Estimated Acute Effects of Ambient Ozone and Nitrogen Dioxide on Mortality in the Pearl River Delta of Southern China

Background and objectives: Epidemiologic studies have attributed adverse health effects to air pollution; however, controversy remains regarding the relationship between ambient oxidants [ozone (O(3)) and nitrogen dioxide (NO(2))] and mortality, especially in Asia. We conducted a four-city time-series study to investigate acute effects of O(3) and NO(2) in the Pearl River Delta (PRD) of southern China, using data from 2006 through 2008. Methods: We used generalized linear models with Poisson regression incorporating natural spline functions to analyze acute mortality in association with O(3) and NO(2), with PM(10) (particulate matter ≤ 10 μm in diameter) included as a major confounder. Effect estimates were determined for individual cities and for the four cities as a whole. We stratified the analysis according to high- and low- exposure periods for O(3). Results: We found consistent positive associations between ambient oxidants and daily mortality across the PRD cities. Overall, 10-μg/m(3) increases in average O(3) and NO(2) concentrations over the previous 2 days were associated with 0.81% [95% confidence interval (CI): 0.63%, 1.00%] and 1.95% (95% CI: 1.62%, 2.29%) increases in total mortality, respectively, with stronger estimated effects for cardiovascular and respiratory mortality. After adjusting for PM(10), estimated effects of O(3) on total and cardiovascular mortality were stronger for exposure during high-exposure months (September through November), whereas respiratory mortality was associated with O(3) exposure during nonpeak exposure months only. Conclusions: Our findings suggest significant acute mortality effects of O(3) and NO(2) in the PRD and strengthen the rationale for further limiting the ambient pollution levels in the area.