Projected Health and Economic Benefits of Air Quality Targets in China: Modeling Study.

Background: Air pollution continues to impose a substantial health and economic burden in China. Despite recent improvements, national annual average PM2.5 (fine particulate matter) concentrations remain substantially above the levels deemed safe by the World Health Organization (WHO), underscoring the need for more stringent air quality control. Objective: This study aims to quantify the projected health and economic benefits of reducing PM2.5 concentrations in China under the Healthy China 2030 plan. Methods: Using the 2020 ground-level PM2.5 data as a baseline, we projected cause-specific mortality and morbidity outcomes for 337 prefecture-level cities in China from 2020 to 2030 under four policy scenarios: (1) Healthy China 2030 (10% reduction by 2025; 25 µg/m³ by 2030) and the WHO targets of (2) 15 µg/m³, (3) 10 µg/m³, and (4) 5 µg/m³ by 2030. Mortality for noncommunicable diseases, lower respiratory infections, stroke, ischemic heart disease, lung cancer, and chronic obstructive pulmonary disease was estimated using the Global Exposure Mortality Model. Hospitalizations were modeled using log-linear models based on national evidence. Results: In 2020, PM2.5 concentrations across the 337 cities ranged from 7 to 63 µg/m³, with a national annual mean of 32.6 µg/m³. Higher concentration levels were observed in eastern China, particularly in the eastern and southeastern regions. Overall, our analysis accounted for nearly 70% of the total population of China in 2020. Our analysis shows that maintaining PM2.5 at 2020 levels was projected to result in 9.04 million (95% CI 7.70-10.67 million) attributable deaths, compared with 8.63 million (95% CI 7.42-10.30 million) under the policy scenario, corresponding to 0.41 million premature deaths averted under the 14th Five-Year Clean Air Plan. Over 2021-2030, PM2.5-attributable deaths declined from 17.76 million (95% CI 14.21-20.95 million) under baseline conditions to 15.96 million (95% CI 12.85-19.15 million) under the policy scenario. Achieving WHO targets would further reduce attributable deaths to 13.99 million (95% CI 11.25-15.25 million) at 15 µg/m³, 12.86 million (95% CI 10.85-14.85 million) at 10 µg/m³, and 11.49 million (95% CI 8.96-13.45 million) at 5 µg/m³. The annual average hospitalizations declined by 21,422 cardiovascular and 26,545 respiratory admissions under the policy scenario, increasing to 41,690 and 51,681 at 15 µg/m³, 51,884 and 64,333 at 10 µg/m³, and 62,146 and 77,073 at 5 µg/m³, respectively. Subsequently, total economic gains reached US $123.7 billion under the policy scenario and increased to US $185.7 billion, US $240.7 billion, and US $306.5 billion under the 15, 10, and 5 µg/m³ scenarios, respectively. Conclusions: Our findings suggest that while the Healthy China 2030 Plan offered substantial health gains, achieving stricter WHO air quality targets could yield 2-3 times greater benefits. These findings will support the future development of stricter evidence-based national air quality standards.