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Am J Respir Crit Care Med. 2011 Oct 1;184(7):836-41. doi: 10.1164/rccm.201102-0227OC.

Ozone and survival in four cohorts with potentially predisposing diseases.

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1
Department of Environmental Health, Harvard School of Public Health, Boston, MA 02215, USA. azanobet@hsph.harvard.edu

Abstract

RATIONALE:

Time series studies have reported associations between ozone and daily deaths. Only one cohort study has reported the effect of long-term exposures on deaths, and little is known about effects of chronic ozone exposure on survival in susceptible populations.

OBJECTIVES:

We investigated whether ozone was associated with survival in four cohorts of persons with specific diseases in 105 United States cities, treating ozone as a time varying exposure.

METHODS:

We used Medicare data (1985–2006), and constructed cohorts of persons hospitalized with chronic conditions that might predispose to ozone effects: chronic obstructive pulmonary disease, diabetes, congestive heart failure, and myocardial infarction. Yearly warm-season average ozone was merged to the individual follow-up in each city. We applied Cox proportional hazard model for each cohort within each city, adjusting for individual risk factors, temperature, and city-specific long-term trends.

MEASUREMENTS AND MAIN RESULTS:

We found significant associations with a hazard ratio for mortality of 1.06 (95% confidence interval [CI], 1.03–1.08) per 5-ppb increase in summer average ozone for persons with congestive heart failure; of 1.09 (95% CI, 1.06–1.12) with myocardial infarction; of 1.07 (95% CI, 1.04–1.09) with chronic obstructive pulmonary disease; and of 1.07 (95% CI, 1.05–1.10) for diabetics.We also found that the effect varied by region, but that this was mostly explained by mean temperature, which is likely a surrogate of air conditioning use, and hence exposure.

CONCLUSIONS:

This is the first study that follows persons with specific chronic conditions, and shows that long-term ozone exposure is associated with increased risk of death in these groups.

Comment in

PMID:
21700916
PMCID:
PMC3208652
DOI:
10.1164/rccm.201102-0227OC
[Indexed for MEDLINE]
Free PMC Article
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