The authors of a new study say their results show the world is facing an “air pollution pandemic.”

The health risks associated with air pollution are shortening people’s lives by nearly three years, according to a new study.

The study, published last week in the journal Cardiovascular Research, looks at different global air pollution sources, distinguishing between natural emissions like wildfires, and human-caused emissions like fossil-fuel use. Researchers found the risks from air pollution exceed those associated with smoking, HIV/AIDS, wars, malaria, dengue, and other vector-born diseases. 

The study’s authors described air pollution, mostly from fossil fuels, as “one of the main global health risks” and pointed to it as the cause of “significant loss of life expectancy,” particularly through cardiovascular diseases. 

“When we looked at how pollution played a role in several diseases, its effect on cardiovascular disease was by far the largest – very similar to the effect of smoking. Air pollution causes damage to the blood vessels through increased oxidative stress, which then leads to increases in blood pressure, diabetes, stroke, heart attacks and heart failure,” said study author Jos Lelieveld, a cardiologist at the University Medical Centre in Mainz, Germany, in a press release.

To compare, air pollution led to 8.8 million deaths per year in 2015, while smoking contributed to about 7.2 million per year, according to WHO estimates

“Since the impact of air pollution on public health overall is much larger than expected, and is a worldwide phenomenon, we believe our results show there is an ‘air pollution pandemic,'” said the study’s co-author Dr. Thomas Münzel. “Policymakers and the medical community should be paying much more attention to this. Both air pollution and smoking are preventable, but over the past decades much less attention has been paid to air pollution than to smoking, especially among cardiologists.”

The study is the first to break down how air pollution contributes to deaths by age (people over the age of 60 are most vulnerable), type of disease (cardiovascular diseases from air pollution account for 43% of the loss in life expectancy) as well as how the impact, and therefore remedies, are different from region to region.

In North America, 1.1 of the 1.4 years of lost life expectancy could be prevented by removing fossil fuel emissions. East Asia had the highest loss of life expectancy in the world due to “avoidable air pollution,” and eliminating fossil fuel emissions there would increase life expectancy three years. In Africa, however, where dust pollution is the main culprit, life expectancy would only increase by 0.7 years.

“In Africa, air pollution represents a health risk that is comparable to HIV/AIDS and malaria,” Lelieveld said. “However, in most of the rest of the world air pollution is a much greater health risk.”

Two-thirds of premature deaths worldwide can be linked to human-made air pollution, according to the study. In high-income countries, that’s a whopping 80%. If fossil fuel emissions, which include emissions from power generation, industry, traffic, and residential energy use, were eliminated, 5.5 million deaths could be avoided globally each year, and average life expectancy around the world would increase by over a year. Life expectancy would increase by almost two years if all human-made emissions were eliminated. 

In addition to smoking, diabetes, and high blood pressure, Münzel said, air pollution should also be considered a risk factor for heart and blood vessel disease.