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The world’s 100 worst polluted cities are in Asia — and 83 of them are in just one country

Hong Kong (CNN )—  All but one of the 100 cities with the world’s worst air pollution last year were in Asia, according to a new report, with the climate crisis playing a pivotal role in bad air quality that is risking the health of billions of people worldwide.

The vast majority of these cities — 83 — were in India and all exceeded the World Health Organization’s air quality guidelines by more than 10 times, according to the report by IQAir, which tracks air quality worldwide.

The study looked specifically at fine particulate matter, or PM2.5, which is the tiniest pollutant but also the most dangerous. Only 9% of more than 7,800 cities analyzed globally recorded air quality that met WHO’s standard, which says average annual levels of PM2.5 should not exceed 5 micrograms per cubic meter.

“We see that in every part of our lives that air pollution has an impact,” said IQAir Global CEO Frank Hammes. “And it typically, in some of the most polluted countries, is likely shaving off anywhere between three to six years of people’s lives. And then before that will lead to many years of suffering that are entirely preventable if there’s better air quality.”

When inhaled, PM2.5 travels deep into lung tissue where it can enter the bloodstream. It comes from sources like the combustion of fossil fuels, dust storms and wildfires, and has been linked to asthma, heart and lung disease, cancer, and other respiratory illnesses, as well as cognitive impairment in children.

Begusarai, a city of half a million people in northern India’s Bihar state, was the world’s most polluted city last year with an average annual PM2.5 concentration of 118.9 — 23 times the WHO guidelines. It was followed in the IQAir rankings by the Indian cities of Guwahati, Assam; Delhi; and Mullanpur, Punjab.

Across India, 1.3 billion people, or 96% of the population, live with air quality seven times higher than WHO guidelines, according to the report.

Central and South Asia were the worst performing regions globally, home to all four of the most polluted countries last year: Bangladesh, Pakistan, India and Tajikistan.

South Asia is of particular concern, with 29 of the 30 most polluted cities in India, Pakistan or Bangladesh. The report ranked the major population centers of Lahore in 5th, New Delhi in 6th and Dhaka in 24th place.

Hammes said no significant improvement in pollution levels in the region is likely without “major changes in terms of the energy infrastructure and agricultural practices.”

“What’s also worrisome in many parts of the world is that the things that are causing outdoor air pollution are also sometimes the things that are causing indoor air pollution,” he added. “So cooking with dirty fuel will create indoor exposures that could be many times what you’re seeing outdoors.”