Yue Niu1, Ting Yang17, Xiaoying Gu6,7,3,4, Renjie Chen1, Xia Meng1, Jianying Xu8, Lan Yang9, Jianping Zhao10, Xiangyan Zhang11, Chunxue Bai12, Jian Kang13, Pixin Ran14,15, Huahao Shen16, Fuqiang Wen17, Kewu Huang18,19, Yahong Chen20, Tieying Sun21,22, Guangliang Shan23, Yingxiang Lin18,19, Sinan Wu6,7,3,4, Jianguo Zhu22, Ruiying Wang8, Zhihong Shi9, Yongjian Xu10, Xianwei Ye11, Yuanlin Song12, Qiuyue Wang13, Yumin Zhou14,15, Liren Ding16, Ting Yang17, Wanzhen Yao20, Yanfei Guo21,22, Fei Xiao24,22, Yong Lu18,19, Xiaoxia Peng25, Biao Zhang23, Dan Xiao6,26,3,4,27, Zuomin Wang28, Hong Zhang18,19, Xiaoning Bu18,19, Xiaolei Zhang2,3,4,5, Li An18,19, Shu Zhang18,19, Zhixin Cao18,19, Qingyuan Zhan2,3,4,5, Yuanhua Yang18,19, Lirong Liang29, Bin Cao2,3,4,5, Huaping Dai2,3,4,5, Tangchun Wu30, Jiang He31, Huichu Li32, Haidong Kan1,33, Chen Wang2,3,4,5,27. 1. School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, National Health Commission Key Lab of Health Technology Assessment, and. 2. Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine. 3. National Center for Respiratory Medicine & National Clinical Research Center for Respiratory Diseases, Beijing, China. 4. Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China. 5. Department of Respiratory Medicine. 6. Center of Respiratory Medicine. 7. Institute of Clinical Medical Sciences, and. 8. Department of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, Shanxi, China. 9. The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China. 10. Tongji Hospital, Tongji Medical College, and. 11. Guizhou Provincial People's Hospital, Guiyang, Guizhou, China. 12. Zhongshan Hospital, Fudan University, Shanghai, China. 13. The First Hospital of China Medical University, Shenyang, Liaoning, China. 14. State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China. 15. National Clinical Research Center for Respiratory Diseases, Guangzhou, Guangdong, China. 16. The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China. 17. State Key Laboratory of Biotherapy of China and Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China. 18. Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Chao-Yang Hospital. 19. Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital. 20. Peking University Third Hospital, Beijing, China. 21. Department of Respiratory and Critical Care Medicine and. 22. National Center of Gerontology, Beijing, China. 23. Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China. 24. Department of Pathology, Beijing Hospital, Beijing, China. 25. Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China. 26. Tobacco Medicine and Tobacco Cessation Center, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China. 27. World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China. 28. Department of Stomatology, Beijing Chao-Yang Hospital, and. 29. Department of Epidemiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China. 30. School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 31. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana. 32. Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts; and. 33. Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, China.
Abstract
Rationale: It remains unknown whether long-term ozone exposure can impair lung function. Objectives: To investigate the associations between long-term ozone exposure and adult lung function in China. Methods: Lung function results and diagnosis of small airway dysfunction (SAD) were collected from a cross-sectional study, the China Pulmonary Health Study (N = 50,991). We used multivariable linear and logistic regression models to examine the associations of long-term ozone exposure with lung function parameters and SAD, respectively, adjusting for demographic characteristics, individual risk factors, and longitudinal trends. We then performed a stratification analysis by chronic obstructive pulmonary disease (COPD). Measurements and Main Results: We observed that each 1 SD (4.9 ppb) increase in warm-season ozone concentrations was associated with a 14.2 ml/s (95% confidence interval [CI], 8.8-19.6 ml/s] decrease in forced expiratory flow at the 75th percentile of vital capacity and a 29.5 ml/s (95% CI, 19.6-39.5 ml/s) decrease in mean forced expiratory flow between the 25th and 75th percentile of vital capacity. The odds ratio of SAD was 1.09 (95% CI, 1.06-1.11) for a 1 SD increase in warm-season ozone concentrations. Meanwhile, we observed a significant association with decreased FEV1/FVC but not with FEV1 or FVC. The association estimates were greater in the COPD group than in the non-COPD group. Conclusions: We found independent associations of long-term ozone exposure with impaired small airway function and higher SAD risks, while the associations with airflow obstruction were weak. Patients with COPD appear to be more vulnerable.
Rationale: It remains unknown whether long-term ozone exposure can impair lung function. Objectives: To investigate the associations between long-term ozone exposure and adult lung function in China. Methods: Lung function results and diagnosis of small airway dysfunction (SAD) were collected from a cross-sectional study, the China Pulmonary Health Study (N = 50,991). We used multivariable linear and logistic regression models to examine the associations of long-term ozone exposure with lung function parameters and SAD, respectively, adjusting for demographic characteristics, individual risk factors, and longitudinal trends. We then performed a stratification analysis by chronic obstructive pulmonary disease (COPD). Measurements and Main Results: We observed that each 1 SD (4.9 ppb) increase in warm-season ozone concentrations was associated with a 14.2 ml/s (95% confidence interval [CI], 8.8-19.6 ml/s] decrease in forced expiratory flow at the 75th percentile of vital capacity and a 29.5 ml/s (95% CI, 19.6-39.5 ml/s) decrease in mean forced expiratory flow between the 25th and 75th percentile of vital capacity. The odds ratio of SAD was 1.09 (95% CI, 1.06-1.11) for a 1 SD increase in warm-season ozone concentrations. Meanwhile, we observed a significant association with decreased FEV1/FVC but not with FEV1 or FVC. The association estimates were greater in the COPD group than in the non-COPD group. Conclusions: We found independent associations of long-term ozone exposure with impaired small airway function and higher SAD risks, while the associations with airflow obstruction were weak. Patients with COPD appear to be more vulnerable.