Trends and projections of PM2.5-attributable disease burden in China: a GBD 2021-based analysis

TL;DR

This study analyzes how PM2.5 pollution has affected health in China from 1990 to 2021 and predicts future trends.

Contribution

The study provides new projections of PM2.5-related disease burden in China using advanced statistical models.

Findings

PM2.5 exposure caused 2.27 million deaths and 46.68 million DALYs in China in 2021.

Ambient PM2.5 became the dominant source of disease burden by 2021.

Bayesian projections suggest continued decline in PM2.5 burdens through 2036.

Abstract

Fine particulate matter (PM2.5) remains a major environmental health risk in China. This study aimed to comprehensively characterize the long-term trends and epidemiological patterns of PM2.5-attributable disease burden across the country.

Using data from the Global Burden of Disease (GBD) 2021, we performed a longitudinal analysis of PM2.5 disease burden from 1990 to 2021. Joinpoint regression was employed to calculate the average annual percentage change (AAPC) in age-standardized rates. The age-period-cohort model was employed to stratify the impact of age, periods, and birth cohorts on disease burden. Finally, the Bayesian age-period-cohort (BAPC) analysis was used to project trends for the period 2022–2036.

In 2021, PM2.5 exposure was responsible for an estimated 2.27 million deaths and 46.68 million disability-adjusted life years (DALYs) in China. Compared to 1990, the age-standardized mortality rate declined to 125 per 100,000 (AAPC = −3.62, net drift = −4.19), while the DALY rate fell to 2,437 per 100,000 (AAPC = −3.93, net drift = −3.87). The disease burden from ambient PM2.5 increased substantially and became the dominant source by 2021, whereas that from household PM2.5 decreased markedly. Overall, males experienced a higher disease burden than females. Notably, the 30–34 age group showed rising trends in ambient PM2.5 burden, while children under five and older adults remained the most vulnerable groups. Bayesian projections indicate that total and ambient PM2.5 burdens may continue to decline through 2036, although household PM2.5 could rebound slightly.

Although substantial improvements in air quality have been achieved, pronounced disparities persist between PM2.5 sources and population subgroups. Strengthening targeted and equitable public health interventions remains essential to sustain progress and reduce the unequal health risks associated with PM2.5 exposure in China.

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