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This is a Cross-Sectional Study study.

February 14, 2026Respiratory Research0 citationsOpen Access

The association between long-term exposure to ozone and respiratory morbidity in Chinese adults: a nationwide cross-sectional study

XSXinran ShanChinese Academy of Medical Sciences & Peking Union Medical College JYJun YanGuangzhou University of Chinese Medicine XHXueyan HanChinese Academy of Sciences

Key Points

To explore the association between long-term exposure to ozone and respiratory morbidity in Chinese adults.
Nationwide cross-sectional study using data from the China Pulmonary Health study.
Respiratory morbidity assessed via CAT scores, mMRC dyspnea scale, and spirometry-defined COPD.
Logistic and linear regression models analyzed the relationship between ozone exposure and health outcomes.
Each 10 µg/m3 increase in ozone linked to higher odds of CAT ≥ 10, mMRC ≥ 1, and spirometry-defined COPD.
0.55-point decline in health-related quality of life measured by SF-12 PCS with increased ozone exposure.
Identified vulnerable subgroups included younger female participants.

Abstract

Long-term ozone (O 3 ) exposure is known to be associated with respiratory mortality and hospitalization, but its effects on respiratory morbidity, symptom severity, and quality of life remain undefined. This study was conducted using data from the China Pulmonary Health (CPH) study. Respiratory morbidity was measured by the COPD Assessment Test (CAT) scores, the modified Medical Research Council (mMRC) dyspnea scale, and spirometry-defined COPD. Health-related quality of life was also considered. Long-term O 3 exposure was defined as the annual average of daily maximum 8-hour average (MDA8) O 3 concentrations in the year prior to the survey. Logistic and linear regression models were used to explore the association between long-term O 3 exposure and the health outcomes. Each 10 µg/m 3 increase in O 3 was associated with increased odds of CAT ≥ 10 (measured in participants with a post-bronchodilator FEV 1 /FVC ratio less than 0.8; OR = 1.09, 95% CI:1.00, 1.18), mMRC ≥ 1 (OR = 1.13, 95% CI:1.04, 1.22), and COPD (OR = 1.11, 95% CI:1.05, 1.17), as well as a 0.55-point decline in SF-12 PCS (95% CI: -0.71, -0.39). Positive associations were also observed for some single CAT items. Female and younger participants were identified as subgroups particularly vulnerable to O 3 . Long-term O 3 exposure was associated with the presence of respiratory symptoms, increased prevalence of spirometry-defined COPD, and poorer quality of life. These findings underscore the importance of raising awareness of the respiratory effects of O 3 exposure and the need for O 3 control. Not applicable.

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