Drought and ozone air quality in California: Identifying susceptible regions in the preparedness of future drought.

California experienced extreme and prolonged drought conditions during the early 2010s. To date, little is known regarding the influence of drought on air quality. Our study quantified site-specific associations between drought (defined by the Standardized Precipitation-Evapotranspiration Index; SPEI) and daily maximum 8-h ozone (O) concentrations for California, USA, and then pooled these associations for the years 2009-2015. Overall, ambient O concentration was higher during droughts by 1.18 ppb (95% confidence interval (CI) = 1.00-1.36). The sensitivity of O to drought was greater during the warm season than during the cool season (1.73 ppb versus 0.79 ppb higher O during droughts) with substantial regional variation. In a pooled analysis with meteorological parameters as potential effect modifiers, the spatial heterogeneity of drought-O associations was explained strongly by average relative humidity for each season (71.9% (warm season) and 73.4% (cool season) of the drought-O associations explained), followed by the drought-related changes in relative humidity (47.6% (warm season)) and temperature (53.6% (cool season)). The pooled regression further identified regions susceptible for drought-related O increases as those with relatively low average relative humidity (10-25 percentiles or 44.3-47.3%) and larger drought-related decrease in relative humidity and increase in temperature. As the drought events are projected to occur with increased frequency and intensity in the era of climate change, the excess health burdens from O exposures attributed to the projected drought events need to be taken into account when allocating air quality and health resources. The impacts of O on health during droughts would confound the health burdens from the drought itself.