Urban air pollution has emerged as one of the most critical environmental and public health challenges in rapidly developing economies. Indian metropolitan cities experience consistently high levels of particulate matter, nitrogen oxides, sulfur dioxide, and ground-level ozone due to vehicular emissions, industrial activity, construction, and energy generation. Prolonged exposure to polluted air has been linked to respiratory diseases, cardiovascular disorders, reduced life expectancy, and declining quality of life. This study investigates the long-term health impacts of urban air pollution in selected Indian metropolitan cities using empirical data and statistical analysis. Primary health perception data were collected from urban residents, while secondary air quality data were sourced from national monitoring agencies. The study examines the relationship between air pollution exposure and chronic health outcomes such as asthma, bronchitis, hypertension, and reduced lung capacity. Findings indicate a strong association between prolonged exposure to high pollution levels and adverse health outcomes, emphasizing the urgent need for integrated urban environmental management and public health interventions.