Exposure to ambient and indoor particle matter (PM2.5) leads to millions of premature deaths in China. In recent
years,
indoor air pollution and premature deaths associated with polluting
fuel cooking demonstrate an abrupt decline. However, the driving forces
behind the mortality change are still unclear due to the uncertainty
in household fuel use prediction. Here, we propose an integrated approach
to estimate the fuel use fractions and PM2.5-related deaths
from outdoor and indoor sources during 2000–2020 across China.
Our model estimated 1.67 and 1.21 million premature deaths attributable
to PM2.5 exposure in 2000 and 2020, respectively. We find
that the residential energy transition is associated with a substantial
reduction in premature deaths from indoor sources, with 100,000 (95%
CI: 76,000–122,000) for urban and 265,000 (228,000–300,000)
for rural populations during 2000–2020. Economic growth is
the dominant driver of fuel use transition and avoids 21% related
deaths (357,000, 315,000–402,000) from polluting fuel cooking
since 2000, which offsets the adverse impact of ambient emissions
contributed by economic growth. Our findings give an insight into
the coupled impact of socioeconomic factors in reshaping health burden
in exposure pathways.