Air pollution has posed a serious public health issue in China. In the study, we aimed to examine the burden of air pollution and its association with climate factors and total mortality. City-level daily air quality index (AQI) data in 161 cities of China in 2014, and meteorological factors, socioeconomic status and total morality were obtained from China environmental, meteor-ology and healthcare agencies. Linear regression, spatial autocorrelation analysis and panel fixed models were applied in data analysis. Among 161 cities, monthly average AQI was significantly different by seasons and regions. The highest average AQI was in winter, and the lowest in summer. A significant clustering distribution of AQI by cities was observed, with the highest AQI in north China (22 cities, mean = 117.36). Among the 161 cities, 5 cities (3%) had AQI > 150 (e.g., moderate polluted reference value), and 50 cities (31.1%) had AQI between 100 and 150 (slightly polluted value). Daily heat index, precipitation and sunshine hours were negatively and significantly, but air pressure was positively correlated with AQI. Cities with higher AQI concentrations had higher total mortality than those with lower AQI. This AQI-mortality association remained significant after adjustment for socioeconomic status. In conclusion, the study highlights the burden and seasonal, regional and areas variations in air pollution across the nation. Air pollution is estimated to account for more than 4% of the urban health inequality in total mortality in China.
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