What drives long-term PM₂.₅-attributable premature mortality change? A case study in central China using high-resolution satellite data from 2003 to 2018

Ambient PM2.5 was reported to be related to numerous negative health outcomes, leading to adverse public health impacts in many countries such as China. Despite the apparent reduction in PM2.5 levels over China due to its emission control policies in recent years, the health burdens were not reduced as much as expected. This calls for a comprehensive analysis to explain the reasons behind to provide a useful reference for formulating effective emission control strategies. Taking central China as an example due to its large population and high levels of PM2.5, this study quantified the spatiotemporal dynamics of premature mortality associated with PM2.5 pollution in central China for each year during 2003-2018 and applied a decomposition analysis to dissect the contribution of various driving factors including ambient PM2.5 level, demographic distribution and baseline incidence rate of four diseases related to air pollution. Results show significant spatiotemporal variations in PM2.5-attributed health impact in central China, including Henan, Hubei, and Hunan provinces. Five Henan cities had the largest PM2.5-attributable premature mortality (∼8-12 K premature mortalities), while three Hubei cities and one Hebei city had the least chronic PM2.5-related all-cause mortality numbers (