Meta-analysis of the Chinese studies of the association between ambient ozone and mortality

To investigate short-term effects of ambient ozone exposure on mortality in Chinese cities, we conducted a meta-analysis of 10 effect estimates of 5 short-term studies, which reported associations between ambient ozone and mortality in Chinese mainland cities. And we estimated pooled effects by non-accidental mortality, cardiovascular mortality, and respiratory mortality. Combined estimates and their 95%CI were tested by RevMan 5, and Funnel plots were used for the bias analysis. For a 10 μg m−3 increase of maximum 8-h average concentration of ozone, the percent change for non-accidental mortality, cardiovascular mortality, and respiratory mortality were 0.42 (95%CI, 0.32-0.52%), 0.44% (95%CI, 0.17-0.70%) and 0.50% (95%CI, 0.22-0.77%), respectively. Compared with pooled estimates from other meta-analyses on ambient ozone-associated mortality, our pooled estimate for non-accidental mortality was slightly higher than previous ones and pooled estimate for cardiovascular mortality was consistent with others. However, we observed significantly positive association between ambient ozone and respiratory mortality, which were generally nonsignificant in earlier studies. By combining estimates from published evidence, a small but substantial association between ambient ozone level and mortality was observed in Mainland China.