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Particulate air pollution and mortality in 38 of China’s largest cities: time series analysis

BMJ 2017; 356 doi: (Published 14 March 2017) Cite this as: BMJ 2017;356:j667

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  1. Peng Yin, associate professor1,
  2. Guojun He, assistant professor2,
  3. Maoyong Fan, associate professor3,
  4. Kowk Yan Chiu, research assistant4,
  5. Maorong Fan, associate professor5,
  6. Chang Liu, research assistant6,
  7. An Xue, associate professor7,
  8. Tong Liu, graduate student4,
  9. Yuhang Pan, graduate student4,
  10. Quan Mu, research fellow8,
  11. Maigeng Zhou, professor1
  1. 1National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  2. 2Division of Social Science, Division of Environment, and Department of Economics, The Hong Kong University of Science and Technology, Hong Kong, China
  3. 3Miller College of Business Department of Economics, Ball State University, Muncie, IN, USA
  4. 4Division of Environment, The Hong Kong University of Science and Technology, Hong Kong, China
  5. 5Department of Respiratory Medicine, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
  6. 6Department of Finance, Scheller College of Business, Georgia Tech, Atlanta, GA, USA
  7. 7Department of Environmental Engineering, College of Environmental Science and Engineering, Peking University, Beijing, China
  8. 8The Nature Conservancy, Beijing, China
  1. Correspondence to: M Zhou maigengzhou{at}
  • Accepted 1 February 2017


Objectives To estimate the short term effect of particulate air pollution (particle diameter <10 μm, or PM10) on mortality and explore the heterogeneity of particulate air pollution effects in major cities in China.

Design Generalised linear models with different lag structures using time series data.

Setting 38 of the largest cities in 27 provinces of China (combined population >200 million).

Participants 350 638 deaths (200 912 in males, 149 726 in females) recorded in 38 city districts by the Disease Surveillance Point System of the Chinese Center for Disease Control and Prevention from 1 January 2010 to 29 June 2013.

Main outcome measure Daily numbers of deaths from all causes, cardiorespiratory diseases, and non-cardiorespiratory diseases and among different demographic groups were used to estimate the associations between particulate air pollution and mortality.

Results A 10 µg/m3 change in concurrent day PM10 concentrations was associated with a 0.44% (95% confidence interval 0.30% to 0.58%) increase in daily number of deaths. Previous day and two day lagged PM10 levels decreased in magnitude by one third and two thirds but remained statistically significantly associated with increased mortality. The estimate for the effect of PM10 on deaths from cardiorespiratory diseases was 0.62% (0.43% to 0.81%) per 10 µg/m3 compared with 0.26% (0.09% to 0.42%) for other cause mortality. Exposure to PM10 had a greater impact on females than on males. Adults aged 60 and over were more vulnerable to particulate air pollution at high levels than those aged less than 60. The PM10 effect varied across different cities and marginally decreased in cities with higher PM10 concentrations.

Conclusion Particulate air pollution has a greater impact on deaths from cardiorespiratory diseases than it does on other cause mortality. People aged 60 or more have a higher risk of death from particulate air pollution than people aged less than 60. The estimates of the effect varied across cities and covered a wide range of domain.


  • We thank Philip Coelho, Ball State University, for comments on the manuscript.

  • Contributors: PY, GH, and MF contributed equally to this manuscript. MYF, GH, PY, and MZ designed the study. PY and MZ collected and cleaned the mortality data. MYF, KYC, and GH conducted the analyses. MRF, AX, and CL reviewed the literature, conducted Geographic Information Systems matching, and contributed to interpretation of the results. TL, YP, and QM collected the pollution data, collected socioeconomic data, and summarised the results. MYF and GH prepared the first draft. All authors commented on this draft and contributed to the final version. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. MYF, GH, PY, and MZ are the guarantors.

  • Funding: The study was supported by the School-Based Initiative research grant (SBI15HS06) from the Hong Kong University of Science and Technology and China National Science and Technology Pillar programme 2013 (2013BAI04B02). The funders were not involved in the research and preparation of the article, including study design; collection, analysis, and interpretation of data; writing of the article; nor in the decision to submit it for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: the study was financially supported by the School-Based Initiative research grant from the Hong Kong University of Science and Technology and China National Science and Technology Pillar programme 2013; no financial relationships with any organizations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: The pollution data and weather data are available from MYF (mfan{at} The mortality data can only be applied for through a government data sharing portal (

  • Transparency: A lead author (MYF) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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