The cardiovascular disease burden attributable to particulate matter pollution in South America: analysis of the 1990–2019 global burden of disease

Objectives: Fine particulate matter <2.5 microns (PM_2.5) is the most studied air pollutant. Both short- and long-term exposure to PM_2.5 have been linked to cardiovascular disease (CVD). Studies evaluating air pollution in South America are scarce. Therefore, the impact of exposure to PM_2.5, household air pollution (HAP), and ambient air pollution (AAP) on CVD mortality and CVD disability-adjusted life years (DALYs) in South American countries from 1990 to 2019 was explored. Study design and methods: The Global Burden of Disease initiative exposure-response function was used to analyze the total PM_2.5, ambient PM_2.5, and household PM_2.5-related CVD deaths and DALYs rates, per 100,000 individuals, in 12 South American countries between 1990 and 2019. The relative change in burden was also assessed by comparing the 1990–1994 to 2015–2019 periods. Results: In 2019, 70,668 deaths and 1,736,414 DALYs due to CVD were attributed to total PM_2.5 exposure in South America. Substantial regional heterogeneity was observed concerning the absolute change in PM_2.5 concentration levels comparing 1990 to 2019. All South American countries observed a relative decline in CVD deaths and DALYs comparing the 1990–1994 to 2015–2019 periods. No country was able to reach the current World Health Organization 5 μg/m³ recommended limit in 2019. Predominantly, AAP was the greatest contributor to the CVD burden. Conclusion: Air pollution substantially impacted CVD in South America; however, this impact was heterogenous, and the relative reduction of HAP and AAP burden was also not uniform. Recognizing PM_2.5 importance is key for developing target population and individual-level interventions, which could ultimately alleviate its burden.