Air quality is a major environmental concern in China, where premature deaths due to air pollution have exceeded 1 million people per year in recent years. Here, using a novel coupling of economic, physical and epidemiological models, we estimate the premature mortality related to anthropogenic outdoor PM2.5 air pollution in seven regions of China in 2010 and show for the first time how the distribution of these deaths in China is determined by a combination of economic activities and physical transport of pollution in the atmosphere. We find that 33 % (338 600 premature deaths) of China's PM2.5-related premature mortality in 2010 were caused by pollutants emitted in a different region of the country and transported in the atmosphere, especially from north to south and from east to west. Trade further extended the cross-regional impact; 56 % of (568 900 premature deaths) China's PM2.5-related premature mortality was related to consumption in another region, including 423 800 (42 % of total) and 145 100 (14 %) premature deaths from domestic consumption and international trade respectively. Our results indicate that multilateral and multi-stage cooperation under a regional sustainable development framework is in urgent need to mitigate air pollution and related health impacts, and efforts to reduce the health impacts of air pollution in China should be prioritized according to the source and location of emissions, the type and economic value of the emitting activities, and the related patterns of consumption.