PM2.5-related premature deaths and potential health benefits of controlled air quality in 34 provincial cities of China during 2001–2017

The influence of fine particulate matter (PM_2.5) pollution on human health in densely populated cities has increased with rapid urbanization and industrialization, posing threats to human health, and leading to premature deaths. Using the Global Burden of Disease (GBD) method, satellite-retrieved PM_2.5 concentrations, population, and city- or provincial-level baseline mortality data, this study established a long-term dataset of PM_2.5-related premature deaths: chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), lung cancer (LNC), acute lower respiratory infection (LRI), and stroke (STR) caused by PM_2.5 in 34 provincial capitals of China based on city- or provincial-level baseline mortality and population data. The total number of annual premature deaths during 2001–2017 was 321,672 (95% confidence interval (CI): 225,345-456,814). Chongqing (37,235 (95% CI: 26,023-52,841)) was the greatest contributor to the total premature deaths attributable to PM_2.5 among all cities, followed by Beijing, Chengdu, and Harbin. STR, IHD, COPD, LNC, and LRI accounted for 51, 30, 9, 6, and 3% of the total deaths, respectively. Based on air quality guidelines (AQG) and interim targets (ITs) published by the World Health Organization, four scenarios were explored for each disease and each city during 2001–2017 to explore the impact of PM_2.5 mitigation measures on premature deaths. As a result, scenarios based on AQG (10 μg/m³), IT-3 (15 μg/m³), IT-2 (25 μg/m³), and IT-1 (35 μg/m³) caused 74.3, 55.2, 32.5, and 16.5% reductions, respectively, relative to the total reference premature deaths (321,672) estimated using the original PM_2.5 concentration. In this study, uncertainties in health burden assessments were reduced using sub-national baseline mortality rates rather than national mortality rates. These data provide a reference for provincial and municipal decision makers to improve air quality and related human health.