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Photochemical modeling can predict the level and distribution of pollutant concentrations over time, but is resource-intensive. Partly for this reason, there are few studies exploring the multi-year trajectory of the historical change in fine particle (PM2.5) levels and associated health impacts in the U.S.We used a unique dataset of Community Multi-Scale Air Quality (CMAQ) model simulations performed for a subset of years over a decade-long period fused with observations to estimate the change in ambient levels of PM2.5 across the contiguous U.S. We also quantified the change in PM2.5-attributable health risks and characterized the level of risk inequality over this period.We estimated annual mean PM2.5 concentrations in 2005, 2011 and 2014. Using log-linear and logistic concentration-response coefficients we estimated changes in the numbers of deaths, hospital admissions and other morbidity outcomes. Calculating the Gini coefficient and Atkinson Index, we characterized the extent to which PM2.5 attributable risks were shared equally across the population or instead concentrated among certain subgroups.In 2005 the estimated fraction of deaths due to PM2.5 was 6.1%. This estimated value falls to 4.6% by 2014. Every portion of the contiguous U.S. experiences a decline in the risk of PM-related premature death over the 10-year period. As measured by the Gini coefficient and Atkinson index, the level of PM mortality risk is shared more equally in 2014 than in 2005 among all subgroups.Between 2005 and 2014, the level of PM2.5 concentrations fall, and the risk of premature death, declined and became more equitably distributed across the U.S. population.PM2.5 exposure and risk fell significantly between 2005 and 2014.The fraction of deaths due to PM2.5 falls from 6.1% to 4.6%.PM2.5 risk is becoming more equitably distributed, including those most susceptible.