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. 2026 Jan 15:14:1684344.
doi: 10.3389/fpubh.2026.1684344. eCollection 2026.

Trends and projections of PM2.5-attributable disease burden in China: a GBD 2021-based analysis

Tao Fang  1   2 , Yang Xu  3 , Na Shen  2 , JinYang Liu  4 , Yanbo Di  2 , Shike Hou  1
Affiliations

Trends and projections of PM2.5-attributable disease burden in China: a GBD 2021-based analysis

Tao Fang et al. Front Public Health. .

Abstract

Background: Fine particulate matter (PM2.5) remains a major environmental health risk in China. This study aimed to comprehensively characterize the long-term trends and epidemiological patterns of PM2.5-attributable disease burden across the country.

Methods: Using data from the Global Burden of Disease (GBD) 2021, we performed a longitudinal analysis of PM2.5 disease burden from 1990 to 2021. Joinpoint regression was employed to calculate the average annual percentage change (AAPC) in age-standardized rates. The age-period-cohort model was employed to stratify the impact of age, periods, and birth cohorts on disease burden. Finally, the Bayesian age-period-cohort (BAPC) analysis was used to project trends for the period 2022-2036.

Results: In 2021, PM2.5 exposure was responsible for an estimated 2.27 million deaths and 46.68 million disability-adjusted life years (DALYs) in China. Compared to 1990, the age-standardized mortality rate declined to 125 per 100,000 (AAPC = -3.62, net drift = -4.19), while the DALY rate fell to 2,437 per 100,000 (AAPC = -3.93, net drift = -3.87). The disease burden from ambient PM2.5 increased substantially and became the dominant source by 2021, whereas that from household PM2.5 decreased markedly. Overall, males experienced a higher disease burden than females. Notably, the 30-34 age group showed rising trends in ambient PM2.5 burden, while children under five and older adults remained the most vulnerable groups. Bayesian projections indicate that total and ambient PM2.5 burdens may continue to decline through 2036, although household PM2.5 could rebound slightly.

Conclusion: Although substantial improvements in air quality have been achieved, pronounced disparities persist between PM2.5 sources and population subgroups. Strengthening targeted and equitable public health interventions remains essential to sustain progress and reduce the unequal health risks associated with PM2.5 exposure in China.

Keywords: age-period-cohort analysis; disease burden; fine particulate matter; prediction; temporal trend.

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Conflict of interest statement

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Age-stratified counts and rates of deaths and DALYs from total PM2.5 in China, 2021, by sex (A–D). (A) Death counts. (B) Death rates. (C) DALY counts. (D) DALY rates. DALY, disability-adjusted life year.
Figure 2
Figure 2
Trends in total PM2.5-attributable disease burden from 1990 to 2021. (A–C) ASMR for both sexes, females, and males. (D–F) ASDR for both sexes, females, and males. ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate; APC, annual percentage change; *, p < 0.05.
Figure 3
Figure 3
Age-period-cohort effects on total PM2.5-attributable disease burden. (A) Local drift in mortality (95% CI). The dashed horizontal lines indicate the net drift. (B) Mortality longitudinal age curves (95% CI). (C) Mortality period rate ratios vs. reference (95% CI). (D) Mortality cohort rate ratios vs. reference (95% CI). (E) Local drift in DALY (95% CI). The dashed horizontal line indicates the net drift. (F) DALY longitudinal age curves (95% CI). (G) DALY period rate ratios vs. reference (95% CI). (H) DALY cohort rate ratios vs. reference (95% CI). DALY, disability-adjusted life year; CI, confidence interval.
Figure 4
Figure 4
Projected total PM2.5-attributable disease burden from 1990 to 2021. (A–C) ASMR for both sexes, females, and males. (D–F) ASDR for both sexes, females, and males. Blue shading shows 5–95% quantile prediction intervals in 10% increments. Solid circles indicate observed cases. Solid lines indicate predictive means. Vertical dashed lines mark the prediction start. ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate.
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