Unappreciated healthcare inequality against PM2.5-related mortality risk

Abstract

Abstract Understanding the inequality of PM2.5-related health is crucial for promoting health, building a just society, and advancing multiple Sustainable Development Goals goals. However, previous research has predominantly concentrated on PM2.5 exposure inequality, neglecting varied prompt responses and protective behaviors against it. Here, we established the relationship between short-term healthcare expenditure and PM2.5 concentration using the number and amount of healthcare transactions across all healthcare categories based on the Union Pay data. We also assessed daily city-specific PM2.5-related mortality and healthcare expenditures and evaluated their inequalities among cities according to the income inequality index, the Gini coefficient. The results show that short-term exposure to PM2.5 leads to severe physiological and health-related economic burdens on Chinese residents. From 2017 to 2019, 77.8 (34.5–121.1) thousand deaths were attributed to daily PM2.5, with healthcare expenditures reaching 93.7 (69.1–118.3) billion Chinese Yuan. Additionally, there were significant inequalities in PM2.5-related mortality and healthcare expenditures among cities. The inequality index for PM2.5-related healthcare expenditures was 0.53, while the inequality index for PM2.5-related mortality was 0.13. The greater inequality in healthcare expenditures than in mortality, implying inadequate healthcare resources amplify the health inequality related to PM2.5 exposure. 28.6% of Chinese cities lacked affordable healthcare resources to address the high physiological burden attributable to PM2.5. Our multidimensional exploration is essential for formulating effective policies addressing environmental health inequality. Focusing on these cities with disproportionate challenges is crucial for creating a more equitable and sustainable society.