Ranking sources of indoor volatile organic compounds by attributable burden of disease in China

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Abstract
Background High-level exposure to indoor air pollutants (IAPs), including volatile organic compounds (VOCs), has substantially contributed to the burden of disease in China over the past two decades. However, the contributions of different indoor VOC sources to the associated health burden remain poorly understood. Objective This study aimed to estimate source-specific residential VOC concentrations and the associated burden of disease to identify and rank the major sources of indoor VOCs in China. Methods Indoor concentrations of 39 VOCs were repeatedly measured across seasons from 2016 to 2017 in 249 residences from nine Chinese cities. We developed a novel integrated approach that combined positive matrix factorization (PMF) for source apportionment of indoor VOCs with the proportional population attributable fraction (PAF) method to quantify source-specific health burden. Results In 2017, the disability-adjusted life years (DALYs) attributable to residential VOCs across nine Chinese provinces reached 134.2 (95% UI: 65.7–225.0) per 100,000, resulting in financial costs of 28.1 (13.8–47.1) billion CNY. The PMF analysis identified six indoor sources and three outdoor sources contributing to indoor VOC concentrations. The three leading sources, which were interpreted as engineered wood products and furniture, outdoor vehicle exhaust, and cooking and indoor combustion, accounted for 42.7%, 25.9%, and 11.0% of the VOC-attributable DALYs, respectively. Significance This study prioritized controlling engineered wood products and furniture to mitigate indoor VOC health burdens in China, and proposed a generalizable health-based approach to rank sources of other IAPs. Impact This is the first study to rank the sources of indoor residential VOCs based on attributable health burden. The findings provide quantitative evidence to prioritize control strategies targeting the dominant residential VOC sources in China, such as engineered wood products and furniture. The proposed approach can be extended to other IAPs and may support future cost-benefit analyses of source-specific intervention strategies.

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