Rapid Increases in Warm-Season Surface Ozone and Resulting Health Impact in China Since 2013

China's nationwide ozone monitoring network initiated in 2013 has observed severe surface ozone pollution. This network, combined with the recent Tropospheric Ozone Assessment Report (TOAR) data set, offers a more comprehensive view on global surface ozone distribution and trends. Here, we report quantitative estimates of the warm-season (April- September) surface ozone trends and resulting health impacts at Chinese cities in 2013-2019. Both the parametric and nonparametric linear trends for 12 ozone metrics relevant to human health and vegetation exposure are derived. We find that all ozone metrics averaged from Chinese urban sites have increased significantly since 2013. The warm-season daily maximum 8-h average (MDA8) ozone levels increased by 2.4 ppb (5.0%) year(-1), with over 90% of the sites showing positive trends and 30% with trends larger than 3.0 ppb year(-1). These rates are among the fastest trends, even faster in some Chinese cities, compared with the urban ozone trends in any other region worldwide reported in TOAR. Ozone metrics reflecting the cumulative exposure effect on human health and vegetation such as SOMO35 and AOT40 have increased at even faster rates (>10% year(-1)) We estimate that the total premature respiratory mortalities attributable to ambient MDA8 ozone exposure in 69 Chinese cities are 64,370 in 2019, which has increased by 60% compared to 2013 levels and requires urgent attention.