]. The short-term effects of air pollution on health have also been the object of intense research in developing countries outside the Asiatic region. For instance, the ESCALA (Estudio de Salud y Contaminacion del Aire en Latinoamerica) study, which was conducted in nine Latin American cities, found a significant association between daily exposure to PM10 and O3 and daily mortality [29]. Likewise, indoor air pollution has been shown to have a significant impact on the health of populations living in rural areas in less industrialized countries such as Pakistan and India [30,31].
Pertaining to the adverse effects on the lungs, air pollution, as previously mentioned, is the cause and aggravating factor of many respiratory diseases like chronic obstructive pulmonary disease, asthma, and lung cancer [32]. Increased ambient O3, NO2, PM2.5, and SO2 levels were consistently associated with increased hospital admission for asthma and pneumonia in various studies conducted in Hong Kong and Taipei [33,34,35,36]. A systematic review confirmed that indoor air pollution due to solid fuel combustion was also an important risk factor for chronic obstructive pulmonary disease in adult populations living in low-income countries, particularly in non-smoking women [37]. In addition, a number of studies have consistently documented the association between air pollution and the risk of developing lung cancer; women carry the highest risk, probably due to their increased exposure to indoor air pollution [38,39,40]. Time-based multiple risk factor models have shown that smoking and solid-fuel use collectively contributed to 75% of lung cancer deaths in China [41]. Each 10 μg/m3 increase in the two-year average of PM2.5 correlated significantly with an increased risk of lung cancer in both males (RR 1.055; 95% CI 1.038 to 1.072) and females (RR 1.149; 95% CI 1.120 to 1.178) [42].
In addition to respiratory diseases, there is also increasing evidence that sustained exposure to ambient and household air pollution has a particularly deleterious effect on the cardiovascular system, and an association has been found between hypertension, coronary heart disease, and stroke [16]. A 2013 review reported a pooled effect of 11% (95% CI 6 to 16%) for cardiovascular mortality with a 10 μg/m3 PM2.5 increase [43]. Although populations in low- and middle-income countries are highly exposed to environmental pollution, the bulk of evidence that links these exposures to cardiovascular disease is derived mostly from populations in high-income countries [16]. Pertaining to developing countries, for instance, the results of a recent study conducted by Chen and colleagues [44] clearly indicate that life-expectancy in Northern China, where air quality is particularly poor, is 5.5 years lower owing to an increased incidence of cardiorespiratory mortality. Notably, a study on long-term exposure to ambient air pollution conducted in Shenyang, the largest and most heavily industrialized city in China, showed that an increase of 10 μg/m3 in the yearly average concentration of PM10 corresponded to 55% and 49% increases in the risk of death due to cardiovascular and cerebrovascular diseases, respectively [45]. In addition to the close link between air pollution and arterial thrombosis, there is also some evidence of the association with venous thromboembolism [45], as suggested by a recent systematic review [46]. A study conducted in Santiago, Chile (a city with a high level of air pollution) between 2001 and 2005 reported that the short-term increase in hospital admissions for venous thrombosis and pulmonary events was proportional to the elevations in the concentration of fine PM, documenting that the burden of this phenomenon is significant also for developing countries [47].

3. Health Effects in Particularly Vulnerable Populations

If air pollution, both outdoor and indoor, is considered a major health problem in developing countries, the burden of this issue is even greater in those population groups that are particularly vulnerable such as pregnant women, newborns, and children [48,49]. In particular, exposure to indoor air pollution from the combustion of solid biofuels is a significant public health hazard predominantly affecting women and small children living in poor households in both rural and urban communities in developing countries [50]. Recent studies have shown that air pollution can affect the developing fetus via maternal exposure, resulting in preterm birth, low birth weight, growth restriction, and potentially adverse cardiovascular and respiratory outcomes [51]. In this regard, a number of epidemiological and clinical studies conducted in low-income countries found an association between exposure to indoor air pollution during pregnancy and low birth weight and still birth [52,53,54,55,56,57], and a meta-analysis by Pope and colleagues calculated that the RR of low birth weight and stillbirth attributable to indoor air pollution in developing countries was 21% and 26%, respectively [58]. Another more recent systematic review and meta-analysis found a strong association between household air pollution from solid fuel use and the risk of adverse pregnancy outcomes; such exposure resulted in an 86.43 g reduction in birth weight and a 35% and 29% increased risk of low birth weight and stillbirth, respectively [59]. Interventions aimed at reducing exposure to household air pollution will result in an improvement of survival outcomes for all children [19]. Notably, a study evaluating the mortality effects of indoor air pollution and ambient urban PM pollution in Mexico estimated that the annual child mortality rate would decrease by 0.1 per 1000 children in the absence of these environmental exposures [60].
There is also consistent evidence that smoke from biofuels can cause acute lower respiratory infections in childhood [61,62,63]. Notably, a randomized controlled trial performed in Guatemala found that a reduction in exposure to household air pollution led to a significant one-third reduction of severe childhood pneumonia, with possible important implications for the reduction of child mortality [64]. In addition, air pollution has been found to be an important contributor to the increased prevalence of allergic diseases in children in developing countries, including asthma [32,65,66]. Coal combustion for heating (odds ratio (OR) 1.5, 95% CI 1.1 to 1.9) and cooking (OR 2.3. 95% CI 1.5 to 3.5) conferred higher risks of childhood asthma in China [67]. Each 10 μg/m3 increase in NO2 corresponded to an adjusted OR of 1.25 (95% CI 1.16 to 1.36) for diagnosed asthma in six to 13 year-old Chinese children [68]. In addition, increased ambient O3, NO2, PM2.5, and SO2 levels were associated with increased hospital admission for asthma in children [33,34,35,69,70]. For instance, Ko and colleagues [34] retrospectively reviewed the relationship between daily emergency hospital admissions and asthma and indices of air pollutants (SO2, NO2, O3, PM10, and PM2.5 levels) for 15 major hospitals in Hong Kong between January 2000 and December 2005. A total of 69,716 admissions were assessed, and significant associations were found between hospital admissions for asthma and NO2, O3, PM10, and PM2.5 levels (respective RRs, 1.04, 1.03, 1.02, and 1.02 per 10 μg/m3 increases). However, the adverse effects of early-life exposure to air pollution could be long lasting. In China, each 15 μg/m3 and 50 μg/m3 increase in NO2 and SO2 levels was associated with an adjusted OR of 1.90 (95% CI 1.20 to 3.00) and 1.62 (95% CI 1.01 to 2.60) for asthma, respectively, whereas the combined exposure to high levels of NO2 and SO2 further increased the OR to 1.85 (95% CI 1.22 to 2.79) in the first year of life [71].

4. Conclusions

Compared with most developed countries that have completed industrialization programs for several years, low- and middle-income countries have experienced an intense process of urbanization and industrial development in a very short period of time, which has led them to become the countries with the largest air pollution-related burdens in recent years. This phenomenon has deleterious effects on the health of people resident in these developing countries, as they are exposed to the joint toxic effects of household and ambient air pollution (Table 1).
In particular, women and children living in severe poverty have the greatest exposure to indoor air pollution from solid fuel use as they spend a lot of time near stoves [72]. As a consequence, such vulnerable populations have an increased risk of developing short-term and long-lasting adverse effects related to air pollution and thus need a closer follow-up. In this regard, the systematic monitoring of ambient air quality by national authorities in such countries will enable the implementation and evaluation of interventions aimed at lowering dangerous air pollutant levels [19,73]. The expenditures of these programs will be largely amortized by the costs saved by the prevention of air pollution-related morbidity and mortality in the population [20]. An impressive example of the potential beneficial effects of such interventions on the health of the population stems from the Beijing 2008 Olympic Games, when maintaining the exposure to PM10 under the limit of 100 μg/m3 during the period of the Games was associated with a nearly 40% reduction in health-related economic costs, compared with the period before the Games [21]. In conclusion, further epidemiological and clinical studies on air pollution in the developing world are warranted for assessing the degree of the burden of air pollution on health outcomes and for setting priorities in taking environmental local control measures.

Author Contributions

P.M.M. conceived the study; M.F. wrote the paper; and P.M.M. critically revised the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.


  1. Franchini, M.; Mengoli, C.; Cruciani, M.; Bonfanti, C.; Mannucci, P.M. Association between particulate air pollution and venous thromboembolism: A systematic literature review. Eur. J. Intern. Med. 2016, 27, 10–13. [Google Scholar] [CrossRef] [PubMed]
  2. Mannucci, P.M.; Harari, S.; Martinelli, I.; Franchini, M. Effects on health of air pollution: A narrative review. Intern. Emerg. Med. 2015, 10, 657–662. [Google Scholar] [CrossRef] [PubMed]
  3. Franchini, M.; Mannucci, P.M.; Harari, S.; Pontoni, F.; Croci, E. The health and economic burden of air pollution. Am. J. Med. 2015, 128, 931–932. [Google Scholar] [CrossRef] [PubMed]
  4. Newby, D.E.; Mannucci, P.M.; Tell, G.S.; Baccarelli, A.A.; Brook, R.D.; Donaldson, K.; Forastiere, F.; Franchini, M.; Franco, O.H.; Graham, I.; et al. Expert position paper on air pollution and cardiovascular disease. Eur. Heart. J. 2015, 36, 83b–93b. [Google Scholar] [CrossRef] [PubMed]
  5. Franchini, M.; Mannucci, P.M. Thrombogenicity and cardiovascular effects of ambient air pollution. Blood 2011, 118, 2405–2412. [Google Scholar] [CrossRef] [PubMed]
  6. Franchini, M.; Mannucci, P.M. Air pollution and cardiovascular disease. Thromb. Res. 2012, 129, 230–234. [Google Scholar] [CrossRef] [PubMed]
  7. WHO. 7 million deaths annually linked to air pollution. Cent. Eur. J. Public Health 2014, 22, 53–59. [Google Scholar]
  8. Burden of Disease from Ambient and Household Air Pollution. Available online: (accessed on 15 August 2017).
  9. Lim, S.S.; Vos, T.; Flaxman, A.D.; Danaei, G.; Shibuya, K.; Adair-Rohani, H.; Amann, M.; Anderson, H.R.; Andrews, K.G.; Aryee, M.; et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the global burden of disease study 2010. Lancet 2012, 380, 2224–2260. [Google Scholar] [CrossRef]
  10. Bonzini, M.; Tripodi, A.; Artoni, A.; Tarantini, L.; Marinelli, B.; Bertazzi, P.A.; Apostoli, P.; Baccarelli, A. Effects of inhalable particulate matter on blood coagulation. J. Thromb. Haemost. 2010, 8, 662–668. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  11. Schwarze, P.E.; Ovreik, J.; Lag, M.; Refsnes, M.; Nafstad, P.; Hetland, R.B.; Dybing, E. Particulate matter properties and health effects. Consistency of epidemiological and toxicological studies. Hum. Exp. Toxicol. 2006, 25, 559–579. [Google Scholar] [CrossRef] [PubMed]
  12. Valavanidis, A.; Fiotakis, K.; Vlachogianni, T. Airborne particulate matter and human health: Toxicological assessment and importance of size and composition of particles for oxidative damage and carcinogenic mechanisms. J. Environ. Sci. Health. C. Environ. Carcinog. Ecotoxicol. Rev. 2008, 26, 339–362. [Google Scholar] [CrossRef] [PubMed]
  13. Franchini, M.; Mannucci, P.M. Impact on human health of climate changes. Eur. J. Intern. Med. 2015, 26, 1–5. [Google Scholar] [CrossRef] [PubMed]
  14. Franchini, M.; Mannucci, P.M. Short-term effects of air pollution on cardiovascular diseases: Outcomes and mechanisms. J. Thromb. Haemost. 2007, 5, 2169–2174. [Google Scholar] [CrossRef] [PubMed]
  15. Bertazzi, P.A. Air pollution risks to human health. Intern. Emerg. Med. 2013, 8, S31–S38. [Google Scholar]
  16. Burroughs Peña, M.S.; Rollins, A. Environmental exposures and cardiovascular disease: A challenge for health and development in low- and middle-income countries. Cardiol. Clin. 2017, 35, 71–86. [Google Scholar] [CrossRef] [PubMed]
  17. Smith, K.R.; Bruce, N.; Balakrishnan, K.; Adair-Rohani, H.; Balmes, J.; Chafe, Z.; Dherani, M.; Hosgood, H.D.; Mehta, S.; Pope, D.; et al. Millions dead: How do we know and what does it mean? Methods used in the comparative risk assessment of household air pollution. Annu. Rev. Public Health 2014, 35, 185–206. [Google Scholar] [CrossRef] [PubMed]
  18. Smith, R.; Mehta, S. The burden of disease from indoor air pollution in developing countries: Comparison and estimates. Int. J. Hyg. Environ. Health 2003, 206, 279–289. [Google Scholar] [CrossRef] [PubMed]
  19. Ezzati, M.; Utzinger, J.; Cairncross, S.; Cohen, A.J.; Singer, B.H. Environmental risks in the developing world: Exposure indicators for evaluating interventions, programmes, and policies. J. Epidemiol. Community Health 2005, 59, 15–22. [Google Scholar] [CrossRef] [PubMed]
  20. Banerjee, R.; Dutta, M.; Roy, S.K.; Sinha, S. Evaluating the health cost of transport pollution. Int. J. Phys. Soc. Sciences 2012, 2, 81–96. [Google Scholar]
  21. Hou, Q.; An, X.Q.; Wang, Y.; Guo, J.P. An evaluation of resident exposure to respirable particulate matter and health economic loss in Beijing during Beijing 2008 Olympic Games. Sci. Total. Environ. 2010, 408, 4026–4032. [Google Scholar] [CrossRef] [PubMed]
  22. Kan, H.; Chen, R.; Tong, S. Ambient air pollution, climate change, and population health in China. Environ. Int. 2012, 42, 10–19. [Google Scholar] [CrossRef] [PubMed]
  23. Stieb, D.M.; Judek, S.; Burnett, R.T. Meta-Analysis of time-series studies of air pollution and mortality: Effects of gases and particles and the influence of cause of death, age, and season. J. Air Waste Manag. Assoc. 2002, 52, 470–484. [Google Scholar] [CrossRef] [PubMed]
  24. Di, Q.; Wang, Y.; Zanobetti, A.; Wang, Y.; Koutrakis, P.; Choirat, C.; Dominici, F.; Schwartz, J.D. Air pollution and mortality in the Medicare population. N. Engl. J. Med. 2017, 376, 2513–2522. [Google Scholar] [CrossRef] [PubMed]
  25. Shang, Y.; Sun, Z.; Cao, J.; Wang, X.; Zhong, L.; Bi, X.; Li, H.; Liu, W.; Zhu, T.; Huang, W. Systematic review of Chinese studies of short-term exposure to air pollution and daily mortality. Environ. Int. 2013, 54, 100–111. [Google Scholar] [CrossRef] [PubMed]
  26. Lelieveld, J.; Evans, J.S.; Fnais, M.; Giannadaki, D.; Pozzer, A. The contribution of outdoor air pollution sources to premature mortality on a global scale. Nature 2015, 525, 367–371. [Google Scholar] [CrossRef] [PubMed]
  27. Zhou, M.; Wang, H.; Zhu, J.; Chen, W.; Wang, L.; Liu, S.; Li, Y.; Wang, L.; Liu, Y.; Yin, P.; et al. Cause-specific mortality for 240 causes in China during 1990–2013: A systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet 2016, 387, 251–272. [Google Scholar] [CrossRef]
  28. Yang, G.; Wang, Y.; Zeng, Y.; Gao, G.F.; Liang, X.; Zhou, M.; Wan, X.; Yu, S.; Jiang, Y.; Naghavi, M.; et al. Rapid health transition in China, 1990–2010: Findings from the Global Burden of Disease Study 2010. Lancet 2013, 381, 1987–2015. [Google Scholar] [CrossRef]
  29. Romieu, I.; Gouveia, N.; Cifuentes, L.A.; de Leon, A.P.; Junger, W.; Vera, J.; Strappa, V.; Hurtado-Díaz, M.; Miranda-Soberanis, V.; Rojas-Bracho, L.; et al. Multicity study of air pollution and mortality in Latin America (the ESCALA study). Res. Rep. Health Eff. Inst. 2012, 171, 5–86. [Google Scholar]
  30. Colbeck, I.; Nasir, Z.A.; Ali, Z. The state of indoor air quality in Pakistan—A review. Environ. Sci. Pollut. Res. 2010, 17, 1187–1196. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  31. Pant, P.; Guttikunda, S.K.; Peltier, R.E. Exposure to particulate matter in India: A synthesis of findings and future directions. Enrviron. Res. 2016, 147, 489–496. [Google Scholar] [CrossRef] [PubMed]
  32. Jiang, X.Q.; M, X.D.; Feng, D. Air pollution and chronic airway diseases: What should people know and do? J. Thor. Dis. 2016, 8, E31–E40. [Google Scholar]
  33. Qiu, H.; Yu, I.T.S.; Tian, L.; Wang, X.; Tse, L.A.; Tam, W.; Wong, T.W. Effects of coarse particulate matter on emergency hospital admissions for respiratory diseases: A time-series analysis in Hong Kong. Environ. Health Perspect. 2012, 120, 572–576. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  34. Ko, F.W.; Tam, W.; Wong, T.W.; Lai, C.K.; Wong, G.W.; Leung, T.F.; Ng, S.S.; Hui, D.S. Effects of air pollution on asthma hospitalization rates in different age groups in Hong Kong. Clin. Exp. Allergy 2007, 37, 1312–1319. [Google Scholar] [CrossRef] [PubMed]
  35. Cheng, M.H.; Cheng, C.C.; Chiu, H.F.; Yang, C.Y. Fine particulate air pollution and hospital admission for asthma: A case-crossover study in Taipei. J. Toxicol. Environ. Health 2014, 77, 1071–1083. [Google Scholar] [CrossRef] [PubMed]
  36. Qiu, H.; Tian, L.W.; Pun, V.C.; Ho, K.F.; Wong, T.W.; Yu, I.T. Coarse particulate matter associated with increased risk of emergency hospital admissions for pneumonia in Hong Kong. Thorax 2014, 69, 1027–1033. [Google Scholar] [CrossRef] [PubMed]
  37. Liu, Y.; Lee, K.; Perez-Padilla, R.; Hudson, N.L.; Mannino, D.M. Outdoor and indoor air pollution and COPD-related diseases in high- and low-income countries. Int. J. Tuberc. Lung. Dis. 2008, 12, 115–127. [Google Scholar] [PubMed]
  38. Hashim, D.; Boffetta, P. Occupational and environmental exposures and cancers in developing countries. Ann. Glob. Health 2014, 80, 393–411. [Google Scholar] [CrossRef] [PubMed]
  39. Zhao, Y.; Wang, S.; Aunan, K.; Seip, H.M.; Hao, J. Air pollution and lung cancer risks in China: A meta-analysis. Sci. Total Environ. 2006, 366, 500–513. [Google Scholar] [CrossRef] [PubMed]
  40. Guo, Y.; Zeng, H.; Zheng, R.; Li, S.; Pereira, G.; Liu, Q.; Chen, W.; Huxley, R. The burden of lung cancer mortality attributable to fine particles in China. Sci. Total Environ. 2017, 579, 1460–1466. [Google Scholar] [CrossRef] [PubMed]
  41. Lin, H.H.; Murray, M.; Cohen, T.; Colijn, C.; Ezzati, M. Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: A time-based, multiple risk factor, modelling study. Lancet 2008, 372, 1473–1483. [Google Scholar] [CrossRef]
  42. Guo, Y.; Zeng, H.; Zheng, R.; Li, S.; Barnett, A.G.; Zhang, S.; Zou, X.; Huxley, R.; Chen, W.; Williams, G. The association between lung cancer incidence and ambient air pollution in China: A spatiotemporal analysis. Environ. Res. 2016, 144, 60–65. [Google Scholar] [CrossRef] [PubMed]
  43. Hoek, G.; Krishnan, R.M.; Beelen, R.; Peters, A.; Ostro, B.; Brunekreef, B.; Kaufman, J.D. Long-term air pollution exposure and cardio-respiratory mortality: A review. Environ. Health 2013, 12, 43. [Google Scholar] [CrossRef] [PubMed]
  44. Chen, Y.; Ebenstein, A.; Greenstone, M.; Li, H. Evidence on the impact of sustained exposure to air pollution on life expectancy from China’s Huai River policy. Proc. Natl. Acad. Sci. USA 2013, 110, 12936–12941. [Google Scholar] [CrossRef] [PubMed]
  45. Zhang, P.; Dong, G.; Sun, B.; Zhang, L.; Chen, X.; Ma, N.; Yu, F.; Guo, H.; Huang, H.; Lee, Y.L.; et al. Long-term exposure to ambient air pollution and mortality due to cardiovascular disease and cerebrovascular disease in Shenyang, China. PLoS ONE 2011, 6, e20827. [Google Scholar] [CrossRef] [PubMed]
  46. Franchini, M.; Guida, A.; Tufano, A.; Coppola, A. Air pollution, vascular disease and thrombosis: Linking clinical data and pathogenic mechanisms. J. Thromb. Haemost. 2012, 10, 2438–2451. [Google Scholar] [CrossRef] [PubMed]
  47. Dales, R.E.; Cakmak, S.; Vidal, B. Air pollution and hospitalization for venous thromboembolic disease in Chile. J. Thromb. Haemost. 2010, 8, 669–674. [Google Scholar] [CrossRef] [PubMed]
  48. Nandasena, Y.L.; Wickremasinghe, A.R.; Sathiakumar, N. Air pollution and health in Sri Lanka: A review of epidemiologic studies. BMC Public Health 2010, 10, 300. [Google Scholar] [CrossRef] [PubMed]
  49. Bruce, N.; Perez-Padilla, R.; Albalak, R. Indoor air pollution in developing countries: A major environmental and public health challenge. Bull. World Health Organ. 2000, 78, 1078–1092. [Google Scholar] [PubMed]
  50. Ezzati, M. Indoor air pollution and health in developing countries. Lancet 2005, 366, 104–106. [Google Scholar] [CrossRef]
  51. Backes, C.H.; Nelin, T.; Gorr, M.W.; Wold, L.E. Early life exposure to air pollution: How bad is it? Toxicol. Lett. 2013, 216, 47–53. [Google Scholar] [CrossRef] [PubMed]
  52. Mishra, V.; Dai, X.; Smith, K.R.; Mika, L. Maternal exposure to biomass smoke and reduced birth weight in Zimbabwe. Ann. Epidemiol. 2004, 14, 740–747. [Google Scholar] [CrossRef] [PubMed]
  53. Boy, E.; Bruce, N.; Delgado, H. Birth weight and exposure to kitchen wood smoke during pregnancy in rural Guatemala. Environ. Health Perspect. 2002, 110, 109–114. [Google Scholar] [CrossRef] [PubMed]
  54. Lakshmi, P.V.M.; Virdi, N.K.; Sharma, A.; Tripathy, J.P.; Smith, K.R.; Bates, M.N.; Kumar, R. Hosehold air pollution and stillbirth in India: Analysis of the DLHS-II National Survey. Environ. Res. 2013, 121, 17–22. [Google Scholar] [CrossRef] [PubMed]
  55. Amegah, A.K.; Nayha, S.; Jaakkola, J.J.K. Do biomass fuel use and consumption of unsafe water mediate educational inequalities in stillbirth risk? An analysis of the 2007 Ghana Maternal Health Survey. BMJ Open 2017, 7, e012348. [Google Scholar] [CrossRef] [PubMed]
  56. Khan, N.; Nurs, C.Z.B.; Isla, M.M.; Islam, R.; Rahman, M. Household air pollution from cooking and risk of adverse health and birth outcomes in Bangladesh: A nationwide population-based study. Environ. Health 2017, 16, 57. [Google Scholar] [CrossRef] [PubMed]
  57. Bruce, N.G.; Dherani, M.K.; Das, J.; Balakrishnan, K.; Adair-Rohani, H.; Bhutta, Z.A.; Pope, D. Control of household air pollution for child survival: Estimates for intervention impacts. BMC Public Health 2013, 13, S8. [Google Scholar]
  58. Pope, D.P.; Mishra, V.; Thompson, L.; Siddiqui, A.R.; Rehfuess, E.A.; Weber, M.; Bruce, N.G. Risk of low birth weight and stillbirth associated with indoor air pollution from solid fuel use in developing countries. Epidemiol. Rev. 2010, 32, 70–81. [Google Scholar] [CrossRef] [PubMed]
  59. Amegah, A.K.; Quansah, R.; Jaakkola, J.J.K. Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: A systematic review and meta-analyisis of the empirical evidence. PLoS ONE 2014, 9, e113920. [Google Scholar] [CrossRef] [PubMed]
  60. Stevens, G.A.; Dias, R.H.; Ezzati, M. The effect of 3 environmental risks on mortality disparities across Mexican communities. Proc. Natl. Acad. Sci. USA 2008, 105, 16860–16865. [Google Scholar] [CrossRef] [PubMed]
  61. Fullerton, D.G.; Bruce, N.; Gordon, S.B. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans. R. Soc. Trop. Med. Hyg. 2008, 102, 843–851. [Google Scholar] [CrossRef] [PubMed]
  62. Ezzati, M.; Kammen, D.M. Quantifying the effects of exposure to indoor air pollution from biomass combustion on acute respiratory infections in developing countries. Environ. Health Perspect. 2001, 109, 481–488. [Google Scholar] [CrossRef] [PubMed]
  63. Ezzati, M.; Kammen, D. Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: An exposure-response study. Lancet 2001, 358, 619–624. [Google Scholar] [CrossRef]
  64. Smith, K.R.; McCracken, J.P.; Weber, M.W.; Hubbard, A.; Jenny, A.; Thompson, L.M.; Balmes, J.; Diaz, A.; Arana, B.; Bruce, N. Effect of reduction in household air pollution on childhood pneumonia in Guatemala (RESPIRE): A randomized controlled trial. Lancet 2011, 378, 1717–1726. [Google Scholar] [CrossRef]
  65. Leung, T.F.; Ko, F.W.; Wong, G.W. Roles of pollution in the prevalence and exacerbations of allergic diseases in Asia. J. Allergy Clin. Immunol. 2012, 129, 42–47. [Google Scholar] [CrossRef] [PubMed]
  66. Nandasena, S.; Wickremasinghe, A.R.; Sathiakumar, N. Indoor air pollution and respiratory health of children in the developing world. World J. Clin. Pediatr. 2013, 2, 6–15. [Google Scholar] [CrossRef] [PubMed]
  67. Zheng, T.; Niu, S.; Lu, B.; Fan, X.; Sun, F.; Wang, J.; Zhang, Y.; Zhang, B.; Owens, P.; Hao, L.; et al. Childhood asthma in Beijing, China: A population-based case-control study. Am. J. Epidemiol. 2002, 156, 977–983. [Google Scholar] [CrossRef] [PubMed]
  68. Liu, F.; Zhao, Y.; Liu, Y.Q.; Liu, Y.; Sun, J.; Huang, M.M.; Liu, Y.; Dong, G.H. Asthma and asthma related symptoms in 23326 Chinese children in relation to indoor and outdoor environmental factors: The Seven Northeastern Cities (SNEC) study. Sci. Total Environ. 2014, 497–498, 10–17. [Google Scholar] [CrossRef] [PubMed]
  69. Wong, G.W.; Ko, F.W.; Lau, T.S.; Li, ST.; Hui, D.; Pang, S.W.; Leung, R.; Fok, T.F.; Lai, C.K. Temporal relationship between air pollution and hospital admissions for asthmatic children in Hong Kong. Clin. Exp. Allergy 2001, 31, 565–569. [Google Scholar] [CrossRef] [PubMed]
  70. Lee, S.L.; Wong, W.H.S.; Lau, Y.L. Association between air pollution and asthma admission among children in Hong Kong. Clin. Exp. Allergy 2006, 36, 1138–1146. [Google Scholar] [CrossRef] [PubMed]
  71. Deng, Q.; Lu, C.; Norback, D.; Bornehag, C.G.; Zhang, Y.; Liu, W.; Yuan, H.; Sundell, J. Early life exposure to ambient air pollution and childhood asthma in China. Environ. Res. 2015, 143, 83–92. [Google Scholar] [CrossRef] [PubMed]
  72. Gordon, S.B.; Bruce, N.G.; Grigg, J.; Hibberd, P.L.; Kurmi, O.P.; Lam, K.B.; Mortimer, K.; Asante, K.P.; Balakrishnan, K.; Balmes, J.; et al. Respiratory risks from household air pollution in low and middle income countries. Lancet Respir. Med. 2014, 2, 823–860. [Google Scholar] [CrossRef]
  73. Quansah, R.; Semple, S.; Ochieng, C.A.; Juvekar, S.; Armah, F.A.; Luginaah, I.; Emina, J. Effectiveness of interventions to reduce household air pollution and/or improve health in homes using solid fuel in low-and-middle income countries: A systematic review and meta-analysis. Environ. Int. 2017, 103, 73–90. [Google Scholar] [CrossRef] [PubMed]
Table 1. The burden of air pollution in developing versus developed countries.
Table 1. The burden of air pollution in developing versus developed countries.
Higher household exposures due to biomass fuels[8,18,22,30,49,61]
More rapid and disharmonic industrialization, urbanization and transportation development[8,19,22,26,28]
Fewer preventative health services and generally less surveillance[18,19,73]
Higher maternal exposure during pregnancy[52,53,56,57,58,59]
Higher children exposure[66,67,68,69,70,71]

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Mannucci, P.M.; Franchini, M. Health Effects of Ambient Air Pollution in Developing Countries. Int. J. Environ. Res. Public Health 2017, 14, 1048.

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Mannucci PM, Franchini M. Health Effects of Ambient Air Pollution in Developing Countries. International Journal of Environmental Research and Public Health. 2017; 14(9):1048.

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Mannucci, Pier Mannuccio, and Massimo Franchini. 2017. "Health Effects of Ambient Air Pollution in Developing Countries" International Journal of Environmental Research and Public Health 14, no. 9: 1048.

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