Socioeconomic and energy transition disparities in air pollution-related mortality across Europe.

Marked socioeconomic divides and unequal advances in renewable energy transition across Europe have raised concerns about widening inequalities in air pollution exposure and related health risks. Here we analyzed 88.8 million deaths across 653 contiguous regions in 31 European countries, encompassing the entire urban and rural population of 521 million people from 2003 to 2019, to investigate how socioeconomic conditions and renewable energy adoption relate to regional disparities in acute air pollution-related mortality risks and their trends over time. Regions with higher gross domestic product per capita, lower poverty rates and longer life expectancy-primarily in Western and Northern Europe-showed lower and declining risks in air pollution-related mortality compared to other regions in Europe. We assessed renewable energy transition as both an upstream driver and an effect modifier of the relationship between air pollution and mortality. As an upstream driver, greater renewable energy adoption was associated with 15-54% lower air pollutant levels and, consequently, 12-53% fewer attributable deaths. As an effect modifier, high renewable adoption was significantly associated with lower and declining mortality risks. Taken together, our findings show that differences in socioeconomic conditions and energy transition are associated with widening disparities in air pollution-related health risks across Europe.