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Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study

BACKGROUND: There are a few epidemiological studies that (1) link increased ambient air pollution (AP) with an increase in lung cancer incidence rates and (2) investigate whether residing in green spaces could be protective against cancer. However, it is completely unclear whether other forms of can...

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Autores principales: Datzmann, Thomas, Markevych, Iana, Trautmann, Freya, Heinrich, Joachim, Schmitt, Jochen, Tesch, Falko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994126/
https://www.ncbi.nlm.nih.gov/pubmed/29884153
http://dx.doi.org/10.1186/s12889-018-5615-2
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author Datzmann, Thomas
Markevych, Iana
Trautmann, Freya
Heinrich, Joachim
Schmitt, Jochen
Tesch, Falko
author_facet Datzmann, Thomas
Markevych, Iana
Trautmann, Freya
Heinrich, Joachim
Schmitt, Jochen
Tesch, Falko
author_sort Datzmann, Thomas
collection PubMed
description BACKGROUND: There are a few epidemiological studies that (1) link increased ambient air pollution (AP) with an increase in lung cancer incidence rates and (2) investigate whether residing in green spaces could be protective against cancer. However, it is completely unclear whether other forms of cancer are also affected by AP and if residential green spaces could lower cancer incidence rates in general. Therefore, the objective was to estimate whether AP and green space are associated with several cancer types. METHODS: The analysis was based on routine health care data from around 1.9 million people from Saxony who were free of cancer in 2008 and 2009. Incident cancer cases (2010–2014) of mouth and throat, skin (non-melanoma skin cancer - NMSC), prostate, breast, and colorectum were defined as: (1) one inpatient diagnosis, or (2) two outpatient diagnoses in two different quarters within one year and a specific treatment or death within two quarters after the diagnosis. Exposures, derived from freely available 3rd party data, included particulate matter with aerodynamic diameter of less than 10 μm (PM(10)) and nitrogen dioxide (N0(2)) as well as green space (Normalized Difference Vegetation Index - NDVI). Associations between air pollutants, green space, and cancer incidence were assessed by multilevel Poisson models. Age, sex, physician contacts, short- and long-term unemployment, population density, and having an alcohol-related disorder were considered as potential confounders. RESULTS: Three thousand one hundred seven people developed mouth and throat cancer, 33,178 NMSC, 9611 prostate cancer, 9577 breast cancer, and 11,975 colorectal cancer during the follow-up period (2010–2014). An increase in PM(10) of 10 μg/m(3) was associated with a 53% increase in relative risk (RR) of mouth and throat cancer and a 52% increase in RR of NMSC. Prostate and breast cancer were modestly associated with PM(10) with an increase in RR of 23 and 19%, respectively. The associations with N0(2) were in the same direction as PM(10) but the effect estimates were much lower (7–24%). A 10% increase in NDVI was most protective of mouth and throat cancer (− 11% RR) and of NMSC (− 16% RR). Colorectal cancer was not affected by any of the exposures. CONCLUSIONS: In addition to the studies carried out so far, this study was able to provide evidence that higher ambient AP levels increase the risk of mouth and throat cancer as well as of NMSC and that a higher residential green space level might have a protective effect for NMSC in areas with low to moderate UV intensity. Nevertheless, we cannot rule out residual confounding by socioeconomic or smoking status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-018-5615-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-59941262018-06-21 Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study Datzmann, Thomas Markevych, Iana Trautmann, Freya Heinrich, Joachim Schmitt, Jochen Tesch, Falko BMC Public Health Research Article BACKGROUND: There are a few epidemiological studies that (1) link increased ambient air pollution (AP) with an increase in lung cancer incidence rates and (2) investigate whether residing in green spaces could be protective against cancer. However, it is completely unclear whether other forms of cancer are also affected by AP and if residential green spaces could lower cancer incidence rates in general. Therefore, the objective was to estimate whether AP and green space are associated with several cancer types. METHODS: The analysis was based on routine health care data from around 1.9 million people from Saxony who were free of cancer in 2008 and 2009. Incident cancer cases (2010–2014) of mouth and throat, skin (non-melanoma skin cancer - NMSC), prostate, breast, and colorectum were defined as: (1) one inpatient diagnosis, or (2) two outpatient diagnoses in two different quarters within one year and a specific treatment or death within two quarters after the diagnosis. Exposures, derived from freely available 3rd party data, included particulate matter with aerodynamic diameter of less than 10 μm (PM(10)) and nitrogen dioxide (N0(2)) as well as green space (Normalized Difference Vegetation Index - NDVI). Associations between air pollutants, green space, and cancer incidence were assessed by multilevel Poisson models. Age, sex, physician contacts, short- and long-term unemployment, population density, and having an alcohol-related disorder were considered as potential confounders. RESULTS: Three thousand one hundred seven people developed mouth and throat cancer, 33,178 NMSC, 9611 prostate cancer, 9577 breast cancer, and 11,975 colorectal cancer during the follow-up period (2010–2014). An increase in PM(10) of 10 μg/m(3) was associated with a 53% increase in relative risk (RR) of mouth and throat cancer and a 52% increase in RR of NMSC. Prostate and breast cancer were modestly associated with PM(10) with an increase in RR of 23 and 19%, respectively. The associations with N0(2) were in the same direction as PM(10) but the effect estimates were much lower (7–24%). A 10% increase in NDVI was most protective of mouth and throat cancer (− 11% RR) and of NMSC (− 16% RR). Colorectal cancer was not affected by any of the exposures. CONCLUSIONS: In addition to the studies carried out so far, this study was able to provide evidence that higher ambient AP levels increase the risk of mouth and throat cancer as well as of NMSC and that a higher residential green space level might have a protective effect for NMSC in areas with low to moderate UV intensity. Nevertheless, we cannot rule out residual confounding by socioeconomic or smoking status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-018-5615-2) contains supplementary material, which is available to authorized users. BioMed Central 2018-06-08 /pmc/articles/PMC5994126/ /pubmed/29884153 http://dx.doi.org/10.1186/s12889-018-5615-2 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Datzmann, Thomas
Markevych, Iana
Trautmann, Freya
Heinrich, Joachim
Schmitt, Jochen
Tesch, Falko
Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study
title Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study
title_full Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study
title_fullStr Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study
title_full_unstemmed Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study
title_short Outdoor air pollution, green space, and cancer incidence in Saxony: a semi-individual cohort study
title_sort outdoor air pollution, green space, and cancer incidence in saxony: a semi-individual cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994126/
https://www.ncbi.nlm.nih.gov/pubmed/29884153
http://dx.doi.org/10.1186/s12889-018-5615-2
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