Global, regional and national burden of ischemic heart disease attributable to ambient fine particulate matter pollution from 1990 to 2021, with predictions to 2072: An analysis of the global burden of disease study 2021

Background and aims: To assess the global burden of ischemic heart disease (IHD) attributable to ambient PM2.5 pollution, including trends, geographic disparities, demographic drivers, and future projections. Methods: Using Global Burden of Diseases (GBD) 2021 data, we quantified PM2.5-related IHD deaths and disability-adjusted life years (DALYs). Decomposition analysis identified demographic drivers (population growth, aging, and epidemiological changes), and projection models estimated 50-year trends in age-standardized mortality and DALY rates. Results: In 2021, ambient PM2.5 caused 2.4 million deaths and 54.7 million DALYs globally. Although PM2.5-attributable IHD burden declined from 1990 to 2021, mortality and DALY rates stayed disproportionately high because population growth and aging increased the overall burden. The burden of ischemic heart disease attributable to ambient PM2.5 is projected to continue rising over the next 50 years. Conclusions: This study highlights the association between ambient PM2.5 pollution and IHD, particularly in low-and middle-income regions, males, and older populations, and indicates that age-standardized mortality and DALY rates are projected to rise. Monitoring exposure and implementing targeted strategies for these susceptible groups to address these inequities are critically important.