A new study blames pollution of all types for 9 million deaths a year globally, with the death toll attributed to dirty air from cars, trucks and industry rising 55 percent since 2000.

That increase is offset by fewer pollution deaths from primitive indoor stoves and water contaminated with human and animal waste. Overall, pollution deaths in 2019 are about the same as 2015.

The United States is the only fully industrialised country in the top 10 nations for total pollution deaths, ranking 7th with 142,883 deaths blamed on pollution in 2019, sandwiched between Bangladesh and Ethiopia, according to a new study in the journal The Lancet Planetary Health.

The pre-pandemic study is based on calculations derived from the Global Burden of Disease database and the Institute for Health Metrics and Evaluation in Seattle.

India and China lead the world in pollution deaths with nearly 2.4 million and almost 2.2 million deaths a year, but the two nations also have the world’s largest populations.

When deaths are put on a per population rate, the United States ranks 31st from the bottom at 43.6 pollution deaths per 100,000. Chad and the Central African Republic rank the highest with rates about 300 pollution deaths per 100,000, more than half of them due to tainted water, while Brunei, Qatar and Iceland have the lowest pollution death rates ranging from 15 to 23. The global average is 117 pollution deaths per 100,000 people.

Pollution kills about the same number of people a year around the world as cigarette smoking and second-hand smoke combined, the study said.

“9 million deaths is a lot of deaths,” said Philip Landrigan, director of the Global Public Health Program and Global Pollution Observatory at Boston College.

“The bad news is that it’s not decreasing,” Landrigan said. “We’re making gains in the easy stuff and we’re seeing the more difficult stuff, which is the ambient (outdoor industrial) air pollution and the chemical pollution, still going up.”

It doesn’t have to be this way, researchers said.

“They are preventable deaths. Each and every one of them is a death that is unnecessary,” said Dr Lynn Goldman, dean of the George Washington University School of Public Health, who wasn’t part of the study. She said the calculations made sense and if anything was so conservative about what it attributed to pollution, that the real death toll is likely higher.

The certificates for these deaths don’t say pollution. They list heart disease, stroke, lung cancer, other lung issues and diabetes that are “tightly correlated” with pollution by numerous epidemiological studies, Landrigan said. To then put these together with actual deaths, researchers look at the number of deaths by cause, exposure to pollution weighted for various factors, and then complicated exposure response calculations derived by large epidemiological studies based on thousands of people over decades of study, he said. It’s the same way scientists can say cigarettes cause cancer and heart disease deaths.

The study authors came up with eight recommendations to reduce pollution deaths, highlighting the need for better monitoring, better reporting and stronger government systems regulating industry and cars.