The mortality burden attributable to PM and NO from all sources and traffic-related air pollution in Australia.

Background: Fine particulate matter (PM) and nitrogen dioxide (NO) are associated with multiple health risks, including death. In Australia, the mortality burden attributable to PM has been estimated, but there are no published estimates for NO or the combined impacts of both pollutants.

Objectives: To estimate the mortality burden attributable to PM and NO from all anthropogenic sources and traffic-related air pollution (TRAP) in Australia.

Methods: We used previously published predictions for all source PM and NO and chemical transport model outputs to estimate TRAP-related concentrations. We estimated the attributable number of deaths by applying a life tables approach. We used publicly available population and mortality data together with effect estimates obtained from global meta-analyses, and incorporated recent recommendations for including single- and two-pollutant effect estimates into health impact assessment methods for air pollution. We did a series of sensitivity analyses to assess the influence of different modelling approaches and choices on our results.

Results: In 2015, an estimated 3684 (95 % CI, 3051-4350) premature deaths were attributable to air pollution from all sources, with 51 % (95 % CI, 19 %-86 %) linked to TRAP. Using mutually adjusted coefficients from two pollutant models and summing results did not appreciably change estimates derived from a single pollutant marker. Our results support PM as a reliable marker for mortality impacts from diverse emission sources, and NO as a robust marker for TRAP-related mortality in Australia. Sensitivity analyses including exposures below low-threshold cutoffs, using estimates for low pollution settings, and using location-specific threshold cutoffs for NO, yielded higher mortality estimates. This suggests our results may be conservative.

Conclusions: Air pollution remains a significant contributor to mortality in Australia. Reducing exposure, particularly from TRAP, could yield substantial public health benefits. Policies promoting cleaner transport modes offer a promising avenue for rapid improvement.