BackgroundThe association between fine particulate matter (PM2.5) and lung cancer (LC) mortality in China is limited. The Beijing-Tianjin-Hebei region is infamous for serious air pollution. Seven of the top 10 cities with the worst air quality are located in Hebei Province. Thus, we explored the effect of 10 years of PM2.5 on the LC mortality rate in Hebei Province. MethodsWe quantified associations between LC mortality and PM2.5 and estimated the LC mortality burden attributed to PM2.5 with predicted county level LC deaths in 2014. ResultsThe 10-year PM2.5 LC mortality associations were non-linear, with thresholds of 63g/m(3) overall, 69g/m(3) for men, 68g/m(3) for women, 66g/m(3) for those aged 30-64years, and 62g/m(3) for those aged 65years. The relative risks for these groups were 1.09 (95% confidence interval [CI] 1.08-1.10), 1.06 (95% CI 1.03-1.10), 1.20 (95% CI 1.10-1.26), 1.07 (95% CI 1.05-1.11), and 1.10 (95% CI: 1.07-1.13), respectively. There were 2525 (95% CI 2265-2780) LC deaths attributed to 10-year PM2.5 in 2014, at fractions of 8.3% (95% CI 7.4-9.1%) overall, 5.7% (95% CI 2.8-9.4%) for men, 16.7% (95% CI: 8.3-21.6%) for women, 6.5% (95% CI 4.7-10.3%) for those aged 30-64years, and 9.1% (95% CI 6.4-11.5%) for those aged 65years. ConclusionOur results suggest that a reduction in the PM2.5 exposure levels below thresholds would prevent a substantial number of LC deaths in Hebei Province.