The economic burden of mortality and morbidity due to air pollution in Tehran, Iran: a systematic review



Today, air pollution is creating a huge economic burden on communities by causing deaths and various diseases. The present study aimed to systematically review the economic burden of mortality and morbidity of air pollution and the methods for measuring these costs in Tehran, Iran.


A literature search of online databases (PubMed, Scopus, Web of Sciences, Embase, and Ovid) was searched through August 1, 2019, by using the appropriate English keywords. Also, Iran Medex, Barkat, and Magiran databases were searched for Persian articles.


Four English and two Persian studies were included in this review. All the articles investigated the economic burden of mortality due to air pollution, in which five, one, and one studies used value of statistical life, compensation payment, and human capital approach. The economic burden of mortality due to air pollution was estimated at $ 316 million to $ 2630 million. Also, five studies (83%) investigated the economic burden of morbidity due to air pollution, in which three, two, and one studies used the cost of illness, percentage of mortality costs, and willingness to pay methods, respectively. The economic burden of morbidity due to air pollution was estimated at $ 236 million to $ 546 million.


By systematically reviewing and emphasizing on different methods of measuring the economic burden of mortality and morbidity caused by air pollution, the results show that air pollution is a serious problem in Tehran. Nevertheless, appropriate methods should be used to measure costs to get robust and reliable results.

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We thank Iran University of Medical Sciences for financial supports. The present study is part of a PhD thesis that was supported by the Iran University of Medical Sciences under Grant No. “12847.”

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THK had the idea for the article, MH and PR performed the literature search and data analysis, and THK performed drafted and critically revised. All authors reviewed and approved the final manuscript.

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Correspondence to Touraj Harati Khalilabad.

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Appendix 1. Search strategy:

(“Air pollution” OR Pollution OR “Particulate matter” OR “Air quality” OR “Airborne particulate matter” OR “Particulate air pollutants” OR “Ambient particulate matter” OR Pollutant) AND (Health OR “Risk assessment” OR “Health risk assessment” OR “Benefit-Risk assessment” OR “Benefit risk assessment” OR “Risk benefit assessment” OR “Cardiovascular disease” OR Hospitalization OR “Health related outcome” OR Mortality OR Morbidity OR Admission OR "Emergency room" OR Death OR “Health impact” OR “Health burden”) AND ("Economic cost" OR “Economic impact” OR "Economic burden" OR Cost OR "Economic evaluation" OR "cost of illness" OR “Economic outcome” OR "Cost of disease" OR “Monetary impact” OR "Monetary burden" OR "Monetary valuation" OR "Financial burden" OR "Health economic loss" OR "External cost" OR "Economic valuation" OR “Contingent valuation method” OR “Value of statistical life” OR “Willingness to pay”) AND (“Islamic Republic of Iran” OR Iran)

Appendix 2

Table 4 Quality assessment checklist of Consensus on Health Economic Criteria (CHEC) and quality assessment results

Appendix 3

Table 5 Quality assessment of articles based on CHEC checklists

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Hadian, M., Raeissi, P. & Harati Khalilabad, T. The economic burden of mortality and morbidity due to air pollution in Tehran, Iran: a systematic review. Air Qual Atmos Health (2020).

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  • Air pollution
  • Economic burden
  • Mortality
  • Morbidity
  • Systematic review