Ozone exposure and cardiovascular-related mortality in the Canadian Census Health and Environment Cohort (CANCHEC) by spatial synoptic classification zone

Abstract

Our objective is to analyse the association between long term ozone exposure and cardiovascular related mortality while accounting for climate, location, and socioeconomic factors. We assigned subjects with 16 years of follow-up in the Canadian Census Health and Environment Cohort (CanCHEC) to one of seven regions based on spatial synoptic classification (SSC) weather types and examined the interaction of exposure to both fine particulate matter (PM2.5) and ground level ozone and cause of death using survival analysis, while adjusting for socioeconomic characteristics and individual confounders. Correlations between ozone and PM2.5 varied across SSC zones from -0.02 to 0.7. Comparing zones using the most populated SSC zone as a reference, a 10 ppb increase in ozone exposure was associated with increases in hazard ratios (HRs) that ranged from 1.007 (95% CI 0.99, 1.015) to 1.03 (95% CI 1.02, 1.041) for cardiovascular disease, 1.013 (95% CI 0.996, 1.03) to 1.058 (95% CI 1.034, 1.082) for cerebrovascular disease, and 1.02 (95% CI 1.006, 1.034) for ischemic heart disease. HRs remained significant after adjustment for PM2.5. Long term exposure to ozone is related to an increased risk of mortality from cardiovascular and cerebrovascular diseases; the risk varies by location across Canada and is not attenuated by adjustment for PM2.5. This research shows that the SSC can be used to define geographic regions and it demonstrates the importance of accounting for that spatial variability when studying the long term health effects of air pollution.

Increasing Probability of Heat-Related Mortality in a Mediterranean City Due to Urban Warming

“…Air pollution has gained a growing interest the past decades due to its negative effects on human health; specifically cardiovascular and respiratory related diseases [22,23,24,25,26,27]. Especially in metropolitan areas, environmental conditions may worsen, with a combination of increasing heatwaves and reduced air quality [28].…”

Measurement-based assessment of health burdens from long-term ozone exposure in the United States, Europe, and China

“…In addition, there is evidence suggesting that long-term O 3 exposure is not only associated with COPD, but a more comprehensive set of respiratory diseases (Jerrett et al 2009, US EPA 2013, Turner et al 2016. Some studies even report significant associations with increased premature cardiovascular mortality (Lipsett et al 2011, Jerrett et al 2013, Crouse et al 2015, Cakmak et al 2016, Turner et al 2016, Day et al 2017. When incorporating these epidemiological updates, the estimated health burden attributable to long-term O 3 exposure increases (Malley et al 2017, Shindell et al 2018, indicating that efforts to reduce long-term O 3 exposure could be more effective in reducing total air pollution-attributable premature mortalities than previously identified (Schwartz 2016).…”

Magnitude, Trends, and Impacts of Ambient Long-Term Ozone Exposure in the United States from 2000–2015

“…CC BY 4.0 License. Cakmak et al, 2016;Lim et al, 2019), found a significant relationship between long-term O 3 exposure and other mortality end 190 points, such as cardiovascular disease.…”

“…In terms of impacts, there is evidence that O 3 affects more than what was presented here. Several epidemiological studies suggest that human-health impacts may extend to cardiovascular mortality (Jerrett et al, 2013;Crouse et al, 2015;Cakmak et al, 2016;Turner et al, 2016;Lim et al, 2019). Separately, we also applied a log-linear exposure-response function when performing the human-health calculations presented here since it is most common in the community.…”