The Impact of Air Quality Improvement Policies on Cardiovascular Disease Mortality: An Empirical Study Based on the EU Air Quality Directive

Abstract

Fine particulate matter (PM2.5) pollution has emerged as a critical environmental risk factor affecting global public health. The European Union’s Air Quality Directive implemented in 2008 offers a quasi-experimental setting to evaluate the health effects of air quality improvement policies. This study employs a difference-in-differences approach, utilizing data from the World Bank and World Health Organization spanning 2000-2020, to analyze policy effect variations between 19 EU countries and 8 non-EU developed countries. Results indicate that following the implementation of the EU Air Quality Directive, PM2.5 exposure concentrations decreased from 17.2 μg/m³ pre-policy to 13.5 μg/m³ post-policy, representing a 21.5% reduction; cardiovascular disease mortality rates declined from 234 per 100,000 to 166 per 100,000, a 29.1% decrease. The difference-in-differences model estimation shows a a significant policy effect coefficient of -24.71 (p<0.001), equivalent to a 14.61% improvement in average cardiovascular mortality rates. Sensitivity analyses confirm the robustness of results, with effect coefficients remaining between -23 and -25 across different policy time windows. This research provides direct evidence of air quality policy intervention on cardiovascular health, offering empirical foundations for developing more precise environmental health policies.