Does temperature modify short-term effects of ozone on total mortality in 60 large eastern US communities? — An assessment using the NMMAPS data

Many studies have indicated that ozone is associated with morbidity and mortality. A few studies have reported that the association is heterogeneous across seasons and geographic regions. However, little information is available on whether both temperature and geographic factors simultaneously modify the ozone effect. This study used a Poisson regression model to explore whether temperature modifies the effect of ozone on mortality in the 60 large eastern US communities during April to October, 1987–2000. Results show that temperature modified ozone-mortality associations and that such modification varied across geographic regions. In the northeast region, a 10-ppb increment in ozone was associated with an increase of 2.22% (95% posterior interval [PI]: 1.19%, 3.13%), 3.06% (95% PI: 2.21%, 3.76%) and 6.22% (95% PI: 4.77%, 7.56%) in mortality at low, moderate and high temperature level, respectively, while in the southeast region a 10-ppb increment in ozone was associated with an increase of 1.13% (95% PI:− 1.12%, 3.18%), 1.50% (95% PI: 0.22%, 2.81%) and 1.29% (95% PI:− 0.33%, 2.96%) in mortality, respectively. We concluded that temperature synergistically modified the ozone-mortality association in the northeast region, but such a pattern was not apparent in the southeast region. Thus, both temperature and geographic factors should be considered in the assessment of ozone effects.