The health burden from exposure to ambient fine particulates (PM2.5) in Equatorial Asia is substantially affected by the peatland fires in Indonesia, but the long-term health effect of the fires on local inhabitants is unclear. In this study, PM2.5-associated excess mortality in Equatorial Asia over the past 30 years (1990–2019) was estimated and then the health effect of biomass burning was identified. The PM2.5-related death in Equatorial Asia almost tripled from 113 (95% confidence interval, 100–125) thousand in 1990 to 337 (300–373) thousand in 2019, with a rate of increase of 6.4 (6.2–6.9) thousand/yr. The intense biomass burning between 1990 and 2019 was estimated to have induced 317 (282–348) thousand excess deaths in the study regions, with excess deaths mainly occurring in the El Niño years, such as in 1997, 2006, 2015 and 2019. Although the remote sensing data and emission inventories both reveal that the effective control measures have reduced biomass burning intensity in Equatorial Asia (especially in Sumatra and Borneo), the corresponding health benefit has been offset by variations in demographic factors, i.e., population and age structure. Over the same period, fossil fuel emissions continued to increase rapidly. Thus, more stringent and ambitious policies are required to reduce the health burden from biomass burning and anthropogenic emissions simultaneously to maximize the health benefits from government measures and policies.
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