Concentration-response function for ozone and daily mortality: results from five urban and five rural U.K. populations

Environ Health Perspect. 2012 Oct;120(10):1411-7. doi: 10.1289/ehp.1104108. Epub 2012 Jul 19.

Abstract

Background: Short-term exposure to ozone has been associated with increased daily mortality. The shape of the concentration-response relationship-and, in particular, if there is a threshold-is critical for estimating public health impacts.

Objective: We investigated the concentration-response relationship between daily ozone and mortality in five urban and five rural areas in the United Kingdom from 1993 to 2006.

Methods: We used Poisson regression, controlling for seasonality, temperature, and influenza, to investigate associations between daily maximum 8-hr ozone and daily all-cause mortality, assuming linear, linear-threshold, and spline models for all-year and season-specific periods. We examined sensitivity to adjustment for particles (urban areas only) and alternative temperature metrics.

Results: In all-year analyses, we found clear evidence for a threshold in the concentration-response relationship between ozone and all-cause mortality in London at 65 µg/m3 [95% confidence interval (CI): 58, 83] but little evidence of a threshold in other urban or rural areas. Combined linear effect estimates for all-cause mortality were comparable for urban and rural areas: 0.48% (95% CI: 0.35, 0.60) and 0.58% (95% CI: 0.36, 0.81) per 10-µg/m3 increase in ozone concentrations, respectively. Seasonal analyses suggested thresholds in both urban and rural areas for effects of ozone during summer months.

Conclusions: Our results suggest that health impacts should be estimated across the whole ambient range of ozone using both threshold and nonthreshold models, and models stratified by season. Evidence of a threshold effect in London but not in other study areas requires further investigation. The public health impacts of exposure to ozone in rural areas should not be overlooked.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants / analysis
  • Air Pollutants / toxicity*
  • Dose-Response Relationship, Drug
  • Environmental Exposure*
  • Environmental Monitoring
  • Humans
  • Models, Theoretical
  • Mortality*
  • Ozone / analysis
  • Ozone / toxicity*
  • Particle Size
  • Particulate Matter / analysis
  • Particulate Matter / toxicity*
  • Poisson Distribution
  • Regression Analysis
  • Rural Population
  • Seasons
  • Temperature
  • Time Factors
  • United Kingdom / epidemiology
  • Urban Population

Substances

  • Air Pollutants
  • Particulate Matter
  • Ozone