India's air pollution killed 2 mn in 2023, worsening chronic diseases: Study

Air pollution is driving a wave of chronic, life-threatening illnesses across India, the State of Global Air 2025 reveals, with most deaths tied to non-communicable diseases

India is breathing itself sick. The latest State of Global Air 2025 report warns that polluted air is quietly eroding the nation’s health. It’s not just choking lungs and straining hearts but also harming brain function and worsening chronic illnesses. With nearly two million deaths in 2023 linked to air pollution, India continues to bear one of the world’s heaviest disease burdens.

Released by the Health Effects Institute (HEI) and the Institute for Health Metrics and Evaluation (IHME), United States, the report shows a staggering 43 per cent rise in air pollution-linked deaths in India since 2000, when the toll stood at 1.4 million.

India’s air-pollution burden

The report finds that death rates in India from air pollution are almost ten times higher than in high-income countries, with about 186 deaths per 100,000 people in India compared with 17 per 100,000 in wealthier nations. 

In 2023, the country recorded more than two million lives lost due to air pollution-linked illnesses, with around 89 per cent of these deaths attributed to non-communicable diseases such as heart disease, lung cancer, chronic obstructive pulmonary disease (COPD) and diabetes.

 

In 2021, India alone accounted for 2.1 million of the 2.6 million air pollution-related deaths reported across South Asia, underscoring the country’s overwhelming share of the regional health burden. 

•  Around 70 per cent of all COPD deaths in India are attributable to air-pollution exposure.
• One in three lung-cancer deaths are linked to polluted air.
• More than one in four heart-disease deaths are tied to air-pollution exposure.
• Nearly one in five deaths from diabetes are linked to ambient air pollution.

 

The report also highlights growing evidence that exposure to fine particles (PM2.5) damages brain tissue, contributing to cognitive decline and other neurological impacts. 

These figures make it clear that air pollution in India is not just a respiratory hazard but a major driver of chronic, multisystem diseases that are undermining the nation’s overall health.

 

Also read: Air pollution alert: What to do immediately when AQI turns unhealthy

Changing sources

Although deaths from household air pollution (from solid-fuel cooking) have declined, deaths from ambient (outdoor) fine-particle pollution (PM2.5) and ozone have increased. 

Approximately 75 per cent of India’s population lives in regions where annual PM2.5 exposure exceeds the World Health Organization’s interim target of 35 µg/m³.

Regional hotspots in India

The disease burden is unevenly distributed across states and regions.

• States such as Maharashtra, Uttar Pradesh, Rajasthan, Bihar and West Bengal each recorded more than 100,000 deaths from air-pollution exposure in 2023.
• Northern India and the Indo-Gangetic Plain remain particularly vulnerable due to geography (pollution traps, winter inversion layers) and the mix of sources including industry, transport, biomass burning and crop-residue fires.

Policy implications and what needs to be done

The findings of State of Global Air 2025 report highlight the urgent need for integrated action:

• Regional strategies are vital - states need tailored air-quality action plans that reflect their unique sources and exposure contexts
• Health systems must adapt - a large proportion of air-pollution deaths come from NCDs, national health policy must recognise air pollution as a core risk factor and integrate screening, prevention and treatment accordingly.
• Monitoring and data - better air-quality monitoring and health surveillance at regional/state levels will help policy-makers identify hotspots and measure progress.
• Pollution reduction efforts must be multi-sectoral, involving health, environment, transport, energy and urban planning, otherwise the disease burden will continue to grow.
• Focus must shift more to ambient air quality (particularly PM2.5 and ozone) rather than only household cooking emissions, given that the latter are declining while the former are rising.

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