Long-term ozone exposure and mortality in a large prospective study
Open accessAbstract
RATIONALE: Tropospheric ozone (O3) is potentially associated with cardiovascular disease risk and premature death. Results from long-term epidemiological studies on O3 are scarce and inconclusive. OBJECTIVES: In this study, we examined associations between chronic ambient O3 exposure and all-cause and cause-specific mortality in a large cohort of U.S. adults. METHODS: Cancer Prevention Study II participants were enrolled in 1982. A total of 669,046 participants were analyzed, among whom 237,201 deaths occurred through 2004. We obtained estimates of O3 concentrations at the participant's residence from a hierarchical Bayesian space-time model. Estimates of fine particulate matter (particulate matter with an aerodynamic diameter of up to 2.5 μm [PM2.5]) and NO2 concentrations were obtained from land use regression. Cox proportional hazards regression models were used to examine mortality associations adjusted for individual- and ecological-level covariates. MEASUREMENTS AND MAIN RESULTS: In single-pollutant models, we observed significant positive associations between O3, PM2.5, and NO2 concentrations and all-cause and cause-specific mortality. In two-pollutant models adjusted for PM2.5, significant positive associations remained between O3 and all-cause (hazard ratio [HR] per 10 ppb, 1.02; 95% confidence interval [CI], 1.01-1.04), circulatory (HR, 1.03; 95% CI, 1.01-1.05), and respiratory mortality (HR, 1.12; 95% CI, 1.08-1.16) that were unchanged with further adjustment for NO2. We also observed positive mortality associations with both PM2.5 (both near source and regional) and NO2 in multipollutant models. CONCLUSIONS: Findings derived from this large-scale prospective study suggest that long-term ambient O3 contributes to risk of respiratory and circulatory mortality. Substantial health and environmental benefits may be achieved by implementing further measures aimed at controlling O3 concentrations.
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Other estimates of relative risk for ambient ozone are even smaller; e.g., 1.02 (95% CI 1.01-1.04) and 1.01 (95% CI 0.9-1.1).
“Other estimates of relative risk are even smaller; e.g., 1.02 (95% CI 1.01–1.04) [74] and 1.01 (95% CI 0.9–1.1) [75].”
Long-term exposure to ozone is associated with increased cardiovascular mortality.
“A recent cohort study by Lim et al. further confirmed this association between long-term exposure to ozone and increased cardiovascular mortality (45).”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [14]
Warm-season averages have often been used in epidemiological studies, assuming that the health risk associated with lower-level ozone in cold months is negligible.
“warm-season averages have often been used (14, 15), assuming that the health risk associated with lower-level ozone in cold months is negligible.”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [14]
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- Authors
- Turner, M. C., Jerrett, M., Pope, C. A., Krewski, D., Gapstur, S. M., Diver, W. R., Beckerman, B. S., Marshall, J. D., Su, J., Crouse, D. L., & Burnett, R. T.
- Affiliations
- University of Ottawa (CA)
- University of California, Berkeley (US)
- Brigham Young University (US)
- American Cancer Society (US)
- University of Minnesota (US)
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada; and
- Health Canada (CA)
- Corresponding author
- Turner, Michelle C.
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-05
- Volume
- 193
- Issue
- 10
- Pages
- 1134-1142
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- PMC
- PMC4872664
- OpenAlex
- W2209260785
- Cited by
- 938
- References
- 36
- Citations by year
- 2026: 69 · 2025: 112 · 2024: 120 · 2023: 129 · 2022: 122 · 2021: 123 · 2020: 78 · 2019: 69 · 2018: 63 · 2017: 38 · 2016: 13 · 2015: 1 · 2013: 1
- FWCI
- 23.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- 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, all-cause mortality, circulatory disease mortality, respiratory mortality, PM2.5, nitrogen dioxide, Cancer Prevention Study II, air quality policy
- MeSH terms
- Adult, Aged, Aged, 80 and over, Air Pollutants, Air Pollution, Death, Environmental Exposure, Female, Humans, Male, Middle Aged, Ozone, Prospective Studies, Puerto Rico, Risk, Risk Factors, Time, United States, Proportional Hazards Models
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