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Background <p>Long-term ozone (O<sub>3</sub>) exposure is known to be associated with respiratory mortality and hospitalization, but its effects on respiratory morbidity, symptom severity, and quality of life remain undefined.</p> Methods <p>This study was conducted using data from the China Pulmonary Health (CPH) study. Respiratory morbidity was measured by the COPD Assessment Test (CAT) scores, the modified Medical Research Council (mMRC) dyspnea scale, and spirometry-defined COPD. Health-related quality of life was also considered. Long-term O<sub>3</sub> exposure was defined as the annual average of daily maximum 8-hour average (MDA8) O<sub>3</sub> concentrations in the year prior to the survey. Logistic and linear regression models were used to explore the association between long-term O<sub>3</sub> exposure and the health outcomes.</p> Results <p>Each 10&#xa0;µg/m<sup>3</sup> increase in O<sub>3</sub> was associated with increased odds of CAT ≥ 10 (measured in participants with a post-bronchodilator FEV<sub>1</sub>/FVC ratio less than 0.8; OR = 1.09, 95% CI:1.00, 1.18), mMRC ≥ 1 (OR = 1.13, 95% CI:1.04, 1.22), and COPD (OR = 1.11, 95% CI:1.05, 1.17), as well as a 0.55-point decline in SF-12 PCS (95% CI: -0.71, -0.39). Positive associations were also observed for some single CAT items. Female and younger participants were identified as subgroups particularly vulnerable to O<sub>3</sub>.</p> Conclusion <p>Long-term O<sub>3</sub> exposure was associated with the presence of respiratory symptoms, increased prevalence of spirometry-defined COPD, and poorer quality of life. These findings underscore the importance of raising awareness of the respiratory effects of O<sub>3</sub> exposure and the need for O<sub>3</sub> control.</p> Trial registration <p>Not applicable.</p>

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The association between long-term exposure to ozone and respiratory morbidity in Chinese adults: a nationwide cross-sectional study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月12日

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  • Xinran Shan,
  • Jisong Yan,
  • Xueyan Han,
  • Hailu Zhu,
  • Zhaoyang Pan,
  • Linhong Pang,
  • Zijun Li,
  • Yicong Wang,
  • Qi Wang,
  • Ke Huang,
  • Tianjia Guan,
  • Ting Yang,
  • Chen Wang

摘要

Background

Long-term ozone (O3) exposure is known to be associated with respiratory mortality and hospitalization, but its effects on respiratory morbidity, symptom severity, and quality of life remain undefined.

Methods

This study was conducted using data from the China Pulmonary Health (CPH) study. Respiratory morbidity was measured by the COPD Assessment Test (CAT) scores, the modified Medical Research Council (mMRC) dyspnea scale, and spirometry-defined COPD. Health-related quality of life was also considered. Long-term O3 exposure was defined as the annual average of daily maximum 8-hour average (MDA8) O3 concentrations in the year prior to the survey. Logistic and linear regression models were used to explore the association between long-term O3 exposure and the health outcomes.

Results

Each 10 µg/m3 increase in O3 was associated with increased odds of CAT ≥ 10 (measured in participants with a post-bronchodilator FEV1/FVC ratio less than 0.8; OR = 1.09, 95% CI:1.00, 1.18), mMRC ≥ 1 (OR = 1.13, 95% CI:1.04, 1.22), and COPD (OR = 1.11, 95% CI:1.05, 1.17), as well as a 0.55-point decline in SF-12 PCS (95% CI: -0.71, -0.39). Positive associations were also observed for some single CAT items. Female and younger participants were identified as subgroups particularly vulnerable to O3.

Conclusion

Long-term O3 exposure was associated with the presence of respiratory symptoms, increased prevalence of spirometry-defined COPD, and poorer quality of life. These findings underscore the importance of raising awareness of the respiratory effects of O3 exposure and the need for O3 control.

Trial registration

Not applicable.