Fine Particulate Matter and Respiratory Healthcare Encounters among Survivors of Childhood Cancers

Some chemotherapies that treat childhood cancers have pulmonary-toxic properties that increase risk for adverse respiratory-health outcomes. PM(2.5) causes similar outcomes but its effect among pulmonary compromised cancer survivors is unknown. This case-crossover study identified the PM(2.5)-associated odds for primary-respiratory hospitalizations and emergency department visits among childhood cancer survivors in Utah. We compared risk among chemotherapy-treated survivors to a cancer-free sample. We calculated 3-day-average PM(2.5) by ZIP code and county for event and control days. Conditional logistic regression estimated odds ratios. Models were stratified by cause of admission (infection, respiratory disease, asthma), previous chemotherapy, National Ambient Air Quality Standard (NAAQS), and other variables. Results are presented per 10 µg/m(3) of PM(2.5). 90% of events occurred at 3-day PM(2.5) averages <35.4 µg/m(3), the NAAQS 24-h standard. For survivors, PM(2.5) was associated with respiratory hospitalizations (OR = 1.84, 95% CI = 1.13–3.00) and hospitalizations from respiratory infection (OR = 2.09, 95% CI = 1.06–4.14). Among chemotherapy-treated survivors, the PM(2.5)-associated odds of respiratory hospitalization (OR = 2.03, 95% CI = 1.14–3.61) were significantly higher than the cancer-free sample (OR = 0.84, 95% CI = 0.57–1.25). This is the first study to report significant associations between PM(2.5) and respiratory healthcare encounters in childhood cancer survivors. Chemotherapy-treated survivors displayed the highest odds of hospitalization due to PM(2.5) exposure and their risk is significantly higher than a cancer-free sample.