Abstract
BACKGROUND AND AIM: Evidence based on long-term prospective cohort studies is lacking to investigate the association between ambient ozone (O3) and blood pressure among older adults. We aim to evaluate the associations of peak season O3 with change of blood pressure in a long-term cohort study among older adults without hypertension. METHODS: We included 5940 older adults aged ≥65 years and with repeated measurements of blood pressure from 2005 to 2018 in 23 provinces of China, estimated monthly O3 exposures at 0.05 ° ×0.05 ° resolution were matched to each participant. Peak season O3 exposure was measured as the average from April to September. Outcomes include blood pressure measurements of SBP, DBP, PP and MAP. Linear mixed models were performed to evaluate the associations between O3 exposures and blood pressure. Natural splines were applied to explore the potential non-linear concentration-response associations. RESULTS: In this study, peak-season O3 ranges from 72.6 to 151.7 μg/m3 in China. In fully adjusted model, per 10 μg/m3 increase in peak season O3 was associated with increases of 2.46 mmHg (95% confidence interval [CI]: 1.85-3.06) in SBP, 2.46 mmHg (95%CI: 1.94-2.99) in PP and 0.74 mmHg (95%CI: 0.38-1.11) in MAP, but non-significant decrease in DBP. Female, ethnic minorities, and older adults who were not in marriage, underweight, with medium or low income levels were susceptible to O3 exposure. Non-linear curves indicated that the effect of O3 exposure on SBP, PP and MAP were monotone increasing, with faster increase in risk magnitude before WHO interim target 1 at 100 μg/m3, but slow down thereafter. CONCLUSIONS: The study added evidence to support the World Health Organization interim targets for peak-season O3, however, lower interim targets should be set to maintain healthy blood pressure among populations in countries with high O3 concentrations. KEYWORDS:Ozone; blood pressure; older adult; cohort study
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