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Ambient air pollution causes a considerable disease burden, particularly in South Asia. The objective of the study is to test the feasibility of applying the environmental burden of disease method at state level in India and to quantify a first set of disease burden estimates due to ambient air pollution in Kerala. Particulate Matter (PM) was used as an indicator for ambient air pollution. The disease burden was quantified in Years of Life Lost (YLL) for the population (30 + years) living in urban areas of Kerala. Scenario analyses were performed to account for uncertainties in the input parameters. 6108 (confidence interval (95% CI): 4150-7791) of 81,636 total natural deaths can be attributed to PM, resulting in 96,359 (95% CI: 65,479-122,917) YLLs due to premature mortality (base case scenario, average for 2008-2011). Depending on the underlying assumptions the results vary between 69,582 and 377,195 YLLs. Around half of the total burden is related to cardiovascular deaths. Scenario analyses show that a decrease of 10% in PM concentrations would save 15,904 (95% CI: 11,090-19,806) life years. The results can be used to raise awareness about air quality standards at a local level and to support decision-making processes aiming at cleaner and healthier environments.

Burden of Outdoor Air Pollution in Kerala, India—A First Health Risk Assessment at State Level