Historical transboundary ozone health impact linked to affluence

Ozone pollution is a major transboundary threat to global health. Systematic improvement of mitigation strategy for transboundary ozone requires a socioeconomic understanding of historical lessons in countries at different affluence levels. Here, we explore the changes in transboundary ozone related premature deaths over 1951–2019 driven by anthropogenic emissions of four country groups categorized by income level. By integrating global emission datasets, a chemical transport model (GEOS-Chem), in situ ozone measurements worldwide and an ozone exposure-response model, we find that mortality caused by transboundary anthropogenic ozone increases by 27 times from 1951 to 2019, and on average contributes about 27% of global anthropogenic ozone related deaths. All groups exert and suffer from substantial transboundary ozone related mortality. The high-income and upper middle groups have each experienced an inverted U-shaped relationship between its affluence and per-million-people contribution to mortality caused by transboundary ozone, with the turning point around 23 000 USD and 6300 USD, respectively. The lower middle group has gradually matched the growth pathway of the upper middle group with a turning point less clear. Concerted efforts to ensure early turning points in less affluent countries will have considerable global health benefits.