Association of mortality and combined oxidative capacity of ozone and nitrogen dioxide

Yue Niu; Renjie Chen; Francesco Sera; Aleš Urban; Ana Maria Vicedo-Cabrera; Yasushi Honda; Veronika Huber; Yuming Guo; Shilu Tong; Micheline de Sousa Zanotti Stagliorio Coelho; Paulo Hilario Nascimento Saldiva; Eric Lavigne; Patricia Matus Correa; Nicolás Valdés Ortega; Samuel Osorio; Souzana Achilleos; Dominic Roye; Jouni J.K. Jaakkola; Niilo Ryti; Mathilde Pascal; Alexandra Schneider; Susanne Breitner-Busch; Alireza Entezari; Fatemeh Mayvaneh; Raanan Raz; Chris Fook Sheng Ng; Masahiro Hashizume; Gabriel Carrasco; Susana das Neves Pereira da Silva; Joana Madureira; Iulian Horia Holobaca; Ho Kim; Whanhee Lee; Aurelio Tobias; Carmen Íñiguez; Yue Leon Guo; Shih Chun Pan; Shanshan Li; Pierre Masselot; Michelle L. Bell; Antonella Zanobetti; Joel Schwartz; Antonio Gasparrini; Haidong Kan

doi:10.1038/s41893-026-01875-y

Association of mortality and combined oxidative capacity of ozone and nitrogen dioxide

Yue Niu
, Renjie Chen
, Francesco Sera
, Aleš Urban
, Ana Maria Vicedo-Cabrera
, Yasushi Honda
, Veronika Huber
, Yuming Guo
, Shilu Tong
, Micheline de Sousa Zanotti Stagliorio Coelho
, Paulo Hilario Nascimento Saldiva
, Eric Lavigne
, Patricia Matus Correa
, Nicolás Valdés Ortega
, Samuel Osorio
, Souzana Achilleos
, Dominic Roye
, Jouni J.K. Jaakkola
, Niilo Ryti
, Mathilde Pascal

Alexandra Schneider, Susanne Breitner-Busch, Alireza Entezari, Fatemeh Mayvaneh, Raanan Raz, Chris Fook Sheng Ng, Masahiro Hashizume, Gabriel Carrasco, Susana das Neves Pereira da Silva, Joana Madureira, Iulian Horia Holobaca, Ho Kim, Whanhee Lee, Aurelio Tobias, Carmen Íñiguez, Yue Leon Guo, Shih Chun Pan, Shanshan Li, Pierre Masselot, Michelle L. Bell, Antonella Zanobetti, Joel Schwartz, Antonio Gasparrini, Haidong Kan^*

^*Corresponding author for this work

Department of Social Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Ozone (O₃) and nitrogen dioxide (NO₂) are two common gaseous pollutants that both possess oxidizing properties with consequences for human health and have an inextricable chemical relationship that could have distinct public health impacts when considered in combination. We examined the short-term associations of the combined oxidative capacity of O₃ and NO₂ (represented by Ox^wt, the average of O₃ and NO₂ concentrations weighted by their standard electrode potential) with total, cardiovascular and respiratory mortality in 380 cities across 23 countries or regions between 1985 and 2020. Over 2 days (LAG01), a 10-ppb increase in Ox^wt concentration was associated with an increase of 0.82% (95% confidence interval (CI): 0.55%, 1.10%) in total mortality, 1.09% (95% CI: 0.83%, 1.35%) in cardiovascular mortality and 0.88% (95% CI: 0.31%, 1.45%) in respiratory mortality. We also observed variations in this association by geographic region and study period. More deaths were attributable to Ox^wt than to either O₃ or NO₂ but fewer than the sum of the two. Thus, Ox^wt might be a valuable indicator for use in public health efforts to capture the combined effects of O₃ and NO₂.

Original language	English
Journal	Nature Sustainability
DOIs	https://doi.org/10.1038/s41893-026-01875-y
State	Accepted/In press - 2026

Bibliographical note

Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature Limited 2026.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 11 Sustainable Cities and Communities

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10.1038/s41893-026-01875-y

Cite this

Niu, Y., Chen, R., Sera, F., Urban, A., Vicedo-Cabrera, A. M., Honda, Y., Huber, V., Guo, Y., Tong, S., Coelho, M. D. S. Z. S., Saldiva, P. H. N., Lavigne, E., Matus Correa, P., Ortega, N. V., Osorio, S., Achilleos, S., Roye, D., Jaakkola, J. J. K., Ryti, N., ... Kan, H. (Accepted/In press). Association of mortality and combined oxidative capacity of ozone and nitrogen dioxide. Nature Sustainability. https://doi.org/10.1038/s41893-026-01875-y

@article{578aba500798438f87d06051caf4b8b1,

title = "Association of mortality and combined oxidative capacity of ozone and nitrogen dioxide",

abstract = "Ozone (O3) and nitrogen dioxide (NO2) are two common gaseous pollutants that both possess oxidizing properties with consequences for human health and have an inextricable chemical relationship that could have distinct public health impacts when considered in combination. We examined the short-term associations of the combined oxidative capacity of O3 and NO2 (represented by Oxwt, the average of O3 and NO2 concentrations weighted by their standard electrode potential) with total, cardiovascular and respiratory mortality in 380 cities across 23 countries or regions between 1985 and 2020. Over 2 days (LAG01), a 10-ppb increase in Oxwt concentration was associated with an increase of 0.82\% (95\% confidence interval (CI): 0.55\%, 1.10\%) in total mortality, 1.09\% (95\% CI: 0.83\%, 1.35\%) in cardiovascular mortality and 0.88\% (95\% CI: 0.31\%, 1.45\%) in respiratory mortality. We also observed variations in this association by geographic region and study period. More deaths were attributable to Oxwt than to either O3 or NO2 but fewer than the sum of the two. Thus, Oxwt might be a valuable indicator for use in public health efforts to capture the combined effects of O3 and NO2.",

author = "Yue Niu and Renjie Chen and Francesco Sera and Ale{\v s} Urban and Vicedo-Cabrera, \{Ana Maria\} and Yasushi Honda and Veronika Huber and Yuming Guo and Shilu Tong and Coelho, \{Micheline de Sousa Zanotti Stagliorio\} and Saldiva, \{Paulo Hilario Nascimento\} and Eric Lavigne and \{Matus Correa\}, Patricia and Ortega, \{Nicol{\'a}s Vald{\'e}s\} and Samuel Osorio and Souzana Achilleos and Dominic Roye and Jaakkola, \{Jouni J.K.\} and Niilo Ryti and Mathilde Pascal and Alexandra Schneider and Susanne Breitner-Busch and Alireza Entezari and Fatemeh Mayvaneh and Raanan Raz and Ng, \{Chris Fook Sheng\} and Masahiro Hashizume and Gabriel Carrasco and \{da Silva\}, \{Susana das Neves Pereira\} and Joana Madureira and Holobaca, \{Iulian Horia\} and Ho Kim and Whanhee Lee and Aurelio Tobias and Carmen {\'I}{\~n}iguez and Guo, \{Yue Leon\} and Pan, \{Shih Chun\} and Shanshan Li and Pierre Masselot and Bell, \{Michelle L.\} and Antonella Zanobetti and Joel Schwartz and Antonio Gasparrini and Haidong Kan",

note = "Publisher Copyright: {\textcopyright} The Author(s), under exclusive licence to Springer Nature Limited 2026.",

year = "2026",

doi = "10.1038/s41893-026-01875-y",

language = "אנגלית",

journal = "Nature Sustainability",

issn = "2398-9629",

publisher = "Nature Publishing Group",

}

Niu, Y, Chen, R, Sera, F, Urban, A, Vicedo-Cabrera, AM, Honda, Y, Huber, V, Guo, Y, Tong, S, Coelho, MDSZS, Saldiva, PHN, Lavigne, E, Matus Correa, P, Ortega, NV, Osorio, S, Achilleos, S, Roye, D, Jaakkola, JJK, Ryti, N, Pascal, M, Schneider, A, Breitner-Busch, S, Entezari, A, Mayvaneh, F, Raz, R, Ng, CFS, Hashizume, M, Carrasco, G, da Silva, SDNP, Madureira, J, Holobaca, IH, Kim, H, Lee, W, Tobias, A, Íñiguez, C, Guo, YL, Pan, SC, Li, S, Masselot, P, Bell, ML, Zanobetti, A, Schwartz, J, Gasparrini, A & Kan, H 2026, 'Association of mortality and combined oxidative capacity of ozone and nitrogen dioxide', Nature Sustainability. https://doi.org/10.1038/s41893-026-01875-y

TY - JOUR

T1 - Association of mortality and combined oxidative capacity of ozone and nitrogen dioxide

AU - Niu, Yue

AU - Chen, Renjie

AU - Sera, Francesco

AU - Urban, Aleš

AU - Vicedo-Cabrera, Ana Maria

AU - Honda, Yasushi

AU - Huber, Veronika

AU - Guo, Yuming

AU - Tong, Shilu

AU - Coelho, Micheline de Sousa Zanotti Stagliorio

AU - Saldiva, Paulo Hilario Nascimento

AU - Lavigne, Eric

AU - Matus Correa, Patricia

AU - Ortega, Nicolás Valdés

AU - Osorio, Samuel

AU - Achilleos, Souzana

AU - Roye, Dominic

AU - Jaakkola, Jouni J.K.

AU - Ryti, Niilo

AU - Pascal, Mathilde

AU - Schneider, Alexandra

AU - Breitner-Busch, Susanne

AU - Entezari, Alireza

AU - Mayvaneh, Fatemeh

AU - Raz, Raanan

AU - Ng, Chris Fook Sheng

AU - Hashizume, Masahiro

AU - Carrasco, Gabriel

AU - da Silva, Susana das Neves Pereira

AU - Madureira, Joana

AU - Holobaca, Iulian Horia

AU - Kim, Ho

AU - Lee, Whanhee

AU - Tobias, Aurelio

AU - Íñiguez, Carmen

AU - Guo, Yue Leon

AU - Pan, Shih Chun

AU - Li, Shanshan

AU - Masselot, Pierre

AU - Bell, Michelle L.

AU - Zanobetti, Antonella

AU - Schwartz, Joel

AU - Gasparrini, Antonio

AU - Kan, Haidong

PY - 2026

Y1 - 2026

N2 - Ozone (O3) and nitrogen dioxide (NO2) are two common gaseous pollutants that both possess oxidizing properties with consequences for human health and have an inextricable chemical relationship that could have distinct public health impacts when considered in combination. We examined the short-term associations of the combined oxidative capacity of O3 and NO2 (represented by Oxwt, the average of O3 and NO2 concentrations weighted by their standard electrode potential) with total, cardiovascular and respiratory mortality in 380 cities across 23 countries or regions between 1985 and 2020. Over 2 days (LAG01), a 10-ppb increase in Oxwt concentration was associated with an increase of 0.82% (95% confidence interval (CI): 0.55%, 1.10%) in total mortality, 1.09% (95% CI: 0.83%, 1.35%) in cardiovascular mortality and 0.88% (95% CI: 0.31%, 1.45%) in respiratory mortality. We also observed variations in this association by geographic region and study period. More deaths were attributable to Oxwt than to either O3 or NO2 but fewer than the sum of the two. Thus, Oxwt might be a valuable indicator for use in public health efforts to capture the combined effects of O3 and NO2.

AB - Ozone (O3) and nitrogen dioxide (NO2) are two common gaseous pollutants that both possess oxidizing properties with consequences for human health and have an inextricable chemical relationship that could have distinct public health impacts when considered in combination. We examined the short-term associations of the combined oxidative capacity of O3 and NO2 (represented by Oxwt, the average of O3 and NO2 concentrations weighted by their standard electrode potential) with total, cardiovascular and respiratory mortality in 380 cities across 23 countries or regions between 1985 and 2020. Over 2 days (LAG01), a 10-ppb increase in Oxwt concentration was associated with an increase of 0.82% (95% confidence interval (CI): 0.55%, 1.10%) in total mortality, 1.09% (95% CI: 0.83%, 1.35%) in cardiovascular mortality and 0.88% (95% CI: 0.31%, 1.45%) in respiratory mortality. We also observed variations in this association by geographic region and study period. More deaths were attributable to Oxwt than to either O3 or NO2 but fewer than the sum of the two. Thus, Oxwt might be a valuable indicator for use in public health efforts to capture the combined effects of O3 and NO2.

UR - https://www.scopus.com/pages/publications/105041784186

U2 - 10.1038/s41893-026-01875-y

DO - 10.1038/s41893-026-01875-y

M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???

AN - SCOPUS:105041784186

SN - 2398-9629

JO - Nature Sustainability

JF - Nature Sustainability

ER -

Association of mortality and combined oxidative capacity of ozone and nitrogen dioxide

Abstract

Bibliographical note

UN SDGs

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