Abstract
BACKGROUND: In China, the increasing concentration of ozone (O(3)) has emerged as a significant air pollution issue, leading to adverse effects on public health, particularly the respiratory system. Despite the progress made in managing air pollution in China, it is crucial to address the problem of environmental O(3) pollution at present. METHODS: The connection between O(3) exposure and respiratory mortality in Shenyang, China, from 2014 to 2018 was analyzed by a time-series generalized additive regression model (GAM) with quasi-Poisson regression. Additionally, the potential combined effects of fine particulate matter (PM(2.5)) and O(3) were investigated using the synergy index (SI). RESULTS: Our findings indicate that each 10 μg/m(3) increase in O(3) at lag 2 days was associated with a maximum relative risk (RR) of 1.0150 (95% CI: 1.0098-1.0202) for respiratory mortality in the total population. For individuals aged ≥55 years, unmarried individuals, those engaged in indoor occupations, and those with low educational attainment, each 10 μg/m(3) increase in O(3) at lag 07 days was linked to RR values of 1.0301 (95% CI: 1.0187-1.0417), 1.0437 (95% CI: 1.0266-1.0610), 1.0317 (95% CI: 1.0186-1.0450), and 1.0346 (95% CI: 1.0222-1.0471), respectively. Importantly, we discovered a synergistic effect of PM(2.5) and O(3), resulting in an SI of 2.372 on the occurrence of respiratory mortality. CONCLUSIONS: This study confirmed a positive association between O(3) exposure and respiratory mortality. Furthermore, it highlighted the interaction between O(3) and PM(2.5) in exacerbating respiratory deaths.