This study estimated PM 2.5 (atmospheric fine particulate matter with aerodynamic diameter ≤2.5 µg) concentrations and the health burden in mainland China from 2010 to 2049 under two scenarios: Current Legistaions and Maximum Technical Feasible Reductions. We assess premature deaths from PM 2.5 exposure, examining sources like coal combustion, biomass burning, industry, and tailpipe emission from on-road transport. Results show that central and eastern China account for 75% of PM 2.5 -related deaths, with biomass burning (40%) and industry (34%) as primary contributors. Under the Current Legistaions and Maximum Technical Feasible Reductions scenarios, PM 2.5 -related premature deaths are projected to decrease by 43% and 80% (linear EVA) and by 28% increase and 40% decrease (nonlinear EVA) from 2010 to 2049. Assuming a linear relationship, the Maximum Technical Feasible Reductions scenario estimates that reduced PM 2.5 exposure could avoid 1.55 million premature deaths annually by 2049 compared to 2010, primarily from coal combustion for heating, biomass burning, industry, and tailpipe emission from on-road transport.