Cardiovascular and respiratory mortality attributed to ground-level ozone in Ahvaz, Iran

  • Gholamreza Goudarzi
  • Sahar Geravandi
  • Hossein Foruozandeh
  • Ali Akbar Babaei
  • Nadali Alavi
  • Mehdi Vosoughi Niri
  • Mohammad Javad Khodayar
  • Shokrollah Salmanzadeh
  • Mohammad Javad MohammadiEmail author


Ahvaz, the capital city of Khuzestan Province, which produces Iran’s most oil, is on the rolls of fame in view of air pollution. It has also suffered from dust storm during the recent two decades. So, emissions from transportation systems, steel, oil, black carbon, and other industries as anthropogenic sources and dust storm as a new phenomenon are two major concerns of air pollution in Ahvaz. Without any doubt, they can cause many serious problems for the environment and humans in this megacity. The main objective of the present study was to estimate the impact of ground-level ozone (GLO) as a secondary pollutant on human heath. Data of GLO in four monitoring stations were collected at the first step and they were processed and at the final step they were inserted to a health effect model. Findings showed that cumulative cases of cardiovascular and respiratory deaths which attributed to GLO were 43 and 173 persons, respectively. Corresponding RR for these two events were 1.008 (95 % CI) and 1.004 (95 % CI), respectively. Although we did not provide a distinction between winter and summer in case of mentioned mortalities attributed to GLO, ozone concentrations in winter due to more fuel consumption and sub adiabatic condition in tropospheric atmospherewere higher than those GLO in summer.


Air pollution Ground-level ozone Cardiovascular mortality Respiratory mortality Ahvaz 


  1. Bell, M. L., & Dominici, F. (2008). Effect modification by community characteristics on the short-term effects of ozone exposure and mortality in 98 US communities. American Journal of Epidemiology, 167(8), 986–997.CrossRefGoogle Scholar
  2. Bell, M. L., McDermott, A., Zeger, S. L., Samet, J. M., & Dominici, F. (2004). Ozone and short-term mortality in 95 US urban communities, 1987–2000. JAMA, 292(19), 2372–2378.CrossRefGoogle Scholar
  3. Boyce, C. P., Goodman, J. E., Sax, S. N., & Loftus, C. T. (2015). Providing perspective for interpreting cardiovascular mortality risks associated with ozone exposures. Regulatory Toxicology and Pharmacology, 72(1), 107–116.CrossRefGoogle Scholar
  4. Chen, C.-H., Chan, C.-C., Chen, B.-Y., Cheng, T.-J., & Guo, Y. L. (2015). Effects of particulate air pollution and ozone on lung function in non-asthmatic children. Environmental Research, 137, 40–48.CrossRefGoogle Scholar
  5. Desqueyroux, H., Pujet, J.-C., Prosper, M., Squinazi, F., & Momas, I. (2002). Short-term effects of low-level air pollution on respiratory health of adults suffering from moderate to severe asthma. Environmental Research, 89(1), 29–37.CrossRefGoogle Scholar
  6. Di Nardo, F., & Laurenti, P. (2015). Respiratory diseases and health disorders related to indoor and outdoor air pollution. In A Systematic Review of Key Issues in Public Health (pp. 109–127). Berlin: Springer.Google Scholar
  7. EPA, U. S. (2013). Integrated science assessment of ozone and related photochemical oxidants. In E. R. DC (Ed.)Google Scholar
  8. Frampton, M. W., Pietropaoli, A., Dentler, M., Chalupa, D., Little, E. L., Stewart, J., Frasier, L., Oakes, D., Wittshire, J., Vora, R., & Utell, M. J. (2015). Cardiovascular effects of ozone in healthy subjects with and without deletion of glutathione-S-transferase M1. Inhalation Toxicology, 27(2), 113–119.CrossRefGoogle Scholar
  9. Franklin, B. A., Brook, R., & Pope, C. A. (2015). Air pollution and cardiovascular disease. Current Problems in CardiologyGoogle Scholar
  10. Frischer, T. M., Kuehr, J., Pullwitt, A., Meinert, R., Forster, J., Studnicka, M., & Koren, H. (1993). Ambient ozone causes upper airways inflammation in children. American Review of Respiratory Disease, 148, 961.CrossRefGoogle Scholar
  11. Gent, J. F., Triche, E. W., Holford, T. R., Belanger, K., Bracken, M. B., Beckett, W. S., & Leaderer, B. P. (2003). Association of low-level ozone and fine particles with respiratory symptoms in children with asthma. JAMA, 290(14), 1859–1867.CrossRefGoogle Scholar
  12. Geravandi, S., Mohammadi, M., Goudarzi, G., A. A. K., Neisi, A., & Zalaghi, E. (2014). Health effects of exposure to particulate matter less than 10 microns (PM10) in Ahvaz. Journal of JQUMS, 18(5), 45–53.Google Scholar
  13. Geravandi, S., Neisi, A., Goudarzi, G., Vousoghi Niri, M., & Mohammadi, M. (2015). Estimation of cardiovascular and respiratory deaths related to ozone exposure in Ahvaz, during 2011. Journal of Rafsanjan University of Medical Sciences, 13(11), 1073–1082.Google Scholar
  14. Goudarzi, G., Geravandi, S., Salmanzadeh, S., Mohammadi, M. Javad, & Zallaghi, E. (2014a). The number of myocardial infarction and cardiovascular death cases associated with sulfur dioxide exposure in Ahvaz, Iran. Archives of Hygiene Sciences, 3(3), 112–119.Google Scholar
  15. Goudarzi, G., Geravandi, S., Vosoughi, M., Mohammadi, M. J., & Taghavirad, S. s. (2014b). Cardiovascular deaths related to carbon monoxide exposure in Ahvaz, Iran. Iranian Journal of Health, Safety and Environment, 1(3), 126–131.Google Scholar
  16. Goudarzi, G., Shirmardi, M., Khodarahmi, F., Hashemi-Shahraki, A., Alavi, N., Ankali, K. A., Babaei, A. A., Soleimani, Z., & Marzouni, M. B. (2014c). Particulate matter and bacteria characteristics of the Middle East dust (MED) storms over Ahvaz. Iran. Aerobiologia, 1–12.Google Scholar
  17. Goudarzi, G., Geravandi, S., Mohammadi, M. J., Salmanzadeh, S., Vosoughi, M., & Sahebalzamani, M. (2015). The relationship between air pollution exposure and chronic obstructive pulmonary disease in Ahvaz, Iran. Chronic Diseases Journal, 3(1), 14–20.Google Scholar
  18. Goudarzi, G., Zallaghi, E., Neissi, A., Ankali, K. A., Saki, A., Babaei, A. A., Alavi, N., & Mohammadi, J. M. (2013). Cardiopulmonary mortalities and chronic obstructive pulmonary disease attributed to ozone air pollution. Archives of Hygiene Sciences, 2(2), 62–72.Google Scholar
  19. Gryparis, A., Forsberg, B., Katsouyanni, K., Analitis, A., Touloumi, G., Schwartz, J., Samoli, E., Medina, S., Anderson, H. R., Niciu, E. M., Wichmann, H.-E., Kriz, B., Kosnik, M., Skorkovsky, J., Vonk, J. M., & Dörtbudak, Z. (2004). Acute effects of ozone on mortality from the “air pollution and health: a European approach” project. American Journal of Respiratory and Critical Care Medicine, 170(10), 1080–1087.CrossRefGoogle Scholar
  20. Jane, C., & Fanny, W. (2015). Air pollution: its impact on adult patients with respiratory conditions. The Cover Shot, 20(1), 12.Google Scholar
  21. Kampa, M., & Castanas, E. (2008). Human health effects of air pollution. Environmental Pollution, 151(2), 362–367.CrossRefGoogle Scholar
  22. Kariisa, M., Foraker, R., Pennell, M., Buckley, T., Diaz, P., Criner, G. J., & Wilkins III, J. R. (2015). Short-and long-term effects of ambient ozone and fine particulate matter on the respiratory health of chronic obstructive pulmonary disease subjects. Archives of Environmental & Occupational Health, 70(1), 56–62.CrossRefGoogle Scholar
  23. Katsouyanni, K., Samet, J. M., Anderson, H., Atkinson, R., Le Tertre, A., Medina, S., Samoli, E., Touloumi, G., Burnett, R. T., Krewski, D., Ramsay, T., Dominici, F., Peng, R. D., Schwartz, J., & Zanobetti, A. (2009). Air pollution and health: a European and North American approach (APHENA). Research Report. Health Effects Institute, 142, 5–90.Google Scholar
  24. Lave, L. B., & Seskin, E. P. (2013). Air pollution and human health. London:Routledge.Google Scholar
  25. Li, T., Yan, M., Ma, W., Ban, J., Liu, T., Lin, H., & Lui, Z. (2015). Short-term effects of multiple ozone metrics on daily mortality in a megacity of China. Environmental Science and Pollution Research, 1-9.Google Scholar
  26. Lippmann, M. (1989). Health effects of ozone a critical review. JAPCA, 39(5), 672–695.CrossRefGoogle Scholar
  27. Loomis, D., Grosse, Y., Lauby-Secretan, B., Ghissassi, F. E., Bouvard, V., Benbrahim-Tallaa, L., Guha, N., Baan, R., Mattock, H., & Straif, K. (2013). The carcinogenicity of outdoor air pollution. The Lancet Oncology, 14(13), 1262–1263.CrossRefGoogle Scholar
  28. McClellan, R. O., Frampton, M. W., Koutrakis, P., McDonnell, W. F., Moolgavkar, S., North, D. W., Smith, A. E., Smith, R. L., & Utell, M. J. (2009). Critical considerations in evaluating scientific evidence of health effects of ambient ozone: a conference report. Inhalation Toxicology, 21(S2), 1–36.CrossRefGoogle Scholar
  29. McConnell, R., Berhane, K., Gilliland, F., London, S. J., Islam, T., Gauderman, W. J., Avol, E., Margolis, H. G., & Peters, J. M. (2002). Asthma in exercising children exposed to ozone: a cohort study. The Lancet, 359(9304), 386–391.CrossRefGoogle Scholar
  30. Mohammadi, M. J., Godini, H., Khak, M. T., Daryanoosh, S. M., Dobaradaran, S., & Goudarzi, G. (2015). An association between air quality and COPD in Ahvaz, Iran. Jundishapur Journal of Chronic Disease Care, 4(1): e26621.Google Scholar
  31. Mraihi, R., Harizi, R., Mraihi, T., & Bouzidi, M. T. (2015). Urban air pollution and urban daily mobility in large Tunisia’ s cities. Renewable and Sustainable Energy Reviews, 43, 315–320.CrossRefGoogle Scholar
  32. Norval, M., Lucas, R., Cullen, A., De Gruijl, F., Longstreth, J., Takizawa, Y., & van der Leun, J. C. (2011). The human health effects of ozone depletion and interactions with climate change. Photochemical & Photobiological Sciences, 10(2), 199–225.CrossRefGoogle Scholar
  33. PAGE, J. P. (2003). Health effects of ozone. JAMA, 290(14)Google Scholar
  34. Peng, R. D., Butz, A. M., Hackstadt, A. J., Williams, D., Diette, G. B., Breysse, P. N., & Matsui, E. C. (2015). Estimating the health benefit of reducing indoor air pollution in a randomized environmental intervention. Journal of the Royal Statistical Society: Series A (Statistics in Society), 178(2), 425–443.CrossRefGoogle Scholar
  35. Peters, A., Skorkovsky, J., Kotesovec, F., Brynda, J., Spix, C., Wichmann, H. E., & Heinrich, J. (2000). Associations between mortality and air pollution in central Europe. Environmental Health Perspectives, 108(4), 283.CrossRefGoogle Scholar
  36. Pope, C. A., Burnett, R. T., Turner, M. C., Cohen, A., Krewski, D., Jerrett, M., Gapstur, S. M., & Thun, M. J. (2002). Lung cancer and cardiovascular disease mortality associated with ambient air pollution and cigarette smoke: shape of the exposure-response relationships. Environmental Health Perspectives, 119(11), 1616.CrossRefGoogle Scholar
  37. Pride, K. R., Peel, J. L., Robinson, B. F., Busacker, A., Grandpre, J., Bisgard, K. M., Yiph, F. Y., & Murphyi, T. D. (2015a). Association of short-term exposure to ground-level ozone and respiratory outpatient clinic visits in a rural location—Sublette County, Wyoming, 2008–2011. Environmental Research, 137, 1–7.CrossRefGoogle Scholar
  38. Raaschou-Nielsen, O., Andersen, Z. J., Beelen, R., Samoli, E., Stafoggia, M., Weinmayr, G., Hoffmann, B., Fischer, P., Nieuwenhuijsen, M. J., Brunekreef, B., Xun, W. W., Katsouyanni, K., Dimakopoulou, K., Sommar, J., Forsberg, B., Modig, L., Oudin, A., Oftedal, B., Schwarze, P. E., Nafstad, P., & De Faire, U. (2013). Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for air Pollution Effects (ESCAPE). The Lancet Oncology, 14(9), 813–822.CrossRefGoogle Scholar
  39. Rad, H. D., Babaei, A. A., Goudarzi, G., Angali, K. A., Ramezani, Z., & Mohammadi, M. M. (2014). Levels and sources of BTEX in ambient air of Ahvaz metropolitan city. Air Quality, Atmosphere and Health, 7(4), 515–524.CrossRefGoogle Scholar
  40. Ren, C., Melly, S., & Schwartz, J. (2010). Modifiers of short-term effects of ozone on mortality in eastern Massachusetts—a case-crossover analysis at individual level. Environmental Health, 9(3), 10.1186.Google Scholar
  41. Samoli, E., Zanobetti, A., Schwartz, J., Atkinson, R., LeTertre, A., Schindler, C., Pérez, L., Cadum, E., Pekkanen, J., Paldy, A., Touloumi, G., & Katsouyanni, K. (2009). The temporal pattern of mortality responses to ambient ozone in the APHEA project. Journal of Epidemiology and Community Health, 63(12), 960–966.CrossRefGoogle Scholar
  42. Schlink, U., Herbarth, O., Richter, M., Dorling, S., Nunnari, G., Cawley, G., & Pelikan, E. (2006). Statistical models to assess the health effects and to forecast ground-level ozone. Environmental Modelling & Software, 21(4), 547–558.CrossRefGoogle Scholar
  43. Shah, A. S., Lee, K. K., McAllister, D. A., Hunter, A., Nair, H., Whiteley, W., Langrish, J. P., Newby, D. E., & Mills, N. L. (2015). Short term exposure to air pollution and stroke: systematic review and meta-analysis. BMJ, 350, h1295.CrossRefGoogle Scholar
  44. Sheffield, P. E., Zhou, J., Shmool, J. L. C., & Clougherty, J. E. (2015). Ambient ozone exposure and children’s acute asthma in New York City: a case-crossover analysis. Environmental Health, 14(1), 25.CrossRefGoogle Scholar
  45. Sousounis, P. J., Scott, C. P., & Wilson, M. L. (2002). Possible climate change impacts on ozone in the Great Lakes region: some implications for respiratory illness. Journal of Great Lakes Research, 28(4), 626–642.CrossRefGoogle Scholar
  46. Trasande, L., & Thurston, G. D. (2005). The role of air pollution in asthma and other pediatric morbidities. Journal of Allergy and Clinical Immunology, 115(4), 689–699.CrossRefGoogle Scholar
  47. Wang, N., Guo, H., Jiang, F., Ling, Z., & Wang, T. (2015). Simulation of ozone formation at different elevations in mountainous area of Hong Kong using WRF-CMAQ model. Science of the Total Environment, 505, 939–951.CrossRefGoogle Scholar
  48. WHO (2014). Ambient (outdoor) air quality and health. In U. M. 2014 (Ed.), Fact sheet N°313. WHO Media CentreGoogle Scholar
  49. Woerman, A. L. (2013). Air pollution & cardiovascular disease. Washington, DC:The George Washington University.Google Scholar
  50. Wong, T., Tam, W., Yu, T., & Wong, A. (2002). Associations between daily mortalities from respiratory and cardiovascular diseases and air pollution in Hong Kong, China. Occupational and Environmental Medicine, 59(1), 30–35.CrossRefGoogle Scholar
  51. Yang, C., Yang, H., Guo, S., Wang, Z., Xu, X., Duan, X., & Kan, H. (2012). Alternative ozone metrics and daily mortality in Suzhou: the China Air Pollution and Health Effects Study (CAPES). Science of the Total Environment, 426, 83–89.CrossRefGoogle Scholar
  52. Zallaghi, E., Goudarzi, G., Geravandi, S., Mohammadi, M., Vosoughi Niri, M., & Vesyi, E. (2014a). Estimating the prevalence of cardiovascular and respiratory diseases due to particulate air pollutants in Tabriz air. Scientfic Journal of Ilam University of Medical Sciences, 22(1), 84–91.Google Scholar
  53. Zallaghi, E., Goudarzi, G., Geravandi, S., & Javad, M. (2014b). Epidemiological indexes attributed to particulates with less than 10 micrometers in the air of Ahvaz City during 2010 to 2013.Health Scope, 3(4),e22276.Google Scholar
  54. Zallaghi, E., Goudarzi, G., Nourzadeh Haddad, M., Moosavian, S., & Mohammadi, M. (2014c). Assessing the effects of nitrogen dioxide in urban air on health of west and southwest cities of Iran. Jundishapur J Health Sci, 6(4), e23469.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Gholamreza Goudarzi
    • 1
  • Sahar Geravandi
    • 2
    • 3
  • Hossein Foruozandeh
    • 4
  • Ali Akbar Babaei
    • 1
  • Nadali Alavi
    • 1
  • Mehdi Vosoughi Niri
    • 5
  • Mohammad Javad Khodayar
    • 4
  • Shokrollah Salmanzadeh
    • 3
    • 6
  • Mohammad Javad Mohammadi
    • 3
    • 5
    Email author
  1. 1.Department of Environmental Health Engineering, School of Public Health, Environmental Technologies Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
  2. 2.Islamic Azad University, Tehran Medical Sciences BranchTehranIran
  3. 3.Razi Hospital Ahvaz Jundishapur University of Medical SciencesAhvazIran
  4. 4.Department of Pharmacology and Toxicology, Pharmacy and Toxicology Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
  5. 5.Department of Environmental Health Engineering, School of Public HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
  6. 6.Infectious and Tropical Diseases Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran

Personalised recommendations