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The burden of air pollution on years of life lost in Beijing, China, 2004-08: retrospective regression analysis of daily deaths

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7139 (Published 09 December 2013) Cite this as: BMJ 2013;347:f7139

Re: The burden of air pollution on years of life lost in Beijing, China, 2004-08: retrospective regression analysis of daily deaths

Guo and colleagues have clearly shown the effects of heavy exposure to air pollution on years of life lost (YLL) and mortality risks in Beijing, China. Their findings strongly imply the need to reduce the high levels of air pollution in Beijing, China.[1] We totally agree with the authors that the high levels of air pollution in China may be a medical threat for the residents in China as well as adjacent Asian countries including Japan.

However, the authors did not suggest that the potential further risk for the great health burden might exist in the people of China. Although particulate matter less than 10 μm in aerodynamic diameter (PM10), sulphur dioxide (SO2), and nitrogen dioxide (NO2) may cause a variety of diseases, the most important risk of the particles may be the increased incidence of chronic obstructive pulmonary disease (COPD).

Since tobacco consumption is one of the major contributing factors for the increase in COPD, the prevalence of the disease will increase up to the year 2020 in the USA and Europe. [2] The peak tobacco consumption of age was during the 1950s in USA but the 1970s in Japan. Further, tobacco consumption was still increasing in China. A survey found that the average daily consumption of tobacco per person in China rose from one cigarette in 1952 to ten cigarettes in 1990—a rate similar to that in the USA 50 years earlier. [3] The survey also estimated that the prevalence of COPD was 3% of the total population in the 1990s, but could increase to 10% in the 2020s.

The similarities between developing and/or developed Eastern countries and developed Western countries are that COPD is a disease of older individuals, is linked to the local smoking prevalence, and the trend is of rising mortality and morbidity.[4] The burden of COPD will continue to increase over the next 10 years in the USA and Europe, but over the next 30 years in China.[5] Thus, the currently augmented environmental pollutions in addition to the cigarette smoking burden may exaggerate the development of COPD in adult people in China.

COPD is a major cause of death and disability worldwide, and the burden of disease will continue to increase over the next 10 years in USA and Europe, but over the next 30 years in China. Now, we have more than 43 million people dying of COPD. China is the largest country in the world. Preventive action against COPD is very important in China.

COPD costs a lot in the medical field. In the USA, the direct healthcare costs of COPD are projected to be a total of 29.5 billion US dollars [6]. Long-term oxygen therapy costs Medicare more than 2 billion US dollars per year for COPD and the cost is growing by 12-18% per year [6]. Thus, smoking cessation campaigns and the reduction of air pollution are necessary to reduce the future risk of heavy burden of medical costs in China.

Reference List
[1] Guo Y, Li S, Tian Z, Pan X, Zhang J, Williams G. The burden of air pollution on years of life lost in Beijing, China, 2004-08: retrospective regression analysis of daily deaths 2013;347:f7139.

[2] Calverley PMA, Walker P. Chronic obstructive pulmonary disease. Lancet 2003; 362: 1053-1061.

[3] Zhang H, Cai B. The impact of tobacco on lung health in China. Respirology 2003; 8: 17-21.

[4] Tan WC, Ng TP. COPD in Asia. Where East meets West. Chest 2008;133:517-527.

[5] Teramoto S, Yamamoto H, Yamaguchi Y, et al. Global burden of COPD in Japan and Asia. Lancet 2003;362:1764-1765.

[6] Croxton TL, Bailey WC: Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research: an NHLBI workshop report. m J Respir Crit Care Med 2006, 174:373-378.

Competing interests: None declared

Competing interests: No competing interests

10 December 2013
Shinji Teramoto
Professor of pulmonary medicine
Hitachinaka Medical Education and Research Center, The University of Tsukuba
20-1 Ishikawa-cho, Hitachinaka-shi, Ibaraki,Japan 312-0057