{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:47:58Z","timestamp":1793303278878,"version":"4.5.0"},"reference-count":50,"publisher":"American Chemical Society (ACS)","issue":"34","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-045"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Disease burden of ground-level ozone (O3) may be underestimated partly due to unresolved inconsistencies in O3 health effects reported in the literature. Inaccurate exposure assessment, copollutant confounding, and other methodological issues have not fully explained the inconsistencies. To explore an alternative explanation, we hypothesize that acute cardiorespiratory effects of O3 can be modified by longer-term PM2.5 exposure (30 day average), which may predispose people to heightened susceptibility. We tested the hypothesis by using two complementary approaches, including a panel study in healthy adults and a meta-regression analysis of O3 on cardiorespiratory effects reported in the literature. In the panel study, we observed significantly stronger associations between short-term O3 exposure and decreased lung function (FEV1, FEF25\u201375, and PEF) and increased systolic and diastolic blood pressure under higher PM2.5 exposure levels (&amp;gt;22 \u03bcg\/m3). These findings were further supported by the meta-regression analysis, which showed that study areas with higher annual PM2.5 concentrations had greater effect sizes of short-term ozone exposure on both FEV1 and blood pressure. Together, our results suggest that higher background PM2.5 concentrations may amplify the acute adverse cardiorespiratory effects of O3, which may partly explain the inconsistent health effect of ozone exposure reported in prior studies.<\/jats:p>","DOI":"10.1021\/acs.est.6c05604","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:19:48Z","timestamp":1787066388000},"page":"23852-23861","source":"Crossref","is-referenced-by-count":1,"title":["Respiratory and\nCardiovascular Effects of Ozone Modified\nby PM2.5: Evidence from a Panel Study and a Meta-Regression\nAnalysis"],"prefix":"10.1021","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3645-3891","authenticated-orcid":true,"given":"Shiyu","family":"Zhang","sequence":"first","affiliation":[{"name":"Duke University , , , ,","place":["Durham, North Carolina, United States, 27708"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuehan","family":"Chen","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou Medical University , , ,","place":["Guangzhou, China, 510000"]},{"name":"Shenzhen University , , ,","place":["Shenzhen, China, 518000"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keheng","family":"Xiang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou Medical University , , ,","place":["Guangzhou, China, 510000"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3559-9530","authenticated-orcid":true,"given":"Linchen","family":"He","sequence":"additional","affiliation":[{"name":"Peking University , , ,","place":["Beijing, China, 100871"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4384-8354","authenticated-orcid":true,"given":"Yan","family":"Lin","sequence":"additional","affiliation":[{"name":"Duke University , , , ,","place":["Durham, North Carolina, United States, 27708"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junayed","family":"Khan","sequence":"additional","affiliation":[{"name":"Duke University , , , ,","place":["Durham, North Carolina, United States, 27708"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kefang","family":"Lai","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou Medical University , , ,","place":["Guangzhou, China, 510000"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3759-6672","authenticated-orcid":true,"given":"Junfeng Jim","family":"Zhang","sequence":"additional","affiliation":[{"name":"Duke University , , , ,","place":["Durham, North Carolina, United States, 27708"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"issue":"11","key":"2026090307130415300_cit1","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1056\/NEJMoa0803894","article-title":"Long-Term\nOzone Exposure and Mortality","volume":"360","author":"Jerrett","year":"2009","journal-title":"N. 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Total Environ."},{"issue":"7382","key":"2026090307130415300_cit18","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1136\/bmj.326.7382.219","article-title":"Interaction Revisited:\nThe Difference between Two Estimates","volume":"326","author":"Altman","year":"2003","journal-title":"BMJ"},{"key":"2026090307130415300_cit19","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/j.envpol.2018.01.001","article-title":"Global Association\nbetween Ambient\nAir Pollution and Blood Pressure: A Systematic Review and Meta-Analysis","volume":"235","author":"Yang","year":"2018","journal-title":"Environ. 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Public\nHealth"},{"issue":"46","key":"2026090307130415300_cit23","doi-asserted-by":"publisher","first-page":"65140","DOI":"10.1007\/s11356-021-15246-x","article-title":"Short-Term\nEffects of Real-Time Individual Fine Particulate Matter Exposure on\nLung Function: A Panel Study in Zhuhai, China","volume":"28","author":"Ye","year":"2021","journal-title":"Environ. Sci. Pollut. Res."},{"issue":"9","key":"2026090307130415300_cit24","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1001\/jamainternmed.2017.2842","article-title":"(Jim). Association\nof Ozone Exposure With Cardiorespiratory Pathophysiologic Mechanisms\nin Healthy Adults","volume":"177","author":"Day","year":"2017","journal-title":"JAMA Intern. 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Immunol."},{"key":"2026090307130415300_cit27","doi-asserted-by":"publisher","first-page":"114444","DOI":"10.1016\/j.ecoenv.2022.114444","article-title":"The Pathophysiological and Molecular Mechanisms of\nAtmospheric PM2.5 Affecting Cardiovascular Health: A Review","volume":"249","author":"Feng","year":"2023","journal-title":"Ecotoxicol. Environ. Saf."},{"issue":"6","key":"2026090307130415300_cit28","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1152\/physiol.00017.2020","article-title":"Air Pollution-Induced\nAutonomic Modulation","volume":"35","author":"Taylor-Clark","year":"2020","journal-title":"Physiol."},{"key":"2026090307130415300_cit29","doi-asserted-by":"publisher","first-page":"110579","DOI":"10.1016\/j.envres.2020.110579","article-title":"Short-Term Personal and Outdoor Exposure to Ultrafine\nand Fine Particulate Air Pollution in Association with Blood Pressure\nand Lung Function in Healthy Adults","volume":"194","author":"van Nunen","year":"2021","journal-title":"Environ.\nRes."},{"issue":"10","key":"2026090307130415300_cit30","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.019063","article-title":"Short-Term Effects\nof Particle Size and Constituents on Blood Pressure in Healthy Young\nAdults in Guangzhou, China","volume":"10","author":"Guo","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"2026090307130415300_cit31","doi-asserted-by":"publisher","first-page":"113024","DOI":"10.1016\/j.ecoenv.2021.113024","article-title":"Acute Effect\nof Fine Particulate Matter on Blood Pressure, Heart\nRate and Related Inflammation Biomarkers: A Panel Study in Healthy\nAdults","volume":"228","author":"Li","year":"2021","journal-title":"Ecotoxicol. Environ. Saf."},{"issue":"suppl 4","key":"2026090307130415300_cit32","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1289\/ehp.01109s4579","article-title":"Airway Reflexes, Autonomic Function,\nand Cardiovascular\nResponses","volume":"109","author":"Widdicombe","year":"2001","journal-title":"Environ. Health Perspect."},{"key":"2026090307130415300_cit33","doi-asserted-by":"publisher","first-page":"105579","DOI":"10.1016\/j.envint.2020.105579","article-title":"Short Time Exposure\nto Ambient Ozone and Associated Cardiovascular\nEffects: A Panel Study of Healthy Young Adults","volume":"137","author":"Song","year":"2020","journal-title":"Environ. Int."},{"issue":"4","key":"2026090307130415300_cit34","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1164\/ajrccm.152.4.7551367","article-title":"Ozone Exposure in Humans:\nInflammatory,\nSmall and Peripheral Airway Responses","volume":"152","author":"Weinmann","year":"1995","journal-title":"Am. J.\nRespir. Crit. Care Med."},{"key":"2026090307130415300_cit35","doi-asserted-by":"publisher","first-page":"114013","DOI":"10.1016\/j.ecoenv.2022.114013","article-title":"Acute Effects of Exposure to Fine Particulate Matter\nand Ozone on\nLung Function, Inflammation and Oxidative Stress in Healthy Adults","volume":"243","author":"Xu","year":"2022","journal-title":"Ecotoxicol. Environ. Saf."},{"issue":"4","key":"2026090307130415300_cit36","doi-asserted-by":"publisher","first-page":"312","DOI":"10.2188\/jea.JE20130155","article-title":"Acute Effects of Summer\nAir Pollution on Pulmonary Function and Airway Inflammation in Healthy\nYoung Women","volume":"24","author":"Yoda","year":"2014","journal-title":"J. Epidemiol."},{"key":"2026090307130415300_cit37","doi-asserted-by":"publisher","first-page":"28","DOI":"10.2174\/1381612822666151109111712","article-title":"Air Pollution Exposure and Blood\nPressure: An Updated Review of the Literature","volume":"22","author":"Giorgini","year":"2015","journal-title":"Curr. Pharm. Des."},{"issue":"1","key":"2026090307130415300_cit38","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/j.chest.2021.07.2170","article-title":"Systematic Review\nof Ozone Effects on Human Lung Function,\n2013 Through 2020","volume":"161","author":"Holm","year":"2022","journal-title":"Chest"},{"issue":"10","key":"2026090307130415300_cit39","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1289\/ehp.9256","article-title":"Ozone\u2019s\nImpact on Public Health: Contributions from Indoor Exposures to Ozone\nand Products of Ozone-Initiated Chemistry","volume":"114","author":"Weschler","year":"2006","journal-title":"Environ.\nHealth Perspect."},{"issue":"9","key":"2026090307130415300_cit40","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1164\/rccm.202212-2203LE","article-title":"(Jim). Ozone Reaction Products Associated\nwith Biomarkers of Cardiorespiratory Pathophysiology","volume":"207","author":"He","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"2026090307130415300_cit41","doi-asserted-by":"publisher","first-page":"117892","DOI":"10.1016\/j.ecoenv.2025.117892","article-title":"Interactive\nEffects of Short-Term Ozone Exposure and Plasma Biomarkers Related\nto Nitric Oxide Pathway and Inflammation on Myocardial Ischemia","volume":"291","author":"Xu","year":"2025","journal-title":"Ecotoxicol. Environ. Saf."},{"issue":"5","key":"2026090307130415300_cit42","doi-asserted-by":"publisher","first-page":"2859","DOI":"10.1021\/acs.est.9b05978","article-title":"Modification Effects\nof Temperature on the Ozone\u2013Mortality Relationship: A Nationwide\nMulticounty Study in China","volume":"54","author":"Shi","year":"2020","journal-title":"Environ. Sci. Technol."},{"issue":"1","key":"2026090307130415300_cit43","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1186\/s12916-025-04471-7","article-title":"Integrated\nRisks from Air Pollution\nand Climate Extremes: Synergistic Effects of Ozone, Heat, and Humidity\non Cardiovascular Mortality","volume":"23","author":"Wei","year":"2025","journal-title":"BMC Med."},{"key":"2026090307130415300_cit44","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-075203","article-title":"Interactive Effects of Ambient Fine Particulate Matter and Ozone\non Daily Mortality in 372 Cities: Two Stage Time Series Analysis","volume":"383","author":"Liu","year":"2023","journal-title":"BMJ"},{"key":"2026090307130415300_cit45","doi-asserted-by":"publisher","first-page":"12865","DOI":"10.1021\/acs.est.3c10951","article-title":"Joint Effect\nof Short-Term Exposure to Fine Particulate Matter and Ozone on Mortality:\nA Time Series Study in 272 Chinese Cities","volume":"58","author":"Xu","year":"2024","journal-title":"Environ.\nSci. Technol."},{"issue":"10","key":"2026090307130415300_cit46","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.3390\/antiox13101256","article-title":"Particulate Matter-Induced Emerging\nHealth Effects\nAssociated with Oxidative Stress and Inflammation","volume":"13","author":"Lim","year":"2024","journal-title":"Antioxidants"},{"key":"2026090307130415300_cit47","doi-asserted-by":"publisher","first-page":"967174","DOI":"10.3389\/fnmol.2022.967174","article-title":"A Review of Respirable Fine Particulate Matter (PM2.5)-Induced\nBrain Damage","volume":"15","author":"Li","year":"2022","journal-title":"Front. Mol. Neurosci."},{"issue":"7","key":"2026090307130415300_cit48","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1080\/10937404.2020.1822971","article-title":"Effects of Ambient Particulate Matter\non Vascular Tissue:\nA Review","volume":"23","author":"Shkirkova","year":"2020","journal-title":"J. Toxicol. Environ. Health, Part\nB"},{"issue":"5","key":"2026090307130415300_cit49","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1289\/ehp.6042","article-title":"Chronic Exposure\nto High Levels of Particulate Air\nPollution and Small Airway Remodeling","volume":"111","author":"Churg","year":"2003","journal-title":"Environ.\nHealth Perspect."},{"issue":"2","key":"2026090307130415300_cit50","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1165\/rcmb.2019-0454OC","article-title":"Genome-Wide Analysis\nReveals Mucociliary Remodeling of the Nasal Airway Epithelium Induced\nby Urban PM2.5","volume":"63","author":"Montgomery","year":"2020","journal-title":"Am. J. Respir. Cell Mol. Biol."}],"container-title":["Environmental Science &amp;\nTechnology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.acs.org\/doi\/pdf\/10.1021\/acs.est.6c05604","content-type":"application\/pdf","content-version":"vor","intended-application":"unspecified"},{"URL":"https:\/\/pubs.acs.org\/esthag\/article-pdf\/60\/34\/23852\/66816101\/acs.est.6c05604.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.acs.org\/esthag\/article-pdf\/60\/34\/23852\/66816101\/acs.est.6c05604.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:13:08Z","timestamp":1788433988000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.acs.org\/esthag\/article\/60\/34\/23852\/5273212\/Respiratory-and-Cardiovascular-Effects-of-Ozone"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":50,"journal-issue":{"issue":"34","published-online":{"date-parts":[[2026,8,18]]},"published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1021\/acs.est.6c05604","relation":{},"ISSN":["0013-936X","1520-5851"],"issn-type":[{"value":"0013-936X","type":"print"},{"value":"1520-5851","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]}}}