Association between exposure to air pollution and lung cancer incidence and mortality

摘要

Background and aimsFew studies on long-term exposure to air pollution and mortality and lung cancer incidence have been reported from Europe. Within the multi-center European Study of Cohorts for Air Pollution Effects (ESCAPE) we investigated the association between mortality and lung cancer incidence, and long-term exposure to multiple air pollutants. MethodsData from 16-22 European cohort studies were used. Residential exposure was assessed following a strictly standardized protocol as annual average concentrations of particles less than 2.5μm (PM2.5), less than 10μm (PM10), and between 10μm and 2.5μm (PMcoarse), PM2.5 absorbance, and nitrogen oxides (NO2 and NOx) using Land Use Regression (LUR) models. Cohort-specific statistical analyses using confounder models with increasing level of adjustment were conducted using Cox proportional hazards models using a common protocol. Random-effects meta-analysis was used to obtain pooled effect estimates.Results The total study population consisted of ～300,000 participants, of which 29,0765 died from a natural mortality cause and of which 2,026 developed incident lung cancer. Significant and borderline significant associations between PM10 (HR=1.22 per 10 μg/m3; 95% CI: 1.03-1.45) and PM2.5 (HR=1.22 per 5 μg/m3; 95% CI: 0.98-1.52) and the risk for lung cancer were found. A significantly elevated hazard ratio for natural cause mortality for PM2.5 of 1.07 (95% CI: 1.02-1.13) per 5 μg/m3 was found. Hazard ratios for PM2.5 remained statistically significant elevated even when only subjects with concentrations below 20 μg/m3 were included.Increased effect estimates for PM2.5 were found for stroke mortality, but not for overall cardiovascular, ischemic heart disease and respiratory mortality.ConclusionsLong-term exposure to fine particulate air pollution was associated with natural cause mortality and lung cancer incidence even over concentration ranges well below the current European annual mean Limit Value.