Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA.
Ecotoxicol Environ Saf. 2024 Jul 15;280:116478. doi: 10.1016/j.ecoenv.2024.116478. Epub 2024 Jun 3.
Evidence of a potential causal link between long-term exposure to particulate matter (PM) and all-site cancer mortality from large population cohorts remained limited and suffered from residual confounding issues with traditional statistical methods.
We aimed to examine the potential causal relationship between long-term PM exposure and all-site cancer mortality in South China using causal inference methods.
We used a cohort in southern China that recruited 580,757 participants from 2009 through 2015 and tracked until 2020. Annual averages of PM, PM and PM concentrations were generated with validated spatiotemporal models. We employed a causal inference approach, the Marginal Structural Cox model, based on observational data to evaluate the association between long-term exposure to PM and all-site cancer mortality.
With an increase of 1 µg/m³ in PM, PM and PM, the hazard ratios (HRs) and 95% confidence interval (CI) for all-site cancer were 1.033 (95% CI: 1.025-1.041), 1.032 (95% CI: 1.027-1.038), and 1.020 (95% CI: 1.016-1.025), respectively. The HRs (95% CI) for digestive system and respiratory system cancer mortality associated with each 1 µg/m³ increase in PM were 1.022 (1.009-1.035) and 1.053 (1.038-1.068), respectively. In addition, inactive participants, who never smoked, or who lived in areas of low surrounding greenness were more susceptible to the effects of PM exposure, the HRs (95% CI) for all-site cancer mortality were 1.042 (1.031-1.053), 1.041 (1.032-1.050), and 1.0473 (1.025-1.070) for every 1 µg/m³ increase in PM, respectively. The effect of PM tended to be more pronounced in the low-exposure group than in the general population, and multiple sensitivity analyses confirmed the robustness of the results.
This study provided evidence that long-term exposure to PM may elevate the risk of all-site cancer mortality, emphasizing the potential health benefits of improving air quality for cancer prevention.
长期暴露于颗粒物（PM）与来自大型人群队列的所有部位癌症死亡率之间潜在因果关系的证据仍然有限，并且传统统计方法存在残留混杂问题。
我们旨在使用因果推理方法检查华南地区长期 PM 暴露与所有部位癌症死亡率之间的潜在因果关系。
我们使用了中国南方的一个队列，该队列于 2009 年至 2015 年期间招募了 580,757 名参与者，并追踪至 2020 年。使用经过验证的时空模型生成了 PM、PM 和 PM 浓度的年平均值。我们采用了一种因果推理方法，即边际结构 Cox 模型，基于观察数据来评估 PM 长期暴露与所有部位癌症死亡率之间的关联。
PM 增加 1μg/m³时，所有部位癌症的危害比（HR）和 95%置信区间（CI）分别为 1.033（95%CI：1.025-1.041）、1.032（95%CI：1.027-1.038）和 1.020（95%CI：1.016-1.025）。与 PM 增加 1μg/m³相关的消化系统和呼吸系统癌症死亡率的 HR（95%CI）分别为 1.022（1.009-1.035）和 1.053（1.038-1.068）。此外，不活跃的参与者、从不吸烟的参与者或居住在周围绿化程度较低的地区的参与者更容易受到 PM 暴露的影响，PM 每增加 1μg/m³时，所有部位癌症死亡率的 HR（95%CI）分别为 1.042（1.031-1.053）、1.041（1.032-1.050）和 1.0473（1.025-1.070）。PM 的影响在低暴露组中似乎比在一般人群中更为明显，并且多项敏感性分析证实了结果的稳健性。
本研究提供了长期暴露于 PM 可能会增加所有部位癌症死亡率的风险的证据，强调了改善空气质量以预防癌症的潜在健康益处。
