Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Institute of Reproductive and Child Health / Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
Sci Total Environ. 2020 Oct 10;738:140313. doi: 10.1016/j.scitotenv.2020.140313. Epub 2020 Jun 17.
We aimed to establish a representative exposure response function between PM and lung cancer to evaluate the impact on lung cancer burden and the benefits gained in association with the environmental policy change in Beijing, China.
Based on population-based cancer registration data during 2001-2016, using a spatiotemporal Poisson regression model, long-term concentrations of PM were linked to sex-age adjusted incidence rates of total lung cancer and its pathological subtypes. We calculated the health and monetary benefits associated with air quality improvement using the cost of illness method.
In the constructed regression model, a 10 μg/m increment of PM was associated with increases of 6.0% (95% confidence interval [95% CI]: 4.3%, 7.7%), 14.8% (10.3%, 19.4%), and 6.5% (3.3%, 9.8%) in the incidence of total lung cancer, squamous cell carcinoma, and adenocarcinoma, respectively. The estimated associations indicate that long-term exposure to PM contributed 1947 to 3059 incident cases of lung cancer per year among the residents in Beijing during the study period. Clean air actions saved 4978 (95% CI: 2711, 7417) lung cancer cases, which brought a savings of 218 (118, 324) million RMB (31 [17, 46] million US dollars) in direct inpatient medical expenditures. If air quality had met national standards of long-term PM (35 μg/m) in 2014-2016, 10,003 (95% CI: 9325, 10,650) lung cancer cases could have been prevented and direct inpatient medical expenditures of 438 (409, 466) million RMB (63 [58, 67] million US dollars) could have been saved.
This study enriches epidemiological study, confirming the association between exposure to PM and lung cancer or its subtypes, and provides novel evidence for the notable reduction in lung cancer burden and medical expenditure savings that were achieved through air quality improvements in Beijing from 2014 to 2016.
建立 PM 与肺癌之间具有代表性的暴露反应函数，以评估环境政策变化对北京市肺癌负担的影响及其带来的收益。
基于 2001-2016 年的人群癌症登记数据，采用时空泊松回归模型，将 PM 的长期浓度与总肺癌及其病理亚型的年龄别性别调整发病率相关联。我们使用疾病成本法计算与空气质量改善相关的健康和货币效益。
在构建的回归模型中，PM 每增加 10μg/m³，总肺癌、鳞状细胞癌和腺癌的发病率分别增加 6.0%（95%置信区间[95%CI]：4.3%，7.7%）、14.8%（10.3%，19.4%）和 6.5%（3.3%，9.8%）。估计的关联表明，在研究期间，北京居民长期暴露于 PM 导致每年新增 1947 至 3059 例肺癌病例。清洁空气行动挽救了 4978 例（95%CI：2711，7417）肺癌病例，直接住院医疗支出节省了 218 亿元（118 亿元，324 亿元）人民币（约 31 亿美元）。如果 2014-2016 年空气质量达到国家长期 PM（35μg/m³）标准，可预防 10003 例（95%CI：9325，10650）肺癌病例，直接住院医疗支出可节省 438 亿元（409 亿元，466 亿元）人民币（约 63 亿美元）。
本研究丰富了流行病学研究，证实了暴露于 PM 与肺癌或其亚型之间的关联，并为 2014 年至 2016 年北京空气质量改善带来的肺癌负担显著减轻和医疗支出节省提供了新的证据。
