The spatiotemporal trends of PM2.5- and O3-related disease burden coincident with the reduction in air pollution in China between 2005 and 2017

Significant progress has been made in reducing air pollution across China after years of efforts. However, it remains uncertain as to how these changes in pollution have influenced disease burden. Furthermore, only limited data are available with regard to the spatiotemporal patterns of air pollution related disability-adjusted life-years (DALYs) across China. Using multi-parameter and random-forest derived PM2.5 and O3 concentrations from 2005 to 2017 and based on the updated non-linear integrated exposure-response functions (IERs), we estimated the county-level PM2.5- and O3-related DALYs across China and explored the spatiotemporal trends. In 2017, the ambient PM2.5 and O3 were estimated to cause 0.894 million premature deaths and 22.77 million DALYs in China. From 2005 to 2017, the DALYs related to PM2.5 declined across China, especially after 2013, although levels remained high. The DALYs related to O3 are generally increasing, although at a lower rate when compared with PM2.5. Approximately 96.7% of the PM2.5-related DALYs, and 94.8% of the O3-related DALYs, are from the southeast side of the Huhuanyong Line, of the country. The reduction of air pollution in China has led to a significant improvement in health. Higher related DALYs were observed in regions with dense populations and higher concentrations of PM2.5 and O3. Different pollutants and related outcomes are associated with different spatial patterns and change trends. Strict regulatory policies, and coordinated and regional-specific measurements are needed to continually reduce air pollution and mitigate the health burden caused by air pollution in China.