An estimate of global cardiovascular mortality burden attributable to ambient ozone exposure reveals urban-rural environmental injustice
Zhe Sun, Kim Robin van Daalen, Lídia Morawska, Serge Guillas, Chiara Giorio, Qian Di, Haidong Kan, Evelyn Xiu Ling Loo, Lynette Pei‐Chi Shek, Nick Watts, Yuming Guo, Alexander T. Archibald
Abstract
Escalating health risks associated with ambient ozone (O 3 ) pollution presents a pressing challenge to global population well-being. An ever-increasing body of evidence supports an association between O 3 pollution and cardiorespiratory conditions. However, previous studies only consider exposure-attributable respiratory deaths, completely disregarding O 3 -induced cardiovascular mortality. An updated estimate is urgently needed to accurately assess O 3 -associated risks. Here, we integrate multiple well-developed high-resolution O 3 concentration databases to track population exposure between 1990 and 2019. We pool up-to-date concentration-response relationships to estimate cardiovascular premature mortality burden attributable to O 3 , which increased globally from 404,200 (95% uncertainty interval [UI] 216,400–605,200) in 1990 to 581,900 (95% UI 306,300–905,800) in 2019. The analysis confirms that O 3 -related health burden is substantially underestimated in previous research. Our results further reveal that rural residents were exposed to 7.7 ± 1.8 ppb higher O 3 than urban citizens over the past 30 years, uncovering a long-overlooked issue of urban-rural environmental injustice. More control efforts should be directed to highly O 3 -polluted rural areas, especially in regions with high cardiovascular incidences.