Ambient Air Pollution and Socioeconomic Status in China

BACKGROUND: Air pollution disparities by socioeconomic status (SES) are well documented for the United States, with most literature indicating an inverse relationship (i.e., higher concentrations for lower-SES populations). Few studies exist for China, a country accounting for 26% of global premature deaths from ambient air pollution. OBJECTIVE: Our objective was to test the relationship between ambient air pollution exposures and SES in China. METHODS: We combined estimated year 2015 annual-average ambient levels of nitrogen dioxide ([Formula: see text]) and fine particulate matter [PM [Formula: see text] in aerodynamic diameter ([Formula: see text])] with national demographic information. Pollution estimates were derived from a national empirical model for China at [Formula: see text] spatial resolution; demographic estimates were derived from national gridded gross national product (GDP) per capita at [Formula: see text] resolution, and (separately) a national representative sample of 21,095 individuals from the China Health and Retirement Longitudinal Study (CHARLS) 2015 cohort. Our use of global data on population density and cohort data on where people live helped avoid the spatial imprecision found in publicly available census data for China. We quantified air pollution disparities among individual’s rural-to-urban migration status; SES factors (education, occupation, and income); and minority status. We compared results using three approaches to SES measurement: individual SES score, community-averaged SES score, and gridded GDP per capita. RESULTS: Ambient [Formula: see text] and [Formula: see text] levels were higher for higher-SES populations than for lower-SES population, higher for long-standing urban residents than for rural-to-urban migrant populations, and higher for the majority ethnic group (Han) than for the average across nine minority groups. For the three SES measurements (individual SES score, community-averaged SES score, gridded GDP per capita), a 1-interquartile range higher SES corresponded to higher concentrations of [Formula: see text] [Formula: see text] and [Formula: see text] [Formula: see text]; average concentrations for the highest and lowest 20th percentile of SES differed by 41–89% for [Formula: see text] and 12–25% for [Formula: see text]. This pattern held in rural and urban locations, across geographic regions, across a wide range of spatial resolution, and for modeled vs. measured pollution concentrations. CONCLUSIONS: Multiple analyses here reveal that in China, ambient [Formula: see text] and [Formula: see text] concentrations are higher for high-SES than for low-SES individuals; these results are robust to multiple sensitivity analyses. Our findings are consistent with the idea that in China’s current industrialization and urbanization stage, economic development is correlated with both SES and air pollution. To our knowledge, our study provides the most comprehensive picture to date of ambient air pollution disparities in China; the results differ dramatically from results and from theories to explain conditions in the United States. https://doi.org/10.1289/EHP9872