Ozone Mortality Burden Changes Driven by Population Aging and Regional Inequity in China in 2013-2050

Air pollution exposure is closely linked to population age and socioeconomic status. Population aging and imbalance in regional economy are thus anticipated to have important implications on ozone (O₃)-related health impacts. Here we provide a driver analysis for O₃ mortality burden due to respiratory disease in China over 2013-2050 driven by population aging and regional inequity. Unexpectedly, we find that population aging is estimated to result in dramatic rises in annual O₃ mortality burden in China; by 56, 101-137, and 298-485 thousand over the periods 2013-2020, 2020-2030, and 2030-2050, respectively. This reflects the exponential rise in baseline mortality rates with increasing age. The aging-induced mortality burden rise in 2030-2050 is surprisingly large, as it is comparable to the net national mortality burden due to O₃ exposure in 2030 (359-399 thousand yr^-1). The health impacts of O₃ pollution, shown as mortality burden per capita, are inequitably distributed, with more severe effects in less developed provinces than their developed counterparts by 23.1% and 21.5% in 2019 and 2030, respectively. However, the regional inequity in O₃ mortality burden is expected to be mitigated in 2050. This temporal variation reflects evolving demographic dividend characterized by a larger proportion of younger individuals in developed regions. These findings are critical for targeted improvement of healthcare services to ensure the sustainability of social development.