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Background  In recent years, air pollution has become an imminent problem in China. Few studies have investigated the impact of air pollution on the mortality of the middle-aged and elderly people. Therefore, this study aims to evaluate the impact of PM 2.5  (fine particulate matter) and O 3  (ozone) on non-accidental mortality and respiratory mortality of the middle-aged and elderly people in Lishui District of Nanjing and provide the evidence for potential prevention and control measures of air pollution.    Method  Using daily mortality and atmospheric monitoring data from 2015 to 2019, we applied a generalized additive model with time-series analysis to evaluate the association of PM 2.5  and O 3  exposure with daily non-accidental mortality and respiratory mortality in Lishui District. Using the population attributable fractions to estimate the death burden caused by short-term exposure to O 3  and PM 2.5。 .    Result  For every 10 μg/m 3  increase in PM 2.5 , non-accidental mortality increased 0.94% with 95% confidence interval (CI) between 0.05 and 1.83%, and PM 2.5  had a more profound impact on females than males. For every 10 μg/m 3  increase in O 3 , respiratory mortality increased 1.35% (95% CI: 0.05, 2.66%) and O 3  had a more profound impact on males than females. Compared with the single pollutant model, impact of the two-pollutant model on non-accidental mortality and respiratory mortality slightly decreased. In summer and winter as opposed to the other seasons, O 3  had a more obvious impact on non-accidental mortality. The population attributable fractions of non-accidental mortality were 0.84% (95% CI:0.00, 1.63%) for PM 2.5  and respiratory mortality were 0.14% (95% CI:0.01, 0.26%) for O 3 . For every 10 μg/m 3  decrease in PM 2.5,  122 (95% CI: 6, 237) non-accidental deaths could be avoided. For every 10 μg/m 3  decrease in O 3 , 10 (95% CI: 1, 38) respiratory deaths could be avoided.    Conclusion  PM 2.5  and O 3  could significantly increase the risk of non-accidental and respiratory mortality in the middle-aged and elderly people in Lishui District of Nanjing. Exposed to air pollutants, men were more susceptible to O 3  damage, and women were more susceptible to PM 2.5  damage. Reduction of PM 2.5  and O 3  concentration in the air may have the potential to avoid considerable loss of lives.

Short-term effect of fine particulate matter and ozone on non-accidental mortality and respiratory mortality in Lishui district, China