Chronic obstructive pulmonary disease (COPD) attributable to ozone in Germany: Burden of disease estimates for the years 2007-2016

Abstract

BACKGROUND AND AIM: Long-term exposure to ground-level ozone has been associated with the development and exacerbation of chronic obstructive pulmonary disease (COPD) and COPD mortality. We aimed to estimate the COPD burden due to long-term exposure to ozone in Germany from 2007 to 2016. A particular emphasis was on the disease burden based on effect estimates adjusting for fine particulate matter (PM₂.₅) and nitrogen dioxide (NO₂). METHODS: We estimated population-weighted average maximum 8-hour ozone concentrations during the summer months (April to September) at a 2 km × 2 km resolution based on a combination of chemical transport models and ground-level measurements. Estimates for the exposure-response function were extracted from recent cohort studies and pooled using random-effects meta-analysis. We calculated the burden of COPD due to ozone using a counterfactual value of 65 µg/m³. We used German data on population, life expectancy, and mortality to reflect the national situation as adequately as possible. RESULTS:The attributable proportion of the COPD disease burden and the years of life lost (YLL) estimates per 100,000 inhabitants due to summer ozone varied from 6.11% (95% confidence interval [95% CI]: 4.68%-7.36%) (year 2013) to 8.29% (95% CI: 6.36%-9.96%) (year 2015) and 18.33 YLL per 100,000 inhabitants (95% CI: 14.02-22.08) (year 2007) to 35.77 YLL per 100,000 inhabitants (95% CI: 27.45-42.98) (year 2015). Overall, no clear temporal trend in the burden could be observed for the period 2007 to 2016. Results indicated that ozone affects the COPD burden independent of PM₂.₅ and NO₂. CONCLUSIONS:Long-term exposure to summer ozone contributed to the burden of COPD in the German population. Effective emission reduction strategies are needed as ongoing climate change is expected to increase ozone concentrations. The project was funded by the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (research code 3718 62 208 0). KEYWORDS: ozone, air pollution, chronic obstructive pulmonary disease (COPD), mortality, environmental burden of disease