Decoding the effect of demographic factors on environmental health based on city-level PM2.5 pollution in China

Although considerable health effects are gained from air quality improvement action plans implemented in China recently, they may have been amplified or offset due to the complexity and uncertainty of the changing demographic factors. In this study, we developed a framework for analyzing the effects of demographic factors on environmental health effects, focusing on three aspects: population scale, age structure, and spatial distribution. We quantified the above three effects by investigating how the health endpoint changed by the three demographic factors, based on a strategy of counterfactual and step-by-step relaxing hypothesis. We found that the increasing population scale and population aging caused 44,279 to 292,442 premature deaths, which offset the health effect of air quality improvement efforts for China. The change in population spatial distribution, in general, has little impact on the health effects of air quality improvement. Furthermore, the three effects are distributed unevenly across regions, especially the spatial distribution effect. Considering the widespread effect of demographic factors, PM2.5 concentration should be further reduced, and the aged population and mega-cities should be targeted for managing air quality in a cost-effective manner.