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Between 2002 and 2017, China’s gross domestic product grew by 284%, but this surge was accompanied by a similarly prodigious growth in energy consumption, air pollution and air pollution-related deaths. Here we use a combination of index decomposition analysis and chemical transport modelling to quantify the relative influence of eight different factors on PM_2.5-related deaths in China over the 15-year period from 2002 to 2017. We show that, over this period, PM_2.5-related deaths increased by 0.39 million (23%) in China. Emission control technologies mandated by end-of-pipe control policies avoided 0.87 million deaths, which is nearly three-quarters (71%) of the deaths that would have otherwise occurred due to the country’s increased economic activity. In addition, energy-climate policies and changes in economic structure have also became evident recently and together avoided 0.39 million deaths from …