Long-Term Exposure to Ozone and Cause-Specific Mortality Risk in the United States
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Abstract Rationale Many studies have linked short-term exposure to ozone (O3) with morbidity and mortality, but epidemiologic evidence of associations between long-term O3 exposure and mortality is more limited. Objectives To investigate associations of long-term (annual or warm season average of daily 8-h maximum concentrations) O3 exposure with all-cause and cause-specific mortality in the NIH-AARP Diet and Health Study, a large prospective cohort of U.S. adults with 17 years of follow-up from 1995 to 2011. Methods The cohort (n = 548,780) was linked to census tract–level estimates for O3. Associations between long-term O3 exposure (averaged values from 2002 to 2010) and multiple causes of death were evaluated using multivariate Cox proportional hazards models, adjusted for individual- and census tract–level covariates, and potentially confounding copollutants and temperature. Measurements and Main Results Long-term annual average exposure to O3 was significantly associated with deaths caused by cardiovascular disease (per 10 ppb; hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01–1.06), ischemic heart disease (HR, 1.06; 95% CI, 1.02–1.09), respiratory disease (HR, 1.04; 95% CI, 1.00–1.09), and chronic obstructive pulmonary disease (HR, 1.09; 95% CI, 1.03–1.15) in single-pollutant models. The results were robust to alternative models and adjustment for copollutants (fine particulate matter and nitrogen dioxide), although some evidence of confounding by temperature was observed. Significantly elevated respiratory disease mortality risk associated with long-term O3 exposure was found among those living in locations with high temperature (Pinteraction < 0.05). Conclusions This study found that long-term exposure to O3 is associated with increased risk for multiple causes of mortality, suggesting that establishment of annual and/or seasonal federal O3 standards is needed to more adequately protect public health from ambient O3 exposures.
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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 [45]
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- Authors
- Lim, C. C., Hayes, R. B., Ahn, J., Shao, Y., Silverman, D. T., Jones, R. R., Garcia, C., Bell, M. L., & Thurston, G. D.
- Affiliations
- Department of Environmental Medicine
- New York University (US)
- National Institutes of Health (US)
- California Air Resources Board (US)
- Yale University (US)
- Corresponding author
- Lim, Chris C.
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-10
- Volume
- 200
- Issue
- 8
- Pages
- 1022-1031
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- PMC
- PMC6794108
- OpenAlex
- W2943402416
- Cited by
- 237
- References
- 41
- Citations by year
- 2026: 23 · 2025: 42 · 2024: 36 · 2023: 50 · 2022: 27 · 2021: 32 · 2020: 19 · 2019: 8
- FWCI
- 9.29
- 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)
- Funders
- NIH National Institute of Environmental Health Sciences (1R01 ES019584-01A1, R21 ES021194, 5T32ES007324-18)
- U.S. Environmental Protection Agency (RD835871)
- Environmental Protection Agency (RD831697, RD-83830001, K24ES013195, P30ES07033)
- 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
- long-term ozone exposure, cause-specific mortality, cardiovascular mortality, ischemic heart disease, respiratory mortality, chronic obstructive pulmonary disease, air pollution health effects, ozone standards, NIH-AARP Diet and Health Study
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Air Pollution, Cause of Death, Environmental Exposure, Female, Humans, Male, Middle Aged, Oxidants, Photochemical, Ozone, Prospective Studies, Respiratory Tract Diseases, Risk Factors, United States, Cohort Studies, Proportional Hazards Models, Risk Assessment, Young Adult
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