Cited by 938Air Quality and Health ImpactsIndoor Air Quality and Microbial ExposureAtmospheric chemistry and aerosols

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Long-Term Ozone Exposure and Mortality in a Large Prospective Study

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Turner, Michelle C., Jerrett, Michael, Pope, C. Arden, Krewski, Daniel, Gapstur, Susan M., Diver, W. Ryan, Beckerman, Bernardo S., Marshall, Julian D., Su, Jason, Crouse, Daniel L., Burnett, Richard T.·2016·American Journal of Respiratory and Critical Care Medicine

DOI 10.1164/rccm.201508-1633ocPMC PMC4872664

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Abstract

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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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: Turner, Michelle C.
Jerrett, Michael
Pope, C. Arden
Krewski, Daniel
Gapstur, Susan M.
Diver, W. Ryan
Marshall, Julian D.
Su, Jason
Burnett, Richard T.
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
DOI: 10.1164/rccm.201508-1633oc
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
FWCI: 23.81
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: academic.oup.com/pages/standard-publication-reuse-rights (vor)
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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