Global, regional, and national burden of household air pollution, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021.

Summary

This Global Burden of Disease analysis estimates that 2.67 billion people (33.8% of the world population) were exposed to household air pollution in 2021, with updated fuel type-specific exposure modeling across 204 countries from 1990–2021. Despite declines, HAP remains a major contributor to COPD, lower respiratory infections, and other diseases, particularly in sub-Saharan Africa and South Asia, underscoring the need for accelerated transitions to clean household energy.

Key Findings

• In 2021, 2.67 billion people (33.8%) were exposed to household air pollution globally.
• Updated exposure modeling incorporated fuel type-specific concentrations across 204 countries and territories (1990–2021).
• Despite declines, HAP remains a substantial risk factor for respiratory and cardiometabolic diseases, especially in sub-Saharan Africa and South Asia.

Clinical Implications

Clinicians should screen for HAP exposure in at-risk populations, counsel on clean cooking/heating, and collaborate with public health programs to reduce COPD and LRI risks.

Limitations

• Model-based estimates rely on exposure assumptions and may not capture within-country heterogeneity
• Limited direct measured exposure data in many regions may introduce uncertainty

Future Directions

Integrate more ground-truth exposure measurements (personal and household monitors), assess intervention effectiveness at scale, and link HAP reductions to longitudinal respiratory outcomes.