Association between ambient ozone pollution and mortality from a spectrum of causes in Guangzhou, China

Ambient ozone (O3) has emerged as an important public health issue worldwide. Previous studies found an association between O3 and cardiorespiratory mortality. However, evidence was limited regarding the risk of O3 on mortality from other diseases. In this study, we aimed to estimate the association between O3 and mortality from a broad spectrum of diseases in Guangzhou, China, which has experienced a rapid increase in O3 concentration over the past decades. Daily data were obtained on cause-specific mortality, air pollutant concentrations and weather conditions during 2013–2018. A generalized additive model with quasi-Poisson regression was applied to examine the association between O3 and mortality from 10 broad causes and 26 refined subcategories, with adjustment of long-term and seasonal trends, weather conditions, public holidays and days of the week. We found that the threshold concentrations of O3 were 40 μg/m3 for all-cause, non-accidental, cardiovascular and respiratory mortality. Mortality risk increased monotonically with O3 concentrations above the threshold. Per 10 μg/m3 increase of O3 at lag 0–3 days was associated with 0.54% (95%CI: 0.34–0.74%), 0.56% (95%CI: 0.36–0.76%), 0.59% (95%CI: 0.30–0.88%), 0.78% (95%CI: 0.33–1.24%) and 0.52% (95%CI: 0.21–0.83%) elevated risk of death from all causes, non-accidental causes, cardiovascular diseases, respiratory diseases and neoplasms, respectively. Among the subcategories, the largest effect estimate was observed in people with chronic obstructive pulmonary disease. The elderly suffered from a higher mortality risk from O3. Stringent emission control strategies and multi-sectoral collaborations are needed to reduce the detrimental impact of O3 on vulnerable populations.