BMC Public Health · Aug 2, 2025

Impaired physical function in relation to later-life exposure to ambient fine particulate matter and ozone among Chinese middle-aged and older adults

By Tan Y, Xiang Q, Zhang Y et al.

While ambient fine particulate matter (PM2.5) and ozone (O₃) are extensively associated with population health, no studies have yet assessed the potential association between concurrent exposure to these two pollutants and physical function (PF) in middle-aged and elderly individuals. By collecting data from three phases of the China Health and Retirement Longitudinal Study (CHARLS), we included 8834 follow-up observations from 4110 participants aged 45 years and older who had undergone at least two physical examinations between 2011 and 2015. PF scores of enrolled participants were assessed through four objective tests including grip strength, balance, walking speed, and repeated chair stands. Annual average concentrations of PM2.5 and O₃ prior to physical tests were assigned to participants at the prefecture-level residence in each survey. A linear mixed-effects model was used to evaluate the effects of long-term exposure to PM2.5 and O₃ on PF, adjusting for multiple covariates including sociodemographic, behavioral, and health status. Stratified analyses were performed to compare the effects of PM2.5 under low- and high-level O₃ groups and the effects of O₃ under low- and high-level PM2.5 groups. Additive interactive effects were testified by introducing a 2 × 2-level dummy variable to model the joint exposure of PM2.5 and O₃. Each 10-µg/m³ increase in PM2.5 and O₃ exposure was associated with a declined PF score of -0.561 points (95% confidence interval: -0.617, -0.506) and -1.154 points (-1.341, -0.968), respectively. Stratified analyses for co-pollutants indicated weakened effects of PM2.5 and O₃ at higher co-pollutant levels (PM2.5: -0.448 [-0.522, -0.373]; O₃: -0.796 [-1.070, -0.522]) than at lower levels (PM2.5: -0.608 [-0.708, -0.507]; O₃: -1.293 [-1.612, -0.974]). Despite greater effects in the case of simultaneous high-level exposures to both pollutants, we did not identify any evidence for additive interactive effects of co-exposures to PM2.5 and O₃ in the total and age- and sex-subgroup populations. This study provided novel evidence for the independent and modifying effects of long-term exposure to PM2.5 and O₃ on impaired PF in middle-aged and elderly people.

doi.org/10.1186/s12889-025-23885-9Open accessPubMed 40753416Populations