title: Who is more affected by ozone pollution? A systematic review and meta-analysis.
abstract: Ozone is associated with adverse health; however, less is known about vulnerable/sensitive populations, which we refer to as sensitive populations. We systematically reviewed epidemiologic evidence (1988-2013) regarding sensitivity to mortality or hospital admission from short-term ozone exposure. We performed meta-analysis for overall associations by age and sex; assessed publication bias; and qualitatively assessed sensitivity to socioeconomic indicators, race/ethnicity, and air conditioning. The search identified 2,091 unique papers, with 167 meeting inclusion criteria (73 on mortality and 96 on hospitalizations and emergency department visits, including 2 examining both mortality and hospitalizations). The strongest evidence for ozone sensitivity was for age. Per 10-parts per billion increase in daily 8-hour ozone concentration, mortality risk for younger persons, at 0.60% (95% confidence interval (CI): 0.40, 0.80), was statistically lower than that for older persons, at 1.27% (95% CI: 0.76, 1.78). Findings adjusted for publication bias were similar. Limited/suggestive evidence was found for higher associations among women; mortality risks were 0.39% (95% CI: -0.22, 1.00) higher than those for men. We identified strong evidence for higher associations with unemployment or lower occupational status and weak evidence of sensitivity for racial/ethnic minorities and persons with low education, in poverty, or without central air conditioning. Findings show that some populations, especially the elderly, are particularly sensitive to short-term ozone exposure.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Bell
authors.forename: Antonella
authors.initials: A
authors.lastname: Zanobetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Dominici
mesh_terms: D000367:Age Factors; D000393:Air Pollutants / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009026:Mortality; D010126:Ozone / Q000009:adverse effects*; D044469:Racial Groups / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D000393:Air Pollutants; D010126:Ozone
keywords: age; air pollution; effect modifiers; hospitalization; mortality; ozone; sex