Reducing PM2.5-related premature mortality is essential for health-related sustainable development. China, one of the most populated and PM2.5 polluted developing countries in the world, is striving to be in the vanguard for meeting this target. However, the global chemical transport methods for future PM2.5 projections are difficult to use and computationally expensive and may import measurement uncertainty into regional exposure assessments, thus bringing challenges to policy making. Here, we proposed an integrated PM2.5 projection model framework based on regional land use, emission, climate and population simulations. The ambient PM2.5 exposure and associated premature mortality to 2100 in China at a scale of 10 x 10 km were projected and compared under different development pathways. Ambient PM2.5 exposure is expected to peak in recent decades (2030-2060) with mean values ranging from 32.72 to 35.11 mu g/m(3) for different pathways, while associated premature mortality are projected to decrease (2273.9-778.59) (in thousands) over time (2030-2100). The change in the emission scenario with significant CH4 and NMVOC increases could lead to the greatest increase in average PM2.5 exposure (4.03 mu g/m(3)), while the decrease (-0.90 mu g/m(3)) was linked to BC, SO2, CH4, and NMVOC decreases. Meanwhile, premature deaths decrease (15-226,424) for most projection periods when land use, emissions, and population data were separately replaced with RCP2.6-SSP1 data. Land use impacts in socioeconomic change scenarios could be moderate in certain regions. Therefore, the sustainable development pathway of the RCP2.6-SSP1 scenario should be prioritized in China for future development considering both environmental protection and health sustainability. Plain Language Summary Reducing PM2.5 exposure and the related health burden is one of the primary tasks for sustainable environmental and health development. China has made great efforts to meet this challenge, but the influence duration and future trend are not clear. We projected the future PM2.5 exposure and associated health burden to 2100 in China for four common development pathways and develop sensitivity analyses by replacing land use, emissions, and population data separately. We found that ambient PM2.5 exposure and associated premature mortality for the pathway with low radiative forcing levels and sustainable socioeconomic development were the lowest for most projection periods in common pathways and sensitivity analyses. This illustrates that the sustainable development pathway for both climate and socioeconomic factors should be a top priority for China.