Fine particles (PM₂.₅) were associated with around 79,000 preventable deaths, followed by nitrogen dioxide (NO₂) , ozone (O₃) and coarser particles (PM₂.₅-₁₀, particles with a diameter between 2.5 and 10 micrometres). These are among the findings of a new study conducted by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the "la Caixa" Foundation, in collaboration with the Barcelona Supercomputing Center–Centro Nacional de Supercomputación (BSC-CNS), which provides the first Europe-wide estimate of short-term mortality associated with the combined effects of multiple pollutants across 31 European countries. The findings, published in Nature Health, support the development of impact-based early warning systems to help protect the population from the health effects of air pollution .
Although the overall health burden is dominated by long-term exposure, short-term air pollution can trigger acute physiological responses, such as systemic inflammation, autonomic imbalance and increased blood clotting, that elevate mortality risk over the following days. Recent studies have shown that daily pollution levels are linked to daily short-term increases in mortality, but important limitations remain. Most research focuses only on cities, overlooking peri-urban and rural areas; and they often fail to account for regional differences in vulnerability (such as age, baseline health, socioeconomic status or environment) and air pollution toxicity. In addition, pollutants are usually analysed separately, making it difficult to understand their combined effects.
"Our study addressed these limitations by combining daily data on major air pollutants across Europe with the new mortality database from the EARLY-ADAPT project of the European Research Council (ERC) , which covers the whole population in 31 countries representing over 530 million people," explains Zhao-Yue Chen , researcher at ISGlobal and first author of the study. "This allows a more precise analysis of how short-term exposure to the major pollutants affects people differently depending on age, sex and cause of death." The study analysed nearly 89 million deaths recorded between 2003 and 2019 across 653 European regions.
"To assess exposure to air pollution , daily levels of several pollutants were estimated across Europe using data from monitoring stations, satellites, land use and meteorological variables, and then adjusted at the regional level, giving more weight to areas where more people live," explains Carlos Pérez García-Pando, ICREA and AXA Professor at BSC-CNS.
PM₂.₅, the most harmful pollutant
An estimated 146,500 premature deaths per year were associated with short-term exposure to overall air pollution when all pollutants are considered together. When each pollutant was analysed separately, the greatest impact was attributed to PM₂.₅ (around 79,000 deaths), followed by NO₂ (69,000), O₃ (31,000) and PM2.5-10 (29,000). These figures cannot be simply added together; pollutants often occur simultaneously, so their effects overlap.
PM2.5 is the most harmful pollutant because it penetrates deep into the lungs and can enter the bloodstream, causing inflammation and other rapid effects in the body. By contrast, PM2.5-10 mainly affects the upper airways due to its larger size, while gases such as NO₂ and O₃ irritate the lungs and increase vulnerability to respiratory diseases.
Most earlier large studies focused only on fine particles (PM₂.₅) when estimating the short-term health burden of air pollution, leaving the impact of other pollutants in Europe largely unknown. This new study considers several pollutants together, providing a more complete and realistic picture of health risks. It also suggests that previous global estimates based solely on PM₂.₅ may have somewhat overestimated the burden in Europe, potentially reflecting biases from evidence derived in other regions.
Young men are more vulnerable than young women, but the pattern reverses with increasing age
Air pollution does not affect everyone in the same way. Young men showed greater vulnerability to ambient air pollutants than young women, likely due to higher exposure (outdoor work, traffic, smoking, etc.) or to the earlier appearance of comorbidities in men at young ages. However, this pattern changes with age: at older ages (especially from 85 years onwards), the highest risk is observed in women. For specific causes of death, particulate matter was more strongly associated with cardiovascular risks in women, while O₃ had a greater impact on men. These findings highlight the need for tailored protection measures, in contrast to one-size-fits-all approaches.
"Our findings are highly relevant for policymakers and public health professionals, as they support the use of epidemiological models fitted with data by sex, age and comorbidities to create a new generation of impact-based early warning systems (for example, the ERC -funded platform Forecaster.Health ), which specifically target vulnerable groups," explains Joan Ballester , researcher at ISGlobal and coordinator of the study. In a context where new daily air quality standards are being introduced across Europe, these results provide practical insights to help protect the population more effectively.
Reference
Chen, Z.-Y., Achebak, H., Petetin, H., Huang, W., Méndez Turrubiates, R. F., Beltrán, N., Peyrusse, F., Guo, Y., Pérez García-Pando, C., & Ballester, J. (2026). Short-term sex-specific, age-specific and cause-specific mortality from particulate matter, nitrogen dioxide and ozone: European-wide analysis of 653 contiguous regions. Nature Health. Doi: 10.1038/s44360-026-00124-y.
