National and provincial burden of disease attributable to fine particulate matter air pollution in China, 1990–2021: an analysis of data from the Global Burden of Disease Study 2021

Fine particulate matter (PM2·5) is the leading environmental risk factor for mortality and disability worldwide. We aimed to evaluate the temporal trend in, and spatial distribution of, the disease burden attributable to PM2·5 in China from 1990 to 2021. Based on the methodology framework and general analytical strategies applied in the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we calculated the numbers, age-standardised rates, and percentage of deaths and disability-adjusted life-years (DALYs) attributable to PM2·5 air pollution from 1990 to 2021 at the national and provincial level in China, by disease, sex, and age groups. Exposure to PM2·5, including ambient PM2·5 pollution and household PM2·5 pollution from solid fuels, was evaluated across 33 provincial administrative units in China. In 2021, 2·3 million (95% uncertainty interval [UI] 1·8-2·9) deaths and 46·7 million (36·6-59·7) DALYs could be attributable to PM2·5 pollution in China, accounting for 19·4% (16·0-23·6) of total deaths and 11·6% (9·4-14·1) of total DALYs. Of these, 1·9 million (95% UI 1·3-2·3) deaths and 37·8 million (26·3-46·5) DALYs resulted from ambient exposure, while 0·4 million (0·1-1·3) deaths and 8·9 million (1·5-27·8) DALYs were due to household exposure from solid fuel use. Stroke, ischaemic heart disease, and chronic obstructive pulmonary disease were the leading three causes. Two peaks in the burden were observed: in children aged younger than 5 years, and in people aged 70 years and older. The percentage of deaths and DALYs due to ambient PM2·5 was higher in men, while that due to household PM2·5 was higher in women. Geographically, the disease burden from ambient PM2·5 was higher in north and northwest China, while that from household PM2·5 was higher in southwest China. From 1990 to 2021, age-standardised death rates attributable to total PM2·5 decreased by 66·0% (95% UI 57·7-73·1) and those attributable to household PM2·5 decreased by 92·2% (76·6-98·7), with larger reductions observed in east and south China. By contrast, the disease burden related to ambient PM2·5 continued to increase and only began to decline in the past decade. Despite the decline in the disease burden attributable to total PM2·5 in China during 1990-2021, ambient PM2·5 remains a major contributor to mortality and disability. This study highlights considerable spatial heterogeneity across different provinces and provides valuable insights for developing geographically tailored strategies for PM2·5 control and public health promotion in China. Stricter control of ambient air pollution is needed in northern and northwestern regions, while promoting clean cooking energy is more urgently warranted in southwestern areas. National Natural Science Foundation of China, National Key Research and Development Program of China, Shanghai Municipal Science and Technology Major Project, China Postdoctoral Science Foundation.