BACKGROUND

Environmental pollution not only poses a direct threat to human health but also exacerbates economic inequality through various channels. The China Clean Air Action (CCAA) has been shown to alleviate the health burden caused by air pollution. Although the link between environmental degradation and poverty have been increasingly recognized, there are few studies that systematically assess the impact of the CCAA on reducing multidimensional poverty and the role of respiratory diseases (RD) in this context.

METHODS

We utilized data from three waves of the China Health and Retirement Longitudinal Study and estimated annual average particulate matter (PM) exposure using a high-resolution (1 × 1 km) satellite-based model. A Difference-in-Differences approach was employed to account for potential confounders like time trends and regional variations. Additionally, a dual mediation model was applied to examine the relationships between CCAA, PM levels, and multidimensional poverty, focusing on the mediating roles of RD and peak expiratory flow (PEF).

RESULTS

After adjusting for confounders, from 2011 to 2015, the intervention group exhibited a significantly greater reduction in multidimensional poverty index (MPI) compared to the control group, with an average difference of -0.0206 points (95% confidence interval: -0.0318 to -0.0092). As long-term PM exposure declined, there was a significant reduction in multidimensional poverty, with notable improvements across its sub-dimensions, including health status, living standard, social participation, and income level. The dual mediation model revealed a complex interplay among CCAA, PM, and MPI, with RD and PEF mediating 22.80% of the indirect effect.

CONCLUSION

This study demonstrates that long-term PM exposure increases the risk of respiratory diseases and reduces lung function, exacerbating the multidimensional poverty burden among middle-aged and older adults. Thus, we recommend incorporating air quality indicators into poverty reduction standards and establishing a dynamic monitoring system.