Exposure to outdoor fine particulate matter (PM_2.5) is a leading risk factor for mortality. We develop global estimates of annual PM_2.5 concentrations and trends for 1998–2018 using advances in satellite observations, chemical transport modeling, and ground-based monitoring. Aerosol optical depths (AODs) from advanced satellite products including finer resolution, increased global coverage, and improved long-term stability are combined and related to surface PM_2.5 concentrations using geophysical relationships between surface PM_2.5 and AOD simulated by the GEOS-Chem chemical transport model with updated algorithms. The resultant annual mean geophysical PM_2.5 estimates are highly consistent with globally distributed ground monitors (R² = 0.81; slope = 0.90). Geographically weighted regression is applied to the geophysical PM_2.5 estimates to predict and account for the residual bias with PM_2.5 monitors, yielding even higher cross validated agreement (R² = 0.90–0.92; slope = 0.90–0.97) with ground monitors and improved agreement compared to all earlier global estimates. The consistent long-term satellite AOD and simulation enable trend assessment over a 21 year period, identifying significant trends for eastern North America (−0.28 ± 0.03 μg/m³/yr), Europe (−0.15 ± 0.03 μg/m³/yr), India (1.13 ± 0.15 μg/m³/yr), and globally (0.04 ± 0.02 μg/m³/yr). The positive trend (2.44 ± 0.44 μg/m³/yr) for India over 2005–2013 and the negative trend (−3.37 ± 0.38 μg/m³/yr) for China over 2011–2018 are remarkable, with implications for the health of billions of people.