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Decadal Evolution of NO2 Pollution and Attributable Mortality Burden in China under Clean Air Actions and Population
Jian Qian1, You Zou1, Ruoyu Li1
1West China School of Public Health and West China Fourth Hospital, Sichuan University, No 16 Section 3 Renmin South Road, Chengdu, Sichuan Province, China.
Abstract:
Ambient nitrogen dioxide (NO2) pollution remains an important public health concern in China. However, nationwide evidence remains limited on changes in NO2 pollution since 2020 and on whether the associated health gains have been sustained amid rapid population aging. We generated a seamless daily 1km NO2 concentration dataset for mainland China from 2015 to 2024 to characterize the spatiotemporal evolution of NO2 pollution. We estimated all-cause, cardiovascular, and respiratory mortality attributable to long-term NO2 exposure and applied decomposition analysis to quantify the contributions of changes in NO2 concentrations and population aging to temporal changes in these mortality burdens. The population-weighted mean NO2 concentration decreased from 26.13 μg/m3 in 2015 to 18.76 μg/m3 in 2024. However, 97.52% of the population in China still lived in areas where annual NO2 concentrations exceeded the WHO air quality guideline of 10 μg/m3 in 2024. Between 2015 and 2024, all-cause, cardiovascular, and respiratory deaths attributable to long-term NO2 exposure decreased by approximately 188, 125, and 32 thousand, respectively. Compared with 2015, changes in NO2 concentrations in 2024 contributed to reductions of 42.72%, 46.97%, and 37.58% in all-cause, cardiovascular, and respiratory attributable mortality, respectively, whereas population aging contributed to corresponding increases of 20.12%, 25.12%, and 22.41%. Overall, population-weighted NO2 exposure and its associated mortality burdens declined substantially from 2015 to 2024. Following a rebound in 2023, population-weighted NO2 concentrations declined again in 2024, although the pace of improvement has slowed markedly since 2020, while population aging increasingly offset the associated health gains. Sustained efforts to further reduce NO2 exposure remain necessary, and future air pollution control strategies should be better integrated with healthy aging strategies to ensure that improvements in air quality translate into sustained public health benefits.
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