TY - JOUR
T1 - Short term association between ozone and mortality
T2 - global two stage time series study in 406 locations in 20 countries
AU - Vicedo-Cabrera, Ana M.
AU - Sera, Francesco
AU - Liu, Cong
AU - Armstrong, Ben
AU - Milojevic, Ai
AU - Guo, Yuming
AU - Tong, Shilu
AU - Lavigne, Eric
AU - Kyselý, Jan
AU - Urban, Aleš
AU - Orru, Hans
AU - Indermitte, Ene
AU - Pascal, Mathilde
AU - Huber, Veronika
AU - Schneider, Alexandra
AU - Katsouyanni, Klea
AU - Samoli, Evangelia
AU - Stafoggia, Massimo
AU - Scortichini, Matteo
AU - Hashizume, Masahiro
AU - Honda, Yasushi
AU - Ng, Chris Fook Sheng
AU - Hurtado-Diaz, Magali
AU - Cruz, Julio
AU - Silva, Susana
AU - Madureira, Joana
AU - Scovronick, Noah
AU - Garland, Rebecca M.
AU - Kim, Ho
AU - Tobias, Aurelio
AU - Íñiguez, Carmen
AU - Forsberg, Bertil
AU - Åström, Christofer
AU - Ragettli, Martina S.
AU - Röösli, Martin
AU - Guo, Yue Liang Leon
AU - Chen, Bing Yu
AU - Zanobetti, Antonella
AU - Schwartz, Joel
AU - Bell, Michelle L.
AU - Kan, Haidong
AU - Gasparrini, Antonio
PY - 2020/2/10
Y1 - 2020/2/10
N2 - OBJECTIVE: To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide. DESIGN: Two stage time series analysis. SETTING: 406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network. POPULATION: Deaths for all causes or for external causes only registered in each city within the study period. MAIN OUTCOME MEASURES: Daily total mortality (all or non-external causes only). RESULTS: A total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m3 increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m3) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m3), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively. CONCLUSIONS: Results suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.
AB - OBJECTIVE: To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide. DESIGN: Two stage time series analysis. SETTING: 406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network. POPULATION: Deaths for all causes or for external causes only registered in each city within the study period. MAIN OUTCOME MEASURES: Daily total mortality (all or non-external causes only). RESULTS: A total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m3 increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m3) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m3), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively. CONCLUSIONS: Results suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.
UR - http://www.scopus.com/inward/record.url?scp=85079239921&partnerID=8YFLogxK
U2 - 10.1136/bmj.m108
DO - 10.1136/bmj.m108
M3 - Article
C2 - 32041707
AN - SCOPUS:85079239921
VL - 368
JO - The BMJ
JF - The BMJ
SN - 0959-535X
M1 - m108
ER -