The association between lung cancer incidence and ambient air pollution in China: A spatiotemporal analysis
Introduction
Lung cancer is now the most common cancer in the world, with the majority of the cases in developing countries (Ferlay et al., 2010, Jemal, 2011). China has the highest lung cancer burden in the world (Zhao et al., 2010). According to the latest Chinese cancer registration annual report, the world age-standardized incidence rate of lung cancer was 47.5 per 100,000 for men and 22.2 per 100,000 for women in 2009 (Chen et al., 2013), and these incidences are expected to rise (Chen et al., 2011).
Determining the risk factors associated with this high burden is crucial for cancer prevention and control. The established risk factors for lung cancer include smoking (Correa et al., 1983, Hackshaw et al., 1997, Hecht, 2002, Janerich et al., 1990) and air pollution (Cohen, 2000, Mumford et al., 1987, Pope et al., 2002, Vineis et al., 2004). In particular, ambient air pollution is the most widespread environmental carcinogen (Cohen, 2000, Vineis et al., 2004). Globally, it is estimated that 12.8% of lung cancer death can be attributed to exposure of the fine particulate matter air pollution alone (Evans et al., 2013, Fajersztajn et al., 2013). In 2010, an estimated 223,000 deaths from lung cancer worldwide were attributed to air pollution (Straif et al., 2013).
With the rapid economic growth and increased urbanization of rural areas, China is experiencing very high concentrations of air pollutants (Brauer et al., 2012). The average concentration of fine particulate matter in densely populated regions of China can exceed 100 μg/m3 (Guo et al., 2013). However, studies on ambient air pollution and lung cancer have never been performed at the national level. In the present study, we investigated lung cancer incidence in relation to long-term exposure to two ambient air pollutants, fine particulate matter (PM2.5) and ozone (O3), using population-based national cancer registration data of China.
Section snippets
Study design and participants
The National Cancer Registration Center of China is responsible for the collection, evaluation and publication of cancer statistics from population-based cancer registries in China each year since 1970s. All data on cancer incidence are reported to population-based cancer registries from hospitals, community health centers or other departments, including centers of township medical insurance and the New-type Rural Cooperative Medical System. Based on the integrity and quality of lung cancer
Results
There were 368,762 lung cancer cases, including 247,533 (67%) men and 312678 (85%) cases living in urban area. Table S1 shows the rates of lung cancer incidence in China from 1990 to 2009. The crude rates of lung cancer incidence increased significantly from 1990 to 2009 for all groups. However, the standardized rates changed slightly during the study period for all groups. Men had higher crude and standardized rates than women. There was spatial variation in the standardized lung cancer
Discussion
To the best of our knowledge, this study is the first to assess the associations between ambient PM2.5 and O3 and lung cancer in China. A large data set of 75 communities spread across the country during 1990–2009 was used in present study. We developed the spatial age-period-cohort mode which fitted the data very well (Supplemental material, Fig. S3). There were statistically significant associations between PM2.5 and O3 and lung cancer in China. In general, the effects of air pollution on
Conclusions
The findings suggest that lung cancer is associated with ambient air pollution in China. Air pollution is a serious problem in China, and on the basis of our findings, decrease in concentrations of air pollution can be expected to greatly reduce the future number of lung cancer cases in China.
Conflict of interests
The authors have declared that no competing interests exist.
Ethical approval
This study was approved by the University of Queensland’s behavior and social sciences ethical review committee (#2013000739).
Acknowledgements
We gratefully acknowledged the cooperation of all the population-based cancer registries in providing cancer statistics, data collection, sorting, verification and database creation. YG is supported by the University of Queensland Research Fellowship. The study was funded by Hope Run Malathon Fund (Cancer Institute & Hospital, Chinese Academy of Medical Sciences, LC2011Y41), and the Australia National Health and Medical Research Council (#APP1030259). No funding bodies had any role in study
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These authors contributed equally to the study.