Inequality in PM2.5 Exposure and Health burden attributable in China

PM2.5 pollution poses significant health risks in China, with over one million premature deaths annually. Although major air quality regulations were enacted in 2013 and substantial progress has been made, the equitable distribution of health benefits remains uncertain. This study uses epidemiological modeling and inequality decomposition to assess PM2.5-related health burden disparities in China from 2000 to 2019. Results show that premature deaths decreased by 85,500 (95% CI: 81,300–89,700) after 2013, with population growth, mortality rates, and aging contributing increases of 5.0%, 7.2%, and 8.3%, respectively, while PM2.5 reduction led to a 25.1% decrease. However, the Gini coefficient for health burden disparities rose by 19.7%, indicating an increasing concentration of health risks in certain regions and populations. Provincial and urban disparities contributed 78.9% and 88.3% of this inequality. Targeted policy interventions are urgently needed to ensure that future air quality improvements yield more equitable health outcomes across China.