RATIONALE Adverse health impacts from outdoor air pollution occur across the U.S., but the magnitude of these impacts varies widely by geographic region. Ambient pollutant concentrations, emission sources, baseline health conditions, and population sizes and distributions are all important factors that need to be taken into account to quantify local health burdens. OBJECTIVE To determine health impacts from ambient air pollution concentrations in the U.S. that exceed recommended levels from the American Thoracic Society (ATS). METHODS Using a methodology that has been well established in previous "Health of the Air" reports, this study provides policy-relevant estimates for every monitored county and city in the U.S. for the adverse health impacts of outdoor pollution concentrations, using Environmental Protection Agency (EPA) design values for years 2018-2020. Additionally, for the first time, the report includes adverse birth outcomes as well as estimates of health impacts specifically attributable to wildland fires using an exposure dataset generated through Community Multi-scale Air Quality (CMAQ) simulations. RESULTS The adverse health burdens attributable to air pollution occur across the entire age spectrum, including adverse birth outcomes (10,660 preterm and/or low weight births; 95% CI: 3,180-18,330), in addition to mortality impacts (21,300 avoidable deaths; 95% CI: 16,150-26,200), lung cancer incidence (3,000 new cases; 95% CI: 1,550-4,390), multiple types of cardiovascular and respiratory morbidity (748,660 events; 95% CI: 326,050-1,057,080), and adversely impacted days (52.4 million days; 95% CI: 7.9-92.4 million). Two different estimates of mortality impacts from wildland fires were estimated based on assumptions regarding the underlying toxicity of particles from wildland fires (low estimate of 4,080 deaths, 95% CI: 240-7,890; middle estimate of 28,000 deaths, 95% CI: 27,300-28,700). Conclusions - This year's report identified sizable health benefits that are expected to occur across the U.S. from meeting more health-protective air quality standards such as those recommended by ATS. This study also indicates that a large number of excess deaths are attributable to emissions from wildland fires; air quality management strategies outside what is required by the Clean Air Act will be needed to best address this important source of air pollution and its associated health risks. Primary Source of Funding: National Aeronautics and Space Administration, Environmental Defense Fund.

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美国户外空气污染（包括野火）对健康的不利影响：“空气健康”，2018-2020 年。

基本原理 室外空气污染对健康造成的不利影响在美国各地都有发生，但这些影响的程度因地理区域而异。环境污染物浓度、排放源、基线健康状况以及人口规模和分布都是量化当地健康负担时需要考虑的重要因素。目的 确定美国环境空气污染浓度超过美国胸科学会 (ATS) 建议水平对健康的影响。方法 本研究采用之前“空气健康”报告中已确立的方法，利用美国环境保护署 (Environmental Protection Agency) 的数据，对美国每个受监测县和城市的室外污染浓度对健康造成的不利影响进行了政策相关的估计。 EPA）2018-2020 年的设计值。此外，该报告首次使用通过社区多尺度空气质量（CMAQ）模拟生成的暴露数据集，包括不良出生结果以及对荒地火灾造成的健康影响的估计。结果 空气污染造成的不利健康负担发生在整个年龄段，包括不良出生结局（10,660 例早产和/或低体重儿；95% CI：3,180-18,330），以及死亡率影响（21,300 例可避免的死亡；95 % CI：16,150-26,200）、肺癌发病率（3,000 例新病例；95% CI：1,550-4,390）、多种类型的心血管和呼吸系统发病率（748,660 起事件；95% CI：326,050-1,057,080）以及受到不利影响的天数（ 5240 万天；95% CI：7.9-9240 万）。根据有关荒地火灾颗粒物潜在毒性的假设，对荒地火灾造成的死亡率影响进行了两种不同的估计（低估计为 4,080 人死亡，95% CI：240-7,890；中估计为 28,000 人死亡，95% CI：27,300- 28,700）。结论 - 今年的报告指出，通过满足更健康的空气质量标准（例如 ATS 推荐的标准），预计将在美国各地带来巨大的健康益处。这项研究还表明，大量的超额死亡是由荒地火灾的排放造成的；为了最好地解决这一重要的空气污染源及其相关的健康风险，需要《清洁空气法》要求之外的空气质量管理策略。主要资金来源：国家航空航天局、环境保护基金。