Short-term exposure to ground-level ozone in cities is associated with increased mortality and is expected to worsen with climate and emission changes. However, no study has yet comprehensively assessed future ozone-related acute mortality across diverse geographic areas, various climate scenarios, and using CMIP6 multi-model ensembles, limiting our knowledge on future changes in global ozone-related acute mortality and our ability to design targeted health policies. Here, we combine CMIP6 simulations and epidemiological data from 406 cities in 20 countries or regions. We find that ozone-related deaths in 406 cities will increase by 45 to 6,200 deaths/year between 2010 and 2014 and between 2050 and 2054, with attributable fractions increasing in all climate scenarios (from 0.17% to 0.22% total deaths), except the single scenario consistent with the Paris Climate Agreement (declines from 0.17% to 0.15% total deaths). These findings stress the need for more stringent air quality regulations, as current standards in many countries are inadequate.

Asian Demographic Research Institute Shanghai University Shanghai 200444 China

Ciberesp Madrid Spain

Climate Air Quality Research Unit School of Public Health and Preventive Medicine Monash University Melbourne NSW Australia

Climate and Global Dynamics Laboratory National Center for Atmospheric Research Boulder CO USA

Department of Earth Atmospheric and Planetary Sciences Massachusetts Institute of Technology Cambridge MA 02139 USA

Department of Environmental Health Harvard T H Chan School of Public Health Harvard University Boston MA USA

Department of Environmental Health National Institute of Public Health Cuernavaca Morelos Mexico

Department of Environmental Health Rollins School of Public Health Emory University Atlanta GA USA

Department of Environmental Health School of Public Health Boston University Boston MA 02118 USA

Department of Environmental Health School of Public Health Fudan University Shanghai China

Department of Environmental Health Sciences Yale School of Public Health New Haven CT 06510 USA

Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne NSW Australia

Department of Epidemiology Lazio Regional Health Service Rome Italy

Department of Family Medicine and Public Health University of Tartu Tartu Estonia

Department of Geography Geoinformatics and Meteorology University of Pretoria Pretoria South Africa

Department of Global Health Policy Graduate School of Medicine The University of Tokyo Tokyo Japan

Department of Hygiene Epidemiology and Medical Statistics National and Kapodistrian University of Athens Athens Greece

Department of Occupational and Environmental Medicine College of Medicine Ewha Womans University Seoul Republic of Korea

Department of Public Health and Clinical Medicine Umeå University Umeå Sweden

Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London UK

Department of Quantitative Methods School of Medicine University of the Republic Montevideo Uruguay

Department of Statistics and Computational Research Universitat de València València Spain

Environment and Health Modelling Lab Department of Public Health Environments and Society London School of Hygiene and Tropical Medicine London UK

Environmental and Occupational Medicine National Taiwan University College of Medicine and NTU Hospital Taipei Taiwan

Environmental Health and Science Bureau Heatlh Canada Ottawa ON Canada

Environmental Health Department of the National Health Institute of Health Dr Ricardo Jorge Porto Portugal

Environmental Research Group School of Public Health Imperial College London London UK

EPIUnit Instituto de Saúde Pública Universidade do Porto Porto Portugal

Estonian Environmental Research Centre Tallinn Estonia

Faculty of Environmental Sciences Czech University of Life Sciences Prague Czech Republic

Graduate School of Public Health Seoul National University Seoul Republic of Korea

IBE Chair of Epidemiology Faculty of Medicine LMU Munich Munich Germany

Institute of Atmospheric Physics Czech Academy of Sciences Prague Czech Republic

Institute of Environmental Assessment and Water Research Barcelona Spain

Institute of Epidemiology Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg Germany

Institute of Ewha SCL for Environmental Health Seoul Republic of Korea

Institute of Social and Preventive Medicine University of Bern Bern Switzerland

Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional Porto Portugal

National Institute of Environmental Health Science National Health Research Institutes Zhunan Taiwan

Oeschger Center for Climate Change Research University of Bern Bern Switzerland

Population Council New York NY 10017 USA

Santé Publique France Department of Environmental Health French National Public Health Agency Saint Maurice France

School of Epidemiology and Public Health Faculty of Medicine University of Ottawa Ottawa ON Canada

School of Public Health and Institute of Environment and Human Health Anhui Medical University Hefei China

School of Public Health and Social Work Queensland University of Technology Brisbane QLD Australia

School of the Environment Yale University New Haven CT USA

School of Tropical Medicine and Global Health Nagasaki University Nagasaki Japan

Shanghai Children's Medical Centre Shanghai Jiao Tong University Shanghai China

Swiss Tropical and Public Health Institute Basel Switzerland

The Centre on Climate Change and Planetary Health London School of Hygiene and Tropical Medicine London UK

University of Basel Basel Switzerland

Yale Center on Climate Change and Health Yale School of Public Health New Haven CT 06510 USA

Zobrazit více v PubMed

Fuller R, Landrigan PJ, Balakrishnan K, Bathan G, Bose-O’Reilly S, Brauer M, Caravanos J, Chiles T, Cohen A, Corra L, et al. Pollution and health: a progress update. Lancet Planet Health. 2022;6:E535–E547. PubMed

Zhang JJ, Wei Y, Fang Z. Ozone Pollution: A Major Health Hazard Worldwide. Front Immunol. 2019;10:2518. PubMed PMC

Orellano P, Reynoso J, Quaranta N, Bardach A, Ciapponi A. Short-term exposure to particulate matter (PM10 and PM2.5), nitrogen dioxide (NO2), and ozone (O3) and all-cause and cause-specific mortality: Systematic review and meta-analysis. Environ Int. 2020;142:105876. PubMed

Bell ML, McDermott A, Zeger SL, Samet JM, Dominici F. Ozone and Short-term Mortality in 95 US Urban Communities, 1987-2000. JAMA. 2004;292:2372–2378. PubMed PMC

Vicedo-Cabrera AM, Sera F, Liu C, Armstrong B, Milojevic A, Guo Y, Tong S, Lavigne E, Urban A, et al. Short term association between ozone and mortality: global two stage time series study in 406 locations in 20 countries. Br Med J. 2020;368:m108. PubMed PMC

Fiore AM, Naik V, Leibensperger EM. Air Quality and Climate Connections. J Air Waste Manag Assoc. 2015;65:645–685. PubMed

Zanis P, Akritidis D, Turnock S, Naik V, Szopa S, Georgoulias AK, Bauer SE, Deushi M, Horowitz LW, Keeble J, et al. Climate change penalty and benefit on surface ozone: a global perspective based on CMIP6 earth system models. Environ Res Lett. 2022;17:024014

Chen K, Fiore AM, Chen R, Jiang L, Jones B, Schneider A, Peters A, Bi J, Kan H, Kinney PL. Future ozone-related acute excess mortality under climate and population change scenarios in China: A modeling study. PLoS Med. 2018;15:e1002598. PubMed PMC

Fann NL, Nolte CG, Sarofim MC, Martinich J, Nassikas NJ. Associations Between Simulated Future Changes in Climate, Air Quality, and Human Health. JAMA. 2021;4:e2032064 PubMed PMC

Chang HH, Zhou J, Fuentes M. Impact of Climate Change on Ambient Ozone Level and Mortality in Southeastern United States. Int J Environ Res Public Health. 2010;7:2866–2880. PubMed PMC

Pozzer A, Anenberg SC, Dey S, Haines A, Lelieveld J, Chowdhury S. Mortality attributable to ambient air pollution: A review of global estimates. GeoHealth. 2023;7:e2022GH000711 PubMed PMC

Chen K, Vicedo-Cabrera AM, Dubrow R. Projections of Ambient Temperature-and Air Pollution-Related Mortality Burden Under Combined Climate Change and Population Aging Scenarios: a Review. Curr Environ Health Rep. 2020;7:243–255. PubMed

Environmental Protection Agency. Review of the Ozone National Ambient Air Quality Standards. 2020. https://www.govinfo.gov/content/pkg/FR-2020-12-31/pdf/2020-28871.pdf .

Official Journal of the European Union. Directive 2008/50/EC of the European Parliament and of the Council of 21 May 2008 on Ambient Air Quality and Cleaner Air for Europe. 2008. https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32008L0050&qid=1696086918600 .

State of Environment Reporting, Ministry of Environment and Climate Change Strategy, British Columbia, Canada. Status of Ground-Level Ozone in BC. (2018-2020) 2022. https://www.env.gov.bc.ca/soe/indicators/air/ozone.html#:?:text=Ground%2DLevel%20Ozone:%20Canadian%20Ambient .

Yeo MJ, Kim YP. Long-term trends of surface ozone in Korea. J Clean Prod. 2021;294:125352

Wang Z, Tan Y, Guo M, Cheng M, Gu Y, Chen S, Wu X, Chai F. Prospect of China’s ambient air quality standards. J Environ Sci. 2023;123:255–269. PubMed

Diario Oficial de la Federación. NORMA Oficial Mexicana NOM-020-SSA1-2014, Salud ambiental. Valor limite permisible para la concentración de ozono (O3) en el aire ambiente y criterios para su evaluación. 2014. https://dof.gob.mx/nota_detalle.php?codigo=5356801&fecha=19/08/2014#gsc.tab=0 .

O’Neill BC, Kriegler E, Riahi K, Ebi KL, Hallegatte S, Carter TR, Mathur R, van--Vuuren DP. A new scenario framework for climate change research: the concept of shared socioeconomic pathways. Clim Change. 2013;122:387–400.

IPCC. Summary for Policymakers. Climate Change 2021: The Physical Science Basis Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press; 2021. pp. 3–32.

Ban J, Lu K, Wang Q, Li T. Climate change will amplify the inequitable exposure to compound heatwave and ozone pollution. One Earth. 2022;5:677–686.