Health Impacts of Ambient PM2.5 Pollution in China: Historical Trends and Future Projections

Abstract

China's rapid industrialization and urbanization have led to some of the worst air pollution in the world, with fine particulate matter (PM2.5) posing serious threats to population health. Over the past two decades, China has applied stringent air pollution control measures and policies to enhance air quality and has also committed to ambitious climate goals, such as peaking carbon emissions by 2030 and achieving net zero emissions by 2060. However, China's large and aging population, coal-dominated energy structure, and manufacturing-driven economic structure pose significant challenges to future air quality improvements.

Against this background, this thesis has assessed historical trends of PM2.5 attributable mortality in China, explored the impact of population aging on attributable mortality, and projected future PM2.5 attributable health and economic burden under various scenarios, integrating China's carbon emission targets with clean air policies. The thesis contains three major studies: The first study provided a comprehensive assessment of historical trends in mortality attributable to ambient PM2.5 exposure in China. It incorporated the newly developed Fusion relative risk model with updated cause-specific baseline mortality rates from the Global Burden of Disease (GBD) 2021 study, offering a more accurate evaluation of PM2.5 related mortality and highlighting significant regional disparities. The second study assessed China's age- and cause- specific mortality from PM2.5 based on high-resolution demographic data and adopted a decomposition method to assess the impact of different underlying factors that influence the trends in PM2.5 related mortality in the past and future, with a focus on population aging. The third study projected future PM2.5 related mortality and years of life lost (YLL) across 31 provinces in China from 2020 to 2060, under four scenarios combining local air pollution control with different climate policies. This study further evaluated health costs using two metrics - value of a statistical life (VSL) and value per statistical life year (VSLY).

The findings of this thesis offer critical implications for policymaking in China and provide broader lessons for countries facing similar challenges of addressing air pollution and related health impacts amid rapid urbanization, economic growth, population aging, and the pursuit of ambitious climate goals.