Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Feb 23;6(2):e009493.
doi: 10.1136/bmjopen-2015-009493.

Long-term exposure to ambient ozone and mortality: a quantitative systematic review and meta-analysis of evidence from cohort studies

R W Atkinson  1 , B K Butland  1 , C Dimitroulopoulou  2 , M R Heal  3 , J R Stedman  4 , N Carslaw  5 , D Jarvis  6 , C Heaviside  2 , S Vardoulakis  2 , H Walton  7 , H R Anderson  8
Affiliations
Meta-Analysis

Long-term exposure to ambient ozone and mortality: a quantitative systematic review and meta-analysis of evidence from cohort studies

R W Atkinson et al. BMJ Open. .

Abstract

Objectives: While there is good evidence for associations between short-term exposure to ozone and a range of adverse health outcomes, the evidence from narrative reviews for long-term exposure is suggestive of associations with respiratory mortality only. We conducted a systematic, quantitative evaluation of the evidence from cohort studies, reporting associations between long-term exposure to ozone and mortality.

Methods: Cohort studies published in peer-reviewed journals indexed in EMBASE and MEDLINE to September 2015 and PubMed to October 2015 and cited in reviews/key publications were identified via search strings using terms relating to study design, pollutant and health outcome. Study details and estimate information were extracted and used to calculate standardised effect estimates expressed as HRs per 10 ppb increment in long-term ozone concentrations.

Results: 14 publications from 8 cohorts presented results for ozone and all-cause and cause-specific mortality. We found no evidence of associations between long-term annual O3 concentrations and the risk of death from all causes, cardiovascular or respiratory diseases, or lung cancer. 4 cohorts assessed ozone concentrations measured during the warm season. Summary HRs for cardiovascular and respiratory causes of death derived from 3 cohorts were 1.01 (95% CI 1.00 to 1.02) and 1.03 (95% CI 1.01 to 1.05) per 10 ppb, respectively.

Conclusions: Our quantitative review revealed a paucity of independent studies regarding the associations between long-term exposure to ozone and mortality. The potential impact of climate change and increasing anthropogenic emissions of ozone precursors on ozone levels worldwide suggests further studies of the long-term effects of exposure to high ozone levels are warranted.

Keywords: Air Pollution; EPIDEMIOLOGY; Mortality; Ozone; PUBLIC HEALTH; Systematic review.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Overview of ascertainment of studies.
Figure 2
Figure 2
RR (95% CI) of death per 10 ppb increase in long-term exposure to ozone. ACS CPS II, American Cancer Society Cancer Prevention Study II; AHSMOG, Adventist Health Study of Smog; CTS, California Teachers Study; IHD, ischaemic heart disease; RR, relative risk; WU-EPRI, Washington University - Electric Power Research Institute Veterans Cohort.
Figure 3
Figure 3
RR (95% CI) of death per 10 ppb increase in long-term ‘warm-season’ ozone exposure. ACS CPS II, American Cancer Society Cancer Prevention Study II; IHD, ischaemic heart disease; RR, relative risk; WU-EPRI, Washington University - Electric Power Research Institute Veterans Cohort.
Figure 4
Figure 4
RR (95% CI) of death per 10 ppb increase in long-term ozone exposure, adjusted for long-term exposure to PM2.5. Note: For Krewski 2009, ozone increment assumed to be 10 ppb. ACS CPS II, American Cancer Society Cancer Prevention Study II; CTS, California Teachers Study; IHD, ischaemic heart disease; WU-EPRI, Washington University - Electric Power Research Institute Veterans Cohort; RR, relative risk; PM2.5, mass of particles with a median aerodynamic diameter less than 2.5 µm.
See this image and copyright information in PMC

References

    1. World Health Organisation. Review of evidence on health aspects of air pollution—REVIHAAP project: final technical report. 2013. http://www.euro.who.int/en/health-topics/environment-and-health/air-qual... - PubMed
    1. The Royal Society. Ground-level ozone in the 21st century: future trends, impacts and policy implications. 2008; Report 15/08. https://royalsociety.org/topics-policy/publications/2008/ground-level-oz...
    1. Air Quality Expert Group. Ozone in the United Kingdom 2009. http://www.defra.gov.uk/environment/airquality/publications/ozone/pdf/aq...
    1. Heal MR, Heaviside C, Doherty RM et al. . Health burdens of surface ozone in the UK for a range of future scenarios. Environ Int 2013;61:36–44. 10.1016/j.envint.2013.09.010 - DOI - PubMed
    1. 2012. Health Effects of Climate Change in the UK 2012. Current evidence, recommendations and research gaps. Health Protection Agency, UK. https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil....

Publication types