Potential Cardiovascular and Total Mortality Benefits of Air Pollution Control in Urban China

BACKGROUND: Outdoor air pollution ranks fourth among preventable causes of China's burden of disease. We hypothesized that the magnitude of health gains from air quality improvement in urban China could compare with achieving recommended blood pressure or smoking control goals. METHODS: The Cardiovascular Disease Policy Model. China projected coronary heart disease, stroke, and all-cause deaths in urban Chinese adults 35 to 84 years of age from 2017 to 2030 if recent air quality (particulate matter with aerodynamic diameter <= 2.5 mu m, PM2.5) and traditional cardiovascular risk factor trends continue. We projected life-years gained if urban China were to reach 1 of 3 air quality goals: Beijing Olympic Games level (mean PM2.5, 55 mu g/m(3)), China Class II standard (35 mu g/m(3)), or World Health Organization standard (10 mu g/m(3)). We compared projected air pollution reduction control benefits with potential benefits of reaching World Health Organization hypertension and tobacco control goals. RESULTS: Mean PM2.5 reduction to Beijing Olympic levels by 2030 would gain approximate to 241,000 (95% uncertainty interval, 189 000-293 000) life-years annually. Achieving either the China Class II or World Health Organization PM 2.5 standard would yield greater health benefits (992000 [95% uncertainty interval, 790000-1180000] or 1827000 [95% uncertainty interval, 148100-2129000] annual life-years gained, respectively) than World Health Organization-recommended goals of 25% improvement in systolic hypertension control and 30% reduction in smoking combined (928000 [95% uncertainty interval, 830000-1033000] life-years). CONCLUSIONS: Air quality improvement in different scenarios could lead to graded health benefits ranging from 241000 life-years gained to much greater benefits equal to or greater than the combined benefits of 25% improvement in systolic hypertension control and 30% smoking reduction.