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

虽然暴露在颗粒物(PM)中的不利影响已得到充分证实，但可归因于臭氧的不利影响却没有得到充分的调查，特别是在过去20年里。环保局对臭氧和健康进行的最全面的审查(综合科学评估，ISA)得出的结论是，研究结果提供了短期接触臭氧和呼吸健康之间存在“因果关系”的证据，但很少有研究探讨臭氧对肺功能的长期影响。有几个强有力的论据证实了欧洲需要与臭氧相关的呼吸健康研究：1)美国和加拿大的研究结果到欧洲的翻译有问题，2)气候变化将增加某些地区的臭氧水平，并将延长欧洲臭氧浓度高的持续时间，3)关于居住在靠近绿色社区和肺功能之间的不一致的结果可能是由于潜在地与较高的臭氧水平相混淆。我们假设：-长期暴露在臭氧中与20年后的肺功能发育呈负相关。-通过土地利用衍生的绿地和卫星衍生的NDVI来评估生活在绿色社区中，在20年内对肺功能产生不利影响。-长期暴露在臭氧中和生活在绿色社区中，在20年内对肺功能发展产生协同的不利影响。来自11个欧洲国家21个研究中心的近6000名成年人的肺活量测量数据将用于分析。根据地理编码的住址，包括季节变化在内的长期臭氧暴露的个性化评估将是人们感兴趣的主要暴露。长达20年的肺功能测定将是主要结果。除了短期臭氧暴露和长期暴露于PM2.5、BC和NO2等额外空气污染物外，回归模型还将根据相关个人层面的人口和生活方式因素进行充分调整。这项研究有几个创新之处：地面臭氧暴露对肺功能的长期影响需要进一步研究；鉴于欧洲一些地区臭氧水平预计会因气候变化而上升；该项目是及时的，具有很高的公众相关性；现有的欧洲共同体呼吸健康调查队列丰富的纵向健康数据库与新产生的臭氧暴露数据相结合是优雅、经济有效和独特的；绿地和臭氧暴露对肺功能的相互作用是合理的，但到目前为止还没有被调查过。

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.