An estimate of global cardiovascular mortality burden attributable to ambient ozone exposure reveals urban-rural environmental injustice
Open accessAbstract
Escalating health risks associated with ambient ozone (O 3 ) pollution presents a pressing challenge to global population well-being. An ever-increasing body of evidence supports an association between O 3 pollution and cardiorespiratory conditions. However, previous studies only consider exposure-attributable respiratory deaths, completely disregarding O 3 -induced cardiovascular mortality. An updated estimate is urgently needed to accurately assess O 3 -associated risks. Here, we integrate multiple well-developed high-resolution O 3 concentration databases to track population exposure between 1990 and 2019. We pool up-to-date concentration-response relationships to estimate cardiovascular premature mortality burden attributable to O 3 , which increased globally from 404,200 (95% uncertainty interval [UI] 216,400–605,200) in 1990 to 581,900 (95% UI 306,300–905,800) in 2019. The analysis confirms that O 3 -related health burden is substantially underestimated in previous research. Our results further reveal that rural residents were exposed to 7.7 ± 1.8 ppb higher O 3 than urban citizens over the past 30 years, uncovering a long-overlooked issue of urban-rural environmental injustice. More control efforts should be directed to highly O 3 -polluted rural areas, especially in regions with high cardiovascular incidences.
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Attributing cardiovascular disease to ozone exposure aligns with more recent epidemiological findings and improves the completeness of ozone-related health impact assessments.
“here we attribute cardiovascular disease to ozone exposure, which aligns with more recent epidemiological findings (Sun et al., 2024; Niu et al., 2022) and improves the completeness of ozone-related health impact assessments.”
From Air quality impacts of stratospheric aerosol injections are likely small and mainly driven by changes in climate, not aerosol settling (2026) · cites this paper as Sun et al., 2024
For cardiovascular disease mortality, the applied beta is ln(1.028) per 10 ppb ozone (95% CI 1.010-1.047).
“For cardiovascular disease mortality, we apply a of ln(1.028) per 10 ppb ozone (95 % CI 1.010-1.047) (Sun et al., 2024).”
From Air quality impacts of stratospheric aerosol injections are likely small and mainly driven by changes in climate, not aerosol settling (2026) · cites this paper as Sun et al., 2024
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Wang, C., Visioni, D., Chua, G., & Bednarz, E. M. (2026) · Atmospheric Chemistry and Physics · doi:10.5194/acp-26-1339-2026 · Cited by 3 · see citing works
“For cardiovascular disease mortality, we apply a β of ln(1.028) per 10 ppb ozone (95 % CI 1.010–1.047) ( Sun et al., 2024).”
Influential
- Authors
- Sun, H. Z., van Daalen, K. R., Morawska, L., Guillas, S., Giorio, C., Di, Q., Kan, H., Loo, E. X.-L., Shek, L. P., Watts, N., Guo, Y., & Archibald, A. T.
- Affiliations
- The Alan Turing Institute (GB)
- University of Cambridge (GB)
- Tsinghua University (CN)
- Fudan University (CN)
- Agency for Science, Technology and Research (SG)
- National University of Singapore (SG)
- Monash University (AU)
- Corresponding author
- Guo, Yuming
- Archibald, Alexander T.
- ORCID
- Venue
- One Earth
- Publisher
- Elsevier BV
- Published
- 2024-10
- Volume
- 7
- Issue
- 10
- Pages
- 1803-1819
- ISSN
- 2590-3322 (ISSN-L)
- OpenAlex
- W4402740705
- Cited by
- 41
- References
- 9
- Citations by year
- 2026: 21 · 2025: 19 · 2024: 1
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- One Earth (publishedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Funders
- Australian Research Council (DP210102076)
- National University of Singapore (NUHSRO/2024/045/Startup/06)
- National Health and Medical Research Council (APP1163693, APP2000581)
- UK Research and Innovation (EP/S022961/1, AI4ER)
- Gates Cambridge Trust
- National Centre for Atmospheric Science
- Engineering and Physical Sciences Research Council
- Natural Environment Research Council
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
- Physical Sciences › Earth and Planetary Sciences › Atmospheric Science › Atmospheric chemistry and aerosols
- Keywords
- ambient ozone, cardiovascular mortality, air pollution health effects, rural exposure, concentration-dependent effects
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