Air pollution shortens life expectancy by almost three years, which is more than tobacco, AIDS, wars or diseases such as malaria, according to a new study.

The results of the report (carried out among others by the Max Planck Institute and the University of Mainz, both in Germany) suggest that “the world is facing a ‘pandemic’ of air pollution,” according to a statement from the European Society of Cardiology.

The study points out that poor air quality especially affects older people and overall, about two-thirds of premature deaths due to air pollution are attributable to people generated sources, mainly due to the use of fossil fuels.

Using a new method to model the effects of various sources of air pollution on mortality rates, the researchers estimated that global air pollution caused 8.8 million additional premature deaths in 2015. This represents a shorter life expectancy of almost three years for everyone in the world.

There are, however, large regional differences due to the diversity of emissions, the study said. In East Asia, the reduction in life expectancy is an average of 3.9 years; in Africa of 3.1; in Europe 2.2 years; in North America of 1.4 and in South America, around 1 year.

By comparison, tobacco use shortens life expectancy by an average of 2.2 years (7.2 million deaths), HIV/AIDS by 0.7 years (1 million deaths), diseases such as malaria transmitted by parasites or insects 0.6 years (600,000 deaths), and all forms of violence, including deaths in wars, for 0.3 years (530,000 deaths).

The researchers analyzed the effect of air pollution on six categories of diseases: lower respiratory tract infection, chronic obstructive pulmonary disease, lung cancer, heart disease, stroke that leads to stroke and other noncommunicable diseases, including pathologies such as hypertension and diabetes.

They discovered that cardiovascular diseases are responsible for the largest proportion of lives shortened by air pollution: 43% of the loss of life expectancy worldwide. Air pollution causes damage to blood vessels, which in turn causes increases in blood pressure, diabetes, strokes, heart attacks, and heart failure.

Poor air quality has a great effect on reducing the life expectancy of older people, the study showed. It is estimated that 75% of deaths attributed to air pollution are from people over 60 years. The only exception is the deaths of children under five in low-income countries in Africa and Southeast Asia.

One of the authors, Thomas Münzel, of the University of Mainz, said: “About two-thirds of premature deaths can be attributed to man-made air pollution, mainly from the use of fossil fuels, a figure that reaches up to 80% in high-income countries. Five and a half million annual deaths in the world are potentially preventable.”

Nine out of ten people are now breathing polluted air and the cities that are struggling the most are located in India in China, according to the World Air Quality Report. Bangladesh was found to be the country with the most air pollution on the planet, South Korea within the OECD and Bosnia-Herzegovina in Europe.

The study was published in the journal Cardiovascular Research.