Global Burden and 33-Year Trends of Chronic Obstructive Pulmonary Disease Attributable to Ambient Ozone Pollution: Analysis of Global Burden of Disease Study 2023 Data

Background Long-term exposure to ambient ozone pollution is associated with increased respiratory morbidity and mortality, particularly from chronic obstructive pulmonary disease (COPD). We explored spatial and temporal trends in mortality and burden of disease attributable to ambient ozone pollution f rom 1990 to 2023 at global, regional, and national levels. Methods We used Global Burden of Disease 2023 estimates to assess ozone-attributable COPD mortality. Population-weighted warm-season 8-hour ozone concentrations were estimated using a high-resolution data fusion model combining monitoring, satellite, chemical transport, and land-use data. Relative risks were based on a log-linear exposure–response function from cohort studies, and attributable COPD deaths and DALYs were analysed for 1990–2023 at global, regional, and national levels. Findings Ambient ozone was a notable contributor to COPD mortality in 2023. Exposure to ozone caused approximately 480 000 (95% uncertainty interval [UI] reflecting cohort-based uncertainty) deaths and millions of disability-adjusted life-years (DALYs) from COPD in 2023, with the highest age-standardised rates in South Asian countries (peaking at 17·1 per 100 000 in Nepal). Deaths attributable to ambient ozone increased over the period from 1990 to 2023 in many low- and middle-income countries, driven by population growth and ageing, whereas substantial declines occurred in most high-income regions due to effective precursor controls.Interpretation Ambient ozone pollution contributed persistently to the global burden of COPD mortality in 2023, with absolute numbers of attributable deaths rising over the past 33 years due to demographic transitions in low- and middle-income countries offsetting modest exposure reductions in some regions. The log-linear exposure-response function indicates that meaningful reductions in burden require sustained declines in seasonal ozone concentrations. International experience shows that aggressive air quality management targeting major precursor sources can lower population exposure and associated COPD burden.