Divergent trends and regional disparities in PM2.5 and O3 health economic burdens in China, 2013–2023: an integrated assessment with policy implications

Utilizing China's air quality monitoring data from 2013 to 2023, this study employs spatial autocorrelation analysis and health impact assessment methodologies to quantify the health economic costs and temporal trends of PM_2.5 and O₃ pollution across mainland China. Results indicate a substantial decline in PM_2.5-attributable mortality over the study period. With 0 and 15 μg/m³ taken as the reference concentrations, all-cause mortality decreased by 47.41% (233,173 cases) and 65.55% (240,448 cases), respectively. Cardiovascular disease mortality declined by 47.71% (56,086 cases) and 65.75% (57,504 cases), while respiratory disease mortality reduced by 46.97% (38,519 cases) and 65.27% (40,055 cases). Conversely, O₃-related mortality exhibited a significant upward trend. At reference concentrations of 0 and 60 μg/m³, all-cause mortality increased by 24.25% (365,084 cases) and 79.70% (372,724 cases), respectively. Cardiovascular mortality rose by 25.43% (80,056 cases) and 81.52% (77,497 cases), and respiratory mortality increased by 15.46% (98,620 cases) and 64.54% (163,165 cases). Spatially, health economic costs and their GDP proportions for both pollutants followed a high distribution in the east and a low distribution in the west. Shandong, Henan and Jiangsu were the top regions for PM_2.5-related economic costs, with Henan, Hebei and Tianjin exhibiting the highest GDP ratios. For O₃, Guangdong, Jiangsu and Shandong incurred the greatest economic costs, while Henan, Hebei and Gansu showed the highest GDP proportions. These findings underscore the divergent trends in PM_2.5 and O₃ health impacts and provide critical evidence for targeted air pollution control strategies in China.