Air pollution shortens life expectancy and health expectancy for older adults: the case of China

Background: Outdoor air pollution is one of the most worrying environmental threats China faces today. Comprehensive and quantitative analysis of the health consequences of air pollution in China is lacking. This study reports age-sex-specific life expectancy (LE) and health expectancies (HEs) corresponding to different levels of air pollution based on associations between air pollution and individual risks for a host of health conditions and mortality net of individual- and community-level confounders. Methods: This is a multilevel prospective cohort study based a nationally representative sample of Chinese elders. The main outcome measures in this study include life expectancy estimated from mortality and health expectancies based on five health conditions including activity of daily living (ADL), instrumental activity of daily living (IADL), cognitive status, self-rated health, and chronic conditions. Results: Net of the controls, exposure to outdoor air pollution corresponded to subsequent reductions of LE and HEs for all five health conditions. These detrimental pollution effects were stronger for women. The gap in LE between areas with good air quality and moderately heavily polluted areas was 3.78 years for women of age 65 and 0.93 for men. The differences in HEs at age 65 were also large, ranging from 1.47 years for HE for good self-rated health in men to 5.20 years for ADL-disability-free HE in women. Conclusions: Air pollution has devastating health impacts on Chinese elders reducing longevity and shortening health expectancies. Women are more vulnerable than men. More strict air policy should be implemented to pursue sustainable development in China.