Table 3_Trends and projections of PM2.5-attributable disease burden in China: a GBD 2021-based analysis.docx

BackgroundFine 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.
MethodsUsing 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.
ResultsIn 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.
ConclusionAlthough 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.

研究背景
细颗粒物（PM2.5）仍是中国主要的环境健康风险。本研究旨在全面刻画全国范围内PM2.5相关疾病负担的长期趋势与流行病学特征。
研究方法
本研究采用2021年全球疾病负担（Global Burden of Disease, GBD）数据集，对1990年至2021年的PM2.5相关疾病负担进行纵向分析。采用连接点回归（Joinpoint regression）计算年龄标化率的年均变化百分比（average annual percentage change, AAPC）；运用年龄-时期-队列模型（age-period-cohort model）分解年龄、时期与出生队列对疾病负担的影响。最后，通过贝叶斯年龄-时期-队列模型（Bayesian age-period-cohort, BAPC）对2022年至2036年的疾病负担趋势进行预测。
研究结果
2021年，中国PM2.5暴露预计导致227万例死亡以及4668万伤残调整寿命年（disability-adjusted life years, DALYs）。与1990年相比，年龄标化死亡率降至每10万人125例（AAPC=-3.62，净漂移（net drift）=-4.19），伤残调整寿命年率降至每10万人2437例（AAPC=-3.93，净漂移（net drift）=-3.87）。环境PM2.5相关疾病负担大幅上升，至2021年已成为主要来源；而家庭PM2.5相关疾病负担则显著下降。整体而言，男性的疾病负担高于女性。值得注意的是，30~34岁年龄组的环境PM2.5相关疾病负担呈上升趋势，而5岁以下儿童与老年人仍是最脆弱的群体。贝叶斯预测结果显示，至2036年，总PM2.5与环境PM2.5相关疾病负担或持续下降，但家庭PM2.5相关负担或出现小幅反弹。
研究结论
尽管中国空气质量已取得显著改善，但不同PM2.5来源以及不同人群亚组间仍存在显著差异。强化靶向性与公平性的公共卫生干预措施，对于持续推进相关工作、降低中国境内PM2.5暴露相关的不均等健康风险仍至关重要。