Potential gains in life expectancy by attaining daily ambient fine particulate matter pollution standards in mainland China: A modeling study based on nationwide data

Autoři: Jinlei Qi aff001;  Zengliang Ruan aff002;  Zhengmin (Min) Qian aff003;  Peng Yin aff001;  Yin Yang aff002;  Bipin Kumar Acharya aff002;  Lijun Wang aff001;  Hualiang Lin aff002
Působiště autorů: National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China aff001;  Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China aff002;  College for Public Health & Social Justice, Saint Louis University, St. Louis, Missouri, United States of America aff003
Vyšlo v časopise: Potential gains in life expectancy by attaining daily ambient fine particulate matter pollution standards in mainland China: A modeling study based on nationwide data. PLoS Med 17(1): e32767. doi:10.1371/journal.pmed.1003027
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003027



Ambient fine particulate matter pollution (PM2.5) is one leading cause of disease burden, but no study has quantified the association between daily PM2.5 exposure and life expectancy. We aimed to assess the potential benefits in life expectancy by attaining the daily PM2.5 standards in 72 cities of China during 2013–2016.

Methods and findings

We applied a two-stage approach for the analysis. At the first stage, we used a generalized additive model (GAM) with a Gaussian link to examine the city-specific short-term association between daily PM2.5 and years of life lost (YLL); at the second stage, a random-effects meta-analysis was used to generate the regional and national estimations. We further estimated the potential gains in life expectancy (PGLE) by assuming that ambient PM2.5 has met the Chinese National Ambient Air Quality Standard (NAAQS, 75 μg/m3) or the ambient air quality guideline (AQG) of the World Health Organization (WHO) (25 μg/m3). We also calculated the attributable fraction (AF), which denoted the proportion of YLL attributable to a higher-than-standards daily mean PM2.5 concentration. During the period from January 18, 2013 to December 31, 2016, we recorded 1,226,849 nonaccidental deaths in the study area. We observed significant associations between daily PM2.5 and YLL: each 10 μg/m3 increase in three-day–averaged (lag02) PM2.5 concentrations corresponded to an increment of 0.43 years of life lost (95% CI: 0.29–0.57). We estimated that 168,065.18 (95% CI: 114,144.91–221,985.45) and 68,684.95 (95% CI: 46,648.79–90,721.11) years of life lost can be avoided by achieving WHO’s AQG and Chinese NAAQS in the study area, which corresponded to 0.14 (95% CI: 0.09–0.18) and 0.06 (95% CI: 0.04–0.07) years of gain in life expectancy for each death in these cities. We observed differential regional estimates across the 7 regions, with the highest gains in the Northwest region (0.28 years of gain [95% CI: 0.06–0.49]) and the lowest in the North region (0.08 [95% CI: 0.02–0.15]). Furthermore, using WHO’s AQG and Chinese NAAQS as the references, we estimated that 1.00% (95% CI: 0.68%–1.32%) and 0.41% (95% CI: 0.28%–0.54%) of YLL could be attributable to the PM2.5 exposure at the national level. Findings from this study were mainly limited by the unavailability of data on individual PM2.5 exposure.


This study indicates that significantly longer life expectancy could be achieved by a reduction in the ambient PM2.5 concentrations. It also highlights the need to formulate a stricter ambient PM2.5 standard at both national and regional levels of China to protect the population’s health.

Klíčová slova:

Aerodynamics – Air pollution – Air quality – Humidity – China – Life expectancy – Particulates – Public and occupational health


1. Zhong M, Chen F, Saikawa E. Sensitivity of projected PM2.5- and O3-related health impacts to model inputs: A case study in mainland China. Environ Int. 2019;123:256–64. doi: 10.1016/j.envint.2018.12.002 30544090

2. Tian Y, Liu H, Zhao Z, Xiang X, Li M, Juan J, et al. Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis. PLoS Med. 2018;15(10):e1002668. doi: 10.1371/journal.pmed.1002668 30286080

3. Brauer M, Freedman G, Frostad J, van Donkelaar A, Martin RV, Dentener F, et al. Ambient Air Pollution Exposure Estimation for the Global Burden of Disease 2013. Environ Sci Technol. 2016;50(1):79–88. doi: 10.1021/acs.est.5b03709 26595236

4. World Health Organization. WHO Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide-Global update 2005-Summary of risk assessment, 2006. Geneva: World Health Organization; 2006.

5. Han L, Zhou W, Li W, Li L. Impact of urbanization level on urban air quality: A case of fine particles (PM2.5) in Chinese cities. Environ Pollut. 2014;194:163–70. doi: 10.1016/j.envpol.2014.07.022 25113968

6. Chen R, Yin P, Meng X, Liu C, Wang L, Xu X, et al. Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities. Am J Respir Crit Care Med. 2017;196(1):73–81. doi: 10.1164/rccm.201609-1862OC 28248546

7. Guo Y, Li S, Tian Z, Pan X, Zhang J, Williams G. The burden of air pollution on years of life lost in Beijing, China, 2004–08: retrospective regression analysis of daily deaths. BMJ. 2013;347:f7139. doi: 10.1136/bmj.f7139 24322399

8. Lin H, Liu T, Xiao J, Zeng W, Li X, Guo L, et al. Mortality burden of ambient fine particulate air pollution in six Chinese cities: Results from the Pearl River Delta study. Environ Int. 2016;96:91–7. doi: 10.1016/j.envint.2016.09.007 27639206

9. Pimpin L, Retat L, Fecht D, de Preux L, Sassi F, Gulliver J, et al. Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035. PLoS Med. 2018;15(7):e1002602. doi: 10.1371/journal.pmed.1002602 29990358

10. Abel DW, Holloway T, Harkey M, Meier P, Ahl D, Limaye VS, et al. Air-quality-related health impacts from climate change and from adaptation of cooling demand for buildings in the eastern United States: An interdisciplinary modeling study. PLoS Med. 2018;15(7):e1002599. doi: 10.1371/journal.pmed.1002599 29969461

11. Chen K, Fiore AM, Chen R, Jiang L, Jones B, Schneider A, et al. Future ozone-related acute excess mortality under climate and population change scenarios in China: A modeling study. PLoS Med. 2018;15(7):e1002598. doi: 10.1371/journal.pmed.1002598 29969446

12. Zhang L, Yang Y, Li Y, Qian Z, Xiao W, Wang X, et al. Short-term and long-term effects of PM2.5 on acute nasopharyngitis in 10 communities of Guangdong, China. Sci Total Environ. 2019;688:136–42. doi: 10.1016/j.scitotenv.2019.05.470 31229811

13. Cai Y, Zhang B, Ke W, Feng B, Lin H, Xiao J, et al. Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension. Hypertension. 2016;68(1):62–70. doi: 10.1161/HYPERTENSIONAHA.116.07218 27245182

14. Liang F, Xiao Q, Gu D, Xu M, Tian L, Guo Q, et al. Satellite-based short- and long-term exposure to PM2.5 and adult mortality in urban Beijing, China. Environ Pollut. 2018;242:492–9. doi: 10.1016/j.envpol.2018.06.097 30005261

15. Brook Robert D, Brook Jeffrey R, Urch B, Vincent R, Rajagopalan S, Silverman F. Inhalation of Fine Particulate Air Pollution and Ozone Causes Acute Arterial Vasoconstriction in Healthy Adults. Circulation. 2002;105(13):1534–6. doi: 10.1161/01.cir.0000013838.94747.64 11927516

16. Zhong J, Urch B, Speck M, Coull Brent A, Koutrakis P, Thorne Peter S, et al. Endotoxin and β-1,3-d-Glucan in Concentrated Ambient Particles Induce Rapid Increase in Blood Pressure in Controlled Human Exposures. Hypertension. 2015;66(3):509–16. doi: 10.1161/HYPERTENSIONAHA.115.05342 26123683

17. Mills NL, Miller MR, Lucking AJ, Beveridge J, Flint L, Boere AJF, et al. Combustion-derived nanoparticulate induces the adverse vascular effects of diesel exhaust inhalation. Eur Heart J. 2011;32(21):2660–71. doi: 10.1093/eurheartj/ehr195 21753226

18. Zhong P, Huang S, Zhang X, Wu S, Zhu Y, Li Y, et al. Individual-level modifiers of the acute effects of air pollution on mortality in Wuhan, China. Global Health Research and Policy. 2018;3(1):27. doi: 10.1186/s41256-018-0080-0 30214944

19. Bennett JE, Tamura-Wicks H, Parks RM, Burnett RT, Pope CA III, Bechle MJ, et al. Particulate matter air pollution and national and county life expectancy loss in the USA: A spatiotemporal analysis. PLoS Med. 2019;16(7):e1002856. doi: 10.1371/journal.pmed.1002856 31335874

20. Correia AW, Pope CAI, Dockery DW, Wang Y, Ezzati M, Dominici F. Effect of Air Pollution Control on Life Expectancy in the United States: An Analysis of 545 U.S. Counties for the Period from 2000 to 2007. Epidemiology. 2013;24(1):23–31. doi: 10.1097/EDE.0b013e3182770237 23211349

21. Pope CA, Ezzati M, Dockery DW. Fine-Particulate Air Pollution and Life Expectancy in the United States. N Engl J Med. 2009;360(4):376–86. doi: 10.1056/NEJMsa0805646 19164188

22. Chen Y, Ebenstein A, Greenstone M, Li H. Evidence on the impact of sustained exposure to air pollution on life expectancy from China’s Huai River policy. Proc Natl Acad Sci USA. 2013;110(32):12936–41. doi: 10.1073/pnas.1300018110 23836630

23. Ebenstein A, Fan M, Greenstone M, He G, Zhou M. New evidence on the impact of sustained exposure to air pollution on life expectancy from China’s Huai River Policy. Proc Natl Acad Sci USA. 2017;114(39):10384–9. doi: 10.1073/pnas.1616784114 28893980

24. Aburto JM, Wensink M, van Raalte A, Lindahl-Jacobsen R. Potential gains in life expectancy by reducing inequality of lifespans in Denmark: an international comparison and cause-of-death analysis. BMC Public Health. 2018;18(1):831. doi: 10.1186/s12889-018-5730-0 29973183

25. Lai D, Hardy RJ. Potential gains in life expectancy or years of potential life lost: impact of competing risks of death. Int J Epidemiol. 1999;28(5):894–8. doi: 10.1093/ije/28.5.894 10597988

26. Martinez R, Soliz P, Caixeta R, Ordunez P. Reflection on modern methods: years of life lost due to premature mortality—a versatile and comprehensive measure for monitoring non-communicable disease mortality. Int J Epidemiol. 2019;48(4):1367–76. doi: 10.1093/ije/dyy254 30629192

27. Liu S, Wu X, Lopez AD, Wang L, Cai Y, Page A, et al. An integrated national mortality surveillance system for death registration and mortality surveillance, China. Bull World Health Organ. 2016;94(1):46–57. Epub 2015 Oct 28. doi: 10.2471/BLT.15.153148 26769996

28. Wang L, Liu C, Meng X, Niu Y, Lin Z, Liu Y, et al. Associations between short-term exposure to ambient sulfur dioxide and increased cause-specific mortality in 272 Chinese cities. Environ Int. 2018;117:33–9. doi: 10.1016/j.envint.2018.04.019 29715611

29. Li T, Guo Y, Liu Y, Wang J, Wang Q, Sun Z, et al. Estimating mortality burden attributable to short-term PM2.5 exposure: A national observational study in China. Environ Int. 2019;125:245–51. doi: 10.1016/j.envint.2019.01.073 30731374

30. Guo Y, Li S, Tian Z, Pan X, Zhang J, Williams G. The burden of air pollution on years of life lost in Beijing, China, 2004–08: retrospective regression analysis of daily deaths. BMJ: British Medical Journal. 2013;347:f7139. doi: 10.1136/bmj.f7139 24322399

31. Chen R, Yin P, Meng X, Liu C, Wang L, Xu X, et al. Fine Particulate Air Pollution and Daily Mortality. A Nationwide Analysis in 272 Chinese Cities. Am J Respir Crit Care Med. 2017;196(1):73–81. doi: 10.1164/rccm.201609-1862OC 28248546

32. Lin H, Tao J, Du Y, Liu T, Qian Z, Tian L, et al. Particle size and chemical constituents of ambient particulate pollution associated with cardiovascular mortality in Guangzhou, China. Environ Pollut. 2016;208(Pt B):758–66. doi: 10.1016/j.envpol.2015.10.056 26561449

33. Tian L, Qiu H, Pun VC, Lin H, Ge E, Chan JC, et al. Ambient Carbon Monoxide Associated with Reduced Risk of Hospital Admissions for Respiratory Tract Infections. Am J Respir Crit Care Med. 2013;188(10):1240–5. doi: 10.1164/rccm.201304-0676OC 23944864

34. Chen R, Yin P, Wang L, Liu C, Niu Y, Wang W, et al. Association between ambient temperature and mortality risk and burden: time series study in 272 main Chinese cities. BMJ: British Medical Journal. 2018;363:k4306. doi: 10.1136/bmj.k4306 30381293

35. Guo Y, Zeng H, Zheng R, Li S, Barnett AG, Zhang S, et al. The association between lung cancer incidence and ambient air pollution in China: A spatiotemporal analysis. Environ Res. 2016;144:60–5. doi: 10.1016/j.envres.2015.11.004 26562043

36. Lelieveld J, Evans JS, Fnais M, Giannadaki D, Pozzer A. The contribution of outdoor air pollution sources to premature mortality on a global scale. Nature. 2015;525:367. doi: 10.1038/nature15371 26381985

37. Lin H, Tao J, Qian ZM, Ruan Z, Xu Y, Hang J, et al. Shipping pollution emission associated with increased cardiovascular mortality: A time series study in Guangzhou, China. Environ Pollut. 2018;241:862–8. doi: 10.1016/j.envpol.2018.06.027 29913413

38. Huang J, Pan X, Guo X, Li G. Impacts of air pollution wave on years of life lost: A crucial way to communicate the health risks of air pollution to the public. Environ Int. 2018;113:42–9. doi: 10.1016/j.envint.2018.01.022 29421406

39. Schwartz Joel D, Wang Y, Kloog I, Yitshak-Sade Ma, Dominici F, Zanobetti A. Estimating the Effects of PM2.5 on Life Expectancy Using Causal Modeling Methods. Environ Health Perspect. 2018;126(12):127002. doi: 10.1289/EHP3130 30675798

40. de Keijzer C, Agis D, Ambrós A, Arévalo G, Baldasano JM, Bande S, et al. The association of air pollution and greenness with mortality and life expectancy in Spain: A small-area study. Environ Int. 2017;99:170–6. doi: 10.1016/j.envint.2016.11.009 27871798

41. Wang C, Zhou X, Chen R, Duan X, Kuang X, Kan H. Estimation of the effects of ambient air pollution on life expectancy of urban residents in China. Atmos Environ. 2013;80:347–51. doi: 10.1016/j.atmosenv.2013.08.018

42. Dockery DW. Health Effects of Fine Particulate Air Pollution: Lines that Connect AU—Pope, C. Arden. Journal of the Air & Waste Management Association. 2006;56(6):709–42. doi: 10.1080/10473289.2006.10464485 16805397

43. Schwartz J, Laden F, Zanobetti A. The concentration-response relation between PM2.5 and daily deaths. Environ Health Perspect. 2002;110(10):1025–9. doi: 10.1289/ehp.021101025 12361928

44. Beverland Iain J, Cohen Geoffrey R, Heal Mathew R, Carder M, Yap C, Robertson C, et al. A Comparison of Short-term and Long-term Air Pollution Exposure Associations with Mortality in Two Cohorts in Scotland. Environ Health Perspect. 2012;120(9):1280–5. doi: 10.1289/ehp.1104509 22674867

45. Kloog I, Coull BA, Zanobetti A, Koutrakis P, Schwartz JD. Acute and Chronic Effects of Particles on Hospital Admissions in New-England. PLoS ONE. 2012;7(4):e34664. doi: 10.1371/journal.pone.0034664 22529923

46. Brook RD, Rajagopalan S, Pope CA, Brook JR, Bhatnagar A, Diez Roux AV, et al. Particulate matter air pollution and cardiovascular disease. Circulation. 2010;121(21):2331–78. doi: 10.1161/CIR.0b013e3181dbece1 20458016

47. Pope CA III, Dockery DW. Health Effects of Fine Particulate Air Pollution: Lines that Connect. J Air Waste Manage Assoc. 2006;56(6):709–42. doi: 10.1080/10473289.2006.10464485 16805397

48. Bräuner EV, Forchhammer L, Møller P, Barregard L, Gunnarsen L, Afshari A, et al. Indoor Particles Affect Vascular Function in the Aged. Am J Respir Crit Care Med. 2008;177(4):419–25. doi: 10.1164/rccm.200704-632OC 17932377

49. Naz S, Page A, Agho KE. Attributable risk and potential impact of interventions to reduce household air pollution associated with under-five mortality in South Asia. Global Health Research and Policy. 2018;3(1):4. doi: 10.1186/s41256-018-0059-x 29376138

50. Krall Jenna R, Mulholland James A, Russell Armistead G, Balachandran S, Winquist A, Tolbert Paige E, et al. Associations between Source-Specific Fine Particulate Matter and Emergency Department Visits for Respiratory Disease in Four U.S. Cities. Environ Health Perspect. 2017;125(1):97–103. doi: 10.1289/EHP271 27315241

51. Qiao L, Cai J, Wang H, Wang W, Zhou M, Lou S, et al. PM2.5 Constituents and Hospital Emergency-Room Visits in Shanghai, China. Environ Sci Technol. 2014;48(17):10406–14. doi: 10.1021/es501305k 25119795

52. Yang Y, Ruan Z, Wang X, Yang Y, Mason TG, Lin H, et al. Short-term and long-term exposures to fine particulate matter constituents and health: A systematic review and meta-analysis. Environ Pollut. 2019;247:874–82. doi: 10.1016/j.envpol.2018.12.060 30731313

53. Rohde RA, Muller RA. Air Pollution in China: Mapping of Concentrations and Sources. PLoS ONE. 2015;10(8):e0135749. doi: 10.1371/journal.pone.0135749 26291610

54. Liang Z, Yang Y, Qian Z, Ruan Z, Chang J, Vaughn MG, et al. Ambient PM2.5 and birth outcomes: Estimating the association and attributable risk using a birth cohort study in nine Chinese cities. Environ Int. 2019;126:329–35. doi: 10.1016/j.envint.2019.02.017 30825752

55. Burnet N, Jefferies S, Benson R, Hunt D, Treasure F. Years of life lost (YLL) from cancer is an important measure of population burden—and should be considered when allocating research funds. Br J Cancer. 2005;92(2):241–245. doi: 10.1038/sj.bjc.6602321 15655548

56. Qiu H, Zhu X, Wang L, Pan J, Pu X, Zeng X, et al. Attributable risk of hospital admissions for overall and specific mental disorders due to particulate matter pollution: A time-series study in Chengdu, China. Environ Res. 2019;170:230–7. doi: 10.1016/j.envres.2018.12.019 30594694

57. Yang Y, Guo Y, Qian Z, Ruan Z, Zheng Y, Woodward A, et al. Ambient fine particulate pollution associated with diabetes mellitus among the elderly aged 50 years and older in China. Environ Pollut. 2018;243:815–23. doi: 10.1016/j.envpol.2018.09.056 30243190

58. Tan X, Liu X, Shao H. Healthy China 2030: A Vision for Health Care. Value in health regional issues. 2017;12:112–4. doi: 10.1016/j.vhri.2017.04.001 28648308

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