Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adults

Tianyu Zhao^{1

2

3}, Iana Markevych^{4

5}, Elaine Fuertes^{6

7}, Kees de Hoogh^{8

9}, Simone Accordini¹⁰, Anne Boudier^{11

12}, Lidia Casas^{13

14}, Bertil Forsberg¹⁵, Judith Garcia Aymerich^{16

17

18}, Marco Gnesi¹⁹, Mathias Holm²⁰, Christer Janson²¹, Deborah Jarvis^{6

7}, Ane Johannessen²², Rudolf A Jörres^{1

2}, Stefan Karrasch^{1

2

3}, Benedicte Leynaert²³, José Antonio Maldonado Perez²⁴, Andrei Malinovschi²⁵, Jesús Martínez-Moratalla²⁶, Lars Modig¹⁵, Dennis Nowak^{1

2}, James Potts⁶, Nicole Probst-Hensch^{8

9}, José Luis Sánchez-Ramos²⁷, Valerie Siroux¹¹, Isabel Urrutia Landa²⁸, Danielle Vienneau^{8

9}, Simona Villani¹⁹, Bénédicte Jacquemin²⁹, Joachim Heinrich^{1

2

30}

Affiliations

¹ Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
² Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany.
³ Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
⁴ Institute of Psychology, Jagiellonian University, Krakow, Poland.
⁵ "Health and Quality of Life in a Green and Sustainable Environment", SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria.
⁶ National Heart and Lung Institute, Imperial College London, London, United Kingdom.
⁷ MRC Centre for Environment & Health, London, UK.
⁸ Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
⁹ University of Basel, Basel, Switzerland.
¹⁰ Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
¹¹ University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France.
¹² Pediatric Department, CHU Grenoble Alpes, Grenoble, France.
¹³ Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
¹⁴ Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium.
¹⁵ Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁶ ISGlobal, Barcelona, Spain.
¹⁷ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
¹⁸ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
¹⁹ Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
²⁰ Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²¹ Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
²² Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
²³ Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, 94807, Villejuif, France.
²⁴ Sección de Neumología, Hospital Juan Ramón Jiménez, Huelva, Spain.
²⁵ Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
²⁶ Servicio de Neumología del Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
²⁷ Department of Nursing, University of Huelva, Huelva, Spain.
²⁸ Department of Pneumology, Galdakao Hospital, Galdakao, Spain.
²⁹ University Rennes, Inserm, EHESP, Irset (Institut de recherche en Santé, Environnement et travail), UMR_S 1085, F-35000 Rennes, France.
³⁰ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

PMID: 37691742
PMCID: PMC10482740
DOI: 10.1016/j.lanepe.2023.100729

Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adults

Tianyu Zhao et al. Lancet Reg Health Eur. 2023.

. 2023 Sep 1:34:100729.

doi: 10.1016/j.lanepe.2023.100729. eCollection 2023 Nov.

Authors

Affiliations

¹ Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
² Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany.
³ Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
⁴ Institute of Psychology, Jagiellonian University, Krakow, Poland.
⁵ "Health and Quality of Life in a Green and Sustainable Environment", SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria.
⁶ National Heart and Lung Institute, Imperial College London, London, United Kingdom.
⁷ MRC Centre for Environment & Health, London, UK.
⁸ Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
⁹ University of Basel, Basel, Switzerland.
¹⁰ Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
¹¹ University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France.
¹² Pediatric Department, CHU Grenoble Alpes, Grenoble, France.
¹³ Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
¹⁴ Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium.
¹⁵ Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
¹⁶ ISGlobal, Barcelona, Spain.
¹⁷ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
¹⁸ CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
¹⁹ Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
²⁰ Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²¹ Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
²² Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
²³ Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, 94807, Villejuif, France.
²⁴ Sección de Neumología, Hospital Juan Ramón Jiménez, Huelva, Spain.
²⁵ Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
²⁶ Servicio de Neumología del Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
²⁷ Department of Nursing, University of Huelva, Huelva, Spain.
²⁸ Department of Pneumology, Galdakao Hospital, Galdakao, Spain.
²⁹ University Rennes, Inserm, EHESP, Irset (Institut de recherche en Santé, Environnement et travail), UMR_S 1085, F-35000 Rennes, France.
³⁰ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

PMID: 37691742
PMCID: PMC10482740
DOI: 10.1016/j.lanepe.2023.100729

Abstract

Background: While the adverse effects of short-term ambient ozone exposure on lung function are well-documented, the impact of long-term exposure remains poorly understood, especially in adults.

Methods: We aimed to investigate the association between long-term ozone exposure and lung function decline. The 3014 participants were drawn from 17 centers across eight countries, all of which were from the European Community Respiratory Health Survey (ECRHS). Spirometry was conducted to measure pre-bronchodilation forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC) at approximately 35, 44, and 55 years of age. We assigned annual mean values of daily maximum running 8-h average ozone concentrations to individual residential addresses. Adjustments were made for PM_2.5, NO₂, and greenness. To capture the ozone-related change in spirometric parameters, our linear mixed effects regression models included an interaction term between long-term ozone exposure and age.

Findings: Mean ambient ozone concentrations were approximately 65 μg/m³. A one interquartile range increase of 7 μg/m³ in ozone was associated with a faster decline in FEV₁ of -2.08 mL/year (95% confidence interval: -2.79, -1.36) and in FVC of -2.86 mL/year (-3.73, -1.99) mL/year over the study period. Associations were robust after adjusting for PM_2.5, NO₂, and greenness. The associations were more pronounced in residents of northern Europe and individuals who were older at baseline. No consistent associations were detected with the FEV₁/FVC ratio.

Interpretation: Long-term exposure to elevated ambient ozone concentrations was associated with a faster decline of spirometric lung function among middle-aged European adults over a 20-year period.

Funding: German Research Foundation.

Keywords: Air pollution; Forced expiratory volume; Middle aged; NDVI; Spirometry; Vital capacity.

PubMed Disclaimer

Conflict of interest statement

Marco Gnesi is currently an employee at AstraZeneca SpA; however, the research presented here has been conducted previously and AstraZeneca had no role in any phase of the research project. The authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
Included ECRHS study centers and numbers of available participants in each center.

**Fig. 2**
Distribution of annual ozone concentrations across three ECRHS surveys and 17 centers.

**Fig. 3**
Associations between 7 μg/m³ increase in ambient ozone and FEV₁ and FVC change (mL/year) over a 20-year period.

See this image and copyright information in PMC

References

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Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adults

Affiliations

Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adults

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources