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

虽然暴露于颗粒物（PM）的不利影响已得到充分确认，但臭氧造成的不利影响尚未得到充分调查，特别是在过去20年中。美国环境保护署对臭氧与健康进行的最全面的评估（综合科学评估，ISA）得出结论，这些发现提供了短期臭氧暴露与呼吸健康之间存在“因果关系”的证据，但只有少数研究探讨了臭氧对肺功能的长期影响。有几个强有力的论据证明需要在欧洲进行与臭氧有关的呼吸健康研究：1)将美国和加拿大的研究结果转化为欧洲的结果存在问题；2)气候变化将增加某些地区的臭氧水平，并将延长欧洲高臭氧浓度的持续时间；3)关于居住在绿色社区附近与肺功能之间的关系的不一致的发现可能是由于臭氧水平较高的潜在混淆。我们假设：-在20年的随访时间内，长期暴露于臭氧与肺功能发展呈负相关。-居住在由土地用途衍生的绿地空间和卫星衍生的NDVI评估的绿色社区，在20年内对肺功能有不利影响。-在长达20年的时间里，长期接触臭氧和生活在绿色社区对肺功能的发展都有协同的不利影响。来自11个欧洲国家21个研究中心的近6000名成年人的肺功能测量数据将用于分析。基于地理编码的居住地址，包括季节变化在内的臭氧长期暴露的个性化评估将是主要关注的暴露。肺功能测量在长达20年的时间内将是主要的结果。回归模型将根据相关的个人人口和生活方式因素，以及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，进行充分调整。绿地暴露程度将根据标准化植被指数（归一化植被指数）评估的绿色社区来确定，该指数由卫星获取的Landsat数据和住宅地址与绿地的接近程度获得。本研究有几个创新之处：地面臭氧暴露对肺功能的长期影响有待进一步研究；鉴于由于气候变化，预计欧洲一些地区的臭氧水平将增加，这个项目是及时的，具有高度的公共相关性；欧洲共同体呼吸健康调查队列现有丰富的纵向健康数据库与新产生的臭氧暴露数据的结合是优雅的、具有成本效益的和独特的；绿色空间和臭氧暴露对肺功能的相互作用似乎是合理的，但迄今尚未进行研究。

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.