Concentration-Response Function for Ozone and Daily Mortality: Results from Five Urban and Five Rural UK Populations

TY - JOUR

T1 - Concentration-Response Function for Ozone and Daily Mortality: Results from Five Urban and Five Rural UK Populations

AU - Atkinson, Richard

AU - Yu, Dahai

AU - Armstrong, Ben G.

AU - Pattenden, Sam

AU - Wilkinson, Paul

AU - Doherty, Ruth M.

AU - Heal, Mathew R.

AU - Anderson, Ross

PY - 2012/10

Y1 - 2012/10

N2 - BACKGROUND: Short-term exposure to ozone has been associated with increased daily mortality. The shape of the concentration-response relationship-and, in particular, if there is a threshold-is critical for estimating public health impacts.OBJECTIVE: We investigated the concentration-response relationship between daily ozone and mortality in five urban and five rural areas in the United Kingdom from 1993 to 2006.METHODS: We used Poisson regression, controlling for seasonality, temperature, and influenza, to investigate associations between daily maximum 8-hr ozone and daily all-cause mortality, assuming linear, linear-threshold, and spline models for all-year and season-specific periods. We examined sensitivity to adjustment for particles (urban areas only) and alternative temperature metrics.RESULTS: In all-year analyses, we found clear evidence for a threshold in the concentration response relationship between ozone and all-cause mortality in London at 65 mu g/m(3) [95% confidence interval (CI): 58, 83] but little evidence of a threshold in other urban or rural areas. Combined linear effect estimates for all-cause mortality were comparable for urban and rural areas: 0.48% (95% CI: 0.35, 0.60) and 0.58% (95% CI: 0.36, 0.81) per 10-mu g/m(3) increase in ozone concentrations, respectively. Seasonal analyses suggested thresholds in both urban and rural areas for effects of ozone during summer months.CONCLUSIONS: Our results suggest that health impacts should be estimated across the whole ambient range of ozone using both threshold and nonthreshold models, and models stratified by season. Evidence of a threshold effect in London but not in other study areas requires further investigation. The public health impacts of exposure to ozone in rural areas should not be overlooked.

AB - BACKGROUND: Short-term exposure to ozone has been associated with increased daily mortality. The shape of the concentration-response relationship-and, in particular, if there is a threshold-is critical for estimating public health impacts.OBJECTIVE: We investigated the concentration-response relationship between daily ozone and mortality in five urban and five rural areas in the United Kingdom from 1993 to 2006.METHODS: We used Poisson regression, controlling for seasonality, temperature, and influenza, to investigate associations between daily maximum 8-hr ozone and daily all-cause mortality, assuming linear, linear-threshold, and spline models for all-year and season-specific periods. We examined sensitivity to adjustment for particles (urban areas only) and alternative temperature metrics.RESULTS: In all-year analyses, we found clear evidence for a threshold in the concentration response relationship between ozone and all-cause mortality in London at 65 mu g/m(3) [95% confidence interval (CI): 58, 83] but little evidence of a threshold in other urban or rural areas. Combined linear effect estimates for all-cause mortality were comparable for urban and rural areas: 0.48% (95% CI: 0.35, 0.60) and 0.58% (95% CI: 0.36, 0.81) per 10-mu g/m(3) increase in ozone concentrations, respectively. Seasonal analyses suggested thresholds in both urban and rural areas for effects of ozone during summer months.CONCLUSIONS: Our results suggest that health impacts should be estimated across the whole ambient range of ozone using both threshold and nonthreshold models, and models stratified by season. Evidence of a threshold effect in London but not in other study areas requires further investigation. The public health impacts of exposure to ozone in rural areas should not be overlooked.

U2 - 10.1289/ehp.1104108

DO - 10.1289/ehp.1104108

M3 - Article

SN - 0091-6765

VL - 120

SP - 1411

EP - 1417

JO - Environmental Health Perspectives

JF - Environmental Health Perspectives

IS - 10

ER -