Indonesia’s air quality has deteriorated from among the cleanest in the world to one of the most polluted over the past two decades, shaving five years from life expectancy in some regions, researchers say. The study by the Energy Policy Institute at the University of Chicago says an increase in coal-fired power stations, burning of land for plantation agriculture and rising car ownership is responsible for the worsening pollution in the world’s fourth-most populous country.

The greatest spike happened in the last few years with air pollution more than doubling between 2013 and 2016, it said. The burden on public health has become one of the highest in the world, behind only India, China, Bangladesh and Pakistan.

“High air pollution is now undermining Indonesians’ health,” said researchers Michael Greenstone and Qing Fan. “In 1998, air pollution barely impacted the life expectancy of Indonesians. In fact, even in 2013, it shaved only a few months off of average life expectancy.”

According to the researchers, sustained high concentrations of particulate matter in the air people breath will cut 2.3 years from lifespans in the capital, Jakarta. On the islands of Sumatra and Borneo, both of which suffer land fires every year, the expected reduction in lifespans is four years on average.

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