European regions with the highest poverty levels are the most vulnerable to the health effects of air pollution

Barcelona, March 19, 2026 (EMBARGOED) -. Socioeconomic factors are widely recognized as potential modifiers of the relationship between air pollution and mortality, but the available evidence remains limited. In this context, a new study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation, in collaboration with the Barcelona Supercomputing Center–Centro Nacional de Supercomputación (BSC-CNS), analysed how socioeconomic conditions and the transition to renewable energy in Europe influence vulnerability to air pollution. The results, published in Nature Medicine, show that regions with higher poverty levels and lower adoption of renewable energy are those with the highest risk of mortality associated with air pollution.

The study analysed a daily mortality database with 88.8 million deaths from the EARLY-ADAPT project (https://www.early-adapt.eu) between 2003 and 2019 in 653 contiguous regions of 31 European countries, including a population of 521 million people. Daily levels of air pollutants—fine particulate matter (PM2.5), coarse particles (PM10), nitrogen dioxide (NO2), and the 8-hour maximum daily ozone (O3)—were estimated using advanced machine learning models.

The researchers also incorporated regional socioeconomic indicators and data on renewable energy consumption, obtained from Eurostat’s regional statistics database. The epidemiological models included these socioeconomic and renewable energy variables to describe how the mortality risks of air pollution are different between populations, and how they evolved over the present century.

The higher the poverty, the greater the vulnerability to air pollution

The health risks of air pollution are not determined by pollution levels alone. They also depend on how vulnerable people are. Even when regions experience similar air pollution, the health consequences can differ greatly because of socioeconomic and demographic conditions.

The study showed regions with higher gross domestic product (GDP) per capita, lower poverty rates, and higher life expectancy, mainly in Northern and Western Europe, presented a lower risk of mortality associated with air pollution. In contrast, the most disadvantaged areas, located in Southern and Eastern Europe, recorded significantly higher risks, even doubling those of regions with better socioeconomic conditions.

These inequalities have also evolved differently over the present century. Wealthier regions experienced a significant decrease in the risks associated with PM2.5, PM10 and NO2 between 2003 and 2019. In contrast, regions with lower income or life expectancy saw only small improvements—or in some cases even increases—in mortality risks associated with these pollutants during the study period.

According to the research team, several mechanisms could explain these patterns. “It is not just that poorer regions are more polluted. Wealthier regions usually have better-equipped healthcare systems, more comprehensive public health programs, and greater social awareness of the effects of air pollution, as well as a higher capacity to implement environmental policies,” notes Zhaoyue Chen, ISGlobal researcher and first author of the study. “Quantifying the mortality risks attributable to air pollution in each region and period can help identify the most vulnerable populations more accurately,” he adds.

The effect of adopting renewable energy

The study also analysed how the transition to renewable energy affects mortality related to air pollution through two complementary pathways: by reducing air pollution levels and by lowering population vulnerability to air-pollution-related health risks.

The analyses show that the increase in renewable energy during the present century is associated with a reduction in air pollution of 15% for fine PM, 54% for coarse PM, and 20% for NO2. This represents a decrease in the mortality due to air pollution of 12% for fine PM, 52% for coarse PM, and 20% for NO2.

In addition, regions with higher and rapid renewable energy adoption experienced lowering population vulnerability to the health impacts of air pollution. Renewable energy adoption is a key component of sustainable environmental and climate policy frameworks and is often accompanied by social and infrastructural improvements—such as cleaner public transport, greener cities, more walkable urban design, cleaner technologies, and stronger environmental regulations—that can reduce communities’ susceptibility to air pollution.

However, progress has been uneven across the continent. Northern countries generally show high and rapid growth in the adoption of clean energy, while several Southern and Eastern countries, such as Malta, Cyprus, Italy and Poland, continue to show a relatively high dependence on fossil fuels.

“Western European countries generally tended to invest more resources in clean energy, green infrastructure, and stricter emission controls. Eastern European countries, on the other hand, have often relied more heavily on external funding and remain at an early stage of integrating renewable energy and pollution-control measures,” says Joan Ballester Claramunt, principal investigator of the EARLY-ADAPT project and senior author of the study.

Equity as a core of environmental policies

The study results highlight the need to integrate health equity into environmental policies, prioritizing pollution reduction in the most affected areas, and strengthening public health infrastructure. “It is urgent to expand environmental and health monitoring to identify disparities, guide equitable strategies, and ensure that resources reach those who need them most,” emphasizes Carlos Pérez García-Pando, ICREA and AXA Professor at the BSC’s Earth Sciences Department and co-author of the study.

According to the research team, although the analysis focused on Europe, the implications are global, as in many low- and middle-income countries, rapid urban growth and industrial expansion advance faster than investments in clean energy and environmental protection, which could further increase population vulnerability to the effects of pollution.

Health alerts of air pollution for vulnerable populations

The air pollution estimates and epidemiological models of the study were used in Forecaster.Health (https://forecaster.health/), an impact-based early warning system issuing alerts of mortality risks due to temperature and air pollution for vulnerable population groups.

Reference:

Chen, ZY., Achebak, H., Huang, W., Paniello-Castillo, B., Petetin, H., Méndez Turrubiates, RF., Pérez García-Pando, C., Ballester, J. Socioeconomic and energy transition disparities in acute air pollution–related mortality across Europe. Nature Medicine, 2026. https://www.nature.com/articles/s41591-026-04293-x

 

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