Assessing ozone-attributable COPD mortality burden and regional control strategies in China

Ground-level ozone (O₃) pollution is a pressing global environmental health threat. In 2021, the World Health Organization (WHO) introduced stringent O₃ control strategies. However, their uniform application across regions with various economic conditions has raised concerns about equity and feasibility, particularly in low- and middle-income areas. To develop region-specific O₃ control strategies, we adopted a log-linear concentration-response (C-R) model to quantify O₃-attributable Chronic Obstructive Pulmonary Disease (COPD) mortality burden and further applied a cost-benefit model to assess the economic costs and health benefits of O₃ reduction across different regions in China. Results showed that in 2021, O₃ concentrations in all Chinese cities exceeded WHO Air Quality Guidelines (AQG), with 54.78% surpassing the Interim target 1 (IT-1). The health burden of O₃-attributable COPD remained severe, with the worst in Eastern China. Based on the cost-benefit model, the O₃ control strategies for Eastern, Central, and Western China were determined as 116 μg/m³, 111 μg/m³, and 100 μg/m³, respectively. This regionalized strategy could reduce COPD deaths by 5.44% while lowering emission reduction costs. Our findings provide a scientific basis for targeted O₃ mitigation policies in China and offer a "Chinese solution" for developing nations around the world to seek a balance between air quality management and economic development.