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Environ Health Perspect. 2017 Nov 21;125(11):117006. doi: 10.1289/EHP1849.

Ambient Ozone Pollution and Daily Mortality: A Nationwide Study in 272 Chinese Cities.

Yin P1, Chen R2,3,4, Wang L1, Meng X5, Liu C2,3, Niu Y2,3, Lin Z2,3, Liu Y1, Liu J1, Qi J1, You J1, Zhou M1, Kan H2,3,6.

Author information

National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Key Laboratory of Public Health Security, School of Public Health, Ministry of Education, Fudan University, Shanghai, China.
Key Laboratory of Health Technique Assessment, School of Public Health, Ministry of Health, Fudan University, Shanghai, China.
Shanghai Key Laboratory of Meteorology and Health, Shanghai, China.
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Key Laboratory of Reproduction Regulation of National Population and Family Planning Commission, Shanghai Institute of Planned Parenthood Research, Institute of Reproduction and Development, Fudan University , Shanghai, China.



Few large multicity studies have been conducted in developing countries to address the acute health effects of atmospheric ozone pollution.


We explored the associations between ozone and daily cause-specific mortality in China.


We performed a nationwide time-series analysis in 272 representative Chinese cities between 2013 and 2015. We used distributed lag models and over-dispersed generalized linear models to estimate the cumulative effects of ozone (lagged over 0-3 d) on mortality in each city, and we used hierarchical Bayesian models to combine the city-specific estimates. Regional, seasonal, and demographic heterogeneity were evaluated by meta-regression.


At the national-average level, a 10-μg/m3 increase in 8-h maximum ozone concentration was associated with 0.24% [95% posterior interval (PI): 0.13%, 0.35%], 0.27% (95% PI: 0.10%, 0.44%), 0.60% (95% PI: 0.08%, 1.11%), 0.24% (95% PI: 0.02%, 0.46%), and 0.29% (95% PI: 0.07%, 0.50%) higher daily mortality from all nonaccidental causes, cardiovascular diseases, hypertension, coronary diseases, and stroke, respectively. Associations between ozone and daily mortality due to respiratory and chronic obstructive pulmonary disease specifically were positive but imprecise and nonsignificant. There were no statistically significant differences in associations between ozone and nonaccidental mortality according to region, season, age, sex, or educational attainment.


Our findings provide robust evidence of higher nonaccidental and cardiovascular mortality in association with short-term exposure to ambient ozone in China.

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