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 µm, PM 2.5 ) 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 PM 2.5 , 55 μg/m 3 ), China Class II standard (35 μg/m 3 ), or World Health Organization standard (10 μg/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 PM 2.5 reduction to Beijing Olympic levels by 2030 would gain ≈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 (992 000 [95% uncertainty interval, 790 000–1 180 000] or 1 827 000 [95% uncertainty interval, 1 481 00–2 129 000] annual life-years gained, respectively) than World Health Organization–recommended goals of 25% improvement in systolic hypertension control and 30% reduction in smoking combined (928 000 [95% uncertainty interval, 830 000–1 033 000] life-years). Conclusions: Air quality improvement in different scenarios could lead to graded health benefits ranging from 241 000 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.