Ozone in urban China: Impact on mortalities and approaches for establishing indoor guideline concentrations

Reducing indoor ozone levels may be an effective strategy to reduce total exposure and associated mortality. Here we estimate (a) premature mortalities attributable to ozone for China's urban population ≥25 years of age; (b) the fraction of total exposure occurring indoors; and (c) mortalities that can be potentially avoided through meeting current and more stringent indoor ozone standards/guidelines based on 1-hour daily maxima. To estimate ozone-attributable premature mortalities, we used hourly outdoor ozone concentrations measured at 1497 monitoring stations located in 339 Chinese cities and a published concentration-response model. We proceeded to estimate province-specific infiltration factors and co-occurring hourly indoor ozone concentrations. For the year 2015, we estimated that indoor exposures accounted for 59% (95% confidence interval (CI): 26%-79%) of the total ozone exposure that resulted in 70800 (95% CI: 35 900-137 700) premature all-cause mortalities in urban China. If the current Chinese indoor ozone standards (80 ppbv (160 µg/m³ ); 56 ppbv (112 µg/m³ )) were met, the mean estimates of reduction in mortalities would be indistinguishable from zero. With stricter 1-hour indoor ozone guidelines, the expected mortality reductions increase exponentially per unit decrease in indoor ozone. The analysis in this paper should help facilitate formulating present and future indoor ozone guidelines.