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Background Exposure to ambient air pollution increases morbidity and mortality, and is a leading contributor to global disease burden. We explored spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015 at global, regional, and country levels.

Methods We estimated global population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2.5 mu m (PM2.5) and ozone at an approximate 11 km x 11 km resolution with satellite-based estimates, chemical transport models, and ground-level measurements. Using integrated exposure-response functions for each cause of death, we estimated the relative risk of mortality from ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infections from epidemiological studies using non-linear exposure-response functions spanning the global range of exposure.

Findings Ambient PM2.5 was the fifth-ranking mortality risk factor in 2015. Exposure to PM2.5 caused 4.2 million (95% uncertainty interval [UI] 3.7 million to 4.8 million) deaths and 103.1 million (90.8 million 115.1 million) disability-adjusted life-years (DALYs) in 2015, representing 7.6% of total global deaths and 4.2% of global DALYs, 59% of these in east and south Asia. Deaths attributable to ambient PM2.5 increased from 3.5 million (95% UI 3.0 million to 4.0 million) in 1990 to 4.2 million (3.7 million to 4.8 million) in 2015. Exposure to ozone caused an additional 254 000 (95% UI 97 000-422 000) deaths and a loss of 4.1 million (1.6 million to 6.8 million) DALYs from chronic obstructive pulmonary disease in 2015.

Interpretation Ambient air pollution contributed substantially to the global burden of disease in 2015, which increased over the past 25 years, due to population ageing, changes in non-communicable disease rates, and increasing air pollution in low-income and middle-income countries. Modest reductions in burden will occur in the most polluted countries un-less PM2.5 values are decreased substantially, but there is potential for substantial health benefits from exposure reduction.