International Journal of Environmental Research and Public Health Article Burden of Disease Due to Air Pollution in Afghanistan—Results from the Global Burden of Disease Study 2019 Omar Hahad 1,2 1 Department of Cardiology I, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany; omar.hahad@unimedizin-mainz.de 2 German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131 Mainz, Germany Abstract: Introduction: Air pollution is a significant risk factor for a range of diseases and leads to substantial disease burden and deaths worldwide. This study aimed to investigate the burden of disease in Afghanistan attributed to air pollution in 2019. Methods: Data from the Global Burden of Disease (GBD) Study 2019 were used to investigate disability-adjusted life-years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths attributed to air pollution in Afghanistan. Results: In 2019, air pollution in Afghanistan was associated with significant health impacts, and contributed to 37,033 deaths (14.72% of total deaths), 1,849,170 DALYs (10.80% of total DALYs), 76,858 YLDs (2.07% of total YLDs), and 1,772,311 YLLs (13.23% of total YLLs). The analysis further revealed that lower respiratory infections, neonatal disorders, ischemic heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and diabetes mellitus were the leading causes of mortality and disease burden associated with air pollution in Afghanistan from 1990 to 2019. Comparative assessments between 1990 and 2019 underscored air pollution as a consistent prominent risk factor that ranked closely with other risk factors, like malnutrition, high blood pressure, and dietary risks, in contributing to deaths, DALYs, YLDs, and YLLs. In a comparative country analysis for the year 2019, Afghanistan emerged as having a substantial burden of disease due to air pollution, closely mirroring other high-burden nations like China, India, Pakistan, and Bangladesh. Discussion: Air pollution is one of the major health risk factors that significantly contribute to the burden of disease in Afghanistan, which emphasizes the urgent need for targeted interventions to address this substantial public health threat. Citation: Hahad, O. Burden of Disease Due to Air Pollution in Afghanistan—Results from the Global Keywords: air pollution; Afghanistan; burden of disease; risk factor; death; Global Burden of Disease Burden of Disease Study 2019. Int. J. Study 2019 Environ. Res. Public Health 2024, 21, 197. https://doi.org/10.3390/ ijerph21020197 1. Introduction Academic Editor: Alexandra Schneider Air pollution, as defined by the World Health Organization (WHO) as the “contamina- tion of the indoor or outdoor environment by any chemical, physical, or biological agent Received: 10 January 2024 that alters the natural characteristics of the atmosphere”, poses an important challenge to Revised: 2 February 2024 global public health [1]. Air pollution, characterized as a diverse mix of particles and gases, Accepted: 6 February 2024 results from a combination of anthropogenically generated pollutants and those originating Published: 8 February 2024 from natural sources. Human activities, such as industrial processes and the combustion of fossil fuels, significantly contribute to the release of pollutants into the atmosphere. Additionally, natural events, such as wildfires, volcanic eruptions, and dust storms, can Copyright: © 2024 by the author. introduce particles and gases that further contribute to the complex composition of air Licensee MDPI, Basel, Switzerland. pollution. Fossil fuel combustion, especially from transportation, releases nitrogen oxides This article is an open access article (NOx), including nitrogen dioxide (NO2), and carbon monoxide (CO). Sulfur dioxide (SO2) distributed under the terms and results from fossil fuel combustion for heating and power, and ozone (O3) forms through conditions of the Creative Commons interactions with compounds like CO and NOx. Particulate matter (PM) air pollution Attribution (CC BY) license (https:// includes various substances from traffic, industry, construction, fires, and waste inciner- creativecommons.org/licenses/by/ ation. PM is categorized by size: coarse PM (PM10), fine PM (PM2.5), and ultrafine PM 4.0/). (PM0.1) [2–4]. Int. J. Environ. Res. Public Health 2024, 21, 197. https://doi.org/10.3390/ijerph21020197 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2024, 21, 197 2 of 11 The Lancet Commission on pollution and health emphasized that deteriorated air quality stands as the primary environmental factor contributing to global disease and premature mortality. Diseases resulting from air pollution led to an estimated nine million premature deaths in 2015, surpassing the combined mortality of acquired immunodefi- ciency syndrome (AIDS), tuberculosis, and malaria by approximately threefold [5]. The primary contributor is ambient air pollution, which reduces the global average life ex- pectancy by about 2.9 years, exceeding the impact of conventional health risk factors such as tobacco smoking (2.2 years) [6]. The WHO reports that up to 12.6 million global deaths in 2012 were linked to unhealthy environments [7,8]. Recent assessments indicate that in 2020 alone, nine million premature deaths worldwide were associated with air pollution in the form of PM2.5 [9,10]. While previous studies primarily focused on global or regional air pollution-related health effects, limited attention has been paid to comprehensively assessing the burden of disease in specific countries arising from air pollution. In the case of Afghanistan, a country navigating the challenges of post-conflict recovery and rapid urbanization, the health effects of air pollution emerge as a critical concern [11]. Afghanistan ranks prominently among the most air-polluted nations globally, with elevated concentrations of PM and other air pollutants posing significant environmental and public health challenges. In 2019, Afghanistan held the fourth position globally in the Air Quality Index (AQI) assessment of PM2.5 levels, indicating a notable standing among countries experiencing elevated pol- lution levels. This ranking positioned Afghanistan just behind Mongolia, Pakistan, and Bangladesh [12]. Exposure patterns in Afghanistan vary between outdoor and indoor sources. Urban areas with a high population density and increased industrialization expe- rience elevated ambient air pollution, while rural areas, which rely on traditional cooking methods, contribute to indoor pollution that particularly affects vulnerable populations like women and children [13–15]. This analysis aims to shed light on the specific health effects experienced by the Afghan population due to exposure to air pollution. Understanding air pollution-related health impacts in Afghanistan is crucial for developing targeted interven- tions that align with the nation’s specific challenges and needs. To achieve this objective, recent data from the Global Burden of Disease (GBD) Study 2019 obtained from the Institute for Health Metrics and Evaluation were analyzed. Specific metrics (i.e., disability-adjusted life-years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths) attributed to air pollution in Afghanistan were taken into consideration to characterize the burden of disease due to air pollution in Afghanistan. 2. Methods 2.1. Data Source This analysis made use of data derived from the GBD Study 2019, providing an extensive evaluation of epidemiological variables like incidence, prevalence, deaths, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) across 369 diseases and injuries, 286 mortality causes, and 87 risk factors spanning 204 countries and regions [16,17]. Pertinent information regarding the burden of disease in Afghanistan attributed to air pollution was extracted from the GBD Results tool available on the Institute for Health Metrics and Evaluation website (https://vizhub.healthdata.org/ gbd-compare// accessed on 2 February 2024). For a more in-depth understanding of data sources, statistical analyses, and modeling procedures, readers are referred to the published works of the authors of the GBD 2019 Study [16,17]. 2.2. Main Input Data The calculation of DALYs in the GBD Study involved an examination of fundamental epidemiological data. Information from reviews, subsequent meta-analyses, and publicly available sources underwent rigorous statistical processing. Estimates, contingent on the quantity and quality of data, were primarily grounded in country-specific sources or de- rived from prediction models that considered incomplete or qualitatively insufficient data. Int. J. Environ. Res. Public Health 2024, 21, 197 3 of 11 2.3. Measures The outcomes of the GBD Study 2019 for Afghanistan are expressed in terms of deaths, YLDs, YLLs, and DALYs. DALYs consist of two essential components, YLLs and YLDs, serving as a metric for lost healthy life years. In the context of burden of disease studies, “disability” refers to any quantifiable (percentage) deviation from optimal health status. The mortality component of YLLs is calculated based on the number of deceased individuals (stratified by age, sex, and cause of death) and a globally standardized life expectancy at birth. The morbidity component of YLDs arises from the prevalence (stratified by age and sex) of the health-impairing condition under scrutiny and disability weights, standardized for all health states considered in the GBD Study 2019. These weights gauge the impact of diseases and injuries on health, ranging from 0 (complete health) to 1 (a state akin to death). The cumulative sum of YLLs and YLDs constitutes the DALYs [18]. 2.4. Air Pollution—Level 2 Risk Air pollution encompasses ambient particulate matter pollution (PM2.5), household air pollution from the use of solid fuels for cooking, and ambient ozone (O3) pollution [16]. The estimation of exposure to household air pollution arising from solid fuels involves an assessment based on two key parameters: the percentage of individuals utilizing solid cooking fuels and the level of exposure to PM2.5 among these individuals. Solid fuels encompass wood, coal/charcoal, dung, and agricultural residues. All presented results incorporate 95% uncertainty intervals (95% UI), which, similar to confidence intervals, en- capsulate uncertainties related to estimation and also encompass uncertainties originating from various sources, such as modeling uncertainties. 3. Results 3.1. Air Pollution and All-Cause Measures As shown in Table 1, the assessment of air pollution in Afghanistan in 2019 highlights a significant impact on various health measures. The estimated number of deaths attributed to air pollution amounted to 37,033, constituting 14.72% of all deaths. The overall DALY burden reached 1,849,170, making up 10.80% of Afghanistan’s total DALYs. YLDs were estimated at 76,858, representing 2.07% of total YLDs. YLLs due to air pollution were estimated at 1,772,311, comprising 13.23% of total YLLs. Table 1. Deaths, disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) attributed to air pollution in Afghanistan for the year 2019. Measure Metric Value UI Upper UI Lower Number 37,033 45,042 29,774 Deaths Percent 14.72 16.56 12.93 Rate 96.75 117.67 77.78 Number 1,849,170 2,250,663 1,485,560 DALYs Percent 10.80 12.67 9.08 Rate 4830.95 5879.85 3881.02 Number 76,858 100,685 55,152 YLDs Percent 2.07 2.55 1.68 Rate 200.79 263.04 144.09 Number 1,772,311 2,167,243 1,410,827 YLLs Percent 13.23 15.28 11.27 Rate 4630.16 5661.92 3685.79 Age-standardized rate per 100,000. UI: 95% uncertainty interval. Int. J. Environ. Res. Public Health 2024, 21, 197 4 of 11 3.2. Air Pollution and Measures for Communicable, Maternal, Neonatal, and Nutritional Diseases (CMNNDs) and Non-Communicable Diseases (NCDs) Moreover, referring to Table 2, the impact of air pollution on CMNNDs and NCDs is presented in detail. Deaths attributed to CMNNDs resulting from air pollution were estimated at 13,459, constituting 19.21% of total CMNND-related deaths. NCDs contributed to 23,573 deaths, representing 17.87% of overall NCD-related mortality. DALYs associated with NCDs reached 772,784, comprising 10.19% of total DALYs attributed to NCDs. In the case of CMNNDs, the DALY burden was estimated at 1,076,385, constituting 17.84% of total DALYs assigned to CMNNDs. YLDs due to NCDs were estimated at 74,667, accounting for 3.10% of total YLDs attributed to NCDs. CMNNDs contributed to a smaller YLD burden of 2191 (0.33% of total YLDs related to CMNNDs). YLLs due to CMNNDs were estimated at 1,074,194, representing 20.04% of total YLLs assigned to CMNNDs. For NCDs, there were 698,117 YLLs, constituting 13.56% of total YLLs attributed to NCDs. Table 2. Deaths, disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to communicable, maternal, neonatal, and nutritional diseases (CMNNDs) and non-communicable diseases (NCDs) attributed to air pollution in Afghanistan for the year 2019. Measure Cause Metric Value UI Upper UI Lower Number 13,459 17,335 10,118 CMNNDs Percent 19.21 23.02 15.42 Rate 35.16 45.29 26.43 Deaths Number 23,573 29,828 18,157 NCDs Percent 17.87 20.72 15.35 Rate 61.59 77.93 47.44 Number 1,076,385 1,403,066 793,828 CMNNDs Percent 17.84 21.36 14.32 Rate 2812.06 3665.51 2073.87 DALYs Number 772,784 981,498 597,716 NCDs Percent 10.19 12.62 8.13 Rate 2018.90 2564.16 1561.53 Number 2191 3152 1448 CMNNDs Percent 0.33 0.42 0.25 Rate 5.73 8.23 3.78 YLDs Number 74,667 98,168 53,437 NCDs Percent 3.10 3.81 2.50 Rate 195.07 256.47 139.61 Number 1,074,194 1,399,321 791,590 CMNNDs Percent 20.04 23.98 16.08 Rate 2806.33 3655.73 2068.03 YLLs Number 698,117 906,658 525,404 NCDs Percent 13.56 17.31 10.55 Rate 1823.83 2368.64 1372.62 Age-standardized rate per 100,000. UI: 95% uncertainty interval. 3.3. Air Pollution and Age-Specific Measures Figure 1 displays distinct patterns of mortality and disability across different age categories, emphasizing the differential health effects of air pollution on various age groups. For deaths, a bimodal distribution was observed, with two prominent peaks. The first peak Int. J. Environ. Res. Public Health 2024, 21, 197 5 of 11 was identified in the age category of 0 to 4 years, underscoring the heightened vulnerability of infants and young children to the adverse consequences of air pollution. The second peak was centered around the ages 40 to 84, indicating a significant impact on the older population. Intriguingly, the highest number of deaths was noted in the earliest days of life, specifically in the 0–6 day age category, highlighting the acute susceptibility of neonates to air pollution-related health risks. A parallel pattern was discerned in DALYs and YLLs, with a comparable bimodal distribution mirroring the peaks observed in the mortality data. Int. J. Environ. Res. Public Health 2024,R 2e1g, xa F rd OiRn PgEtEhRe RaEgVeIdEWist ribution of YLDs, the highest numbers were observed in middle6- aogf e1d3 categories, specifically around 45–49 years. (A) (B) (C) (D) Fiigurree 11.. Nuumbbeerrsso of fd deaetahtshs(A (A), )d, idsaisbailbitilyi-tayd-ajudsjutesdteldif el-iyfee-ayresa(rDs A(DLYAsL)Y(sB)) ,(Bye),a yrsealirvse dlivweidth wdiitsha bdiilsitay- (bYilLitDy s()Y(LCD),sa) n(Cd)y, eaanrds yoefalirfse olof slitfe(Y loLsLts ()Y(LDL)sa) t(tDrib) uattterdibtuoteadir tpoo alliur tpioonlluintioAnf ginh aAnfigshtaannifsotrand iffoferr denift- afegreencat taeggeo rciaetsegfoorritehse fyoera trh2e0 y1e9a.r 2019. 3.4. 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Pu ubl bilcicH Heaelatlhth2 022042,42, 12,11, 9x7 FOR PEER REVIEW 8 of 13 (A) (B) 7 of 11 (A) (B) (C) (D) (C) (D) Figure 3. The leading causes for numbers of deaths (A), disability-adjusted life-years (DALYs) (B), years lived with disability (YLDs) (C), and years of life lost (YLLs) (D) attributed to air pollution in Afghanistan comparing the y ears 1990 and 2019. FiFgiguurere3 3. . TThhee lleeaaddiinngg ccaauusseess ffoorr nnuummbbeersr soof fdedaetahtsh s(A(A), )d, idsaisbailbitiyli-tayd-ajudsjutesdte ldifeli-fyee-ayresa (rDs A(DLAYsL)Y (Bs)), 3(B.y5)e,.a yRresaa nlrisvkielnidvg ew doift wRhi idtshiks daFibasiaclbittoiylri st(y YL(YDLsD) (sC) ()C, a),nadn ydeyaersa rosf olifflei fleoslot s(tY(LYLLsL) s()D(D) a)ttartitbriubtuetde dtot oaiari rpoplolullutitoinon in AfghCanistan comparing the years 1990 and 2019. in Afghoamnipstarnactoivmep asrsinegsstmheeynetasr sb1e9tw90eaend 12909109 .and 2019 in Afghanistan shed light on the pivotal role of air pollution among the leading risk factors contributing to the burden of d3.3i5s..5e.aR Rsaena nk(Fikniinggguo rfoefR R4is)ik.s kAF Faccartocotsrossr sb oth years, air pollution was consistently prominently ranked as a rCiCsokom mfpapacatroarrat,it vicveleoa saseslesyes scsmomeenpntesttsib nbeget wtweietehnn o1 1t9h9e90r0 a saningddn2 ifi2001c1a99ni tni ncA oAnfgftgrhihabanunitsiostratsan nlsi khshe edmdl ailglinghuhtttor ointniot htnhe, e hppiigvihvoo tbatlalolr ordole lpeor foesfa siaurirrp epo, loallunlutdit odionineat maarmoyon rngisgkt hsthe. 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(A) Deaths, number (B) DALYs, number (A) Deaths, number (B) DALYs, number Figure 4. Cont. InInt.t.J .J.E Ennvviriornon. .R Rese.s.P PuubblilcicH Heaealtlhth2 2002244, ,2 211, ,1 x9 7FOR PEER REVIEW 98 ooff 1113 Int. J. Environ. Res. Public Health 2024, 21, x FOR PEER REVIEW 9 of 13 (C) YLDs, number (D) YLLs, number (C) YLDs, number (D) YLLs, number FFigiguurere4 4. .T Thheem moosstti mimppoorrtatannt tr risiskkssf oforrn nuummbbeerrsso offd deeaaththss( A(A),),d disisaabbiliiltiyty-a-addjujussteteddl ilfiefe-y-yeea arsrs( D(DAALLYYss)) (B(B),)Fy,i ygeeauarrsers l4 il.v iTveheded wm wiotihstth di mdisipasoabrbitliailtniytty r( Yi(sYLkLsD Dfso)sr )(n C(uC)m,)a,b anenrdsd yo yef eadaresrastoh ofsfl (ilAfief)e,l odlosistat( bY(iYlLiLtLyLs-as))d( D(juD)s)tie nidn A lAiffefgg-hyhaeannrissi st(atDanAnc LcoYomsm) ppaarirningg th (B), years litheey yeeaarsrs1 19999v0e da nwdit h20 d1is9a. bility (YLDs) (C), and years of life lost (YLLs) (D) in Afghanistan comparing the years 1099a0n adnd2 021091.9. 33.6.6. .A AirirP Poollluluttioionna annddC Coouunntrtryy-S-SppeeccifiificcM Meeaassuurerses 3.6. Air Pollution and Country-Specific Measures FFigiguurree 55 iillustrates percentages of health measures attributed to air pollution in Af- ghanisFtaignu irne 5 lilllusttrates percentages of ohfeahlteha lmtheamsuereass uattrerisbuattetrdi btou taeird ptoolluatiironp ionl lAuft-io in Afgghhaanniissttaann iinn 2 20201011999,, ,rrereevvveeaealaliinlnigng ga a ah hihgiihgg-hrh-a-rnraaknninkkgiin npggo spiotoisosinitti ioconm cpoamrapbaler atob loet htoer o stehleecrt esdel lceocctutend- ccoouunn-- trtireitesrsike kns nkoonwwonwnfn of ofrorar a as s isgiiggnnnifiiifificccaaannnttt bb buuurrdrddeenen noo fo fdfdi dsiesiaseseaeas sdeeud deu uteoe at toior a paioirrllp puotoilollunut,t iiiononcnl,u,i idnnicncllguu dCdihinnigngaC ,C Ihnhidinniaaa,,, I Innddiiaa,, PPaakPkiasikstatiasntna, ,na a,n nadnddB B aBanangngglallaadddeeessshhh... (A()A ) (B) (B) (C) (D) (C) (D) Figure 5. Percentages of deaths (A), disability-adjusted life-years (DALYs) (B), years lived with disability (YLDs) (C), and year s of life lost (YLLs) (D) attributed to air pollution for males and fem ales in selected countries for the year 2019. Int. J. Environ. Res. Public Health 2024, 21, 197 9 of 11 4. Discussion The evaluation of air pollution in Afghanistan in 2019 unveiled a substantial impact on various health measures, highlighting the interplay between environmental factors and the national disease burden. The estimated 37,033 deaths attributed to air pollution, constituting 14.72% of the total, underscores a significant contribution to overall mortality. The burden of disease, quantified by DALYs, amounted to 1,849,170, representing 10.80% of Afghanistan’s total DALYs. This comprehensive metric encapsulates not only mortality, but also YLDs and YLLs, providing a nuanced understanding of the diverse impacts of air pollution exposure. Deaths attributed to CMNNDs represent a substantial proportion of total CMNND-related deaths, revealing distinctive age-specific patterns in mortality, with heightened vulnerability observed in neonates and the elderly. This analysis provided a nuanced understanding of specific health impacts, revealing distinctive age-specific patterns in mortality and other measures, with heightened vulnerability observed in neonates and the elderly. Respiratory diseases, cardiovascular conditions, and other NCDs emerged as predominant causes of death, DALYs, YLDs, and YLLs associated with air pollution in Afghanistan from 1990 to 2019. These findings draw attention to the consistent role of air pollution as a major health risk factor, persisting over decades despite fluctuations in exposure due to various environmental and societal changes. The continuous prominence of air pollution among the top contributors to deaths, DALYs, YLDs, and YLLs positions it alongside established health risk factors such as malnutrition, high blood pressure, and dietary risks. This continuity emphasizes the urgent need for comprehensive strategies that address environmental exposures in conjunction with established health risk factors to effectively mitigate the overall burden of disease in Afghanistan. According to WHO estimates, deaths due to environmental risks constitute 26% of all deaths in Afghanistan, with household air pollution being the single most important environ- mental health risk factor [19]. The capital and largest city of Afghanistan, Kabul, recorded a PM2.5 reading of 58.8 µg/m³ in 2019 (mean annual value), ranking it as the 70th most polluted city globally [12]. Furthermore, the WHO estimated that household air pollution causes over 27,000 deaths per year, whereas ambient (outdoor) air pollution causes over 11,000 deaths in Afghanistan annually. Women and children are at particular risk of exposure to household air pollution, as they stay at home more than men [19]. Although there is a need for further research, epidemiological studies suggest that exposure to household air pollution contributes to low birth weight, stunting, and pre-term birth [20]. The primary sources of ambient air pollution in Afghanistan encompass motor vehicles, agricultural burning, and industrial activ- ities. A primary natural source includes mineral dust generated through soil resuspension, predominantly originating from arid and semiarid soils [21,22]. Factors such as environmental degradation, inadequate infrastructure, accelerated urbanization, transportation emissions, industrial activities, and reliance on solid fuels collectively contribute to elevated levels of air pollutants. Distinct exposure patterns arise from both outdoor and indoor sources, with urban areas witnessing heightened ambient air pollution due to high population density and intensified industrialization. In contrast, rural regions relying on traditional cooking methods contribute to indoor pollution. Although the present study did not explicitly delve into the spatial distribution of air pollutants, it is important to acknowledge the importance of incorporating such assessments when evaluating health burdens. Importantly, spatial distribution can significantly differ between rural and urban areas, adding a layer of com- plexity to our understanding of air quality and its potential health effects. Urban areas often exhibit concentrated sources of pollution, resulting in localized high concentrations, while rural areas may experience more dispersed sources with varying levels of exposure. Recog- nizing these distinct patterns is essential for tailoring interventions and policies to address the specific challenges faced by diverse populations [23]. Further, it is crucial to contextualize these findings within the broader landscape of developing or low-income countries in Asia. Findings indicate that Afghanistan occupied a prominent position in the burden of disease attributable to air pollution compared to countries recognized for facing significant health challenges related to air pollution, specifically China, India, Pakistan, and Bangladesh. Across Int. J. Environ. Res. Public Health 2024, 21, 197 10 of 11 China, India, Pakistan, Bangladesh, and Afghanistan, sources of air pollution exhibit notable variations reflecting diverse socio-economic contexts and developmental stages. China faces emissions from extensive industrial infrastructure and coal combustion [24]. India encounters challenges from urbanization-driven transport-related emissions and industrial activities [25]. Pakistan deals with transportation pollution, industrial emissions, and agricultural prac- tices [26]. Bangladesh copes with growing industrialization, increased traffic, and traditional biomass burning [27–29]. However, despite the imperative need for comprehensive inves- tigations into Afghanistan’s specific air pollution sources, pathways, and health impacts, challenges such as limited monitoring infrastructure and data gaps pose impediments to scientific investigation [12–15]. Afghanistan’s air pollution crisis demands attention and strategic interventions. Al- though geopolitical challenges may hinder large-scale improvements, targeted initiatives, such as phasing out high-pollution vehicles and raising public awareness about the dangers of burning hazardous materials, can contribute to reducing pollution levels and protecting public health, especially that of vulnerable populations such as women and children. Mitigation efforts should prioritize source reduction, targeting prevalent contributors like motor vehicles, agricultural burning, and industrial activities. Urban planning interventions and infrastruc- ture development can alleviate ambient air pollution, particularly in densely populated urban areas. In rural settings, promoting cleaner cooking technologies is pivotal to mitigating indoor pollution [12–15]. A recent study underscores the importance of phasing out fossil fuels, indicating that approximately 5.13 million excess deaths per year globally can be linked to ambient air pollution (including PM2.5 and O3) resulting from fossil fuel use. This suggests potential prevention of these deaths by transitioning to clean, renewable energy sources. This represents approximately 82% of the maximum number of air pollution-related deaths that could be avoided by controlling all human-made emissions [10]. 5. Conclusions Taken together, the present study’s analysis relied on data from the recent GBD Study 2019, which provided a solid basis for assessing the impact of air pollution in Afghanistan. Using diverse health metrics, this study’s findings offer nuanced insights into the health effects of air pollution, focusing specifically on the country’s challenges, age-specific patterns, and diseases linked to air pollution. However, limitations included data constraints from the GBD Study 2019, challenges in attributing health outcomes to specific sources, and gaps in monitoring infrastructure. External factors like seasonal variations and geopolitical challenges may not have been fully captured. Moreover, it is important to acknowledge that results regarding the influence of air pollution and malnutrition on health during the civil war may have been affected by factors such as migration. Despite these limitations, this study contributes valuable insights regarding evidence-based strategies to address air pollution’s health impacts in Afghanistan. In conclusion, this analysis highlights the urgent need for interventions to mitigate the public health impact of air pollution in Afghanistan. Funding: This research received no external funding. Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable. Data Availability Statement: Data are contained within the article. 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