Risk Assessment: COPD Mortality Burden due to Ozone Exposure in Europe

Abstract

BACKGROUND AND AIM: High ground-level ozone may lead to respiratory diseases, thus, ozone levels are important to monitor over time to implement quality control systems. We aim to conduct a health risk assessment on the burden of mortality from chronic obstructive pulmonary disease (COPD) due to ozone exposure in Europe using spatiotemporal analysis to find areas at highest risk. METHODS: A health risk assessment was conducted using COPD mortality rates from the Global Burden of Disease (GBD) data retrieval tool and ozone data (1990-2017) from Tropospheric Ozone Assessment Report (TOAR ). Ozone concentrations are presented as a mixing ratio in ppb as the six-month ozone season average of the daily 8-hr maximum ozone concentration (OSDMA8). A triple nested space/time exponential covariance model was applied. Bayesian Maximum Entropy (BME) geostatistical method was used for OSDMA8 estimates. An RR of 1.09 (1.05-1.13 95%CI) for COPD attributed to a 10 ppb increase in OSDMA8 combined with BME estimates and mortality rates (Y) were used to estimate the premature mortality burden (DY) of COPD due to ozone exposure in Europe. Monte Carlo simulations were applied to the model to propagate uncertainty. RESULTS:South-Eastern European countries had the highest ozone concentrations consistently from 1990-2017, with the Scandinavian region having the lowest. The DY attributable to ozone exposure in Europe (per 100,000 person years) is highest in the areas of Debar, North Macedonia (16.0035); Lazaropole, North Macedonia (15.8856); Milan, Italy (14.4279); Murcia, Spain (14.3085); Vicenza, Italy (14.1843); Trentino, Italy (13.884). CONCLUSIONS:The areas of Northern Italy and North Macedonia may represent a vulnerable sub-population in Europe. This may be due to agricultural techniques as well as industrial sources. To implement proper quality control systems for the health and safety of these communities, further studies should be conducted on the regional variability of ozone exposures to determine causes. KEYWORDS: Air pollution, Risk Assessment, Mortality, Ozone