BACKGROUND: Model-estimated air pollution exposure products have been widely used in epidemiological studies to assess the health risks of particulate matter with diameters of ≤2.5 µm (PM2.5). However, few studies have assessed the disparities in health effects between model-estimated and station-observed PM2.5 exposures. METHODS: We collected daily all-cause, respiratory and cardiovascular mortality data in 347 cities across 15 countries and regions worldwide based on the Multi-City Multi-Country collaborative research network. The station-observed PM2.5 data were obtained from official monitoring stations. The model-estimated global PM2.5 product was developed using a machine-learning approach. The associations between daily exposure to PM2.5 and mortality were evaluated using a two-stage analytical approach. RESULTS: We included 15.8 million all-cause, 1.5 million respiratory and 4.5 million cardiovascular deaths from 2000 to 2018. Short-term exposure to PM2.5 was associated with a relative risk increase (RRI) of mortality from both station-observed and model-estimated exposures. Every 10-μg/m3 increase in the 2-day moving average PM2.5 was associated with overall RRIs of 0.67% (95% CI: 0.49 to 0.85), 0.68% (95% CI: -0.03 to 1.39) and 0.45% (95% CI: 0.08 to 0.82) for all-cause, respiratory, and cardiovascular mortality based on station-observed PM2.5 and RRIs of 0.87% (95% CI: 0.68 to 1.06), 0.81% (95% CI: 0.08 to 1.55) and 0.71% (95% CI: 0.32 to 1.09) based on model-estimated exposure, respectively. CONCLUSIONS: Mortality risks associated with daily PM2.5 exposure were consistent for both station-observed and model-estimated exposures, suggesting the reliability and potential applicability of the global PM2.5 product in epidemiological studies.

Climate Air Quality Research Unit School of Public Health and Preventive Medicine Monash University Melbourne Australia

Department of Climatology Institute of Atmospheric Physics Academy of Sciences of the Czech Republic Prague Czech Republic

Department of Environmental and Occupational Medicine National Taiwan University College of Medicine and NTU Hospital Taipei Taiwan

Department of Environmental Health Harvard T H Chan School of Public Health Boston MA USA

Department of Environmental Health Instituto Nacional de Saúde Dr Ricardo Jorge Porto Portugal

Department of Environmental Health School of Public Health Fudan University Shanghai China

Department of Epidemiology Instituto Nacional de Saúde Dr Ricardo Jorge Lisboa Portugal

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London UK

Department of Statistics Computer Science and Applications 'G Parenti' University of Florence Florence Italy

EPIUnit Instituto de Saúde Pública Universidade do Porto Porto Portugal

Faculty of Environmental Sciences Czech University of Life Sciences Prague Czech Republic

Institute of Environmental and Occupational Health Sciences NTU College of Public Health Taipei Taiwan

Institute of Epidemiology Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg Germany

Monash Biomedicine Discovery Institute Department of Biochemistry and Molecular Biology Monash University Melbourne Australia

National Institute of Environmental Health Sciences National Health Research Institutes Miaoli Taiwan

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