A complex regional air pollution problem dominated by
particulate
matter (PM) and ozone (O3) needs drastic attention since
the levels of O3 and PM are not decreasing in many parts
of the world. Limited evidence is currently available regarding the
association between co-exposure to PM and O3 and mortality.
A multicounty time-series study was used to investigate the associations
of short-term exposure to PM1, PM2.5, PM10, and O3 with daily mortality from different causes,
which was based on data obtained from the Mortality Surveillance System
managed by the Jiangsu Province Center for Disease Control and Prevention
of China and analyzed via overdispersed generalized additive models
with random-effects meta-analysis. We investigated the interactions
of PM and O3 on daily mortality and calculated the mortality
fractions attributable to PM and O3. Our results showed
that PM1 is more strongly associated with daily mortality
than PM2.5, PM10, and O3, and percent
increases in daily all-cause nonaccidental, cardiovascular, and respiratory
mortality were 1.37% (95% confidence interval (CI), 1.22–1.52%),
1.44% (95% CI, 1.25–1.63%), and 1.63% (95% CI, 1.25–2.01%),
respectively, for a 10 μg/m3 increase in the 2 day
average PM1 concentration. We found multiplicative and
additive interactions of short-term co-exposure to PM and O3 on daily mortality. The risk of mortality was greatest among those
with higher levels of exposure to both PM (especially PM1) and O3. Moreover, excess total and cardiovascular mortality
due to PM1 exposure is highest in populations with higher
O3 exposure levels. Our results highlight the importance
of the collaborative governance of PM and O3, providing
a scientific foundation for pertinent standards and regulatory interventions.