Collaborative control of fine particles and ozone required in China for health benefit

● Increased DAAO offsets 3/4 of the decrease of DAAP in 2013–2020. ● DAAO increases are mainly due to O₃ concentration increase and population aging. ● Health benefit from PM_2.5 reduction after 2017 is larger than that before 2017. ● Reducing PM_2.5 concentration by 1% results in 0.6% reduction of DAAP. ● Reducing O₃ concentration by 1% results in 2% reduction of DAAO. PM_2.5 concentration declined significantly nationwide, while O₃ concentration increased in most regions in China in 2013–2020. Recent evidences proved that peak season O₃ is related to increased death risk from non-accidental and respiratory diseases. Based on these new evidences, we estimate excess deaths associated with long-term exposure to ambient PM_2.5 and O₃ in China following the counterfactual analytic framework from Global Burden Disease. Excess deaths from non-accidental diseases associated with long-term exposure to ambient O₃ in China reaches to 579 (95% confidential interval (CI): 93, 990) thousand in 2020, which has been significantly underestimated in previous studies. In addition, the increased excess deaths associated with long-term O₃ exposure (234 (95% CI: 177, 282) thousand) in 2013–2020 offset three quarters of the avoided excess deaths (302 (95% CI: 244, 366) thousand) mainly due to PM_2.5 exposure reduction. In key regions (the North China Plain, the Yangtze River Delta and the Fen-Wei Plain), the former is even larger than the latter, particularly in 2017–2020. Health benefit of PM_2.5 concentration reduction offsets the adverse effects of population growth and aging on excess deaths attributed to PM_2.5 exposure. Increase of excess deaths associated with O₃ exposure is mainly due to the strong increase of O₃ concentration, followed by population aging. Considering the faster population aging process in the future, collaborative control, and faster reduction of PM_2.5 and O₃ are needed to reduce the associated excess deaths.