Huang, WenzhongLi, TiantianMasselot, PierreXu, RongbinGasparrini, AntonioSera, FrancescoBell, Michelle L.Hashizume, MasahiroBreitner, SusanneTong, ShiluKan, HaidongYang, ZhengyuZhang, YiwenYu, WenhuaYu, PeiZhou, ShuangSun, QinghuaZhang, JingweiLavigne, EricMadureira, JoanaGuo, Yue LeonGaio, VâniaLi, ShanshanGuo, YumingMCC Collaborative Research Network2026-01-162026-01-162025-10One Earth. 2025 Nov;8(11):101488. doi: 10.1016/j.oneear.2025.101488. Epub 2025 Oct 142590-3330http://hdl.handle.net/10400.18/10708Ambient air pollutants are leading contributors to global mortality. Despite the well-established risks, most studies have relied on single-pollutant models in limited regions, leaving the combined effects and individual contributions of pollutants unclear, particularly across countries. Here, we integrate daily mortality and air pollutant (nitrogen dioxide [NO], ozone [O], fine particulate matter, and sulfur dioxide) data from 482 cities in 12 countries/territories from 1998 to 2021 to assess the joint mortality risks and identify the main contributing pollutant through an air quality health index of multi-pollutant constrained groupwise additive models (AQHI-Multi). AQHI-Multi outperformed commonly used air quality indices in capturing the overall mortality risks. O and NO were the leading contributors (accounting for over 70% across countries/territories), with O's share increasing slightly to moderately in most countries/territories. These findings highlight the need for developing air quality indices using advanced multi-pollutant models and the emerging global significance of targeted control of O and NO.Highlights - An advanced multi-pollutant model-based air quality health index was developed. -The index outperforms current indices in capturing acute mortality of air pollution. - O3 and NO2 are the main pollutants driving the risk index across regions. - O3 shows rising contributions to the index in most studied countries/territories.engAir-PollutionAir QualityMortalityDeterminantes da Saúde e da DoençaAvaliação do Riscojournal article10.1016/j.oneear.2025.1014882590-332241362416