Reducing air pollution does not necessarily reduce related adults' mortality burden: Variations in 177 countries with different economic levels.

Prolonged exposure to PM _2.5 is associated with increased mortality. However, reducing air pollution concentrations does not necessarily reduce the related burden of deaths. Here, we aim to estimate the variations in PM _2.5 -related mortality due to contributions from key factors - PM _2.5 concentration, population exposure, and healthcare levels - for 177 countries from 2000 to 2018 at the 1-km grid scale according to the Global Mortality Exposure Model (GEMM) model. We find that global reductions in PM _2.5 -related deaths mainly come from high and upper-middle income countries, where lowered air pollutant concentration and better healthcare can offset mortality burdens caused by increasing exposed populations. Changes in population exposure to PM _2.5 contribute the most (54 %) to change in global related deaths over the examined period, followed by changes in healthcare (-42 %) and pollution concentrations (4 %). The impacts vary across countries and regions within them due to other drivers, which are significantly influenced by development status. Policies aiming at reducing PM _2.5 associated health risks need to account for country-specific balances of these key socioeconomic drivers.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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