Long-term exposure to ozone and green space and its association with respiratory health in adults

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Whilst the adverse effects of particulate matter (PM) exposure are well established, those attributable to ozone are under-investigated, in particular during the last 20 years. The most comprehensive review (Integrated Science Assessment, ISA) on ozone and health by the EPA concluded that findings provide evidence of a “causal relationship” between short-term ozone exposure and respiratory health but only few studies explored the long-term effects of ozone on lung function. There are several strong arguments substantiating the need for ozone-related respiratory health research in Europe: 1) questionable translation of findings from U.S. and Canada to Europe, 2) climate change will increase ozone levels in some areas and will prolong the duration of high ozone concentrations in Europe and 3) the inconsistent findings regarding the association of living close to green neighbourhoods and lung function may be due to a potential confounding with higher ozone levels. We hypothesize that:- Long-term exposure to ozone is negatively associated with lung function development over a follow-up time of 20 years. - Living in green neighborhood assessed by land use-derived green spaces and satellite-derived NDVI has detrimental effects on lung function over a period of 20 years.- Both long-term exposure to ozone and living in green neighborhood have synergistic adverse effects on lung function development over a period of 20 years.Spirometric lung function data from a cohort of almost 6000 adults from 21 study centres in 11 European countries will be used for analyses. Based on geocoded residential addresses, individualized assessment of long-term exposure to ozone including seasonal variation will be the primary exposure of interest. Spirometric lung function over a time period of up to 20 years will be the main outcome. Regression models will be fully adjusted for relevant individual-level demographic and life-style factors, in addition to short-term ozone exposures and long-term exposure to additional air pollutants such as PM2.5, BC, and NO2. Exposure to green space will be determined based on a green neighborhood assessed by the Normalized Difference Vegetation Index, obtained from satellite-derived Landsat data and proximity of residential address to green spaces.This study has several innovative aspects: long-term effects of ground level ozone exposure on lung function require further study; in view of the expected increase of ozone levels in some regions in Europe due to climate change this project is timely and of high public relevance; the combination of the existing rich longitudinal health database of the European Community Respiratory Health Survey cohort with exposure data on ozone newly generated is elegant, cost effective, and unique; interacting effects of green space and ozone exposure on lung function are plausible but have not been investigated so far.