Abstract. Air quality in China has changed dramatically in response to rapid development of economy and policies. In this work, we investigate the changes of anthropogenic source contribution to ambient fine particulate matter (PM2.5) air pollution and related health impacts in China during 1990–2015 and elucidate the drivers behind the decadal transition. We estimate the contribution of five anthropogenic emitting sectors to ambient PM2.5 exposure and related premature mortality over China during 1990–2015 with 5-yr intervals, by using an integrated model framework of bottom-up emission inventory, chemical transport model, and the Global Exposure Mortality Model (GEMM). The national anthropogenic PM2.5-related premature mortality estimated with GEMM for the nonaccidental deaths due to noncommunicable diseases and lower respiratory infections rose from 1.26 million (95 % CI: 1.05, 1.46) in 1990 to 2.18 million (95 % CI: 1.84, 2.50) in 2005; then, it decreased to 2.10 million (95 % CI: 1.76, 2.42) in 2015. In 1990, the residential sector was the leading source of the PM2.5-related premature mortality [559,000 (95 % CI: 467,000, 645,900), 44 % of total] in China, followed by industry (29 %), power (13 %), agriculture (9 %) and transportation (5 %). In 2015, the industrial sector became the largest contributor of PM2.5-related premature mortality [734,000 (95 % CI: 615,500, 844,900), 35 % of total], followed by residential (25 %), agriculture (23 %), transportation (10 %) and power (6 %). The decadal changes in source contribution to PM2.5-related premature mortality in China represents a combined impact of socioeconomic development and clean air policy. For example, active control measures have successfully reduced pollution from power sector, while contribution from industrial and transportation sector continuously increased due to more prominent growth of activity rates. Transition in fuel consumption dominated the decrease of contribution from residential sector. In the meanwhile, contribution from agriculture sector continuously increased due to persistent NH3 emissions and enhanced formation of secondary inorganic aerosols under a NH3 rich environment.