Trends and projections of PM_2.5-attributable disease burden in China: a GBD 2021-based analysis

Fine particulate matter (PM_2.5) remains a major environmental health risk in China. This study aimed to comprehensively characterize the long-term trends and epidemiological patterns of PM_2.5-attributable disease burden across the country.

Using data from the Global Burden of Disease (GBD) 2021, we performed a longitudinal analysis of PM_2.5 disease burden from 1990 to 2021. Joinpoint regression was employed to calculate the average annual percentage change (AAPC) in age-standardized rates. The age-period-cohort model was employed to stratify the impact of age, periods, and birth cohorts on disease burden. Finally, the Bayesian age-period-cohort (BAPC) analysis was used to project trends for the period 2022-2036.

In 2021, PM_2.5 exposure was responsible for an estimated 2.27 million deaths and 46.68 million disability-adjusted life years (DALYs) in China. Compared to 1990, the age-standardized mortality rate declined to 125 per 100,000 (AAPC = -3.62, net drift = -4.19), while the DALY rate fell to 2,437 per 100,000 (AAPC = -3.93, net drift = -3.87). The disease burden from ambient PM_2.5 increased substantially and became the dominant source by 2021, whereas that from household PM_2.5 decreased markedly. Overall, males experienced a higher disease burden than females. Notably, the 30-34 age group showed rising trends in ambient PM_2.5 burden, while children under five and older adults remained the most vulnerable groups. Bayesian projections indicate that total and ambient PM_2.5 burdens may continue to decline through 2036, although household PM_2.5 could rebound slightly.

Although substantial improvements in air quality have been achieved, pronounced disparities persist between PM_2.5 sources and population subgroups. Strengthening targeted and equitable public health interventions remains essential to sustain progress and reduce the unequal health risks associated with PM_2.5 exposure in China.