Ambient PM: Health policy implications and management in Khuzestan, Iran.

Ambient fine particulate matter (PM) is a major environmental risk for premature mortality worldwide. This study quantifies the health and economic impacts of PM exposure in Khuzestan Province of Iran. This study quantifies the health and economic impacts of PM exposure in Khuzestan Province, Iran. Validated daily PM data from eight monitoring stations in 2021 were preprocessed, including outlier removal and gap-filling using a PM-to-PM conversion factor of 0.45. Population data were projected from the 2016 census. The U.S. EPA's BenMAP-CE tool was used to estimate avoidable premature deaths under two PM reduction scenarios (10 and 5 μg/m). This study assessed mortality for five outcomes: acute lower respiratory infections (ALRI), ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD), lung cancer (LC), stroke, and all-cause mortality. Economic valuation employed the value of statistical life (VSL), adjusted for Iran's GDP. PM concentrations (30-55 μg/m) surpassed WHO limits by 6-11 times, especially in Ahvaz and Omidiyeh. A total of 3174 avoidable deaths per 100,000 were estimated annually under the WHO's 5 μg/m guidelines. Among diseases, ischemic heart disease (IHD) accounted for the largest share of avoidable deaths (≈38 %), followed by stroke (≈23 %) and all-cause mortality (≈18 %). The annual economic benefits of reducing PM under the 5 μg/m scenario were estimated at USD 46-236.4 million. The greatest health and economic benefits from improved air quality are expected in Ahvaz (central Khuzestan) and Dezful (north), followed by Abadan and Bandar-e-Mahshahr (southwest). This study highlights the high PM burden in Khuzestan's urban and industrial centers. Targeted air quality policies in these areas could bring significant health and economic benefits. The results provide a solid basis for targeted policies, including stricter emission controls in high-burden regions, enhanced air quality monitoring, and community-based interventions such as public awareness campaigns in Iran and other middle-income countries.