Population ageing is the key driver of future air pollution-related mortality in Greece

Air pollution is a major environmental health problem in the EU. The EU has established and recently revised ambient air quality standards and policy to address this issue, underpinned in the Zero Pollution Action Plan. The action plan aims to reduce pollution in European air, water and soil to levels no longer considered harmful for human health and natural ecosystems, and that respect the boundaries our planet can cope with. One of its six headline objectives is to reduce by more than 55% the health impacts (premature deaths) of air pollution by 2030. The action plan is part of the European Green Deal, which sets the goal for Europe’s economy and society to become climate neutral by 2050, enshrined in the European Climate Law. 

While the main emissions linked to climate change are not always the same as those that may cause adverse health impacts, they often share the same sources (e.g. car exhaust fumes, industry) as air pollutants – and therefore efforts to reduce greenhouse gases often lead to improved air quality. Meanwhile, research over the past two decades has shown a clear connection between exposure to air pollutants – especially ozone (O₃) and particulate matter with a diameter of less than 2.5μm (PM_2.5) – and adverse health outcomes across the globe. These small particles can penetrate tissues in the respiratory system and enter the bloodstream, contributing to respiratory infections, lung cancer, chronic obstructive pulmonary disease, heart disease, strokes, and type 2 diabetes. According to global studies on the health burden of atmospheric pollution, about 4.5 million premature deaths annually were attributable to ambient levels of PM_2.5 and O₃ in 2019. 

A new study narrows the focus of global and EU-wide air pollution analysis to a single country –Greece. Global studies have shown that the health burden attributable to air pollution in Greece is projected to increase significantly by the end of the century under specific emission and climate scenarios. However, studies explicitly quantifying the country’s future air pollution-related health burden are lacking, although it is vulnerable to these impacts given its socioeconomic characteristics. Conducted within the framework of the Greek National Research Network for Climate Change and Its Effects (CLIMPACT), the research investigates how the air pollution health burden attributable to PM_2.5 and O₃ is likely to evolve in Greece over the course of the 21st Century, taking into account future air quality and demographic changes. 

The study draws on the methodology for air pollution health effect assessment laid out in the Global Burden of Disease (GBD) research programme[1], assessing the changing health burden of air pollution under different future climate scenarios (since future emissions and air quality are linked to the response to climate change). It provides projections for air pollution-related deaths under three future scenarios (‘Shared Socioeconomic Pathways’, or SSPs), compared to data for the year 2000. SSP 1-2.6  is the optimistic scenario, with strong air pollution mitigation efforts to achieve a 2.0°C warming target; SSP 2-4.5 is ‘middle of the road’, with modest environmental and social challenges and a temperature increase of about 2.7°C; while SSP 3-7.0 is pessimistic, with high population growth combined with high challenges for mitigation and adaptation, high greenhouse gas emissions, and a significant warming of approximately 3.6°C. 

The findings show that, while air quality is expected to improve in Greece, excess mortality linked to air pollution is projected to increase, primarily due to population ageing. In fact, mortality related to PM_2.5 exposure, approximately 7,900 deaths per year in 2000, increases under all SSPs by the year 2090, by a factor of 1.7-2. Mortality related to O₃ exposure, meanwhile, is projected to increase by over 130%, to over 1,000 deaths per year by 2090 – except in the optimistic SSP1-2.6 scenario, where it declines to near-zero in all regions of Greece due to stringent air quality measures.

Under all SSPs, the leading driver of increased mortality associated with air pollution is population ageing. The researchers note that the average age of the Greek population in 2000 was 42 years old, rising to 54-57 in 2090, with the percentage of the population aged over 85 increasing substantially. The health risks of exposure to air pollution rise with age, explain the researchers, and while air quality improvements under some SSPs will have some effect in reducing the associated health burden, they cannot completely counteract the effect of an ageing population. 

For instance, epidemiological studies on exposure to ambient air pollution, household air pollution from the use of solid fuels, and secondhand tobacco smoke (as detailed in the Global Burden of Diseases, 2019) indicate that the associated risk of heart disease and stroke is correlated with age.

The study also shows regional disparities, with striking figures on excess deaths in Attica and Central Macedonia, which host over half of the population of Greece. Attica contains the Athens metropolitan area and has a population of 3.75 million, while the regional capital of Central Macedonia, Thessaloniki, has a population of nearly 1.9 million.

For example, the highest increases in PM_2.5-related mortality are seen in Attica, with 6,000 annual deaths by 2090 under SSP1-2.6. This is an increase of over 200% compared to the year 2000. Attica also sees significant increases in O₃-related mortality under the middle-of-the-road and pessimistic SSPs, where deaths rise by 160%–250%, as does the region of Central Macedonia (an increase of 85–120%). 

The findings underscore the necessity of demographic analysis at both country and regional levels in shaping effective public health and air quality policy to control future air pollution health burden, say the researchers. The results show that, even if pollutant concentrations fall, premature deaths linked to exposure will continue to rise in an ageing population. Still, strict pollution control measures could eliminate ground level ozone-related mortality almost completely. These measures, as part of integrated health and air quality policies, will be vital to address the challenges of ageing in Greece.

Reference: 

Akritidis, D., Georgoulias, A. K., Steffens, B., Pozzer, A. And Zanis, P. (2025) The future health burden of air pollution in Greece and the associated drivers. Science of The Total Environment, Vol. 994, 10 September 2025, 179897. https://www.sciencedirect.com/science/article/pii/S0048969725015384

[1] See Murray, C.J., Aravkin, A.Y., Zheng, P., Abbafati, C., Abbas, K.M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I. and Abegaz, K.H., 2020. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The lancet, 396(10258), pp.1223-1249.; and: Brauer, M., Roth, G.A., Aravkin, A.Y., Zheng, P., Abate, K.H., Abate, Y.H., Abbafati, C., Abbasgholizadeh, R., Abbasi, M.A., Abbasian, M. and Abbasifard, M., 2024. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet, 403(10440), pp.2162-2203.