Potential reductions in premature mortality attributable to PM2.5 by reducing indoor pollution: A model analysis for Beijing-Tianjin-Hebei of China

Background: China has one of the highest PM2.5 (particulate matter with an aerodynamic diameter smaller than 2.5 mu m) pollution levels in the world. It might still be long before air quality reaches the National Class II standard of 35 mu g/m(3). Objective: We aim to estimate the potential reduction in premature mortality by reducing indoor PM2.5 levels in the Beijing-Tianjin-Hebei (BTH) region and compare it with reducing outdoor levels. Methods: We combined PM2.5 transport model and the Global Burden of Disease (2016) methodology to estimate potential reductions in premature mortality attributable to PM2.5 by reducing indoor PM2.5 to National Class I standard of 15 mu g/m(3), and compared with reducing outdoor PM2.5 to Government 2020 Interim target of 64 mu g/m(3) or National Class II standard of 35 mu g/m(3). Results: A total of 74,000 (95% confidence interval (CI): 43,000-111,000) premature deaths were attributable to PM2.5 exposure in 2013. Thirty percent, or 22,000 (95% CI: 17,000-32,000) deaths, would have been averted if indoor PM2.5 had reached the National Class I standard. The benefit is greater than that from reaching the Government 2020 Interim target for outdoor PM2.5 [22%, or 16,000 (95% CI: 12,000-23,000), deaths], although still smaller than that from reaching the National Class II standard [42%, or 31,000 (95% CI: 24,000-45,000), deaths]. Conclusions: Reaching the National Class I level of indoor PM2.5 at current outdoor pollution levels could bring considerable health benefits, which are comparable to those from reaching the Government 2020 Interim target for outdoor PM2.5. Main findings: The avertable premature deaths gained from cleaning indoor PM2.5 to National Class I standard level would be greater than reducing outdoor PM2.5 to Government 2020 Interim target. (C) 2018 Elsevier Ltd. All rights reserved.