{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:14:13Z","timestamp":1788444853048,"version":"build-2803163510"},"reference-count":39,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"unspecified","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the burden of household air pollution (HAP) on chronic obstructive pulmonary disease (COPD) and lung cancer in Morocco in 2019 using population attributable fractions (PAFs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Secondary analytical study based on sex-specific PAF estimation combining Moroccan exposure prevalence from a Moroccan population-based survey conducted in 2010\u20132011, pooled relative risks from an international meta-analysis, national disease frequency estimates (for COPD, two prevalence sources were used: 2010\u20132011 observed Moroccan data and 2019 modelling-based estimates), 2019 burden indicators and direct medical costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Morocco.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults aged 40 years and older included in the Burden of Obstructive Lung Disease (BOLD I) survey in Fez, Morocco.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Sex-specific PAFs, attributable COPD and lung cancer cases, disability-adjusted life years (DALYs) and annual direct medical costs attributable to HAP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In Morocco, HAP accounted for 14.4% (95% CI 8.4% to 21.6%) of COPD cases in men and 25.3% (95% CI 17.0% to 34.0%) in women, and for 14.2% (95% CI 7.9% to 21.8%) of lung cancer cases in men and 25.0% (95% CI 16.1% to 34.2%) in women. The estimated number of COPD cases attributable to HAP ranged from 661 717 (95% CI 411 046 to 948 444) using modelling-based prevalence estimates to 815 368 (95% CI 509 160 to 1 163 973) using Moroccan BOLD I prevalence estimates, while 1356 (95% CI 775 to 2041) lung cancer cases were attributable to HAP. Total attributable DALYs were estimated at 62 561.2 (95% CI 37 588.4 to 91 439.2). Total annual direct medical costs attributable to HAP ranged from US$529.9\u2009million (95% CI US$328.9\u2009million to US$760.0\u2009million) to US$651.6\u2009million (95% CI US$406.6\u2009million to US$930.6\u2009million), depending on the COPD prevalence source used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HAP contributes substantially to the respiratory and economic burden in Morocco. These estimates should be interpreted considering the regional source of exposure data and the application of pooled international relative risks to the Moroccan context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110730","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T16:05:31Z","timestamp":1780502731000},"page":"e110730","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Burden of COPD and lung cancer attributable to household air pollution in Morocco: a secondary analysis using population attributable fractions"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2588-532X","authenticated-orcid":false,"given":"Ibtissam","family":"El Harch","sequence":"first","affiliation":[{"name":"Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Epidemiology and Research in Health Sciences Research Laboratory (ERESS), Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Hassan II University Hospital, Fez, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajar","family":"Mahfoudi","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Epidemiology and Research in Health Sciences Research Laboratory (ERESS), Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Hassan II University Hospital, Fez, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soumaya","family":"Benmaamar","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Epidemiology and Research in Health Sciences Research Laboratory (ERESS), Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Hassan II University Hospital, Fez, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil","family":"Tachfouti","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Epidemiology and Research in Health Sciences Research Laboratory (ERESS), Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Hassan II University Hospital, Fez, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karima","family":"El Rhazi","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Epidemiology and Research in Health Sciences Research Laboratory (ERESS), Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, Morocco"},{"name":"Hassan II University Hospital, Fez, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"2026090306262017000_16.6.e110730.1","unstructured":"WHO (World Health Organization) . 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