Assessing ozone-attributable COPD mortality burden and regional control strategies in China.
Ground-level ozone (O3) pollution is a pressing global environmental health threat. In 2021, the World Health Organization (WHO) introduced stringent O3 control strategies. However, their uniform application across regions with various economic conditions has raised concerns about equity and feasibility, particularly in low- and middle-income areas. To develop region-specific O3 control strategies, we adopted a log-linear concentration-response (C-R) model to quantify O3-attributable Chronic Obstructive Pulmonary Disease (COPD) mortality burden and further applied a cost-benefit model to assess the economic costs and health benefits of O3 reduction across different regions in China. Results showed that in 2021, O3 concentrations in all Chinese cities exceeded WHO Air Quality Guidelines (AQG), with 54.78% surpassing the Interim target 1 (IT-1). The health burden of O3-attributable COPD remained severe, with the worst in Eastern China. Based on the cost-benefit model, the O3 control strategies for Eastern, Central, and Western China were determined as 116 μg/m3, 111 μg/m3, and 100 μg/m3, respectively. This regionalized strategy could reduce COPD deaths by 5.44% while lowering emission reduction costs. Our findings provide a scientific basis for targeted O3 mitigation policies in China and offer a "Chinese solution" for developing nations around the world to seek a balance between air quality management and economic development.