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The impacts of surface ozone (O-3) on human health and vegetation have prompted O-3 precursor emission reductions in the European Union (EU) and United States (US). In contrast, until recently, emissions have increased in East Asia and most strongly in China. As emissions change, the distribution of hourly O-3 concentrations also changes, as do the values of exposure metrics. The distribution changes can result in the exposure metric trend patterns changing in a similar direction as trends in emissions (e.g., metrics increase as emissions increase) or, in some cases, in opposite directions. This study, using data from 481 sites (276 in the EU, 196 in the US, and 9 in China), investigates the response of 14 human health and vegetation O-3 exposure metrics to changes in hourly O-3 concentration distributions over time. At a majority of EU and US sites, there was a reduction in the frequency of both relatively high and low hourly average O-3 concentrations. In contrast, for some sites in mainland China and Hong Kong, the middle of the distribution shifted upwards but the low end did not change and for other sites, the entire distribution shifted upwards. The responses of the 14 metrics to these changes at the EU, US, and Chinese sites were varied, and dependent on (1) the extent to which the metric was determined by relatively high, moderate, and low concentrations and (2) the relative magnitude of the shifts occurring within the O-3 concentration distribution. For example, the majority of the EU and US sites experienced decreasing trends in the magnitude of those metrics associated with higher concentrations. For the sites in China, all of the metrics either increased or had no trends. In contrast, there were a greater number of sites that had no trend for those metrics determined by a combination of moderate and high O-3 concentrations. A result of our analyses is that trends in mean or median concentrations did not appear to be well associated with some exposure metrics applicable for assessing human health or vegetation effects. The identification of shifting patterns in the O-3 distribution and the resulting changes in O-3 exposure metrics across regions with large emission increases and decreases is an important step in examining the linkage between emissions and exposure metric trends. The results provide insight into the utility of using specific exposure metrics for assessing emission control strategies. (C) 2016 Elsevier Ltd. All rights reserved.