Wang Yang-Zhong, Tang Nan, Tao Tao, Peng Xian-Lin
Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing University, Chongqing, China.
Gastroenterology Department, Chongqing University Fuling Hospital, Chongqing University, Chongqing, China.
Front Public Health. 2025 Jul 8;13:1622767. doi: 10.3389/fpubh.2025.1622767. eCollection 2025.
OBJECTIVE: Joint exposure to fine particulate matter (PM₂․₅) and prolonged sedentary behavior in later life may erode physiological reserve and hasten carcinogenesis, yet evidence quantifying their combined impact on incident lung cancer among older Chinese adults is sparse. We investigated whether co-occurrence of high ambient PM₂․₅ and extensive sitting time accelerates incident lung cancer in a nationally representative cohort. METHODS: We analyzed 10,532 adults aged ≥45 years in the China Health and Retirement Longitudinal Study (2011-2018). Chronic PM₂․₅ exposure was assigned from a satellite-chemistry-model product and classified into sex-specific tertiles; daily sitting time was self-reported and dichotomised at ≥8 h day. Eight joint-exposure categories crossed environmental burden (low/low, high PM₂․₅ only, high heat only, high/high) with sedentary status (low vs. high). Weighted Cox models with age as the time axis estimated hazard ratios (HRs) for incident lung cancer; additive interaction was assessed via relative excess risk due to interaction (RERI) and synergy index (S). RESULTS: Over 43,181 person-years, 141 incident lung-cancer cases were recorded (3.3 per 1,000 person-years). Independently, high PM₂․₅ (HR 1.82, 95% CI 1.29-2.57) and high sedentary time (HR 2.10, 95% CI 1.55-2.84) increased risk. Participants simultaneously exposed to high PM₂․₅, high warm-season heat, and ≥8 h sitting exhibited a nearly five-fold hazard (HR 4.95, 95% CI 2.24-10.95) versus the dual-low reference. Additive interaction was evident (RERI 1.10, synergy index 1.39), and associations were most pronounced in men and rural residents. Sensitivity analyses varying sedentary thresholds, excluding early events, and applying competing-risk models yielded consistent findings. CONCLUSION: Concurrent high ambient PM₂․₅ and prolonged sedentary behavior markedly accelerate incident lung cancer in middle-aged and older Chinese adults, with evidence of biologic synergy beyond independent effects. Integrated interventions that couple aggressive air-quality regulation with strategies to curtail sedentary time-particularly among socio-economically disadvantaged and rural populations-are warranted to mitigate China's looming lung-cancer burden in an aging society.
目的：晚年同时暴露于细颗粒物（PM₂.₅）和长期久坐行为可能会消耗生理储备并加速癌症发生，然而，量化它们对中国老年成年人肺癌发病综合影响的证据却很稀少。我们调查了高环境PM₂.₅与长时间久坐同时出现是否会加速一个具有全国代表性队列中的肺癌发病。 方法：我们分析了中国健康与养老追踪调查（2011 - 2018年）中10,532名年龄≥45岁的成年人。慢性PM₂.₅暴露根据卫星化学模型产品进行赋值，并按性别分为三分位数；每日久坐时间通过自我报告获得，并以每天≥8小时进行二分。八个联合暴露类别将环境负担（低/低、仅高PM₂.₅、仅高温、高/高）与久坐状态（低与高）进行交叉。以年龄为时间轴的加权Cox模型估计肺癌发病的风险比（HRs）；通过交互作用的相对超额风险（RERI）和协同指数（S）评估相加交互作用。 结果：在43,181人年的随访期间，记录了141例肺癌发病病例（每1000人年3.3例）。单独来看，高PM₂.₅（HR 1.82，95%CI 1.29 - 2.57）和高久坐时间（HR 2.10，95%CI 1.55 - 2.84）会增加发病风险。与双低参照组相比，同时暴露于高PM₂.₅、高暖季温度和≥8小时久坐的参与者发病风险增加近五倍（HR 4.95，95%CI 2.24 - 10.95）。相加交互作用明显（RERI 1.10，协同指数1.39），且这种关联在男性和农村居民中最为显著。改变久坐阈值、排除早期事件以及应用竞争风险模型的敏感性分析得出了一致的结果。 结论：高环境PM₂.₅与长期久坐行为同时存在会显著加速中国中老年成年人的肺癌发病，且存在超出独立作用的生物学协同证据。有必要采取综合干预措施，将积极的空气质量监管与减少久坐时间的策略相结合——尤其是在社会经济弱势和农村人群中——以减轻中国老龄化社会中日益逼近的肺癌负担。
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