Air quality targets and projected health and economic benefits in China: a modelling study (Preprint)

<sec> <title>BACKGROUND</title> Air pollution continues to pose a significant health and economic burden in China, with PM2.5 concentrations remaining six times above WHO guidelines despite recent progress. </sec> <sec> <title>OBJECTIVE</title> This modelling study evaluates the projected health and economic benefits of reducing national PM2.5 levels. </sec> <sec> <title>METHODS</title> Using 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 from non-communicable diseases (NCD), lower respiratory infections (LRI), stroke, ischaemic heart disease (IHD), lung cancer (LC), and chronic obstructive pulmonary disease (COPD) was estimated using the Global Exposure Mortality Model (GEMM). Hospitalisations were modelled using log-linear functions based on national epidemiological data. </sec> <sec> <title>RESULTS</title> We estimated an average annual reduction of 179,274 in PM2.5-attributable premature deaths across 337 cities. This included 54,726 deaths from IHD, 63,680 from stroke, 15,437 from COPD, 4,968 from LRI, and 24,485 from LC. Annual average reductions in hospitalisations were estimated at 47,967 cases, including 21,423 cases for cardiovascular disease (CVD) and 26,544 cases for respiratory diseases. Subsequently, economic benefits from reductions in mortality and morbidity across 337 cities amounted to $87.5 billion USD. Achieving the 15, 10, and 5 µg/m³ targets is projected to increase annual premature death reductions to 376,863, 489,528, and 626,157, respectively, with corresponding hospitalisation decreases of 93,371, 116,217, and 139,219 cases per year. These reductions would yield increased annual economic benefits of $185.7 billion, $240.7 billion, and $306.5 billion USD, respectively. </sec> <sec> <title>CONCLUSIONS</title> 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. </sec>