Fine particulate matter (PM2.5) pollution in Eastern China (EC) has raised concerns due to its adverse effects on air quality, climate, and human health. This study investigated the long-term variation trend in satellite-derived PM2.5 concentrations and how it was related to pollutant emissions and meteorological parameters over EC and seven regions of interest (ROIs) during 1998-2016. Over EC, the annual mean PM2.5 increased before 2006 due to the enhanced emissions of primary PM2.5, NOx and SO2, but decreased with the reduced SO2 emissions after 2006 evidently in response to China's clean air policies. In addition, results from statistical analyses indicated that in the North China Plain (NCP), Northeast China (NEC), Sichuan Basin (SCB) and Central China (CC) planetary boundary layer height (PBLH) was the dominant meteorological driver for the PM2.5 decadal changes, and in the Pearl River Delta (PRD) wind speed is the leading factor. Overall, the variation in meteorological parameters accounted for 48% of the variances in PM2.5 concentrations over EC. The population-weighted PM2.5 over EC increased from 36.4 μg/m3 in 1998-2004 (P1) to 49.4 μg/m3 in 2005-2010 (P2) then decreased to 46.5 μg/m3 in 2011-2016 (P3). In the NCP and NEC, the percentages of the population living above the World Health Organization (WHO) Interim Target-1 (IT-1, 35 μg/m3) have risen steadily over the past 20 yr, reaching maxima of 97.3% and 78.8% in P3, respectively, but decreases of ∼30% from P2 to P3 were found for the SCB and PRD.