Ozone Mortality Burden Changes Driven by Population Aging and Regional Inequity in China in 2013–2050

Air pollution exposure is closely linked to population age and socioeconomic status. Population aging and imbalance in regional economy are thus anticipated to have important implications on ozone (O₃)-related health impacts. Here we provide a driver analysis for O₃ mortality burden due to respiratory disease in China over 2013–2050 driven by population aging and regional inequity. Unexpectedly, we find that population aging is estimated to result in dramatic rises in annual O₃ mortality burden in China; by 56, 101–137, and 298–485 thousand over the periods 2013–2020, 2020–2030, and 2030–2050, respectively. This reflects the exponential rise in baseline mortality rates with increasing age. The aging-induced mortality burden rise in 2030–2050 is surprisingly large, as it is comparable to the net national mortality burden due to O₃ exposure in 2030 (359–399 thousand yr⁻¹). The health impacts of O₃ pollution, shown as mortality burden per capita, are inequitably distributed, with more severe effects in less developed provinces than their developed counterparts by 23.1% and 21.5% in 2019 and 2030, respectively. However, the regional inequity in O₃ mortality burden is expected to be mitigated in 2050. This temporal variation reflects evolving demographic dividend characterized by a larger proportion of younger individuals in developed regions. These findings are critical for targeted improvement of healthcare services to ensure the sustainability of social development.