Air pollution and lung cancer survival in Pennsylvania

Thomas P McKeon; Anil Vachani; Trevor M Penning; Wei-Ting Hwang

doi:10.1016/j.lungcan.2022.06.004

Air pollution and lung cancer survival in Pennsylvania

Lung Cancer. 2022 Aug:170:65-73. doi: 10.1016/j.lungcan.2022.06.004. Epub 2022 Jun 10.

Authors

Thomas P McKeon¹, Anil Vachani², Trevor M Penning³, Wei-Ting Hwang⁴

Affiliations

¹ Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Departments of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, USA. Electronic address: mckeont@pennmedicine.upenn.edu.
² Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Medicine, Pulmonary, Allergy, and Critical Care Division, Hospital of University of Pennsylvania, Philadelphia, PA 19104, USA.
³ Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Departments of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
⁴ Center of Excellence in Environmental Toxicology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.

Abstract

Objective: Lung cancer is a leading cause of cancer death in the United States. Exposure to outdoor air pollution (OAP) is associated with increased lung cancer incidence, however little is known about the association of OAP and survival after diagnosis.

Methods: We investigated the effects of OAP and lung cancer survival in Pennsylvania using data from Pennsylvania Cancer Registry. The study population consisted of 252,123 patients diagnosed between 1990 and 2017. The Environmental Protection Agency's ambient air monitoring network provided information on OAP exposure of NO₂, O₃, PM_2.5, and PM₁₀. Mean OAP exposures were calculated by interpolating exposure concentrations from the five nearest monitors within a 50-kilometer radius of each patient's residential address from date of diagnosis to date of death or last contact. Cox proportional-hazards models were used to estimate the hazard ratios (HR) for OAP exposures for overall and lung cancer-specific survival. Statistical analyses were stratified by SEER cancer stage groupings (localized, regional, and distant) and adjusted for individual-level and area-level covariates.

Results: Median survival time was 0.76 [CIs: 0.75, 0.77] years for the study population and for localized, regional, and distant site diagnosis were 2.2 [CIs: 2.17, 2.23], 1.13 [CIs: 1.12, 1.15], and 0.42 [CIs: 0.41, 0.43] years, respectively. NO₂ indicated the greatest HR which increased with increasing magnitude of exposure across all cancer staging groups for deaths before 2-years post-diagnosis. HRs varied by stage and magnitude of OAP exposure with greatest overall effects shown in NO₂ followed by PM_2.5, O_3, and PM₁₀. A subgroup analysis of patients with treatment status information (2010-2017) showed similar associations of increasing HRs with increasing exposure.

Conclusion: These findings supported the hypotheses that OAP can influence the carcinogenic process, impairing chemotherapy treatment, and provide important public health implications since environmental factors are not often considered in prognosis of survival after diagnosis.

Keywords: Air pollution; Exposomics; Geospatial; Lung cancer; Public health; Survival analysis.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Air Pollutants* / adverse effects
Air Pollution* / adverse effects
Air Pollution* / analysis
Environmental Exposure / adverse effects
Humans
Lung Neoplasms* / chemically induced
Lung Neoplasms* / etiology
Nitrogen Dioxide / analysis
Particulate Matter / analysis
Pennsylvania / epidemiology

Substances

Air Pollutants
Particulate Matter
Nitrogen Dioxide

Abstract

Publication types

MeSH terms

Substances

Grants and funding