Cited by 305Air Quality and Health ImpactsAtmospheric chemistry and aerosolsIndoor Air Quality and Microbial Exposure

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Updated Global Estimates of Respiratory Mortality in Adults ≥30Years of Age Attributable to Long-Term Ozone Exposure

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Malley, Christopher S., Henze, Daven K., Kuylenstierna, Johan C.I., Vallack, Harry W., Davila, Yanko, Anenberg, Susan C., Turner, Michelle C., Ashmore, Mike R.·2017·Environmental Health Perspectives

DOI 10.1289/ehp1390PMC PMC5880233

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Abstract

Background: Relative risk estimates for long-term ozone (O3) exposure and respiratory mortality from the American Cancer Society Cancer Prevention Study II (ACS CPS-II) cohort have been used to estimate global O3-attributable mortality in adults. Updated relative risk estimates are now available for the same cohort based on an expanded study population with longer follow-up. Objectives: We estimated the global burden and spatial distribution of respiratory mortality attributable to long-term O3 exposure in adults ≥30y of age using updated effect estimates from the ACS CPS-II cohort. Methods: We used GEOS-Chem simulations (2×2.5º grid resolution) to estimate annual O3 exposures, and estimated total respiratory deaths in 2010 that were attributable to long-term annual O3 exposure based on the updated relative risk estimates and minimum risk thresholds set at the minimum or fifth percentile of O3 exposure in the most recent CPS-II analysis. These estimates were compared with attributable mortality based on the earlier CPS-II analysis, using 6-mo average exposures and risk thresholds corresponding to the minimum or fifth percentile of O3 exposure in the earlier study population. Results: We estimated 1.04–1.23 million respiratory deaths in adults attributable to O3 exposures using the updated relative risk estimate and exposure parameters, compared with 0.40–0.55 million respiratory deaths attributable to O3 exposures based on the earlier CPS-II risk estimate and parameters. Increases in estimated attributable mortality were larger in northern India, southeast China, and Pakistan than in Europe, eastern United States, and northeast China. Conclusions: These findings suggest that the potential magnitude of health benefits of air quality policies targeting O3, health co-benefits of climate mitigation policies, and health implications of climate change-driven changes in O3 concentrations, are larger than previously thought. https://doi.org/10.1289/EHP1390

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Background
Improving ozone simulations in Asia via multisource data assimilation: results from an observing system simulation experiment with GEMS geostationary satellite observations
Shu, L., Zhu, L., Bak, J., Zoogman, P., Han, H., Liu, S., Li, X., Sun, S., Li, J., Chen, Y., et al. (2023) · Atmospheric chemistry and physics · doi:10.5194/acp-23-3731-2023 · Cited by 15
Spatially and Temporally Differentiated NO x and VOCs Emission Abatement Could Effectively Gain O 3 -Related Health Benefits
Dong, Z., Jiang, Y., Wang, S., Xing, J., Ding, D., Zheng, H., Wang, H., Huang, C. Y., Yin, D., Song, Q., et al. (2024) · Environmental Science & Technology · doi:10.1021/acs.est.4c01345 · Cited by 14
Ozone response to precursors changes in the Chengdu-Chongqing economic circle, China, from satellite and ground-based observations
Ren, J., Hao, Y., Zheng, X., Li, X., & Xie, S. (2024) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2024.176037 · Cited by 15
Impacts of Meteorology and Emissions on O3 Pollution during 2013–2018 and Corresponding Control Strategy for a Typical Industrial City of China
Yao, S., Wei, W., Cheng, S., Niu, Y., & Guan, P. (2021) · Atmosphere · doi:10.3390/atmos12050619 · Cited by 16
Surface ozone trends and related mortality across the climate regions of the contiguous United States during the most recent climate period, 1991–2020
Mousavinezhad, S., Ghahremanloo, M., Choi, Y., Pouyaei, A., Khorshidian, N., & Sadeghi, B. (2023) · Atmospheric Environment · doi:10.1016/j.atmosenv.2023.119693 · Cited by 17
Historical transboundary ozone health impact linked to affluence
Chen, L., Lin, J., Ni, R., Kong, H., Du, M., Yan, Y., Liu, M., Wang, J., Weng, H., Zhao, Y., et al. (2022) · Environmental Research Letters · doi:10.1088/1748-9326/ac9009 · Cited by 14
“Following previous studies [1, 2, 34], we estimate the uncertainty ranges, and further conduct sensitivity tests to better address its limitation.”
MethodResultInfluential
Innate Lymphoid Cell–Dependent Airway Epithelial and Inflammatory Responses to Inhaled Ozone: A New Paradigm in Pathogenesis
Harkema, J. R., & Wagner, J. G. (2019) · Toxicologic Pathology · doi:10.1177/0192623319873872 · Cited by 14
Marginal Damage of Methane Emissions: Ozone Impacts on Agriculture
Sampedro, J., WALDHOFF, S. T., Sarofim, M. C., & Dingenen, R. V. (2023) · Environmental and Resource Economics · doi:10.1007/s10640-022-00750-6 · Cited by 13
“Methane also causes additional damages through driving the process of formation of tropospheric ozone (O 3 ), including impacts to human health (Malley et al. 2017; Turner et al. 2016), climate (IPCC 2013), biodiversity (Unger et al. 2020), and crops and vegetation (Ainsworth 2017; Emberson 2020;…”
Background
Short-term forecasting of ozone air pollution across Europe with transformers
Hickman, S. H. M., Griffiths, P. T., Nowack, P. J., & Archibald, A. T. (2023) · Environmental Data Science · doi:10.1017/eds.2023.37 · Cited by 15
“…surface is estimated to contribute to between 365,000 and 1,100,000 premature deaths worldwide annually (Anenberg et al., 2010; Silva et al., 2013; Malley et al., 2017; Murray et al., 2020), primarily by causing cardiovascular and respiratory diseases (Filippidou and Koukouliata, 2011; Kim et…”
Background
Changes of PM2.5 and O3 and their impact on human health in the Guangdong-Hong Kong-Macao Greater Bay Area
Zhao, H., Chen, Z., & Li, C. (2024) · Scientific Reports · doi:10.1038/s41598-024-62019-w · Cited by 16
“Consequently, different epidemiological studies have employed varying β values, leading to differing estimations of health risks 31–33 .”
Background
Spatio-temporal variation of particulate matter with health impact assessment and long-range transport - case study: Ankara, Türkiye
Koçak, E., & Balcılar, İ. (2024) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2024.173650 · Cited by 13
Maternal ozone exposure lowers infant’s birthweight: A nationwide cohort of over 4 million livebirths in Iran
Zhu, L., Yuan, Y., Mayvaneh, F., Sun, Z., Zhang, Y., & Hu, C. (2024) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2024.116840 · Cited by 13
Evaluating oil and gas contributions to ambient nonmethane hydrocarbon mixing ratios and ozone-related metrics in the Colorado Front Range
Lyu, C., Capps, S. L., Kurashima, K., Henze, D. K., Pierce, G., Hakami, A., Zhao, S., Resler, J., Carmichael, G. R., Sandu, A., et al. (2020) · Atmospheric Environment · doi:10.1016/j.atmosenv.2020.118113 · Cited by 13
“…CSA attributable to long-term ozone exposure above a theoretical minimum risk exposure level (TMREL) (Cohen et al., 2017; Liang et al., 2018; Lim et al., 2014), which is set at 28.9 ppb by taking the average of the two low concentration cutoff values for North America in Malley et al. (2017).”
BackgroundInfluential
Applications of Machine Learning and Artificial Intelligence in Tropospheric Ozone Research
Hickman, S. H. M., Kelp, M., Griffiths, P. T., Doerksen, K., Miyazaki, K., Pennington, E. A., Koren, G., Iglesias‐Suarez, F., Schultz, M. G., Chang, K., et al. (2025) · Geoscientific model development · doi:10.5194/gmd-18-8777-2025 · Cited by 22
“…pollutant and an important greenhouse gas, contributing to both environmental and public health issues Long-term exposure to elevated ozone levels is linked to hundreds of thousands of premature deaths globally each year (Malashock et al., 2022; Malley et al., 2017; Health Effects Institute, 2024).”
Low- and Medium-Cost Sensors for Tropospheric Ozone Monitoring—Results of an Evaluation Study in Wrocław, Poland
Badura, M., Batog, P., Drzeniecka-Osiadacz, A., & Modzel, P. (2022) · Atmosphere · doi:10.3390/atmos13040542 · Cited by 14
Evaluation of Ozone Formation Potential of Formaldehyde Using Smog Chamber Data
Zhang, H., Xu, Y., & Jia, L. (2023) · Aerosol and Air Quality Research · doi:10.4209/aaqr.220323 · Cited by 12
“It was estimated that about 1.04‒1.23 million respiratory global deaths in adults were attributable to ozone exposures in 2016, a remarkable increase due to the ozone increase in northern India, southeast China, and Pakistan (Malley et al. , 2017).”
BackgroundInfluential
Addressing ozone pollution to promote United Nations sustainable development goal 2: Ensuring global food security
Dewan, S., Bamola, S., & Lakhani, A. (2023) · Chemosphere · doi:10.1016/j.chemosphere.2023.140693 · Cited by 13
Integration of Short-Lived Climate Pollutant and air pollutant mitigation in nationally determined contributions
Malley, C. S., Lefèvre, E. N., Kuylenstierna, J. C. I., Haeussling, S., Howard, I. C., & Borgford‐Parnell, N. (2022) · Climate Policy · doi:10.1080/14693062.2022.2125928 · Cited by 12
“Short-Lived Climate Pollutants (with the exception of HFCs) are, directly or indirectly, also air pollutants, exposure to which results in negative health outcomes (Malley et al., 2017; WHO, 2021).”
Background
Drivers of ozone-related premature mortality in China: Implications for historical and future scenarios
Li, Y., Ma, L., Ni, M., Bai, Y., & Li, C. (2023) · Journal of Environmental Management · doi:10.1016/j.jenvman.2023.118663 · Cited by 12
Development and Field Validation of Low-Cost Metal Oxide Nanosensors for Tropospheric Ozone Monitoring in Rural Areas
Gómez-Suárez, J., Arroyo, P., Cerrato-Álvarez, M., Hontañón, E., Masa, S., Ménini, P., Presmanes, L., Alfonso, R., Pinilla-Gil, E., & Lozano, J. (2022) · Chemosensors · doi:10.3390/chemosensors10110478 · Cited by 12
Innovative approaches for accurate ozone prediction and health risk analysis in South Korea: The combined effectiveness of deep learning and AirQ+
Shams, S. R., Choi, Y., Singh, D., Ghahremanloo, M., Momeni, M., & Park, J. (2024) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2024.174158 · Cited by 13
Integrated analysis of air quality-vegetation-health effects of near-future air pollution control strategies
Pan, R., Zhu, J., Chen, D., Cheng, H., Huang, L., Wang, Y., & Li, L. (2024) · Environmental Pollution · doi:10.1016/j.envpol.2024.125407 · Cited by 11
Air quality and health impacts from the updated industrial emission standards in China
Yang, H., Tao, W., Wang, Y., Liu, Y., Liu, J., Zhang, Y., & Tao, S. (2019) · Environmental Research Letters · doi:10.1088/1748-9326/ab54fa · Cited by 11
“5 (Malley et al 2017).”
BackgroundMethodInfluential
Quantifying anomalies of air pollutants in 9 U.S. cities during 2020 due to COVID-19 lockdowns and wildfires based on decadal trends
Peischl, J., Aikin, K. C., McDonald, B., Harkins, C., Middlebrook, A. M., Langford, A. O., Cooper, O. R., Chang, K., & Brown, S. S. (2023) · Elementa Science of the Anthropocene · doi:10.1525/elementa.2023.00029 · Cited by 12
Response of the ozone-related health burden in Europe to changes in local anthropogenic emissions of ozone precursors
Gu, Y., Henze, D. K., Nawaz, M. O., & Wagner, U. J. (2023) · Environmental Research Letters · doi:10.1088/1748-9326/ad0167 · Cited by 11
“Malley et al [7] estimate that long-term O 3 exposure in 2010 results in 0.40–0.55 million and 1.04–1.23 million premature deaths from respiratory illness globally based on earlier [5] and updated [6] CPS-II exposure response relationships, respectively.”
Influential
Response of ozone to current and future emission scenarios and the resultant human health impact in Southeast Asia
Fang, T., Hu, J., Gu, Y., Sung, J. J. �., & Yim, S. H. L. (2025) · Environment International · doi:10.1016/j.envint.2025.109333 · Cited by 12
Collaborative control of fine particles and ozone required in China for health benefit
Qi, L., Tian, Z., Jiang, N., Zheng, F., Zhao, Y., Geng, Y., & Duan, X. (2023) · Frontiers of Environmental Science & Engineering · doi:10.1007/s11783-023-1692-2 · Cited by 10
“DAAO from RD is 73 (95% CI: 23, 117) thousand in China in 2020, at the lower end of the recent estimates (34–316 thousand, Table S2, Malley et al., 2017; Seltzer et al., 2018; Chowdhury et al., 2020; Maji and Namdeo, 2021).”
Background
Photocatalytic oxidation mechanism of isoprene over titanium oxide by UV–Vis lights
Song, B., Wang, Z., Ma, W., Zhou, W., Tang, Q., Bao, X., Liu, K., & Liu, Y. (2024) · Journal of Catalysis · doi:10.1016/j.jcat.2024.115362 · Cited by 10
Elucidating emissions control strategies for ozone to protect human health and public welfare within the continental United States
Lyu, C., Capps, S. L., Hakami, A., Zhao, S., Resler, J., Carmichael, G. R., Sandu, A., Russell, A. G., Chai, T., & Henze, D. K. (2019) · Environmental Research Letters · doi:10.1088/1748-9326/ab5e05 · Cited by 11
“Using the exposure response models of Jerrett et al (2009) and Turner et al (2016), Malley et al (2017) estimated that 26 000 and 58 700 respiratory-related deaths, respectively, were attributable to ozone exposure over assumed low concentration cutoffs (LCC) in North America during 2010.”
MethodInfluential
Increased Weekly Mean PM2.5, and NO2 Are Associated With Increased Proportions of Lower Airway Granulocytes in Ontario Horses
Brankston, G., Greer, A. L., Marshall, Q., Lang, B., Moore, K., Hodgins, D. C., Hennessey, J. T. G., & Beeler‐Marfisi, J. (2020) · Frontiers in Veterinary Science · doi:10.3389/fvets.2020.00185 · Cited by 10
Respiratory Effects of Sedentary Ozone Exposure at the 70-ppb National Ambient Air Quality Standard: A Randomized Clinical Trial
Hernandez, M. L., Ivins, S. S., Chason, K. D., Burbank, A. J., Rebuli, M. E., Kobernick, A. K., Schworer, S. A., Zhou, H., Alexis, N. E., & Peden, D. B. (2021) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202006-2597le · Cited by 10
A novel soft sensor based warning system for hazardous ground-level ozone using advanced damped least squares neural network
Balram, D., Lian, K., & Sebastian, N. (2020) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2020.111168 · Cited by 10
Applicability of evaluation metrics/schemes for human health burden attributable to regional ozone pollution: A case study in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA), South China
Huang, M., Tao, S., Zhu, K., Feng, H., Lu, X. H., Hang, J., & Wang, X. (2024) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2024.169910 · Cited by 9
Evaluation and Projection of Surface PM2.5 and Its Exposure on Population in Asia Based on the CMIP6 GCMs
Xu, Y., Wu, J., & Han, Z. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912092 · Cited by 12
“It is estimated that exposure to these two air pollutants has caused up to 4 million premature deaths annually [4,5].”
Background
Impacts of Meteorological Parameters on Tropospheric Ozone Concentrations in Çanakkale
Arslan, H. (2023) · International Journal of Advances in Engineering and Pure Sciences · doi:10.7240/jeps.1078886 · Cited by 9
“Many epidemiological studies have shown that exposure to ozone leads to a wide range of health problems such as increased asthma morbidity and mortality, reduced lung function, bronchial symptoms and lung diseases [13-15].”
Background
Impacts of reductions in non-methane short-lived climate forcers on future climate extremes and the resulting population exposure risks in eastern and southern Asia
Li, Y., Wang, Z., Lei, Y., Che, H., & Zhang, X. (2023) · Atmospheric chemistry and physics · doi:10.5194/acp-23-2499-2023 · Cited by 11
Estimation of the NO2 population exposure in the Northern Harbour district of Malta
Camilleri, S. F., & Aquilina, N. J. (2020) · Atmospheric Environment · doi:10.1016/j.atmosenv.2020.117918 · Cited by 9
Evaluating low NO x hydrogen engines designed for off-road and construction applications
Webster, L. S., Ballard, R., Beamish, T., Burnhope, T., Humbert, J., Lewis, A. C., Piaszyk, J., & Moller, S. J. (2025) · Environmental Science Processes & Impacts · doi:10.1039/d4em00448e · Cited by 8
Comparative ozone production sensitivity to NO x and VOCs in Quito, Ecuador, and Santiago, Chile
Cazorla, M. D. C., Trujillo, M., Seguel, R., & Gallardo, L. (2025) · Atmospheric chemistry and physics · doi:10.5194/acp-25-7087-2025 · Cited by 7
Drivers of change in peak-season surface ozone concentrations and impacts on human health over the historical period (1850–2014)
Turnock, S. T., Akritidis, D., Horowitz, L. W., Mertens, M., Pozzer, A., Reddington, C. L. S., Wang, H., Zhou, P., & O’Connor, F. M. (2025) · Atmospheric chemistry and physics · doi:10.5194/acp-25-7111-2025 · Cited by 8
“…models to explore the impact of changes in the different drivers of ozone formation (precursor emissions, stratospheric ozone, aerosols, climate) on the simulated concentrations and how this relates to changes in the risk to human health from long-term exposure to ozone over the same time period.”
Global Estimates of Daily Gapless Atmospheric XCH4 Concentrations From Satellite and Reanalysis Data During 2003–2020
Qu, Y., Wei, J., Xing, H., Shi, X. W., Ao, Z., & Meng, X. (2025) · IEEE Transactions on Geoscience and Remote Sensing · doi:10.1109/tgrs.2025.3593486 · Cited by 7
“This rise in methane emissions has intensiﬁed climate warming, resulting in a variety of detrimental impacts, including the increased frequency of extreme events and a decline in biodiversity [7], [8].”
Facile Method to Create PdCe–MnOx Catalyst for Decomposing O3 under Humidity Conditions
Yang, J., Deng, H., Lu, Y., Ma, J., Shan, W., & He, H. (2023) · Industrial & Engineering Chemistry Research · doi:10.1021/acs.iecr.3c00359 · Cited by 7
Future Ozone Changes and Their Impacts on Vegetation and Human Health in China Under the Shared Socio‐Economic Pathways
Chen, X., Mao, Y., & Liao, H. (2024) · Journal of Geophysical Research Atmospheres · doi:10.1029/2023jd040086 · Cited by 7
“HR is the hazard ratio, which represents the increase in death under 10‐ppb rise in long‐ term ozone exposure (Malley et al., 2017; Turner et al., 2016).”
Background
Fine particulate matter and ozone variability with regional and local meteorology in Beijing, China
Guha, S., Zhang, T., Kinney, P. L., & Henneman, L. (2024) · Atmospheric Environment · doi:10.1016/j.atmosenv.2024.120793 · Cited by 7
Increases in global transportation-induced air pollution mortality and radiative forcing during 1990–2019
Han, H. (2025) · Frontiers in Environmental Science · doi:10.3389/fenvs.2025.1545924 · Cited by 6
O ut of sight, O ut of mind — but not O ut of scope: the need to consider ozone (O 3 ) in restoration science, policy, and practice
Perring, M. P., Bullock, J. M., Alison, J., Holder, A. J., & Hayes, F. (2021) · Restoration Ecology · doi:10.1111/rec.13622 · Cited by 6
Significant human health co-benefits of mitigating African emissions
Wells, C., Kasoar, M. R., Ezzati, M., & Voulgarakis, A. (2024) · Atmospheric chemistry and physics · doi:10.5194/acp-24-1025-2024 · Cited by 11

Authors: Malley, C. S., Henze, D. K., Kuylenstierna, J. C. I., Vallack, H. W., Davila, Y., Anenberg, S. C., Turner, M. C., & Ashmore, M. R.
Affiliations: Stockholm Environment Institute (GB)
University of Colorado Boulder (US)
Environmental Health Analytics, LLC., Washington, District of Columbia, USA
University of Ottawa (CA)
Corresponding author: Malley, Christopher S.
ORCID: Malley, Christopher S.
Henze, Daven K.
Vallack, Harry W.
Davila, Yanko
Anenberg, Susan C.
Turner, Michelle C.
Ashmore, Mike R.
Venue: Environmental Health Perspectives
Publisher: American Chemical Society (ACS)
Published: 2017-08-16
Volume: 125
Issue: 8
Pages: 087021-087021
ISSN: 0091-6765 (ISSN-L)
1552-9924
DOI: 10.1289/ehp1390
PMC: PMC5880233
OpenAlex: W2752961258
Cited by: 305
References: 55
Citations by year: 2026: 16 · 2025: 27 · 2024: 35 · 2023: 56 · 2022: 47 · 2021: 41 · 2020: 34 · 2019: 30 · 2018: 18 · 2017: 1
FWCI: 12.24
Type: journal article
Language: en
Open access: gold
doi.org
Licence: public-domain
Locations: Environmental Health Perspectives (publishedVersion, public-domain)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (publishedVersion, public-domain)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
CU Scholar (University of Colorado Boulder) (submittedVersion)
RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, public-domain)
Funders: National Aeronautics and Space Administration (NNX16AQ26G)
Stockholm Environment Institute
Canadian Institutes of Health Research
Topics: Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
Physical Sciences › Earth and Planetary Sciences › Atmospheric Science › Atmospheric chemistry and aerosols
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
Keywords: ozone exposure, respiratory mortality, attributable mortality, long-term air pollution, GEOS-Chem, spatial distribution of mortality, air quality policy, health co-benefits
MeSH terms: Adult, Aged, Aged, 80 and over, Air Pollutants, Environmental Exposure, Humans, Middle Aged, Ozone, Respiratory Tract Diseases, Risk, Global Health

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Updated Global Estimates of Respiratory Mortality in Adults ≥30Years of Age Attributable to Long-Term Ozone Exposure

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