Ambient ozone exposure and course of non-communicable diseases among elderly individuals with hypertension, diabetes or dyslipidemia: Prospective cohort study in GOLD-Health.

The association between ozone (O3) exposure and the dynamic and accelerated progression of non-communicable diseases (NCDs) remains unclear in elderly individuals with hypertension (HTN), diabetes mellitus (DM), or dyslipidemia. This study included 250,246 participants with HTN, DM, or dyslipidemia from the Guangzhou Older Longitudinal Dynamic Health. Long-term O3 exposure was estimated using bilinear interpolation based on geocoded residential addresses. We employed multi-state models to assess the associations between O3 exposure and transitions from baseline to NCDs (stroke, coronary heart disease, fatty liver disease, chronic obstructive pulmonary disease, chronic kidney disease), multimorbidity and death. Accelerated failure time (AFT) models were further used to examine progression acceleration and predict transition times. Over 727,003.2 person-years of follow-up, 99,246 participants (39.66 %) developed NCDs, of whom 10,349 (10.43 %) progressed to multimorbidity and 5759 (5.80 %) died. We observed that O3 exposure was associated with the dynamic progression of NCDs. Specifically, the hazard ratios (HRs) for each 10 μg/m3 increase in O3 were 1.39 [95 % confidence interval (CI): 1.38, 1.40] and 1.34 (95 % CI: 1.29, 1.39) for transitions from baseline to NCDs and from NCDs to multimorbidity. AFT analyses demonstrated that O3 exposure could accelerate the progression of NCDs, for example, shortening the transition time from baseline to NCDs from 3.61 years at 80 μg/m3 to 1.31 years at 130 μg/m3. These findings suggest that O3 exposure might be an important risk factor for both the dynamic and accelerated progressions of NCDs among elderly populations with HTN, DM, or dyslipidemia.