Mortality burden due to long-term exposure to ambient PM2.5 above the new WHO air quality guideline based on 296 cities in China

Objective: Quantifying the spatial and socioeconomic variation of mortality burden attributable to particulate matters with aerodynamic diameter?<=?2.5?mu m (PM2.5) has important implications for pollution control policy. This study aims to examine the regional and socioeconomic disparities in the mortality burden attributable to long-term exposure to ambient PM2.5 in China. Methods: Using data of 296 cities across China from 2015 to 2019, we estimated all-cause mortality (people aged?>=?16?years) attributable to the long-term exposure to ambient PM2.5 above the new WHO air quality guideline (5?mu g/m(3)). Attributed fraction (AF), attributed deaths (AD), attributed mortality rate (AMR) and total value of statistical life lost (VSL) by regional and socioeconomic levels were reported. Results: Over the period of 2015-2019, 17.0% [95% confidence interval (CI): 7.4-25.2] of all-cause mortality were attributable to long-term exposure to ambient PM2.5, corresponding to 1,425.2 thousand deaths (95% CI: 622.4-2,099.6), 103.5/10(5) (95% CI: 44.9-153.3) AMR, and 1006.9 billion USD (95% CI: 439.8-1483.4) total VSL per year. The AMR decreased from 120.5/10(5) (95% CI: 52.9-176.6) to 92.7/10(5) (95% CI:39.9-138.5) from 2015 to 2019. The highest mortality burden was observed in the north region (annual average AF?=?24.2%, 95% CI: 10.8-35.1; annual average AMR?=?137.0/10(5), 95% CI: 60.9-198.5). The highest AD and economic loss were observed in the east region (annual average AD?=?390.0 thousand persons, 95% CI: 170.3-574.6; annual total VSL?=?275.6 billion USD, 95% CI: 120.3-406.0). Highest AMR was in the cities with middle level of GDP per capita (PGDP)/urbanization. The majority of the top ten cities of AF, AMR and VSL were in high and middle PGDP/urbanization regions. Conclusion: There were significant regional and socioeconomic disparities in PM2.5 attributed mortality burden among Chinese cities, suggesting differential mitigation policies are required for different regions in China.