The association between ozone and years of life lost from stroke, 2013–2017: A retrospective regression analysis in 48 major Chinese cities

The adverse impact of ozone on public health has attracted worldwide attention. However, few studies have addressed the contribution of ozone to disease burden caused by cardiovascular diseases. This study aimed to examine the association between short-term ozone exposure and years of life lost (YLL) from stroke in 48 Chinese cities. City-specific relative change of YLL was estimated by a generalized additive model, then pooled using random-effects meta-analysis. The potential effect modification of individual, climatic, and city-level characteristics was also evaluated. A 10 μg/m3 increase in three-day moving average of ozone concentration was associated with 0.54% (95% CI: 0.41%, 0.66%), 0.25% (95% CI: 0.10%, 0.40%), and 0.70% (95% CI: 0.48%, 0.92%) relative increment in YLL from stroke, haemorrhagic stroke, and ischaemic stroke, respectively. The association magnitudes were larger in elderly people, females, or higher quartile groups of temperature (all p < 0.01). The potential avoidable life lost due to YLL from stroke was 5.5 days per deceased person if ozone concentration could reduce to the standard recommended by the World Health Organization (100 μg/m3). Our findings provided robust evidence on the impact of short-term ozone exposure on YLL from stroke and called for more stringent regulation of ozone.