Long-term mortality benefits of air quality improvement during the twelfth five-year-plan period in 31 provincial capital cities of China

Abstract The severe air pollution across China in the past several years has made the Chinese government recognize its significant impacts on public health and society, and take enormous efforts to improve the air quality all over the country, especially during the Twelfth Five-Year Plan (12th FYP). However, the overall effectiveness of these air pollution control policies remains unclear. In this study, we selected the 31 municipalities and provincial capital cities in mainland China as study settings. We collected the annual average population size, mortality rates (total mortality and mortality due to cardiovascular diseases, respiratory diseases, total cancer, lung cancer and breast cancer) and concentrations of air pollutants (PM10, PM2.5, SO2 and NO2) in each capital city from 2010 to 2015 from national or local Statistical Yearbooks. The effect sizes of air pollutants on mortality were obtained from previously published meta analyses or cohort studies. We first estimated the annual mortality rates attributed to the changes in air pollutant concentrations for every city in each year. Then, we further estimated the mortality benefits in the scenarios where the air quality had reached the grade II levels of Chinese Ambient Air Quality Standards (CAAQS) and World Health Organization (WHO) guidelines. In most capital cities, we observed dominant decreases in air pollutant concentrations during the 12th FYP, particularly from 2013 to 2015, which has led to significant mortality benefits for the public. A total of 121,658 deaths (0.441‰) have been prevented due to the decrease of PM2.5concentrations from 2013 to 2015 in all included cities. The morality benefits were larger in capital cities located in the key regions (the three main regions and ten city groups) than the other cities. In addition, more mortality benefits could be obtained in the future if the air quality reaches the grade II levels of Chinese Ambient Air Quality Standards (CAAQS) or WHO guidelines. We concluded that substantial mortality benefits achieved during the 12th FYP may be attributed to the improvements in China's air quality, which indicated the significant effectiveness of air pollution control policies.

[1]  Yuesi Wang,et al.  The heaviest particulate air-pollution episodes occurred in northern China in January, 2013: Insights gained from observation , 2014 .

[2]  Zhili Zuo,et al.  PM2.5 in China: Measurements, sources, visibility and health effects, and mitigation , 2014 .

[3]  Alan D. Lopez,et al.  Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010 , 2013, The Lancet.

[4]  Haidong Kan,et al.  Health benefits of improving air quality in Taiyuan, China. , 2014, Environment international.

[5]  M. Brauer,et al.  Global Estimates of Ambient Fine Particulate Matter Concentrations from Satellite-Based Aerosol Optical Depth: Development and Application , 2010, Environmental health perspectives.

[6]  C. Lim,et al.  The association between fine particulate matter exposure during pregnancy and preterm birth: a meta-analysis , 2015, BMC Pregnancy and Childbirth.

[7]  Yi Li,et al.  Impact of air pollution control measures and weather conditions on asthma during the 2008 Summer Olympic Games in Beijing , 2011, International journal of biometeorology.

[8]  Joshua C. Wright,et al.  Ongoing progress in cleaning China′s air: A novel outlook into pollution , 2016 .

[9]  Jianhua Xu,et al.  Valuing the health risks of particulate air pollution in the Pearl River Delta, China , 2012 .

[10]  Jiming Hao,et al.  Air quality management in China: issues, challenges, and options. , 2012, Journal of environmental sciences.

[11]  Jie Cao,et al.  Ambient Temperature and Mortality: An International Study in 13 Cities of East Asia , 2010, The Science of the total environment.

[12]  中華人民共和国国家統計局.  China statistical yearbook , 1988 .

[13]  Yangang Wang,et al.  Effect of long-term exposure to air pollution on type 2 diabetes mellitus risk: a systemic review and meta-analysis of cohort studies. , 2014, European journal of endocrinology.

[14]  Y. Lau,et al.  Association between air pollution and asthma admission among children in Hong Kong , 2006, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[15]  F. Song,et al.  Ambient particulate matter and lung cancer incidence and mortality: a meta-analysis of prospective studies. , 2015, European journal of public health.

[16]  Li Chen,et al.  Assessment of population exposure to PM2.5 for mortality in China and its public health benefit based on BenMAP. , 2017, Environmental pollution.

[17]  Tao Liu,et al.  Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension: A Systematic Review and Meta-Analysis , 2016, Hypertension.

[18]  S. Tong,et al.  Mortality reduction following the air pollution control measures during the 2010 Asian Games , 2014 .

[19]  Chunmei Zhao,et al.  The associations between birth weight and exposure to fine particulate matter (PM2.5) and its chemical constituents during pregnancy: A meta-analysis. , 2016, Environmental pollution.

[20]  L. Zhong,et al.  Source apportionment of PM2.5 at urban and suburban areas of the Pearl River Delta region, south China - With emphasis on ship emissions. , 2017, The Science of the total environment.

[21]  Huiming Li,et al.  Mortality effects assessment of ambient PM2.5 pollution in the 74 leading cities of China. , 2016, The Science of the total environment.

[22]  J. Jason West,et al.  An Estimate of the Global Burden of Anthropogenic Ozone and Fine Particulate Matter on Premature Human Mortality Using Atmospheric Modeling , 2010, Environmental health perspectives.

[23]  J. Townend,et al.  Why cardiologists should be interested in air pollution , 2003, Heart.

[24]  H. Kan,et al.  Cardiopulmonary benefits of reducing indoor particles of outdoor origin: a randomized, double-blind crossover trial of air purifiers. , 2015, Journal of the American College of Cardiology.

[25]  Jin-Nan Wang,et al.  China tackles the health effects of air pollution , 2013, The Lancet.

[26]  Ad M J Ragas,et al.  Cumulative risk assessment of chemical exposures in urban environments. , 2011, Environment international.

[27]  J. Schwartz,et al.  Health, wealth, and air pollution: advancing theory and methods. , 2003, Environmental health perspectives.

[28]  G. Carmichael,et al.  Quantifying the human health benefits of curbing air pollution in Shanghai. , 2004, Journal of environmental management.

[29]  Beate Ritz,et al.  Traffic-related air toxics and preterm birth: a population-based case-control study in Los Angeles county, California , 2011, Environmental health : a global access science source.

[30]  R. Burnett,et al.  Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. , 2002, JAMA.

[31]  F. Kelly,et al.  Oxidative stress: its role in air pollution and adverse health effects , 2003, Occupational and environmental medicine.

[32]  Jun Liu,et al.  Estimating adult mortality attributable to PM2.5 exposure in China with assimilated PM2.5 concentrations based on a ground monitoring network. , 2016, The Science of the total environment.

[33]  A. Blair,et al.  Occupational cancer in developed countries , 2011, Environmental health : a global access science source.

[34]  J. Lelieveld,et al.  Model calculated global, regional and megacity premature mortality due to air pollution , 2013 .

[35]  Henrik Andersson,et al.  Environmental Research and Public Health Air Pollution Control Policies in China: a Retrospective and Prospects , 2022 .

[36]  D. Catelan,et al.  Air pollution exposure, cause-specific deaths and hospitalizations in a highly polluted Italian region. , 2016, Environmental research.

[37]  Jie He,et al.  Report of incidence and mortality in China cancer registries, 2009. , 2013, Chinese journal of cancer research = Chung-kuo yen cheng yen chiu.

[38]  L. Samek,et al.  Overall human mortality and morbidity due to exposure to air pollution. , 2016, International journal of occupational medicine and environmental health.

[39]  J. Schwartz,et al.  Association of fine particulate matter from different sources with daily mortality in six U.S. cities. , 2000, Environmental health perspectives.

[40]  Gail M. Williams,et al.  Health benefits from improved outdoor air quality and intervention in China. , 2016, Environmental pollution.

[41]  Tao Liu,et al.  Mortality benefits of vigorous air quality improvement interventions during the periods of APEC Blue and Parade Blue in Beijing, China. , 2017, Environmental pollution.