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• Estimates of PM 2.5 concentrations in 2030 declined compared with 2015. • If the age structure maintains, PM 2.5 -related premature death in 2030 related to 2015 decreased. • With the population aging, PM 2.5 -related premature death would sharply increase in 2030. Fine particulate matter (PM 2.5) pollution is one of the most critical environmental and public health problems in China and has caused an enormous disease burden, especially long-term PM 2.5 exposure. Global climate change represents another environmental challenge in the coming decades and is also an essential factor affecting PM 2.5 pollution. Moreover, China has an aging population with a changing population size and falling age-standardized mortality rates. However, little evidence exists evaluating the potential impacts from climate change and population aging on the long-term PM 2.5 exposure-related disease burden. This study quantifies the impacts of climate and population changes on changes in the disease burden attributed to long-term PM 2.5 exposure from 2015 to 2030 in mainland China, which could add evidence for the revision of relevant environmental standards and health policies. This modeling study investigated long-term PM 2.5 exposure-related mortality across China based on PM 2.5 projections under Intergovernmental Panel on Climate Change Representative Concentration Pathways (RCPs) and population scenarios from shared socioeconomic pathways (SSPs). PM 2.5 concentrations were simulated by the Weather Research and Forecasting (WRF) and Community Multiscale Air Quality (CMAQ) modeling systems. In addition, three types of population projections in 2030 relative to 2015 were set up as follows: (i) the population remained the same as that in 2015; (ii) the population size changed under SSPs, but the age structure remained the same; (iii) both the population size and age structure changed under SSPs. The global exposure mortality model (GEMM) was adopted to estimate PM 2.5 -related premature deaths. Ambient PM 2.5 concentrations decreased from 2015 to 2030 under the two climate and emission scenarios. Estimates of related premature mortality in 2030 declined compared with that in 2015 due to lower PM 2.5 concentrations (RCP4.5: −16.8%; RCP8.5: −16.4%). If the age structure of the population remained unchanged and the population size changed under SSPs, the nonaccidental premature mortality also showed a decrease ranging from −18.6% to −14.9%. When both population size and age structure changed under SSPs, the population in China would become older. Nonaccidental premature mortality would sharply increase by 35.7–52.3% (with a net increase of 666–977 thousand) in 2030. The PM 2.5 pollution in 2030 under both RCP4.5 and RCP8.5 would slightly improve. The population sizes in 2030 projected by SSPs are relatively stable compared with that in 2015. However, the modest decrease due to air pollution improvement and stable population size would be offset by population aging. [ABSTRACT FROM AUTHOR]

Existing studies focused on the evaluation of health burden of long-term exposure to air pollutants, whereas limited information is available on short-term exposure, particularly in China. Air pollutant concentrations in 338 Chinese cities in 2017 were used to estimate the air pollutants related health burden which was defined as premature mortalities from all-cause, cardiovascular and respiratory disease as well as hospital admissions for cardiovascular and respiratory disease. Log-linear model was used as the exposure-response function to estimate the health burden attributable to each air pollutant. The value of statistical life and cost of illness methods were used to estimate economic loss of the premature mortalities and hospital admissions, respectively. The national all-cause premature mortalities attributable to all air pollutants was 1.35 million, accounting for 17.2% of reported deaths in China in 2017. Among all-cause premature mortality, contributions of PM 2.5 , PM 2.5-10 , NO 2 , SO 2 , O 3 and CO were11.1%, 5.2%, 28.9%, 9.6%, 23.0%, and 22.2%, respectively. The national cardiovascular and respiratory premature mortalities were 0.77 and 0.21 million, respectively. About 7.8 million cardiovascular and respiratory disease hospital admissions were attributed to short-term exposure to all air pollutants. The economic loss of the overall health burden (premature mortality and hospital admissions) was 2065.54 billion Yuan, which was equivalent to 2.5% of the national GDP in 2017. The health burden and economic loss attributable to short-term exposure to ambient air pollutant are substantial in China. It suggested that the adverse health effects attributable to short-term exposure to air pollutant should not be neglected in China. In order to reduce the health impact of air pollution, each city should develop air pollution prevention and control measures based on existing scientific evidence. • The mortalities and hospital admissions attributable to short-term exposure to six air pollutants were estimated in China. • The national all-cause premature mortality attributable to all air pollutants was 1.35 million. • About 7.8 million hospital admissions were attributed to short-term exposure to air pollutants. • The economic loss of the overall health burden was 2065.54 billion Yuan, accounting for 2.5% of the national GDP. [ABSTRACT FROM AUTHOR]