Fine Particulate Matter Air Pollution and Mortality Risk among U.S. Cancer Patients and Survivors
A partir des données des registres américains des cancers portant sur 5 591 168 patients atteints d'un cancer et sur 2 318 068 patients ayant survécu 5 ans à un cancer, cette étude analyse l'association entre une exposition à des particules fines et la mortalité, par cancer et par maladie cardiopulmonaire
Background : Exposure to fine particulate matter (PM2.5) air pollution has been linked to increased risk of mortality, especially cardiopulmonary and lung cancer mortality. It is unknown if cancer patients and survivors are especially vulnerable to PM2.5 air pollution exposure. This study evaluates PM2.5 exposure and risk for cancer and cardiopulmonary mortality in cohorts of U.S. cancer patients and survivors.
Methods : A primary cohort of 5,591,168 of cancer patients and a 5-yr survivor cohort of 2,318,068 were constructed using Surveillance, Epidemiology, and End Results Program (SEER) data from 2000–2016, linked with county-level estimates of long-term average concentrations of PM2.5. Cox proportional hazards models were used to estimate PM2.5-mortality hazard ratios controlling for age-sex-race combinations and individual and county-level co-variables.
Results : Of those that died, 26% died of non-cancer causes, mostly from cardiopulmonary disease. Minimal PM2.5-mortality associations were observed for all-cause mortality (HR = 1.01, 95% CI = 1.00–1.03) per 10 µg/m3 increase in PM2.5. Substantial adverse PM2.5-mortality associations were observed for cardiovascular (HR = 1.32, 95% CI = 1.26–1.39), COPD (HR = 1.10, 95% CI = 1.01–1.20), influenza/pneumonia (HR = 1.55, 95% CI = 1.33–1.80), and for cardiopulmonary mortality combined (HR = 1.25, 95% CI = 1.21–1.30). PM2.5-cardiopulmonary mortality HR was higher for cancer patients who received chemotherapy or radiation treatments.
Conclusions : Air pollution is adversely associated with cardiopulmonary mortality for cancer patients and survivors, especially those who received chemotherapy or radiation treatment. Given ubiquitous and involuntary air pollution exposures and large numbers of cancer patients and survivors, these results are of substantial clinical and public health importance.
JNCI Cancer Spectrum , résumé, 2020