Integrative Health Assessments Branch, Division of Translational Toxicology, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States.
Integrated Laboratory Systems, LLC an Inotiv Company, Morrisville, NC, United States.
Environ Int. 2023 Aug;178:108128. doi: 10.1016/j.envint.2023.108128. Epub 2023 Aug 1.
Epidemiological studies conducted mostly in low- and middle-income countries have found a positive association between household combustion of wood and lung cancer. However, most studies have been retrospective, and few have been conducted in the United States where indoor wood-burning usage patterns differ. We examined the association of exposure to indoor wood smoke from fireplaces and stoves with incident lung cancer in a U.S.-wide cohort of women.
We included 50,226 women without prior lung cancer participating in the U.S.-based prospective Sister Study. At enrollment (2003-2009), women reported frequency of use of wood-burning stoves and/or fireplaces in their longest-lived adult residence. Cox regression was used to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (CI) for the association between indoor wood-burning fireplace/stove use and incident lung cancer. Lung cancer was self-reported and confirmed with medical records.
During an average 11.3 years of follow-up, 347 medically confirmed lung cancer cases accrued. Overall, 62.3 % of the study population reported the presence of an indoor wood-burning fireplace/stove at their longest-lived adult residence and 20.6 % reported annual usage of ≥30 days/year. Compared to those without a wood-burning fireplace/stove, women who used their wood-burning fireplace/stove ≥30 days/year had an elevated rate of lung cancer (HR = 1.68; 95 % CI = 1.27, 2.20). In never smokers, positive associations were seen for use 1-29 days/year (HR = 1.64; 95 % CI = 0.87, 3.10) and ≥30 days/year (HR = 1.99; 95 % CI = 1.02, 3.89). Associations were also elevated across all income groups, in Northeastern, Western or Midwestern U.S. regions, and among those who lived in urban or rural/small town settings.
Our prospective analysis of a cohort of U.S. women found that increasing frequency of wood-burning indoor fireplace/stove usage was associated with incident lung cancer, even among never smokers.
在中低收入国家进行的流行病学研究发现，家庭燃烧木材与肺癌之间存在正相关关系。然而，大多数研究都是回顾性的，而且很少有在美国进行的研究，因为美国室内木材燃烧的使用模式不同。我们在美国范围内的女性队列中研究了暴露于壁炉和炉灶室内木烟与肺癌发病之间的关系。
我们纳入了 50226 名无肺癌既往史的美国前瞻性姐妹研究参与者。在入组时（2003-2009 年），女性报告了其最长居住的成年住所中使用烧柴的炉灶和/或壁炉的频率。Cox 回归用于估计室内烧柴壁炉/炉灶使用与肺癌发病之间的关联的调整后的危险比（HR）和 95%置信区间（CI）。肺癌由自我报告，并通过病历确认。
在平均 11.3 年的随访期间，累计了 347 例经医学证实的肺癌病例。总体而言，研究人群中有 62.3%报告其最长居住的成年住所内存在室内烧柴壁炉/炉灶，20.6%报告每年使用≥30 天/年。与没有烧柴壁炉/炉灶的女性相比，每年使用烧柴壁炉/炉灶≥30 天的女性肺癌发病风险较高（HR=1.68；95%CI=1.27，2.20）。在从不吸烟者中，使用 1-29 天/年（HR=1.64；95%CI=0.87，3.10）和≥30 天/年（HR=1.99；95%CI=1.02，3.89）的阳性关联更为明显。在所有收入群体、美国东北部、西部或中西部地区以及城市或农村/小镇居住的人群中，关联均较高。
我们对美国女性队列的前瞻性分析发现，增加室内烧柴壁炉/炉灶的使用频率与肺癌发病有关，即使在从不吸烟者中也是如此。
