BACKGROUND: 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. CONCLUSIONS: 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.
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