King's College London

Research portal

Short term association between ozone and mortality: global two stage time series study in 406 locations in 20 countries

Research output: Contribution to journalArticlepeer-review

Ana M. Vicedo-Cabrera, Francesco Sera, Cong Liu, Ben Armstrong, Ai Milojevic, Yuming Guo, Shilu Tong, Eric Lavigne, Jan Kyselý, Aleš Urban, Hans Orru, Ene Indermitte, Mathilde Pascal, Veronika Huber, Alexandra Schneider, Klea Katsouyanni, Evangelia Samoli, Massimo Stafoggia, Matteo Scortichini, Masahiro Hashizume & 22 more Yasushi Honda, Chris Fook Sheng Ng, Magali Hurtado-Diaz, Julio Cruz, Susana Silva, Joana Madureira, Noah Scovronick, Rebecca M. Garland, Ho Kim, Aurelio Tobias, Carmen Íñiguez, Bertil Forsberg, Christofer Åström, Martina S. Ragettli, Martin Röösli, Yue Liang Leon Guo, Bing Yu Chen, Antonella Zanobetti, Joel Schwartz, Michelle L. Bell, Haidong Kan, Antonio Gasparrini

Original languageEnglish
Article numberm108
Pages (from-to)m108
JournalBMJ (Clinical research ed.)
Early online date10 Feb 2020
Accepted/In press17 Dec 2019
E-pub ahead of print10 Feb 2020


King's Authors


OBJECTIVE: To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide. DESIGN: Two stage time series analysis. SETTING: 406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network. POPULATION: Deaths for all causes or for external causes only registered in each city within the study period. MAIN OUTCOME MEASURES: Daily total mortality (all or non-external causes only). RESULTS: A total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m3 increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m3) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m3), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively. CONCLUSIONS: Results suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.

Download statistics

No data available

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454