Should air pollution be named as one of the causes of sudden death?

Nine out of ten people now breathe polluted air, which kills 7 million people every year, says the World Health Organization (WHO).

Air pollution has now emerged as a major environmental risk factor for health. “The health effects of air pollution are serious – one third of deaths from stroke, lung cancer and heart disease are due to air pollution. This is having an equivalent effect to that of smoking tobacco, and much higher than, say, the effects of eating too much salt” (WHO).

In 2016, as per WHO, ambient or outdoor air pollution caused an estimated 4.2 million premature deaths worldwide in both cities and rural areas; 58% of outdoor air pollution-related premature deaths were due to ischemic heart disease and strokes, while 18% of deaths were due to chronic obstructive pulmonary disease (COPD) and acute lower respiratory infections respectively, and 6% of deaths were due to lung cancer. More than 90% of these deaths occurred in low- and middle-income countries.

And it’s just not outdoor air pollution; household (indoor) air pollution also causes 4 million deaths annually.

Pollutants with the strongest evidence for public health concern include particulate matter (PM), ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2).

Air pollution has been identified as a trigger of acute cardiovascular events (myocardial infarction and stroke). A recent study presented at Heart Rhythm 2018, the Heart Rhythm Society's 39th Annual Scientific Sessions, which evaluated 112,700 women in the ongoing Nurses' Health Study showed that lower-risk women exposed to particular matter (PM) for even a short amount of time are at an increased risk of sudden cardiac death. This association was significant on cold days - at low temperatures below 13°C.

In a report published by the ICMR in The Lancet Planetary Health in December 2017, ICMR clearly stated that 1.24 million deaths in 2017 were caused by exposure to air pollution; one in eight deaths was due to the constantly deteriorating air quality.  ICMR also observed that life expectancy in India is reduced by 1.7 years on an average due to bad air quality.

This report was considered devoid of merit by the Environment ministry.

But, prior to the ICMR report, in 2015, the health ministry had released a report saying that air pollution causes impacts similar to that of tobacco smoking. The report also said that there was evidence of adverse pregnancy outcomes, tuberculosis, asthma exacerbation, cancer and thus, air pollution needs to be addressed during public health programs.

The environment ministry maintains that since no death certificates have pollution listed as the reason of death there is no correlation between air quality and deaths due to the same.

Doctors do not mention pollution as a cause of death, because pollution is not recognized as a cause of death and has no insurance cover. Natural disasters are generally not covered in routine insurance.

However, these statistics only serve to emphasize that perhaps the time has come to declare pollution as one of the causes of all sudden deaths, particularly when the pollution levels in the city are high.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA