A new, large-scale global review shows that the effects of air pollution extend to “every organ” and cell in the body, far beyond the respiratory system itself, according to The Independent.

The review was published in the journal Chest, by researchers from the Forum of International Respiratory Societies.

According to the World Health Organization, nine out of ten people worldwide live in areas with high levels of air pollution, constituting a “public health emergency.” This includes fine particulate matter and nitrogen oxides, from cars, factories, and power plants. A study in March showed that air pollution now leads to more deaths than smoking.

According to the researchers:

“Tissue damage may result directly from pollutant toxicity because fine and ultra-fine particles can gain access to organs, or indirectly through systemic inflammatory processes. It can cause, complicate or exacerbate many adverse health conditions.”

When pollution is inhaled, it causes breathing problems like asthma, emphysema, and lung cancer. There is also increasingly overwhelming evidence that it leads to heart attacks, by narrowing the arteries and weakening muscles.

But scientists are only beginning to understand the way the pollution affects the body beyond the heart and lungs, according to The Guardian, and the new review suggests those effects are extensive.

The tiny particles penetrate the lungs and reach other organs. Brain ailments such as strokes, dementia, and even reduced intelligence were also linked to air pollution. The study also found that the liver, which is responsible for filtering out toxins, can be affected by conditions like fatty liver disease. They found increased rates of bladder and gut cancers, as well as irritable bowel syndrome.

Even skin ageing and brittle bones were linked to the breathing of particulate pollution. Fertility was found to be reduced, with an increased incidence of miscarriages as well. When babies are born, they’re more likely to have low birth weights which have lingering effects throughout their lifetime. And children that breathe unsafe air are vulnerable to conditions like stunted lungs, leukemia, mental health problems, and childhood obesity.

The researchers note:

“Although air pollution affects people of all regions, ages and social groups, it is likely to cause greater illness in those with heavy exposure and greater susceptibility. Persons are more vulnerable to air pollution if they have other illnesses or less social support. Air pollution is controllable and, therefore, many of these adverse health effects can be prevented.”

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