Cohort-based long-term ozone exposure-associated mortality risks with adjusted metrics: A systematic review and meta-analysis

Haitong Zhe Sun; Pei Yu; Changxin Lan; Michelle W.L. Wan; Sebastian Hickman; Jayaprakash Murulitharan; Huizhong Shen; Le Yuan; Yuming Guo; Alexander T. Archibald

doi:10.1016/j.xinn.2022.100246

Cohort-based long-term ozone exposure-associated mortality risks with adjusted metrics: A systematic review and meta-analysis

Haitong Zhe Sun, Pei Yu, Changxin Lan, Michelle W.L. Wan, Sebastian Hickman, Jayaprakash Murulitharan, Huizhong Shen, Le Yuan, Yuming Guo, Alexander T. Archibald

Research output: Contribution to journal › Review Article › Research › peer-review

57 Citations (Scopus)

Abstract

Long-term ozone (O₃) exposure may lead to non-communicable diseases and increase mortality risk. However, cohort-based studies are relatively rare, and inconsistent exposure metrics impair the credibility of epidemiological evidence synthetization. To provide more accurate meta-estimations, this study updates existing systematic reviews by including recent studies and summarizing the quantitative associations between O₃ exposure and cause-specific mortality risks, based on unified exposure metrics. Cross-metric conversion factors were estimated linearly by decadal observations during 1990–2019. The Hunter-Schmidt random-effects estimator was applied to pool the relative risks. A total of 25 studies involving 226,453,067 participants (14 unique cohorts covering 99,855,611 participants) were included in the systematic review. After linearly unifying the inconsistent O₃ exposure metrics, the pooled relative risks associated with every 10 nmol mol⁻¹ (ppbV) incremental O₃ exposure, by mean of the warm-season daily maximum 8-h average metric, were as follows: 1.014 with 95% confidence interval (CI) ranging 1.009–1.019 for all-cause mortality; 1.025 (95% CI: 1.010–1.040) for respiratory mortality; 1.056 (95% CI: 1.029–1.084) for COPD mortality; 1.019 (95% CI: 1.004–1.035) for cardiovascular mortality; and 1.074 (95% CI: 1.054–1.093) for congestive heart failure mortality. Insignificant mortality risk associations were found for ischemic heart disease, cerebrovascular diseases, and lung cancer. Adjustment for exposure metrics laid a solid foundation for multi-study meta-analysis, and widening coverage of surface O₃ observations is expected to strengthen the cross-metric conversion in the future. Ever-growing numbers of epidemiological studies supported the evidence for considerable cardiopulmonary hazards and all-cause mortality risks from long-term O₃ exposure. However, evidence of long-term O₃ exposure-associated health effects was still scarce, so more relevant studies are needed to cover more populations with regional diversity.

Original language	English
Article number	100246
Number of pages	14
Journal	The Innovation
Volume	3
Issue number	3
DOIs	https://doi.org/10.1016/j.xinn.2022.100246
Publication status	Published - 10 May 2022

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10.1016/j.xinn.2022.100246Licence: CC BY-NC-ND

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@article{0b8269e2ce104fb989a6dea3f3a435d3,

title = "Cohort-based long-term ozone exposure-associated mortality risks with adjusted metrics: A systematic review and meta-analysis",

abstract = "Long-term ozone (O3) exposure may lead to non-communicable diseases and increase mortality risk. However, cohort-based studies are relatively rare, and inconsistent exposure metrics impair the credibility of epidemiological evidence synthetization. To provide more accurate meta-estimations, this study updates existing systematic reviews by including recent studies and summarizing the quantitative associations between O3 exposure and cause-specific mortality risks, based on unified exposure metrics. Cross-metric conversion factors were estimated linearly by decadal observations during 1990–2019. The Hunter-Schmidt random-effects estimator was applied to pool the relative risks. A total of 25 studies involving 226,453,067 participants (14 unique cohorts covering 99,855,611 participants) were included in the systematic review. After linearly unifying the inconsistent O3 exposure metrics, the pooled relative risks associated with every 10 nmol mol−1 (ppbV) incremental O3 exposure, by mean of the warm-season daily maximum 8-h average metric, were as follows: 1.014 with 95% confidence interval (CI) ranging 1.009–1.019 for all-cause mortality; 1.025 (95% CI: 1.010–1.040) for respiratory mortality; 1.056 (95% CI: 1.029–1.084) for COPD mortality; 1.019 (95% CI: 1.004–1.035) for cardiovascular mortality; and 1.074 (95% CI: 1.054–1.093) for congestive heart failure mortality. Insignificant mortality risk associations were found for ischemic heart disease, cerebrovascular diseases, and lung cancer. Adjustment for exposure metrics laid a solid foundation for multi-study meta-analysis, and widening coverage of surface O3 observations is expected to strengthen the cross-metric conversion in the future. Ever-growing numbers of epidemiological studies supported the evidence for considerable cardiopulmonary hazards and all-cause mortality risks from long-term O3 exposure. However, evidence of long-term O3 exposure-associated health effects was still scarce, so more relevant studies are needed to cover more populations with regional diversity.",

author = "Sun, {Haitong Zhe} and Pei Yu and Changxin Lan and Wan, {Michelle W.L.} and Sebastian Hickman and Jayaprakash Murulitharan and Huizhong Shen and Le Yuan and Yuming Guo and Archibald, {Alexander T.}",

note = "Funding Information: This study is funded by the UK Natural Environment Research Council (NERC), UK National Centre for Atmospheric Science (NCAS), Australian Research Council ( DP210102076 ) and Australian National Health and Medical Research Council ( APP2000581 ). H.Z.S., M.W., and S.H. receive funding from the Engineering and Physical Sciences Research Council (EPSRC) via the UK Research and Innovation (UKRI) Centre for Doctoral Training in Application of Artificial Intelligence to the study of Environmental Risks ( AI4ER , EP/S022961/1 ). A.T.A. acknowledges funding from NERC ( NE/P016383/1 ) and through the Met Office UKRI Clean Air Program. Y.G. is supported by a Career Development Fellowship of the Australian National Health and Medical Research Council ( APP1163693 ). All contents of this study are solely the responsibility of the grantees and do not represent the official views of the supporting agencies. Funding Information: This study is funded by the UK Natural Environment Research Council (NERC), UK National Centre for Atmospheric Science (NCAS), Australian Research Council (DP210102076) and Australian National Health and Medical Research Council (APP2000581). H.Z.S. M.W. and S.H. receive funding from the Engineering and Physical Sciences Research Council (EPSRC) via the UK Research and Innovation (UKRI) Centre for Doctoral Training in Application of Artificial Intelligence to the study of Environmental Risks (AI4ER, EP/S022961/1). A.T.A. acknowledges funding from NERC (NE/P016383/1) and through the Met Office UKRI Clean Air Program. Y.G. is supported by a Career Development Fellowship of the Australian National Health and Medical Research Council (APP1163693). All contents of this study are solely the responsibility of the grantees and do not represent the official views of the supporting agencies. Special appreciations to Dr Xiao Lu (School of Atmospheric Sciences, Sun Yat-sen University) for his insightful discussion on the quality control of TOAR products, Dr Liuhua Shi (Rollins School of Public Health, Emory University) for her supplementary information on Medicare beneficiary cohort information, and four anonymous reviewers together with the editor for their meticulous efforts in improving the article. A.T.A. and Y.G. conceived the idea for the review; H.Z.S. C.L. and P.Y. performed the literature search; H.Z.S. and P.Y. conducted statistical analyses; H.Z.S. A.T.A. Y.G. P.Y. M.W. S.H. J.M. H.S. and L.Y. contributed to discussions; H.Z.S. wrote the article; and M.W. and S.H. examined the language. The authors declare no competing interests. Publisher Copyright: {\textcopyright} 2022 The Author(s)",

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doi = "10.1016/j.xinn.2022.100246",

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T1 - Cohort-based long-term ozone exposure-associated mortality risks with adjusted metrics

T2 - A systematic review and meta-analysis

AU - Sun, Haitong Zhe

AU - Yu, Pei

AU - Lan, Changxin

AU - Wan, Michelle W.L.

AU - Hickman, Sebastian

AU - Murulitharan, Jayaprakash

AU - Shen, Huizhong

AU - Yuan, Le

AU - Guo, Yuming

AU - Archibald, Alexander T.

N1 - Funding Information: This study is funded by the UK Natural Environment Research Council (NERC), UK National Centre for Atmospheric Science (NCAS), Australian Research Council ( DP210102076 ) and Australian National Health and Medical Research Council ( APP2000581 ). H.Z.S., M.W., and S.H. receive funding from the Engineering and Physical Sciences Research Council (EPSRC) via the UK Research and Innovation (UKRI) Centre for Doctoral Training in Application of Artificial Intelligence to the study of Environmental Risks ( AI4ER , EP/S022961/1 ). A.T.A. acknowledges funding from NERC ( NE/P016383/1 ) and through the Met Office UKRI Clean Air Program. Y.G. is supported by a Career Development Fellowship of the Australian National Health and Medical Research Council ( APP1163693 ). All contents of this study are solely the responsibility of the grantees and do not represent the official views of the supporting agencies. Funding Information: This study is funded by the UK Natural Environment Research Council (NERC), UK National Centre for Atmospheric Science (NCAS), Australian Research Council (DP210102076) and Australian National Health and Medical Research Council (APP2000581). H.Z.S. M.W. and S.H. receive funding from the Engineering and Physical Sciences Research Council (EPSRC) via the UK Research and Innovation (UKRI) Centre for Doctoral Training in Application of Artificial Intelligence to the study of Environmental Risks (AI4ER, EP/S022961/1). A.T.A. acknowledges funding from NERC (NE/P016383/1) and through the Met Office UKRI Clean Air Program. Y.G. is supported by a Career Development Fellowship of the Australian National Health and Medical Research Council (APP1163693). All contents of this study are solely the responsibility of the grantees and do not represent the official views of the supporting agencies. Special appreciations to Dr Xiao Lu (School of Atmospheric Sciences, Sun Yat-sen University) for his insightful discussion on the quality control of TOAR products, Dr Liuhua Shi (Rollins School of Public Health, Emory University) for her supplementary information on Medicare beneficiary cohort information, and four anonymous reviewers together with the editor for their meticulous efforts in improving the article. A.T.A. and Y.G. conceived the idea for the review; H.Z.S. C.L. and P.Y. performed the literature search; H.Z.S. and P.Y. conducted statistical analyses; H.Z.S. A.T.A. Y.G. P.Y. M.W. S.H. J.M. H.S. and L.Y. contributed to discussions; H.Z.S. wrote the article; and M.W. and S.H. examined the language. The authors declare no competing interests. Publisher Copyright: © 2022 The Author(s)

PY - 2022/5/10

Y1 - 2022/5/10

N2 - Long-term ozone (O3) exposure may lead to non-communicable diseases and increase mortality risk. However, cohort-based studies are relatively rare, and inconsistent exposure metrics impair the credibility of epidemiological evidence synthetization. To provide more accurate meta-estimations, this study updates existing systematic reviews by including recent studies and summarizing the quantitative associations between O3 exposure and cause-specific mortality risks, based on unified exposure metrics. Cross-metric conversion factors were estimated linearly by decadal observations during 1990–2019. The Hunter-Schmidt random-effects estimator was applied to pool the relative risks. A total of 25 studies involving 226,453,067 participants (14 unique cohorts covering 99,855,611 participants) were included in the systematic review. After linearly unifying the inconsistent O3 exposure metrics, the pooled relative risks associated with every 10 nmol mol−1 (ppbV) incremental O3 exposure, by mean of the warm-season daily maximum 8-h average metric, were as follows: 1.014 with 95% confidence interval (CI) ranging 1.009–1.019 for all-cause mortality; 1.025 (95% CI: 1.010–1.040) for respiratory mortality; 1.056 (95% CI: 1.029–1.084) for COPD mortality; 1.019 (95% CI: 1.004–1.035) for cardiovascular mortality; and 1.074 (95% CI: 1.054–1.093) for congestive heart failure mortality. Insignificant mortality risk associations were found for ischemic heart disease, cerebrovascular diseases, and lung cancer. Adjustment for exposure metrics laid a solid foundation for multi-study meta-analysis, and widening coverage of surface O3 observations is expected to strengthen the cross-metric conversion in the future. Ever-growing numbers of epidemiological studies supported the evidence for considerable cardiopulmonary hazards and all-cause mortality risks from long-term O3 exposure. However, evidence of long-term O3 exposure-associated health effects was still scarce, so more relevant studies are needed to cover more populations with regional diversity.

AB - Long-term ozone (O3) exposure may lead to non-communicable diseases and increase mortality risk. However, cohort-based studies are relatively rare, and inconsistent exposure metrics impair the credibility of epidemiological evidence synthetization. To provide more accurate meta-estimations, this study updates existing systematic reviews by including recent studies and summarizing the quantitative associations between O3 exposure and cause-specific mortality risks, based on unified exposure metrics. Cross-metric conversion factors were estimated linearly by decadal observations during 1990–2019. The Hunter-Schmidt random-effects estimator was applied to pool the relative risks. A total of 25 studies involving 226,453,067 participants (14 unique cohorts covering 99,855,611 participants) were included in the systematic review. After linearly unifying the inconsistent O3 exposure metrics, the pooled relative risks associated with every 10 nmol mol−1 (ppbV) incremental O3 exposure, by mean of the warm-season daily maximum 8-h average metric, were as follows: 1.014 with 95% confidence interval (CI) ranging 1.009–1.019 for all-cause mortality; 1.025 (95% CI: 1.010–1.040) for respiratory mortality; 1.056 (95% CI: 1.029–1.084) for COPD mortality; 1.019 (95% CI: 1.004–1.035) for cardiovascular mortality; and 1.074 (95% CI: 1.054–1.093) for congestive heart failure mortality. Insignificant mortality risk associations were found for ischemic heart disease, cerebrovascular diseases, and lung cancer. Adjustment for exposure metrics laid a solid foundation for multi-study meta-analysis, and widening coverage of surface O3 observations is expected to strengthen the cross-metric conversion in the future. Ever-growing numbers of epidemiological studies supported the evidence for considerable cardiopulmonary hazards and all-cause mortality risks from long-term O3 exposure. However, evidence of long-term O3 exposure-associated health effects was still scarce, so more relevant studies are needed to cover more populations with regional diversity.

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DO - 10.1016/j.xinn.2022.100246

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JO - The Innovation

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ER -

Cohort-based long-term ozone exposure-associated mortality risks with adjusted metrics: A systematic review and meta-analysis

Abstract

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Multi-Country Study on Health Effects of Bushfire Air Pollution

Climate Change and Human Health in Asia: Current Impacts, Future Risks, and Health Benefits of Mitigation Policies

Improving the assessment of environmental health risks with new technology and novel approaches

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Cohort-based long-term ozone exposure-associated mortality risks with adjusted metrics: A systematic review and meta-analysis

Abstract

UN SDGs

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Other files and links

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Multi-Country Study on Health Effects of Bushfire Air Pollution

Climate Change and Human Health in Asia: Current Impacts, Future Risks, and Health Benefits of Mitigation Policies

Improving the assessment of environmental health risks with new technology and novel approaches

Cite this