Ambient ozone pollution and years of life lost: Association, effect modification, and additional life gain from a nationwide analysis in China.
BACKGROUND
Ozone is one of the dominant air pollutants due to its impact on disease burden and increasing trend in concentration. However, evidence regarding short-term effect of ozone on years of life lost (YLL) is scarce.


METHODS
A national time-series study was conducted in 48 large Chinese cities from 2013 to 2017. Generalized additive model coupled with random effects model were used to estimate national-average associations of ozone with YLL. Potential modifiers and additional life gain due to avoidable YLL under certain scenario were also evaluated.


RESULTS
The average annual mean ozone concentration of these cities was 86.9 μg/m3. For 10 μg/m3 increase in 3-day moving average ozone concentration, we estimated 0.37% [95% confidence interval (CI): 0.29%, 0.46%] increase in YLL from nonaccidental causes, 0.38% (95% CI: 0.30%, 0.46%) increase in YLL from cardiovascular diseases, and 0.36% (95% CI: 0.16%, 0.56%) increase in YLL from respiratory diseases. Moreover, the associations were more evident in people with less education and in cities with lower carbon monoxide concentration or those located at north region with lower mean temperature. Finally, an estimated life of 0.055 (95% CI: 0.043, 0.068) years would be gained per deceased people if ozone concentration could fall to 100 μg/m3.


CONCLUSIONS
Our findings indicated robust associations between short-term exposure to ozone and YLL from nonaccidental causes and cardiopulmonary diseases. Relevant intervention design should take the heterogeneity of both individual- and city-level characteristics into account. Implementation of more stringent standard is beneficial for alleviating YLL caused by ozone.
['Li|Jie|J|', 'Yin|Peng|P|', 'Wang|Lijun|L|', 'Zhang|Xiao|X|', 'Liu|Jiangmei|J|', 'Liu|Yunning|Y|', 'Zhou|Maigeng|M|']
D000393:Air Pollutants D000397:Air Pollution D002681:China D002947:Cities D004781:Environmental Exposure D006801:Humans D009026:Mortality D010126:Ozone D052638:Particulate Matter
Ozone Years of life lost Additional life gain Modifier Time series