Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education, National Health Commission Key Laboratory of Health Technology Assessment, Integrated Research on Disaster Risk, International Centers of Excellence on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China.
Gastroenterology. 2023 Jul;165(1):61-70.e5. doi: 10.1053/j.gastro.2023.03.233. Epub 2023 Apr 13.
BACKGROUND & AIMS: Evidence is sparse and inconclusive on the association between long-term fine (≤2.5 μm) particulate matter (PM) exposure and esophageal cancer. We aimed to assess the association of PM with esophageal cancer risk and compared the esophageal cancer risk attributable to PM exposure and other established risk factors.
This study included 510,125 participants without esophageal cancer at baseline from China Kadoorie Biobank. A high-resolution (1 × 1 km) satellite-based model was used to estimate PM exposure during the study period. Hazard ratios (HR) and 95% CIs of PM with esophageal cancer incidence were estimated using Cox proportional hazard model. Population attributable fractions for PM and other established risk factors were estimated.
There was a linear concentration-response relationship between long-term PM exposure and esophageal cancer. For each 10-μg/m increase in PM, the HR was 1.16 (95% CI, 1.04-1.30) for esophageal cancer incidence. Compared with the first quarter of PM exposure, participants in the highest quarter had a 1.32-fold higher risk for esophageal cancer, with an HR of 1.32 (95% CI, 1.01-1.72). The population attributable risk because of annual average PM concentration ≥35 μg/m was 23.3% (95% CI, 6.6%-40.0%), higher than the risks attributable to lifestyle risk factors.
This large prospective cohort study of Chinese adults found that long-term exposure to PM was associated with an elevated risk of esophageal cancer. With stringent air pollution mitigation measures in China, a large reduction in the esophageal cancer disease burden can be expected.
长期细颗粒物（≤2.5μm）暴露与食管癌之间的关联证据有限且尚无定论。本研究旨在评估 PM 与食管癌风险的关联，并比较 PM 暴露与其他已确定的危险因素对食管癌风险的归因。
本研究纳入了来自中国慢性病前瞻性研究的 510125 名基线时无食管癌的参与者。采用高分辨率（1×1km）卫星基础模型来估计研究期间的 PM 暴露情况。使用 Cox 比例风险模型估计 PM 与食管癌发病率的风险比（HR）和 95%置信区间（CI）。估计了 PM 和其他已确定危险因素的人群归因分数（PAR）。
长期 PM 暴露与食管癌之间存在线性浓度-反应关系。PM 每增加 10μg/m³，食管癌发病率的 HR 为 1.16（95%CI，1.04-1.30）。与 PM 暴露的第一季度相比，PM 暴露最高季度的参与者食管癌风险增加 1.32 倍，HR 为 1.32（95%CI，1.01-1.72）。由于年平均 PM 浓度≥35μg/m³而导致的人群归因风险为 23.3%（95%CI，6.6%-40.0%），高于归因于生活方式危险因素的风险。
这项针对中国成年人的大型前瞻性队列研究发现，长期暴露于 PM 与食管癌风险升高相关。随着中国采取严格的空气污染缓解措施，可以预期食管癌疾病负担会大幅减少。
