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To evaluate the spatiotemporal trends and drivers of PM 2.5 -related health effects in Gansu Province since the implementation of the Air Pollution Prevention and Control Action Plan, the latest global exposure mortality model （GEMM） was adopted to estimate the health burden attributable to PM 2.5 in Gansu Province from 2013 to 2020. The factor decomposition method was used to further quantify the main causes of the long-term changes in deaths attributable to PM 2.5 pollution. The results showed that from 2013 to 2020, the population-weighted PM 2.5 concentration in Gansu Province decreased by 34.57%, and the proportion of people exposed to areas with an annual average PM 2.5 concentration exceeding 35 μg·m -3 decreased significantly from 72.89% to 11.61%. Moreover, the number of attributable deaths in Gansu Province declined from 12 826 （95%CI： 7 840-17 408） in 2 013 to 9 814 （95%CI： 6 407-13 036） in 2020, indicating a decrease of 23.48%. Attributable deaths from stroke, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infection declined, whereas deaths from ischemic heart disease increased by 12.11%. Notably, individuals aged 60 years and older accounted for more than 80% of all age-related deaths. The number of deaths attributable to PM 2.5 in central and eastern Gansu Province was significantly higher than that in the Hexi region, and most regions showed a downward trend. The contribution of the total population, age structure, baseline mortality rate, and PM 2.5 concentration to the change in PM 2.5 -related deaths was -1.26%, 16.16%, -9.84%, and -28.55%, respectively. Overall, population aging and a decrease in PM 2.5 concentration were the main factors contributing to the increase and decrease in PM 2.5 -related deaths, respectively. The active clean air policies in Gansu Province have reduced the health burden caused by PM 2.5 pollution, but with the trend of population aging, a significant reduction in PM 2.5 concentration will be needed in the future to avoid more attributable deaths.

To accurately assess the health benefits of the coal-to-electricity policy during the heating period in the Beijing-Tianjin-Hebei(BTH) Region, the premature deaths caused by PM 2.5 before and after the implementation of the coal-to-electricity policy during the heating period in each district and county of the BTH Region were estimated, and the corresponding health loss values were calculated using the willingness to pay method. The results showed that the implementation of the coal-to-electricity policy in the BTH Region brought 1745 cases(95% CI:1443-1907) of health benefits and 2.38 billion yuan(95% CI:1.45-3.06) in economic benefits. In Beijing, Tianjin, and Hebei there were 495 cases(95% CI:436-554), 296 cases(95% CI:238-354), and 954 cases(95% CI:693-1076) of health benefits, respectively. The economic benefits were 0.35 billion yuan(95% CI:0.30-0.39), 0.33 billion yuan(95% CI:0.27-0.40), and 1.70 billion yuan(95% CI:0.88-2.28), respectively, accounting for 0.01%, 0.02%, and 0.04% of GDP in each region. The number of premature deaths due to COPD, LC, ALRI, IHD, and STROKE decreased by 187 cases(95% CI:165-224), 318 cases(95% CI:178-458), 193 cases(95% CI:115-204), 506 cases(95% CI:232-780), and 542 cases(95% CI:463-621), respectively. Areas with relatively high environmental PM 2.5 concentrations and concentrated population-intensive pollution emissions can achieve significant health and economic benefits.

Research on health and the economic losses caused by PM 2.5 pollution nationwide is critical for pollution control planning. First, the spatiotemporal distribution of PM 2.5 and exposure levels were simulated and analyzed using the air quality model (WRF-Chem) in China in 2016. Then, the health burden and economic loss caused by PM 2.5 pollution were estimated using environmental health risk and environmental value assessment methods. Finally, the health and economic benefits from achieving specific PM 2.5 control targets were estimated. In 2016 in China, high levels of PM 2.5 were concentrated in Beijing-Tianjin-Hebei and the surrounding areas, the Yangtze River Delta, the Sichuan Basin, and the desert areas in northwest China. Furthermore, 71.49% of the total population of China was exposed to an environment with PM 2.5 concentrations higher than 35 μg·m -3 . Subsequently, the national PM 2.5 -related mortality was 1.06 million, accounting for 10.9% of the total deaths in China. Stroke and ischemic heart disease accounted for approximately 80% of the total PM 2.5 -related deaths caused by the five diseases studied. Meanwhile, the PM 2.5 pollution resulted in economic losses of 705.93 billion yuan, which was 0.95% of the Gross Domestic Product (GDP) in 2016. There were significant spatial differences in the health burden and economic loss, which primarily occurred in regions with high PM 2.5 levels or population density. Moreover, reducing PM 2.5 to 35 μg·m -3 would only result in a 17.11% reduction in the health burden and economic loss, while a more exacting standard (reducing PM 2.5 to 10 μg·m -3 ) would bring 80.47% of the health and economic benefits. It is suggested that environmental managers further strengthen their control to better protect the health and wealth benefits of residents, especially for sensitive groups, such as patients with cardio-cerebrovascular diseases, particularly in areas with high premature mortality.

Objective: To explore the trends and distribution of premature mortality caused by four main non-communicable diseases (NCDs) including cardiovascular and cerebrovascular diseases, cancer, chronic respiratory disease and diabetes in different sex and residential areas in Tianjin so as to provide basis for setting up prevention and control programs on premature mortality. Methods: Population data on premature mortality in 1999-2015 were from the 'Tianjin population based mortality surveillance system' maintained by Tianjin Centers for Disease Control and Prevention (CDC). Data related to permanent residents was from the Tianjin Municipal Public Security Bureau. Standardized premature mortality rates were calculated and adjusted for age and gender according to the '2000 world standard population'. Premature mortality probabilities were analyzed according to the methods recommended by WHO. Joinpoint regression and Cochran-Armitage trend methods were used to determine the significance of differences on the trends of mortality. Results: From 1999 to 2015, the premature mortality appeared consistent ( P <0.001) declining in the above-said four diseases with the APC of probabilities as-2.92%, -1.13%, -9.51% and -3.39%, respectively. The probabilities of premature mortality were all declining consistently in both men and women and in both urban and rural areas in Tianjin. From 1999 to 2015, the probabilities of the four main NCDs were between 19.67% and 12.85% (APC=-2.49%, P <0.001), higher in women (from 17.02% to 9.17%, APC=-3.84%, P <0.001) than that in men (from 22.27% to 16.47%, APC=-1.59%, P <0.001), in urban (from 21.04% to 12.34%, APC=-3.26%, P <0.001) than that in rural areas (from 17.80% to 13.54%, APC=-1.54%, P <0.001). Conclusion: Our findings suggested that premature mortality in Tianjin was decreasing during 1999-2015 but attention should still be called for on males and people living in the rural areas to further reducing the premature mortality.