Air pollution concentrations have been decreasing in many cities in the developed countries. We have estimated time trends and health effects associated with exposure to NOx, NO2, O3, and PM10 in the Swedish cities of Stockholm, Gothenburg, and Malmo from the 1990's to 2015. Trend analyses of concentrations have been performed by using the Mann-Kendall test and the Theil-Sen method. Measured concentrations are from central monitoring stations representing urban background levels, and they are assumed to indicate changes in long-term exposure to the population. However, corrections for population exposure have been performed for NOx, O3, and PM10 in Stockholm, and for NOx in Gothenburg. For NOx and PM10, the concentrations at the central monitoring stations are shown to overestimate exposure when compared to dispersion model calculations of spatially resolved population-weighted exposure concentrations, while the reverse applies to O3. The trends are very different for the pollutants that are studied; NOx and NO2 have been decreasing in all cities, O3 exhibits an increasing trend in all cities, and for PM10, there is a slowly decreasing trend in Stockholm, a slowly increasing trend in Gothenburg, and no significant trend in Malmo. When the trends are divided into weekdays and weekends, the decreasing trends associated with NOx and NO2 are more prominent during weekdays compared to weekends, indicating that local emission reductions from traffic to a large part have contributed to these declining trends.

Health effects in terms of changes in life expectancy are calculated based on the trends in exposure to NOx, NO2, O3, and PM10, and the relative risks associated with exposure to these pollutants. The decreased levels of NOx are estimated to increase the life expectancy by up to 11 months for Stockholm and 12 months for Gothenburg. This corresponds to up to one fifth of the total increase in life expectancy (54–70 months) in the cities during the period 1990–2015. In contrast to NOx and NO2, the changing trends associated with O3 and PM10 have relatively little impact on the change in life expectancy. NOx and NO2 are highly associated with vehicle exhaust emissions, indicating that decreasing road-traffic emissions have had significant impact on the public health in these cities.