Wang Lan, Zhao Xiaojing, Xu Wangyue, Tang Jian, Jiang Xiji
College of Architecture and Urban Planning, Tongji University, Shanghai 200092, China.
Department of Thoracic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
J Thorac Dis. 2016 Sep;8(9):2626-2637. doi: 10.21037/jtd.2016.09.10.
The density of particulate matter (PM) in mega-cities in China such as Beijing and Shanghai has exceeded basic standards for health in recent years. Human exposure to PMs has been identified as traceable and controllable factor among all complicated risk factors for lung cancer. While the improvement of air quality needs tremendous efforts and time, certain revision of PM's density might happen associated with the adjustment of built environment. It is also proved that urban built environment is directly relevant to respiratory disease. Studies have respectively explored the indoor and outdoor factors on respiratory diseases. More comprehensive spatial factors need to be analyzed to understand the cumulative effect of built environment upon respiratory system. This interdisciplinary study examines the impact of both indoor (including age of housing, interval after decoration, indoor humidity etc.) and outdoor spatial factors (including density, parking, green spaces etc.) on lung cancer.
A survey of lung cancer patients and a control group has been conducted in 2014 and 2015. A total of 472 interviewees are randomly selected within a pool of local residents who have resided in Shanghai for more than 5 years. Data are collected including their socio-demographic factors, lifestyle factors, and external and internal residential area factors. Regression models are established based on collected data to analyze the associations between lung cancer and urban spatial factors.
Regression models illustrate that lung cancer presents significantly associated with a number of spatial factors. Significant outdoor spatial factors include external traffic volume (P=0.003), main plant type (P=0.035 for trees) of internal green space, internal water body (P=0.027) and land use of surrounding blocks (P=0.005 for residential areas of 7-9 floors, P=0.000 for residential areas of 4-6 floors, P=0.006 for business/commercial areas over 10 floors, P=0.005 for business/commercial areas of 7-9 floors, P=0.043 for business/commercial areas of 4-6 floors). Indoor spatial factors include age of housing (P=0.003) and indoor humidity (P=0.000).
The findings support the hypothesis that both indoor and outdoor spatial factors are independently associated with lung cancer incidence. Certain principles based on the modeling results are proposed to revise the criteria for lung cancer screening of high-risk individuals. It also provides empirical evidence for urban planning and design to improve built environment with more thorough consideration of respiratory health.
近年来，中国北京、上海等特大城市的颗粒物（PM）密度已超过健康基本标准。在肺癌所有复杂的风险因素中，人类接触PM被确定为可追踪和可控的因素。虽然空气质量的改善需要巨大努力和时间，但随着建筑环境的调整，PM密度可能会发生一定程度的变化。事实也证明，城市建筑环境与呼吸系统疾病直接相关。此前已有研究分别探讨了室内和室外因素对呼吸系统疾病的影响。为了解建筑环境对呼吸系统的累积影响，还需要分析更全面的空间因素。这项跨学科研究考察了室内（包括房屋年代、装修后间隔时间、室内湿度等）和室外空间因素（包括密度、停车场、绿地等）对肺癌的影响。
在2014年和2015年对肺癌患者及对照组进行了一项调查。从居住在上海超过5年的当地居民群体中随机选取了472名受访者。收集的数据包括他们的社会人口统计学因素、生活方式因素以及居住区域的外部和内部因素。基于收集到的数据建立回归模型，以分析肺癌与城市空间因素之间的关联。
回归模型表明，肺癌与许多空间因素显著相关。显著的室外空间因素包括外部交通流量（P = 0.003）、内部绿地的主要植物类型（树木，P = 0.035）、内部水体（P = 0.027）以及周边街区的土地用途（7 - 9层住宅区，P = 0.005；4 - 6层住宅区，P = 0.000；10层以上商业/商业区，P = 0.006；7 - 9层商业/商业区，P = 0.005；4 - 6层商业/商业区，P = 0.043）。室内空间因素包括房屋年代（P = 0.003）和室内湿度（P = 0.000）。
研究结果支持了室内和室外空间因素均与肺癌发病率独立相关这一假设。基于建模结果提出了一些原则，用于修订高危个体肺癌筛查标准。该研究还为城市规划和设计提供了实证依据，以便在更全面考虑呼吸健康的情况下改善建筑环境。
