Ambient air pollution and premature mortality from noncommunicable diseases in India using sustainable development goal indicators

India faces an ongoing challenge of ambient air pollution, leading to rising early deaths from non-communicable diseases. Fine particulate matter is a major environmental risk factor for cardiovascular disease, cancer, respiratory disease, and diabetes. However, a national-level time-series study linking long-term particulate exposure to premature mortality in India remains scarce. To examine trends in particulate matter exposure and premature deaths due to major non-communicable diseases in India and to assess their temporal association between 1990 and 2019. An ecological time-series study analysed global health data for trends in particulate matter exposure and premature deaths from noncommunicable diseases. Correlation and regression models examined associations, controlling for non-stationarity and autocorrelation using a socioeconomic index. Differenced and autoregressive distributed lag models were used to evaluate short- and long-term relationships. Particulate matter exposure in India exceeded guidelines throughout the study. Premature deaths from non-communicable diseases increased, primarily from cardiovascular conditions, with diabetes and cancer rising fastest. PM 2.5 exposure showed moderate correlation with early mortality ( r = 0.475, p = 0.008). While immediate PM 2.5 -mortality correlations were insignificant after controlling for socioeconomic factors, analysis revealed significant effects two years post-exposure, though without confirming long-term relationships. Short-term particulate matter exposure did not directly explain premature mortality after accounting for socioeconomic conditions. Results show PM 2.5 exposure correlates with delayed increases in mortality. Mortality in India is influenced by demographic, socioeconomic and environmental factors. Reducing premature deaths requires both improvements in air quality and socioeconomic interventions.