Spatiotemporal Patterns and Equity Analysis of Premature Mortality Due to Ischemic Heart Disease Attributable to PM Exposure in China: 2007-2022.

Long-term exposure to PM pollution increases the risk of cardiovascular diseases, particularly ischemic heart disease (IHD). Current assessments of the health effects related to PM exposure are limited by sparse ground monitoring stations and applicable disease research cohorts, making accurate health effect evaluations challenging. Using satellite-observed aerosol optical depth (AOD) data and the XGBoost-PM25 model, we obtained 1 km scale PM exposure levels across China. We quantified the premature mortality caused by PM-exposure-induced IHD using the Global Exposure Mortality Model (GEMM) and baseline mortality data. Furthermore, we employed the Gini coefficient, a measure from economics to quantify inequality, to evaluate the distribution differences in health impacts due to PM exposure under varying socioeconomic conditions. The results indicate that PM concentrations in China are higher in the central and eastern regions. From 2007 to 2022, the national overall level showed a decreasing trend, dropping from 47.41 μg/m to 25.16 μg/m. The number of premature deaths attributable to PM exposure increased from 819 thousand in 2007 to 870 thousand in 2022, with fluctuations in certain regions. This increase is linked to population growth and aging because PM levels have decreased. The results also indicate disparities in premature mortality from IHD among different economic groups in China from 2007 to 2022, with middle-income groups having a higher cumulative proportion of IHD-related premature deaths compared with high- and low-income groups. Despite narrowing GDP gaps across regions from 2007 to 2022, IHD consistently "favored" the middle-income groups. The highest Gini coefficient was observed in the Northwest (0.035), and the lowest was in the South (0.019). Targeted policy interventions are essential to establish a more equitable atmospheric environment.