Increase in economic losses despite a decline in fine particulate matter-related mortality reveals deepening inequality in China

Despite substantial reductions in ambient particulate matter with a diameter of 2.5 µm or less (PM2.5) concentrations across China since the Air Pollution Prevention Plan began in 2013, the associated health and economic burdens remain unevenly distributed, reinforcing structural inequalities. Here, we quantify PM2.5-attributable mortality and economic losses from 2005 to 2020 using an age- and region-specific value of statistical life, and construct a pollution-adjusted income index to assess real income erosion. Mortality rates declined by 7.51%, but economic losses surged more than fivefold to 1.931 trillion Chinese Yuan in 2020, driven by rising life valuation and persistent exposure. National income improved, yet gains were uneven; less-developed regions experienced limited net progress as environmental costs eroded constrained incomes. Including these costs reveals higher inequality in real income, underscoring the need to integrate environmental externalities into welfare assessments and prioritize mitigation in vulnerable regions for just and inclusive sustainability. In China, fine particulate matter mortality rates dropped, and economic losses increased from 2005 to 2020, due to the higher value placed on life and ongoing exposure to pollution, according to an analysis that uses emission concentration, health, and economic data.