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Ozone, Heat Wave, and Cardiovascular Disease Mortality: A Population-Based Case-Crossover Study
Ruijun Xu1, Hong Sun2, Zihua Zhong1
1Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
Environmental Science & Technology
|December 15, 2023
Summary
High ozone (O3) and heat waves significantly increase cardiovascular disease (CVD) death risk, especially when combined. These environmental factors synergistically trigger CVD mortality, with women and older adults being more vulnerable.
Area of Science:
- Environmental Health
- Cardiovascular Epidemiology
- Toxicology
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Ambient air pollution and extreme heat events are recognized environmental stressors impacting public health.
- Understanding the combined effects of ozone (O3) and heat waves on CVD mortality is crucial for targeted interventions.
Purpose of the Study:
- To investigate the independent and combined associations of ambient ozone (O3) and heat wave exposure with cardiovascular disease (CVD) mortality.
- To explore potential synergistic interactions between O3 and heat waves in triggering CVD deaths.
- To identify vulnerable populations susceptible to these environmental exposures.
Main Methods:
- A case-crossover study design was employed, analyzing 511,767 CVD deaths in Jiangsu province, China (2015-2021).
- Exposure assessment involved high-resolution grid data for ambient O3 and heat waves, defined by apparent temperature thresholds and durations.
- Conditional logistic regression models were used to estimate odds ratios (ORs) and evaluate additive interactions.
Main Results:
- Both O3 and heat wave exposures were significantly associated with increased CVD mortality (ORs for O3: 1.029-1.107; ORs for heat wave: 1.14-1.65).
- Significant synergistic effects between O3 and heat waves on CVD mortality were observed, intensifying with higher O3 levels, temperature thresholds, and heat wave duration.
- Up to 5.8% of CVD deaths were attributable to combined O3 and heat wave exposure, with women and older adults showing greater vulnerability.
Conclusions:
- Combined exposure to ambient ozone and heat waves synergistically increases the risk of cardiovascular disease mortality.
- Public health strategies should consider the interactive effects of these environmental stressors, particularly for vulnerable groups like women and the elderly.
- Mitigation efforts targeting both air pollution and extreme heat are essential for reducing the burden of CVD deaths.
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