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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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“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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InfluentialSimultaneously Mitigating Near-Term Climate Change and Improving Human Health and Food Security
Shindell, D., Kuylenstierna, J. C. I., Vignati, E., van Dingenen, R., Amann, M., Klimont, Z., Anenberg, S. C., Muller, N., Janssens-Maenhout, G., Raes, F., et al. (2012) · Science · doi:10.1126/science.1210026 · Cited by 1,382 · cited 1×
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InfluentialCo-benefits of mitigating global greenhouse gas emissions for future air quality and human health
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InfluentialSelf-citationGlobal distribution and trends of tropospheric ozone: An observation-based review
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InfluentialSilva, R. A., West, J. J., Zhang, Y., Anenberg, S. C., Lamarque, J., Shindell, D. T., Collins, W. J., Dalsøren, S. B., Faluvegi, G., Folberth, G., et al. (2013) · Environmental Research Letters · doi:10.1088/1748-9326/8/3/034005 · Cited by 508 · cited 9×
“…the ln-HR for a 10-ppb increase in O 3 concentration (6mDM1h metric) from the two-pollutant model adjusted for PM 2 : 5 (HR = 1 : 040; 95% CI: 1.013, 1.067), which has been applied in several previous analyses (Anenberg et al. 2010; Fann et al. 2012; Silva et al. 2013, 2016a; West et al. 2013).”
InfluentialMedina-Ramón, M., Zanobetti, A., Cavanagh, D. P., & Schwartz, J. D. (2006) · Environmental Health Perspectives · doi:10.1289/ehp.9074 · Cited by 471 · cited 2×
“…is more limited, with stronger evidence from studies of short-term O 3 and hospital admissions for both COPD and asthma compared with pneumonia (Medina-Ramón et al. 2006; U.S. EPA 2013; Zanobetti and Schwartz 2006), although a recent study reported an association between short-term O 3…”
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“For respiratory mortality, REVIHAAP (2013) identi-fi ed three cohort studies that linked long-term O 3 exposure and relevant outcomes, including respiratory mortality speci fi cally (Jerrett et al. 2009), COPD mortality (Zanobetti and Schwartz 2011), and cardiopulmonary mortality (Smith et al. 2009b).”
Ozone Trends Across the United States over a Period of Decreasing NOx and VOC Emissions
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“For example, there were larger reductions in the O 3 exposure metric, and smaller increases in estimated attributable respiratory deaths, at northern midlati-tudes (eastern United States, northeast China, and central and northern Europe), compared with other regions (e.g., northern India).”
InfluentialAnenberg, S. C., Schwartz, J., Shindell, D., Amann, M., Faluvegi, G., Klimont, Z., Janssens-Maenhout, G., Pozzoli, L., Van Dingenen, R., Vignati, E., et al. (2012) · Environmental Health Perspectives · doi:10.1289/ehp.1104301 · Cited by 442 · cited 1×
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Caiazzo, F., Ashok, A., Waitz, I. A., Yim, S. H. L., & Barrett, S. R. H. (2013) · Atmospheric Environment · doi:10.1016/j.atmosenv.2013.05.081 · Cited by 419 · cited 1×
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“…studies that have assessed long-term O 3 exposure and mortality estimated null or negative associations between O 3 exposure and respiratory mortality (Bentayeb et al. 2015; Carey et al. 2013), and no such cohort studies have been conducted outside North America and Europe (Atkinson et al. 2016).”
Air pollution and emergency admissions in Boston, MA
Zanobetti, A., & Schwartz, J. D. (2006) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2005.039834 · Cited by 262 · cited 1×
“…from studies of short-term O 3 and hospital admissions for both COPD and asthma compared with pneumonia (Medina-Ramón et al. 2006; U.S. EPA 2013; Zanobetti and Schwartz 2006), although a recent study reported an association between short-term O 3 exposure and hospital visits for pneumonia, as…”
Lou, S., Liao, H., & Zhu, B. (2013) · Atmospheric Environment · doi:10.1016/j.atmosenv.2013.12.004 · Cited by 229 · cited 1×
“…for example, Zhu and Liao (2016): mean bias of + 11 : 6 % based on monitoring data from 10 Chinese sites (i.e., GEOS-Chem modeled O 3 concentrations were on average 11.6% higher than the measured concentration), and Lou et al. (2014): mean bias of + 9 % compared with data from 12 Chinese sites.”
InfluentialFang, Y., Naïk, V., Horowitz, L. W., & Mauzerall, D. L. (2013) · Atmospheric chemistry and physics · doi:10.5194/acp-13-1377-2013 · Cited by 217 · cited 6×
“…was subsequently used to derive global estimates of O 3 -attributable mortality ranging from 0.15 to 0.49 million deaths per year (Anenberg et al. 2010; Fang et al. 2013b; GBD 2013 Risk Factors Collaborators 2015; GBD 2015 Risk Factors Collaborators 2016; Lim et al. 2012; Silva et al. 2013, 2016a).”
InfluentialSilva, R. A., Adelman, Z. E., Fry, M. M., & West, J. J. (2016) · Environmental Health Perspectives · doi:10.1289/ehp177 · Cited by 198 · cited 8×
“…the ln-HR for a 10-ppb increase in O 3 concentration (6mDM1h metric) from the two-pollutant model adjusted for PM 2 : 5 (HR = 1 : 040; 95% CI: 1.013, 1.067), which has been applied in several previous analyses (Anenberg et al. 2010; Fann et al. 2012; Silva et al. 2013, 2016a; West et al. 2013).”
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“However, in Asia the exceed-ance of the LCC for the median ADM8h concentration was only 14% greater than for the median 6mDM1h concentrations, compared with 49% and 51% in Europe and North America, respectively (Table 1).”
InfluentialSilva, R. A., West, J. J., Lamarque, J., Shindell, D. T., Collins, W. J., Dalsøren, S. B., Faluvegi, G., Folberth, G., Horowitz, L. W., Nagashima, T., et al. (2016) · Atmospheric chemistry and physics · doi:10.5194/acp-16-9847-2016 · Cited by 164 · cited 8×
“…the ln-HR for a 10-ppb increase in O 3 concentration (6mDM1h metric) from the two-pollutant model adjusted for PM 2 : 5 (HR = 1 : 040; 95% CI: 1.013, 1.067), which has been applied in several previous analyses (Anenberg et al. 2010; Fann et al. 2012; Silva et al. 2013, 2016a; West et al. 2013).”
InfluentialOutdoor air pollution and uncontrolled asthma in the San Joaquin Valley, California
Meng, Y.-Y., Rull, R. P., Wilhelm, M., Lombardi, C., Balmes, J., & Ritz, B. (2010) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2009.083576 · Cited by 159 · cited 3×
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“Punger and West (2013) calculated a less than 6% increase in O 3 attributable mortality estimates in the United States, when derived using modeled O 3 concentrations at a 100 – 400 km grid scale compared with the fi nest (12 km) resolution.”
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“…studies that have assessed long-term O 3 exposure and mortality estimated null or negative associations between O 3 exposure and respiratory mortality (Bentayeb et al. 2015; Carey et al. 2013), and no such cohort studies have been conducted outside North America and Europe (Atkinson et al. 2016).”
Chronic exposure to ambient ozone and asthma hospital admissions among children
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“…based on epidemiologic studies of respiratory mortality (Jerrett et al. 2009; Zanobetti and Schwartz 2011), respiratory morbidity (Jacquemin et al. 2012; Lin et al. 2008; Meng et al. 2010; Parker et al. 2009), and toxicological evidence of biologically plausible mechanisms for respiratory e ff…”
Impacts of 21st century climate change on global air pollution-related premature mortality
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“…was subsequently used to derive global estimates of O 3 -attributable mortality ranging from 0.15 to 0.49 million deaths per year (Anenberg et al. 2010; Fang et al. 2013b; GBD 2013 Risk Factors Collaborators 2015; GBD 2015 Risk Factors Collaborators 2016; Lim et al. 2012; Silva et al. 2013, 2016a).”
InfluentialClimate and health impacts of US emissions reductions consistent with 2 °C
Shindell, D. T., Lee, Y., & Faluvegi, G. (2016) · Nature Climate Change · doi:10.1038/nclimate2935 · Cited by 104 · cited 1×
“Furthermore, human health co-bene fi ts from climate mitigation policies (Anenberg et al. 2012; Shindell et al. 2012, 2016; West et al. 2013), and health burdens from climate-driven changes in O 3 concentrations (Fang et al. 2013a; Silva et al. 2016b; Zhu and Liao 2016) may also be greater than…”
Malig, B. J., Pearson, D. L., Chang, Y. B., Broadwin, R., Basu, R., Green, R. S., & Ostro, B. (2016) · Environmental Health Perspectives · doi:10.1289/ehp.1409495 · Cited by 103
Ozone and Survival in Four Cohorts with Potentially Predisposing Diseases
Zanobetti, A., & Schwartz, J. D. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201102-0227oc · Cited by 95 · cited 4×
“…between long-term exposure to O 3 and respiratory e ff ects ” based on epidemiologic studies of respiratory mortality (Jerrett et al. 2009; Zanobetti and Schwartz 2011), respiratory morbidity (Jacquemin et al. 2012; Lin et al. 2008; Meng et al. 2010; Parker et al. 2009), and toxicological…”
InfluentialReassessing the relationship between ozone and short-term mortality in U.S. urban communities
Smith, R. L., Xu, B., & Switzer, P. (2009) · Inhalation Toxicology · doi:10.1080/08958370903161612 · Cited by 88 · cited 2×
“For respiratory mortality, REVIHAAP (2013) identi-fi ed three cohort studies that linked long-term O 3 exposure and relevant outcomes, including respiratory mortality speci fi cally (Jerrett et al. 2009), COPD mortality (Zanobetti and Schwartz 2011), and cardiopulmonary mortality (Smith et al. 2009b).”
Air Pollution and Childhood Respiratory Allergies in the United States
Parker, J. D., Akinbami, L. J., & Woodruff, T. J. (2008) · Environmental Health Perspectives · doi:10.1289/ehp.11497 · Cited by 87 · cited 3×
“The U.S. EPA (2013) concluded that there was “ likely to be a causal relationship between long-term exposure to O 3 and respiratory e ff ects ” based on epidemiologic studies of respiratory mortality (Jerrett et al. 2009; Zanobetti and Schwartz 2011), respiratory morbidity (Jacquemin et al. 2012; Lin et al. 2008; Meng…”
Jacquemin, B., Kauffmann, F., Pin, I., Moual, N. L., Bousquet, J., Gormand, F., Just, J., Nadif, R., Pison, C. M., VERVLOET, D., et al. (2011) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2010.130229 · Cited by 83 · cited 2×
“…respiratory e ff ects ” based on epidemiologic studies of respiratory mortality (Jerrett et al. 2009; Zanobetti and Schwartz 2011), respiratory morbidity (Jacquemin et al. 2012; Lin et al. 2008; Meng et al. 2010; Parker et al. 2009), and toxicological evidence of biologically plausible mechanisms…”
A multi-scale health impact assessment of air pollution over the 21st century
Likhvar, V., Pascal, M., Markakis, K., Colette, A., Hauglustaine, D. A., Valari, M., Klimont, Z., Médina, S., & Kinney, P. L. (2015) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2015.02.002 · Cited by 77 · cited 1×
“…: 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. 2012; Kim et al. 2015),…”
Gridded Population of the World, Version 3 (GPWv3): Population Count Grid
Center For International Earth Science Information Network-CIESIN-Columbia University, United Nations Food And Agriculture Programme-FAO, & Tropical-CIAT, C. I. D. A. (2014) · Earth Observing System Data and Information System · doi:10.7927/h4639mpp · Cited by 60
Improved simulation of tropospheric ozone by a global-multi-regional two-way coupling model system
Yan, Y., Lin, J., Chen, J., & Hu, L. (2016) · Atmospheric chemistry and physics · doi:10.5194/acp-16-2381-2016 · Cited by 58 · cited 2×
“This bias was identi fi ed by Yan et al. (2016) to be partly due to small scale nonlinear chemical processes that are not captured at the grid resolution of the GEOS-Chem model used here.”
Tong, D., Yu, S., & Kan, H. (2009) · PubMed · Cited by 55
Zhu, J., & Liao, H. (2016) · Journal of Geophysical Research Atmospheres · doi:10.1002/2015jd023926 · Cited by 46 · cited 2×
“…where some of the highest health burdens were estimated, a positive bias was calculated in comparison with available measurements, for example, Zhu and Liao (2016): mean bias of + 11 : 6 % based on monitoring data from 10 Chinese sites (i.e., GEOS-Chem modeled O 3 concentrations were on…”
Assessment of source contributions to seasonal vegetative exposure to ozone in the U.S.
Lapina, K., Henze, D. K., Milford, J. B., Huang, M., Lin, M., Fiore, A. M., Carmichael, G. R., Pfister, G. G., & Bowman, K. W. (2013) · Journal of Geophysical Research Atmospheres · doi:10.1002/2013jd020905 · Cited by 44 · cited 1×
“The model also considers additional emissions, described in further detail by Lapina et al. (2014), which include biogenic VOCs, soil NO x , lightning NO x , and monthly biomass burning emissions.”
Kim, Y., Zhou, Y., Gao, Y., Fu, J. S., Johnson, B. A., Huang, C., & Liu, Y. (2014) · Climatic Change · doi:10.1007/s10584-014-1290-1 · Cited by 29 · cited 1×
“…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. 2012; Kim et al. 2015), and many studies have used relative risk estimates derived from the ACS CPS-II cohort (Jerrett et al. 2009) to estimate mortality…”
Weight-of-evidence evaluation of long-term ozone exposure and cardiovascular effects
Prueitt, R. L., Lynch, H. N., Zu, K., Sax, S. N., Venditti, F. J., & Goodman, J. E. (2014) · Critical Reviews in Toxicology · doi:10.3109/10408444.2014.937855 · Cited by 26
Schwartz, J. D. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201512-2533ed · Cited by 16 · cited 5×
“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).”
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Li, K., Jacob, D. J., Liao, H., Zhu, J., Shah, V. P., Shen, L., Bates, K. H., Zhang, Q., & Zhai, S. (2019) · Nature Geoscience · doi:10.1038/s41561-019-0464-x · Cited by 896
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Fleming, Z. L., Doherty, R. M., von Schneidemesser, E., Malley, C. S., Cooper, O. R., Pinto, J. P., Colette, A., Xu, X., Simpson, D. M., Schultz, M. G., et al. (2018) · Elementa Science of the Anthropocene · doi:10.1525/elementa.273 · Cited by 529
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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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