Exploring China’s Clean Air Act and associated cardiovascular disease risk: a prospective, quasi-experimental, and causal inference modelling study

BACKGROUND: Substantial improvements in air quality have been recorded following the implementation of China's Clean Air Act (CCAA) in 2013. However, the association between CCAA implementation and individual-level cardiovascular disease (CVD) risk remains unclear. We aimed to examine the long-term association between CCAA implementation and individual-level predicted CVD risk. METHODS: and predicted risk after CCAA implementation was analysed using a linear model. The estimated risk differences associated with air pollutant changes were estimated based on the magnitude of changes and their corresponding effect sizes. FINDINGS: concentration with a 0·58 (0·33-0·83) percentage point change. Overall, the observed changes in air pollutants during the study period were associated with an average 6·6 percentage point reduction in predicted CVD risk. INTERPRETATION: The CCAA and improved air quality were associated with a slower increase in predicted CVD risk, supporting the necessity for stricter, multipollutant air quality policies to maximise public health benefits. FUNDING: National Natural Science Foundation of China, Kadoorie Charitable Foundation, Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Key R&D Program of China, Chinese Ministry of Science and Technology, and UK Wellcome Trust.

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Publication Details

Journal
The Lancet Planetary Health
Published
2026-09-01
DOI
https://doi.org/10.1016/j.lanplh.2026.101513
Primary Topic
Air Quality and Health Impacts
Type
article
Field-Weighted Citation Impact
0.00

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article

Exploring China’s Clean Air Act and associated cardiovascular disease risk: a prospective, quasi-experimental, and causal inference modelling study

Iain Turnbull, Sam Morris, Huiming Luo, Jingcen Hu et al.
The Lancet Planetary Health
Air Quality and Health Impacts
article

Exploring China’s Clean Air Act and associated cardiovascular disease risk: a prospective, quasi-experimental, and causal inference modelling study

Iain Turnbull, Sam Morris, Huiming Luo, Jingcen Hu, Haidong Kan, Ling Yang, Andri Iona, Pek Kei Im, Kshitij Kolhe, Dianjianyi Sun, Johnathan Clarke, Canqing Yu, Maryam Rahmati, Alfred Pozarickij, Pang Yao, Hannah Fry, Christiana Kartsonaki, Ka Hung Chan, Ruth Boxall, Baihan Wang, Jun Lv, Ranran Du, Zhenyuan Wu, Neil Wright, Huaidong Du, Yuanjie Pang, Ahmed Edris Mohamed, Yiping Chen, Liming Li, Zhengming Chen, Xiaoming Cui, Maxim Barnard, Junshi Chen, Qingmei Xia, Shichun Yan, Dong Sun, Simon Gilbert, Daniel Avery, Becky Stevens, Dan Schmidt, Honglu Bian, Zhaoxi Pang, Lishun Zhai, Maria Kakkoura, Derrick Bennett, James Liu, Lang Pan, Shiwen Dong, Hubert Lam, Iona Millwood, Robert Clarke, Chi Wang, Mohsen Mazidi, Rory Collins, Robin Walters, Shaojie Wang, Zengchang Pang, Lin Wang, Hua Zhang, Chao Liu, Yongmei Liu, Haiping Duan, Qunhua Nie, Richard Peto, Xia Meng, Xiaoming Yang, Charlotte Clarke, Bin He, Xiaocao Tian, Jinyan Chen, Ruqin Gao, Liang Cheng, Xiao Han, Paul Ryder, Xiaofang Chen, Yujie Wang, Kuang Lin, Shanpeng Li, Dan Hu, Can Hou, Xiaoyan Zheng, Xinxin Chen, Wei Sun, Pei Pei
article en

Abstract

BACKGROUND: Substantial improvements in air quality have been recorded following the implementation of China's Clean Air Act (CCAA) in 2013. However, the association between CCAA implementation and individual-level cardiovascular disease (CVD) risk remains unclear. We aimed to examine the long-term association between CCAA implementation and individual-level predicted CVD risk. METHODS: and predicted risk after CCAA implementation was analysed using a linear model. The estimated risk differences associated with air pollutant changes were estimated based on the magnitude of changes and their corresponding effect sizes. FINDINGS: concentration with a 0·58 (0·33-0·83) percentage point change. Overall, the observed changes in air pollutants during the study period were associated with an average 6·6 percentage point reduction in predicted CVD risk. INTERPRETATION: The CCAA and improved air quality were associated with a slower increase in predicted CVD risk, supporting the necessity for stricter, multipollutant air quality policies to maximise public health benefits. FUNDING: National Natural Science Foundation of China, Kadoorie Charitable Foundation, Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Key R&D Program of China, Chinese Ministry of Science and Technology, and UK Wellcome Trust.

The Lancet Planetary Health
Peking University (CN), Chengdu Medical College (CN), Fudan University (CN), University of Oxford (GB), Ministry of Education (RO), China National Center for Food Safety Risk Assessment (CN)
Wellcome Trust, National Natural Science Foundation of China, Kadoorie Charitable Foundation
Industry, innovation and infrastructure
Openalex Percentile: Top 13%
Air Quality and Health Impacts
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