The acute health effects of ozone and PM2.5 on daily cardiovascular disease mortality: A multi-center time series study in China.

To explore the acute health effects of ozone(O3) and PM2.5 on daily cardiovascular disease mortality in all the cities of Jiangsu province, China. Daily average concentrations of ozone (maximum 8-h average), fine particle matter (PM2.5), meteorological data (including temperature and relative humidity) and daily cardiovascular diseases mortality data were collected from January 1, 2015, to December 31, 2017, in all the 13 cities of Jiangsu Province in China. The time-series model linked with Poisson distribution was used to estimate the correlation between O3 and daily cardiovascular diseases mortality, after adjusting for PM2.5 and other pollutants. Firstly, we evaluated the acute effects of O3 on cardiovascular mortality in each city in Jiangsu province, and then we combined the effects of O3 on cardiovascular disease mortality by meta-analysis. The single-pollutant model indicated that the acute health effects of O3 in different cities were quite different. After combined the effects of 13 cities, the mortality of cardiovascular diseases increased by 0.983%（95%CI：0.588-1.377%）for every 10 μg/m3 increases of O3. O3 showed the strongest effect on 3-day moving average concentration (Lag 0-3). After adjusting PM2.5，NO2, SO2, and CO, the results were still statistically significant at the multi-city level. The study found that O3 had a greater effect on women; the elderly population was susceptible and high-education groups were more vulnerable to O3, although the differences between different subgroups were insignificant. The dose-response curve showed that the mortality of cardiovascular disease increased with the increase of O3. The increase in O3 concentration of atmospheric can increase the daily mortality of cardiovascular diseases in Jiangsu, China.