Beyond mortality: A multi-outcome assessment of health economic benefits from air pollution control in China

China has invested heavily in air pollution control in recent years, yet comprehensive assessments of the associated health economic benefits remain limited. Prior research on the health economic benefits of air pollution control has mainly focused on mortality outcomes and PM_2.5, which may substantially underestimates the true benefits of clean air policies. This study aims to evaluate the health economic benefits and losses associated with air pollution control by incorporating multiple health outcomes, population groups and air pollutants. We integrate daily mortality, hospital admission and outpatient visits and air pollutant (nitrogen dioxide, ozone [O₃] and fine particulate matter) data from 18 cities from 2015 to 2022 to assess the health economic benefits. A generalized additive model was used to estimate concentration-response relationships. Health economic benefits were calculated based on the value of statistical life (VSL) and direct medical costs. Between 2015 and 2022, controlling PM_2.5 and NO₂ yielded significant health economic benefits across all health outcomes. Air pollution control generated significant health economic benefits across multiple outcomes in Guangdong Province. The total health economic benefits associated with PM_2.5 and NO₂ were 10,305.35 and 1017.00 million CNY, respectively. In contrast, O₃ control yielded negative net benefits across all outcomes. Between 2015 and 2022, the multi-outcome health benefits of controlling PM_2.5 exceeded mortality-only estimates by 31.79%, respectively For PM_2.5 control, the elderly accounted for over 85% of the mortality-related benefits. These findings highlight the need for coordinated PM_2.5-O₃ control, the integration of multi-outcome evaluations into policy design, and targeted protection for vulnerable populations particularly the elderly.