Ambient Ozone Pollution and Daily Mortality: A Nationwide Study in 272 Chinese Cities

Abstract

Background:Few large multicity studies have been conducted in developing countries to address the acute health effects of atmospheric ozone pollution.Objective:We explored the associations between ozone and daily cause-specific mortality in China.Methods:We performed a nationwide time-series analysis in 272 representative Chinese cities between 2013 and 2015. We used distributed lag models and over-dispersed generalized linear models to estimate the cumulative effects of ozone (lagged over 0–3 d) on mortality in each city, and we used hierarchical Bayesian models to combine the city-specific estimates. Regional, seasonal, and demographic heterogeneity were evaluated by meta-regression.Results:At the national-average level, a 10-μg/m3 increase in 8-h maximum ozone concentration was associated with 0.24% [95% posterior interval (PI): 0.13%, 0.35%], 0.27% (95% PI: 0.10%, 0.44%), 0.60% (95% PI: 0.08%, 1.11%), 0.24% (95% PI: 0.02%, 0.46%), and 0.29% (95% PI: 0.07%, 0.50%) higher daily mortality from all nonaccidental causes, cardiovascular diseases, hypertension, coronary diseases, and stroke, respectively. Associations between ozone and daily mortality due to respiratory and chronic obstructive pulmonary disease specifically were positive but imprecise and nonsignificant. There were no statistically significant differences in associations between ozone and nonaccidental mortality according to region, season, age, sex, or educational attainment.Conclusions:Our findings provide robust evidence of higher nonaccidental and cardiovascular mortality in association with short-term exposure to ambient ozone in China. https://doi.org/10.1289/EHP1849

Short-term effects of ambient fine particulate matter pollution on hospital visits for chronic obstructive pulmonary disease in Beijing, China

“…We further explored potential effect modification of COPD risk by sex, age (18-64 years and ≥65 years), and season (warm: April to September; cool: October to March) using concurrent day PM 2.5 concentration. A penalized spline function of calendar time on warm or cool season was used to accommodate the long-term trend in hospital visits for COPD [30,31]. The statistical significance of subgroup differences were tested using the Z-test [32].…”

A Random Forest Approach to Estimate Daily Particulate Matter, Nitrogen Dioxide, and Ozone at Fine Spatial Resolution in Sweden

“…It is an oxidant air pollutant generated by photochemical reactions involving nitrogen oxides and volatile organic compounds. Short-term effects of ozone on mortality and morbidity have been reported in the epidemiological literature, among others from large multi-center studies conducted in Europe [13,14], the United States [15], and China [16]. The effects of long-term exposure to ozone on human health has however not been fully established [17].…”

Interactive effects of changing stratospheric ozone and climate on tropospheric composition and air quality, and the consequences for human and ecosystem health

“…Long-term exposure to greater concentrations of O3 (the highest quintile f of exposure concentrations, 82-112 µg m -3 ) was associated with increased incidence of hypertension (HR = 1.09, 95% CI; 1.00-1.18) but the opposite was reported for NO2 (48-73 µg m -3 ) where higher NO2 concentrations were related to lower incidence (HR = 0.92, 95% CI; 0.86-0.98). In a 272-city study in China for data from 2013-2015, 89 a positive association between 10 µg m -3 increments in concentration of O3 and higher daily mortality was reported from cardiovascular diseases (0.27%, 95%, PI = 0.10-0.44%), including hypertension (0.60%. 95% PI = 0.08-1.11%), coronary diseases (0.24%, 95%, PI = 0.02-0.46%), and stroke (0.29%, 95%PI = 0.07-0.50%).…”

“…88 A nationwide study in 272 Chinese cities between 2013 and 2015 showed that a 0.24% increase in daily mortality from all nonaccidental causes (95% Prediction Interval (PI c ) = 0.13%-0.35%) was associated with an increment in 8-h maximum concentration of O3 of 10 µg m -3 , approximately half that reported above. 89 However, no association between increased concentrations of O3 and daily mortality from respiratory diseases was reported.…”