Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality

Wenzhong Huang; Tiantian Li; Pierre Masselot; Rongbin Xu; Antonio Gasparrini; Francesco Sera; Michelle L. Bell; Masahiro Hashizume; Susanne Breitner; Shilu Tong; Haidong Kan; Zhengyu Yang; Yiwen Zhang; Wenhua Yu; Pei Yu; Shuang Zhou; Qinghua Sun; Jingwei Zhang; Eric Lavigne; Joana Madureira; Yue Leon Guo; Vânia Gaio; Shanshan Li; Yuming Guo; Multi-Country Multi-City (MCC) Collaborative Research Network

doi:10.1016/j.oneear.2025.101488

Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality

Wenzhong Huang
, Tiantian Li
, Pierre Masselot
, Rongbin Xu
, Antonio Gasparrini
, Francesco Sera
, Michelle L. Bell
, Masahiro Hashizume
, Susanne Breitner
, Shilu Tong
, Haidong Kan
, Zhengyu Yang
, Yiwen Zhang
, Wenhua Yu
, Pei Yu
, Shuang Zhou
, Qinghua Sun
, Jingwei Zhang
, Eric Lavigne
, Joana Madureira

Yue Leon Guo, Vânia Gaio, Shanshan Li, Yuming Guo, Multi-Country Multi-City (MCC) Collaborative Research Network

Research output: Contribution to journal › Article › Research › peer-review

6 Citations (Scopus)

Abstract

Ambient air pollutants are leading contributors to global mortality. Despite the well-established risks, most studies have relied on single-pollutant models in limited regions, leaving the combined effects and individual contributions of pollutants unclear, particularly across countries. Here, we integrate daily mortality and air pollutant (nitrogen dioxide [NO₂], ozone [O₃], fine particulate matter, and sulfur dioxide) data from 482 cities in 12 countries/territories from 1998 to 2021 to assess the joint mortality risks and identify the main contributing pollutant through an air quality health index of multi-pollutant constrained groupwise additive models (AQHI-Multi). AQHI-Multi outperformed commonly used air quality indices in capturing the overall mortality risks. O₃ and NO₂ were the leading contributors (accounting for over 70% across countries/territories), with O₃’s share increasing slightly to moderately in most countries/territories. These findings highlight the need for developing air quality indices using advanced multi-pollutant models and the emerging global significance of targeted control of O₃ and NO₂.

Original language	English
Article number	101488
Number of pages	12
Journal	One Earth
Volume	8
Issue number	11
DOIs	https://doi.org/10.1016/j.oneear.2025.101488
Publication status	Published - 21 Nov 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 11 Sustainable Cities and Communities

Keywords

acute mortality risks
air pollution
air quality health index
multi-country study
multi-pollutant model
relative risk contributions
risk communication

Access to Document

10.1016/j.oneear.2025.101488

Cite this

Huang, W., Li, T., Masselot, P., Xu, R., Gasparrini, A., Sera, F., Bell, M. L., Hashizume, M., Breitner, S., Tong, S., Kan, H., Yang, Z., Zhang, Y., Yu, W., Yu, P., Zhou, S., Sun, Q., Zhang, J., Lavigne, E., ... Multi-Country Multi-City (MCC) Collaborative Research Network (2025). Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality. One Earth, 8(11), Article 101488. https://doi.org/10.1016/j.oneear.2025.101488

@article{d12685ee6ad1464a834aac186a04c0c8,

title = "Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality",

abstract = "Ambient air pollutants are leading contributors to global mortality. Despite the well-established risks, most studies have relied on single-pollutant models in limited regions, leaving the combined effects and individual contributions of pollutants unclear, particularly across countries. Here, we integrate daily mortality and air pollutant (nitrogen dioxide [NO2], ozone [O3], fine particulate matter, and sulfur dioxide) data from 482 cities in 12 countries/territories from 1998 to 2021 to assess the joint mortality risks and identify the main contributing pollutant through an air quality health index of multi-pollutant constrained groupwise additive models (AQHI-Multi). AQHI-Multi outperformed commonly used air quality indices in capturing the overall mortality risks. O3 and NO2 were the leading contributors (accounting for over 70\% across countries/territories), with O3{\textquoteright}s share increasing slightly to moderately in most countries/territories. These findings highlight the need for developing air quality indices using advanced multi-pollutant models and the emerging global significance of targeted control of O3 and NO2.",

keywords = "acute mortality risks, air pollution, air quality health index, multi-country study, multi-pollutant model, relative risk contributions, risk communication",

author = "Wenzhong Huang and Tiantian Li and Pierre Masselot and Rongbin Xu and Antonio Gasparrini and Francesco Sera and Bell, \{Michelle L.\} and Masahiro Hashizume and Susanne Breitner and Shilu Tong and Haidong Kan and Zhengyu Yang and Yiwen Zhang and Wenhua Yu and Pei Yu and Shuang Zhou and Qinghua Sun and Jingwei Zhang and Eric Lavigne and Joana Madureira and Guo, \{Yue Leon\} and V{\^a}nia Gaio and Shanshan Li and Yuming Guo and \{Multi-Country Multi-City (MCC) Collaborative Research Network\}",

note = "Publisher Copyright: {\textcopyright} 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.",

year = "2025",

month = nov,

day = "21",

doi = "10.1016/j.oneear.2025.101488",

language = "English",

volume = "8",

journal = "One Earth",

issn = "2590-3330",

publisher = "Cell Press",

number = "11",

}

Huang, W, Li, T, Masselot, P, Xu, R, Gasparrini, A, Sera, F, Bell, ML, Hashizume, M, Breitner, S, Tong, S, Kan, H, Yang, Z , Zhang, Y , Yu, W, Yu, P, Zhou, S, Sun, Q, Zhang, J, Lavigne, E, Madureira, J, Guo, YL, Gaio, V, Li, S , Guo, Y & Multi-Country Multi-City (MCC) Collaborative Research Network 2025, 'Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality', One Earth, vol. 8, no. 11, 101488. https://doi.org/10.1016/j.oneear.2025.101488

TY - JOUR

T1 - Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality

AU - Huang, Wenzhong

AU - Li, Tiantian

AU - Masselot, Pierre

AU - Xu, Rongbin

AU - Gasparrini, Antonio

AU - Sera, Francesco

AU - Bell, Michelle L.

AU - Hashizume, Masahiro

AU - Breitner, Susanne

AU - Tong, Shilu

AU - Kan, Haidong

AU - Yang, Zhengyu

AU - Zhang, Yiwen

AU - Yu, Wenhua

AU - Yu, Pei

AU - Zhou, Shuang

AU - Sun, Qinghua

AU - Zhang, Jingwei

AU - Lavigne, Eric

AU - Madureira, Joana

AU - Guo, Yue Leon

AU - Gaio, Vânia

AU - Li, Shanshan

AU - Guo, Yuming

AU - Multi-Country Multi-City (MCC) Collaborative Research Network

PY - 2025/11/21

Y1 - 2025/11/21

N2 - Ambient air pollutants are leading contributors to global mortality. Despite the well-established risks, most studies have relied on single-pollutant models in limited regions, leaving the combined effects and individual contributions of pollutants unclear, particularly across countries. Here, we integrate daily mortality and air pollutant (nitrogen dioxide [NO2], ozone [O3], fine particulate matter, and sulfur dioxide) data from 482 cities in 12 countries/territories from 1998 to 2021 to assess the joint mortality risks and identify the main contributing pollutant through an air quality health index of multi-pollutant constrained groupwise additive models (AQHI-Multi). AQHI-Multi outperformed commonly used air quality indices in capturing the overall mortality risks. O3 and NO2 were the leading contributors (accounting for over 70% across countries/territories), with O3’s share increasing slightly to moderately in most countries/territories. These findings highlight the need for developing air quality indices using advanced multi-pollutant models and the emerging global significance of targeted control of O3 and NO2.

AB - Ambient air pollutants are leading contributors to global mortality. Despite the well-established risks, most studies have relied on single-pollutant models in limited regions, leaving the combined effects and individual contributions of pollutants unclear, particularly across countries. Here, we integrate daily mortality and air pollutant (nitrogen dioxide [NO2], ozone [O3], fine particulate matter, and sulfur dioxide) data from 482 cities in 12 countries/territories from 1998 to 2021 to assess the joint mortality risks and identify the main contributing pollutant through an air quality health index of multi-pollutant constrained groupwise additive models (AQHI-Multi). AQHI-Multi outperformed commonly used air quality indices in capturing the overall mortality risks. O3 and NO2 were the leading contributors (accounting for over 70% across countries/territories), with O3’s share increasing slightly to moderately in most countries/territories. These findings highlight the need for developing air quality indices using advanced multi-pollutant models and the emerging global significance of targeted control of O3 and NO2.

KW - acute mortality risks

KW - air pollution

KW - air quality health index

KW - multi-country study

KW - multi-pollutant model

KW - relative risk contributions

KW - risk communication

UR - https://www.scopus.com/pages/publications/105024894401

U2 - 10.1016/j.oneear.2025.101488

DO - 10.1016/j.oneear.2025.101488

M3 - Article

C2 - 41362416

AN - SCOPUS:105024894401

SN - 2590-3330

VL - 8

JO - One Earth

JF - One Earth

IS - 11

M1 - 101488

ER -

Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality

Abstract

UN SDGs

Keywords

Access to Document

Other files and links

Multi-Country Study on Health Effects of Bushfire Air Pollution

Climate Change and Human Health in Asia: Current Impacts, Future Risks, and Health Benefits of Mitigation Policies

Cite this

Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality

Abstract

UN SDGs

Keywords

Access to Document

Other files and links

Projects

Multi-Country Study on Health Effects of Bushfire Air Pollution

Climate Change and Human Health in Asia: Current Impacts, Future Risks, and Health Benefits of Mitigation Policies

Cite this