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Updated Global Estimates of Respiratory Mortality in Adults ≥30Years of Age Attributable to Long-Term Ozone Exposure
Open accessAbstract
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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In the citing paper
“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 [15]
In the citing paper
“Other ozone-associated mortality estimates include 316,000 respiratory deaths in China (15) and ~23,500 in the European Union8.”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [15]
In the citing paper
“In addition, an estimated 23.0–40.3 million respiratory-related deaths were attributable to long-term O3 exposure in 2016 (15).”
From Ozone pollution: A Major health hazard worldwide (2019) · cites this paper as [15]
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Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., AlMazroa, M. A., Amann, M., Anderson, H. R., Andrews, K. G., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61766-8 · Cited by 11,805 · cited 4×
“…the maximum 3-mo average daily maximum 1-h O 3 concentration, and the single-pollutant J2009 relative risk estimate [1.029 (95% CI 1.010, 1.048)] that was derived for total respiratory mortality (GBD 2013 Risk Factors Collaborators 2015; GBD 2015 Risk Factors Collaborators 2016; Lim et al. 2012).”
InfluentialLung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution
Pope III, C. A. (2002) · JAMA · doi:10.1001/jama.287.9.1132 · Cited by 8,447 · cited 1×
“…(95% CI: 1.06, 1.09) multipollutant model using alternative estimate of PM 2 : 5 exposure: 1.06 (95% CI: 1.04, 1.08)] was similar to that derived in the Krewski et al. (2009) [HR: 1.06 (95% CI: 1.04, 1.08)], and Pope et al. (2002) [HR: 1.06 (95% CI: 1.02, 1.11)] analyses of the ACS CPS-II cohort.”
InfluentialForouzanfar, M. H., Afshin, A., Alexander, L. T., Anderson, H. R., Bhutta, Z. A., Biryukov, S., Brauer, M., Burnett, R., Cercy, K., Charlson, F. J., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31679-8 · Cited by 7,698 · cited 21×
“For each country, the total number of deaths for each disease category (respiratory and COPD) for the population ≥ 30 y of age in 2010 were from the GBD 2015 estimates derived by the Institute of Health Metrics and Evaluation (GBD 2015 Mortality and Causes of Death Collaborators 2016).”
InfluentialWang, H., Naghavi, M., Allen, C., Barber, R. M., Bhutta, Z. A., Carter, A., Casey, D. C., Charlson, F. J., Chen, A. Z., Coates, M. M., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31012-1 · Cited by 6,596
Cohen, A. J., Brauer, M., Burnett, R., Anderson, H. R., Frostad, J., Estep, K., Balakrishnan, K., Brunekreef, B., Dandona, L., Dandona, R., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30505-6 · Cited by 6,583
The contribution of outdoor air pollution sources to premature mortality on a global scale
Lelieveld, J., Evans, J. S., Fnais, M., Giannadaki, D., & Pozzer, A. (2015) · Nature · doi:10.1038/nature15371 · Cited by 5,977 · cited 1×
“…to O 3 and PM 2 : 5 exposure has been estimated at global (Anenberg et al. 2010; Fang et al. 2013b; GBD 2013 Risk Factors Collaborators 2015; Lelieveld et al. 2015; Likhvar et al. 2015; Silva et al. 2013), regional (Crippa et al. 2016), and national scales (Caiazzo et al. 2013; Fann et al.…”
Forouzanfar, M. H., Alexander, L., Anderson, H. R., Bachman, V. F., Biryukov, S., Brauer, M., Burnett, R., Casey, D., Coates, M. M., Cohen, A., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00128-2 · Cited by 2,701
Bey, I., Jacob, D. J., Yantosca, R. M., Logan, J. A., Field, B. D., Fiore, A. M., Li, Q., Liu, H. Y., Mickley, L. J., & Schultz, M. G. (2001) · Journal of Geophysical Research Atmospheres · doi:10.1029/2001jd000807 · Cited by 2,491 · cited 3×
“Global gridded (2 × 2 : 5 , approximately 221 × 278 km at the equator) hourly O 3 concentrations were simulated using the GEOS-Chem Chemical Transport Model (Bey et al. 2001) driven by GEOS-5 meteorological fi elds for 2010 from the Global Modeling and Assimilation O ffi ce, with 47 vertical levels de fi ned from the surf…”
InfluentialMonks, P. S., Archibald, A. T., Colette, A., Cooper, O. R., Coyle, M., Derwent, R. G., Fowler, D., Granier, C., Law, K. S., Mills, G., et al. (2015) · Atmospheric chemistry and physics · doi:10.5194/acp-15-8889-2015 · Cited by 1,720 · cited 4×
“The spatial di ff erences in the magnitude of the all-year compared with 6-mo metrics re fl ects di ff erent seasonal variability in O 3 concentrations at northern midlatitudes, compared with other regions (Monks et al. 2015).”
InfluentialLong-term ozone exposure and mortality
Jerrett, M., Burnett, R. T., Pope, C. A., Ito, K., Thurston, G., Krewski, D., Shi, Y., Calle, E., & Thun, M. (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0803894 · Cited by 1,602 · cited 15×
“Jerrett et al. (2009) reported a relative risk estimate for respiratory mortality in association with long-term O 3 exposure in the CPS-II cohort (hereafter referred to as J2009), which was subsequently used to derive global estimates of O 3 -attributable mortality ranging from 0.15 to 0.49 million…”
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“MDA8 is a widely recognized metric in air quality studies across regions like China, Europe, and the USA, particularly for assessing health risks linked to O 3 exposure (Malley et al., 2017; Ren et al., 2024; Turner et al., 2016).”
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Heyerdahl, I. R., Nhat, P. M., Fernández, L. V., Assunção, R., Byelyey, N., Castro, A., Charalampous, P., Corda, M. O., Gorasso, V., Haagsma, J. A., et al. (2026) · Journal of Public Health · doi:10.1007/s10389-026-02921-x
Metadata
- 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
- 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
- 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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