Investigation of the Association between Long-term Ozone Exposure and Cardiovascular Disease: A Meta-Analysis Addressing Exposure Windows, Vulnerable Populations, and Spatial Variation.

In this study, cohort studies retrieved from PubMed, Web of Science, and Embase were systematically evaluated to clarify the link between long-term ozone exposure and cardiovascular disease (CVD)-related mortality and morbidity, addressing gaps in previous reviews that were not comprehensive or did not distinguish specific CVD types. For every 10 µg/m3 increase in ozone concentration, the relative risk (RR) of CVD mortality was 1.0105 [95% confidence interval (CI): 1.0027, 1.0185], and that of CVD morbidity was 1.0578 (95% CI: 1.0289, 1.0874). In different exposure windows, the CVD mortality risk associated with warm-season ozone exposure (RR=1.0186, 95% CI: 1.0119, 1.0253) was higher than that associated with annual average ozone exposure (RR=0.9971, 95% CI: 0.9781, 1.0164). The RRs for CVD mortality were 1.1135 (95% CI: 1.0057, 1.2328) for females and 1.0707 (95% CI: 0.9855, 1.1633) for males. By region, the RRs were 1.0129 (95% CI: 1.0085, 1.0173) in Europe and the USA, and 1.0326 (95% CI: 0.9323, 1.1436) in Asia. Long-term ozone exposure is associated with a modest increase in the risk of cardiovascular mortality and morbidity. However, evidence regarding the long-term effects of ozone exposure on cardiovascular disease-related health outcomes remains sparse, and further studies covering a broader range of regions and vulnerable populations are urgently required.