Tracing the sources of PM-related health burden in China.

Fine particulate matter (PM2.5) poses a major environmental risk to human health. We estimated PM2.5-related premature deaths in 30 Chinese provinces in 2020 using an integrated exposure response model based on monitored concentrations and obtained regional and sectoral contributions based on the atmospheric transport of the atmospheric transport contribution matrix. From the perspective of regional- and sectoral-scale effects, the results revealed that 740,140 [95% confidence interval (CI):646,538-839,968] premature deaths were related to PM2.5 in 2020, mainly in East (30%), Central (18%), and North (15%) China. Manufacturing activity was found to be the major cause of PM2.5-related premature deaths, accounting for over 50% of the deaths. From the perspective of the interregional atmospheric transport effect, although local emissions were the major source of PM2.5-related premature deaths in all regions, non-local emissions contributed approximately 30%. The overall trend in the net atmospheric transport direction was from north to south. In particular, the Guangdong, Guangxi, and Hainan provinces of South China received contributions of more than 40% from non-local provinces, mainly from the East and Central China. Combined with economic data, the regions and sectors with the highest PM2.5-related premature deaths per unit output or consumption include the manufacturing and household sectors in North and Northeast China and transportation, agriculture, and electricity in Central China. Therefore, from the perspective of the above three impacts, although the potential impact of PM2.5 pollution on health in China has decreased with the decrease in PM2.5 concentration in the past decade owing to strict air pollution control, the central and northern parts of China are still the key areas requiring air pollution control. The health impacts of air pollution associated with the rapid development of China's manufacturing industry in the post-pandemic era cannot be ignored.