The Lancet Regional Health. Europe (Nov 2023)
Impact of long-term exposure to ambient ozone on lung function over a course of 20 years (The ECRHS study): a prospective cohort study in adultsResearch in context
- Tianyu Zhao,
- Iana Markevych,
- Elaine Fuertes,
- Kees de Hoogh,
- Simone Accordini,
- Anne Boudier,
- Lidia Casas,
- Bertil Forsberg,
- Judith Garcia Aymerich,
- Marco Gnesi,
- Mathias Holm,
- Christer Janson,
- Deborah Jarvis,
- Ane Johannessen,
- Rudolf A. Jörres,
- Stefan Karrasch,
- Benedicte Leynaert,
- José Antonio Maldonado Perez,
- Andrei Malinovschi,
- Jesús Martínez-Moratalla,
- Lars Modig,
- Dennis Nowak,
- James Potts,
- Nicole Probst-Hensch,
- José Luis Sánchez-Ramos,
- Valerie Siroux,
- Isabel Urrutia Landa,
- Danielle Vienneau,
- Simona Villani,
- Bénédicte Jacquemin,
- Joachim Heinrich
Affiliations
- Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Corresponding author. Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Ziemssenstraße 5, 80336 Munich, Germany.
- Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland; “Health and Quality of Life in a Green and Sustainable Environment”, SRIPD, Medical University of Plovdiv, Plovdiv, Bulgaria
- Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre for Environment & Health, London, UK
- Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
- Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Anne Boudier
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France; Pediatric Department, CHU Grenoble Alpes, Grenoble, France
- Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium
- Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Marco Gnesi
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; MRC Centre for Environment & Health, London, UK
- Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Rudolf A. Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- Stefan Karrasch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Benedicte Leynaert
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, 94807, Villejuif, France
- José Antonio Maldonado Perez
- Sección de Neumología, Hospital Juan Ramón Jiménez, Huelva, Spain
- Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
- Jesús Martínez-Moratalla
- Servicio de Neumología del Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Lars Modig
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
- James Potts
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
- José Luis Sánchez-Ramos
- Department of Nursing, University of Huelva, Huelva, Spain
- Valerie Siroux
- University Grenoble Alpes, Inserm U 1209, CNRS UMR 5309, Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
- Isabel Urrutia Landa
- Department of Pneumology, Galdakao Hospital, Galdakao, Spain
- Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
- Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Bénédicte Jacquemin
- University Rennes, Inserm, EHESP, Irset (Institut de recherche en Santé, Environnement et travail), UMR_S 1085, F-35000 Rennes, France
- Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Journal volume & issue
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Vol. 34
p. 100729
Abstract
Summary: Background: While the adverse effects of short-term ambient ozone exposure on lung function are well-documented, the impact of long-term exposure remains poorly understood, especially in adults. Methods: We aimed to investigate the association between long-term ozone exposure and lung function decline. The 3014 participants were drawn from 17 centers across eight countries, all of which were from the European Community Respiratory Health Survey (ECRHS). Spirometry was conducted to measure pre-bronchodilation forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) at approximately 35, 44, and 55 years of age. We assigned annual mean values of daily maximum running 8-h average ozone concentrations to individual residential addresses. Adjustments were made for PM2.5, NO2, and greenness. To capture the ozone-related change in spirometric parameters, our linear mixed effects regression models included an interaction term between long-term ozone exposure and age. Findings: Mean ambient ozone concentrations were approximately 65 μg/m³. A one interquartile range increase of 7 μg/m³ in ozone was associated with a faster decline in FEV1 of −2.08 mL/year (95% confidence interval: −2.79, −1.36) and in FVC of −2.86 mL/year (−3.73, −1.99) mL/year over the study period. Associations were robust after adjusting for PM2.5, NO2, and greenness. The associations were more pronounced in residents of northern Europe and individuals who were older at baseline. No consistent associations were detected with the FEV1/FVC ratio. Interpretation: Long-term exposure to elevated ambient ozone concentrations was associated with a faster decline of spirometric lung function among middle-aged European adults over a 20-year period. Funding: German Research Foundation.
