Long-term ozone exposure and mortality
Open accessAbstract
BACKGROUND: Although many studies have linked elevations in tropospheric ozone to adverse health outcomes, the effect of long-term exposure to ozone on air pollution-related mortality remains uncertain. We examined the potential contribution of exposure to ozone to the risk of death from cardiopulmonary causes and specifically to death from respiratory causes. METHODS: Data from the study cohort of the American Cancer Society Cancer Prevention Study II were correlated with air-pollution data from 96 metropolitan statistical areas in the United States. Data were analyzed from 448,850 subjects, with 118,777 deaths in an 18-year follow-up period. Data on daily maximum ozone concentrations were obtained from April 1 to September 30 for the years 1977 through 2000. Data on concentrations of fine particulate matter (particles that are < or = 2.5 microm in aerodynamic diameter [PM(2.5)]) were obtained for the years 1999 and 2000. Associations between ozone concentrations and the risk of death were evaluated with the use of standard and multilevel Cox regression models. RESULTS: In single-pollutant models, increased concentrations of either PM(2.5) or ozone were significantly associated with an increased risk of death from cardiopulmonary causes. In two-pollutant models, PM(2.5) was associated with the risk of death from cardiovascular causes, whereas ozone was associated with the risk of death from respiratory causes. The estimated relative risk of death from respiratory causes that was associated with an increment in ozone concentration of 10 ppb was 1.040 (95% confidence interval, 1.010 to 1.067). The association of ozone with the risk of death from respiratory causes was insensitive to adjustment for confounders and to the type of statistical model used. CONCLUSIONS: In this large study, we were not able to detect an effect of ozone on the risk of death from cardiovascular causes when the concentration of PM(2.5) was taken into account. We did, however, demonstrate a significant increase in the risk of death from respiratory causes in association with an increase in ozone concentration.
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The benefit estimated by Moch et al. is inconsistent with the relative risk estimated by Jerrett and colleagues of about 1.04 (95% CI 1.01-1.07) for a 10 ppbv increase in ambient ozone.
“This is inconsistent with the relative risk estimated by Jerrett and colleagues [73] of about 1.04 (95% CI 1.01–1.07) for a 10 ppbv increase in ambient ozone.”
From Environmental consequences of interacting effects of changes in stratospheric ozone, ultraviolet radiation, and climate: UNEP Environmental Effects Assessment Panel, Update 2024 (2025) · cites this paper as [73]
The Results report a relative risk of 1.040 (95% CI, 1.013–1.067) for each 10-ppb increase in ozone in a two-pollutant model. Those figures round to the cited values, but the estimate is specifically for death from respiratory causes, not mortality generally as the citing sentence could imply. (LLM, conf=0.87)
Experimental — accuracy not yet measuredFor chronic respiratory disease mortality, the applied beta is ln(1.06) per 10 ppb ozone (95% CI 1.03-1.10), derived by GBD 2019.
“For chronic respiratory disease mortality, we apply a of ln(1.06) per 10 ppb ozone (95 % confidence interval (CI) 1.03-1.10) derived by GBD 2019 (Jerrett et al., 2009; Malashock et al., 2022; GBD 2021 Risk Factors Collaborators, 2020).”
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 Jerrett et al., 2009
The Results report an association between a 10-ppb increase in ozone and mortality from respiratory causes, supporting the general relationship. But the paper reports a relative risk of 1.040 (95% CI 1.013–1.067) in its two-pollutant model, not 1.06 (95% CI 1.03–1.10); it does not identify the outcome as chronic respiratory disease mortality or derive a GBD 2019 coefficient. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAn analysis of national databases found a positive association between increase in long-term ozone concentrations and an increased risk of respiratory diseases and death.
“For example, an analysis of national databases found a positive association between increase in long-term ozone concentrations and an increased risk of respiratory diseases and death (44).”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [44]
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Long-term exposure to ozone and life expectancy in the United States, 2002 to 2008
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Bera, B., Bhattacharjee, S., Shit, P. K., Sengupta, N., & Saha, S. (2022) · Stochastic Environmental Research and Risk Assessment · doi:10.1007/s00477-021-02033-w · Cited by 10 · see citing works
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 chronic respiratory disease mortality, we apply a β of ln(1.06) per 10 ppb ozone (95 % confidence interval (CI) 1.03–1.10) derived by GBD 2019 (Jerrett et al., 2009; Malashock et al., 2022; GBD 2021 Risk Factors Collabora-tors, 2020).”
Influential
- Authors
- Jerrett, M., Burnett, R. T., Pope, C. A., Ito, K., Thurston, G., Krewski, D., Shi, Y., Calle, E., & Thun, M.
- Affiliations
- Brigham Young University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2009-03-12
- Volume
- 360
- Issue
- 11
- Pages
- 1085-1095
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4105969
- OpenAlex
- W2168658532
- Cited by
- 1,602
- References
- 32
- Citations by year
- 2026: 65 · 2025: 96 · 2024: 97 · 2023: 116 · 2022: 155 · 2021: 145 · 2020: 120 · 2019: 109 · 2018: 103 · 2017: 77 · 2016: 95 · 2015: 96 · 2014: 61 · 2013: 71 · 2012: 70
- FWCI
- 46.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Environmental Health Sciences (P30ES000260)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Physical Sciences › Earth and Planetary Sciences › Atmospheric Science › Atmospheric chemistry and aerosols
- Keywords
- tropospheric ozone, long-term air pollution exposure, mortality, respiratory mortality, cardiopulmonary mortality, cardiovascular mortality, PM2.5, air pollution and health, Cancer Prevention Study II
- MeSH terms
- Aged, Air Pollution, Cardiovascular Diseases, Dose-Response Relationship, Drug, Environmental Monitoring, Female, Follow-Up Studies, Humans, Male, Middle Aged, Models, Biological, Mortality, Ozone, Respiratory Tract Diseases, Risk, United States, Urban Health, Proportional Hazards Models, Particulate Matter
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