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Urbanization has been considered a driver of PM 2.5 pollution and the attributed health burden. This study systematically measured the spatiotemporal and urban-rural heterogeneity of PM 2.5 -attributed health burden drivers, including income, population, baseline mortality rate, and PM 2.5 level. The results reveal the significantly positive contribution of disposable income and the periodical and urban-rural differentiation of population contribution to PM 2.5 -attributed health burden. The difference in driver performance due to socioeconomic development and urbanization stages might be an important determinant for different or even opposite results of previous studies. Policymaking for mitigating PM 2.5 -attributed health risk could incorporate the re-assessment and driver determination for PM 2.5 -attributed health burden into the construction and development plan from the overall urbanization perspective. The urbanization-perspective driver decomposition could be synergized with the flow analysis, equality evaluation, and policy benefit estimation to achieve further direction-determining and quantitative assessment of the urban-rural PM 2.5 health risk management strategies. • We decomposed the urbanization drivers of PM 2.5 health burden in China 2008–2021. • Drivers were determined as population, baseline mortality rate, income, and PM 2.5. • New driver disposable income showed significant driving influence. • Urban-rural heterogeneity of the drivers was presented during urbanization. [ABSTRACT FROM AUTHOR]