Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada; School of Land Engineering, Chang'an University, Xi'an, Shaanxi, 710064, China.
Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada; Department of Civil and Environmental Engineering, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada.
Environ Pollut. 2021 Jun 15;279:116882. doi: 10.1016/j.envpol.2021.116882. Epub 2021 Mar 9.
In the past decade, particulate matter with aerodynamic diameter less than 2.5 μm (PM) has reached unprecedented levels in China and posed a significant threat to public health. Exploring the long-term trajectory of the PM attributable health burden and corresponding disparities across populations in China yields insights for policymakers regarding the effectiveness of efforts to reduce air pollution exposure. Therefore, we examine how the magnitude and equity of the PM-related public health burden has changed nationally, and between provinces, as economic growth and pollution levels varied during 2005-2017. We derive long-term PM exposures in China from satellite-based observations and chemical transport models, and estimate attributable premature mortality using the Global Exposure Mortality Model (GEMM). We characterize national and interprovincial inequality in health outcomes using environmental Lorenz curves and Gini coefficients over the study period. PM exposure is linked to 1.8 (95% CI: 1.6, 2.0) million premature deaths over China in 2017, increasing by 31% from 2005. Approximately 70% of PM attributable deaths were caused by stroke and IHD (ischemic heart disease), though COPD (chronic obstructive pulmonary disease) and LRI (lower respiratory infection) disproportionately affected poorer provinces. While most economic gains and PM-related deaths were concentrated in a few provinces, both gains and deaths became more equitably distributed across provinces over time. As a nation, however, trends toward equality were more recent and less clear cut across causes of death. The rise in premature mortality is due primarily to population growth and baseline risks of stroke and IHD. This rising health burden could be alleviated through policies to prevent pollution, exposure, and disease. More targeted programs may be warranted for poorer provinces with a disproportionate share of PM-related premature deaths due to COPD and LRI.
在过去的十年中，中国大气中直径小于 2.5μm 的颗粒物（PM）浓度达到了前所未有的水平，对公众健康构成了重大威胁。探索 PM 造成的健康负担的长期轨迹及其在中国人群中的差异，为决策者提供了有关减少空气污染暴露工作效果的深入了解。因此，我们研究了在 2005-2017 年经济增长和污染水平变化期间，全国范围内以及各省之间 PM 相关公共卫生负担的大小和公平性如何变化。我们从卫星观测和化学输送模型中得出中国的长期 PM 暴露量，并使用全球暴露死亡率模型（GEMM）来估计归因于过早死亡的人数。我们在研究期间使用环境洛伦兹曲线和基尼系数来描述全国和省际间健康结果的不平等。PM 暴露导致 2017 年中国有 180 万人（95%置信区间：160 万，200 万）过早死亡，比 2005 年增加了 31%。大约 70%的 PM 归因死亡是由中风和缺血性心脏病（IHD）引起的，尽管慢性阻塞性肺病（COPD）和下呼吸道感染（LRI）对较贫困的省份影响更大。虽然大部分经济增长和与 PM 相关的死亡都集中在少数几个省份，但随着时间的推移，这些增长和死亡在各省之间的分配变得更加公平。然而，作为一个国家，向平等的趋势出现得较晚，且在不同死因之间的情况并不明显。过早死亡率的上升主要是由于人口增长和中风和 IHD 的基线风险。通过预防污染、暴露和疾病的政策，可以缓解这种不断上升的健康负担。对于 COPD 和 LRI 导致的 PM 相关过早死亡比例过高的较贫困省份，可能需要更有针对性的计划。
