Long-term exposure to ambient air pollution and risk of lung cancer - A comparative analysis of incidence and mortality in four administrative cohorts in the ELAPSE study

Jie Chen; Richard W Atkinson; Zorana Jovanovic Andersen; Bente Oftedal; Massimo Stafoggia; Youn-Hee Lim; Terese Bekkevold; Norun Hjertager Krog; Matteo Renzi; Jiawei Zhang; Mariska Bauwelinck; Nicole Janssen; Maciek Strak; Francesco Forastiere; Kees de Hoogh; Sophia Rodopoulou; Klea Katsouyanni; Ole Raaschou-Nielsen; Evangelia Samoli; Bert Brunekreef; Gerard Hoek; Danielle Vienneau

doi:10.1016/j.envres.2024.120236

Long-term exposure to ambient air pollution and risk of lung cancer - A comparative analysis of incidence and mortality in four administrative cohorts in the ELAPSE study

Environ Res. 2024 Oct 24;263(Pt 3):120236. doi: 10.1016/j.envres.2024.120236. Online ahead of print.

Authors

Jie Chen¹, Richard W Atkinson², Zorana Jovanovic Andersen³, Bente Oftedal⁴, Massimo Stafoggia⁵, Youn-Hee Lim³, Terese Bekkevold⁶, Norun Hjertager Krog⁴, Matteo Renzi⁷, Jiawei Zhang³, Mariska Bauwelinck⁸, Nicole Janssen⁹, Maciek Strak⁹, Francesco Forastiere¹⁰, Kees de Hoogh¹¹, Sophia Rodopoulou¹², Klea Katsouyanni¹³, Ole Raaschou-Nielsen¹⁴, Evangelia Samoli¹², Bert Brunekreef¹⁵, Gerard Hoek¹⁵, Danielle Vienneau¹⁶

Affiliations

¹ Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80177, NL, 3508, TD, Utrecht, the Netherlands. Electronic address: [email protected].
² Population Health Research Institute, St George's, University of London, London, SW17 0RE, UK.
³ Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark.
⁴ Department of Air Quality and Noise, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, N-0213, Oslo, Norway.
⁵ Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, 00147 Rome, Italy; Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
⁶ Section of vaccine epidemiology and population studies, Norwegian Institute of Public Health, P.O. Box 222, Skøyen, N-0213 Oslo, Norway.
⁷ Department of Epidemiology, Lazio Region Health Service / ASL Roma 1, 00147 Rome, Italy.
⁸ Brussels Institute for Social and Population Studies (BRISPO) - Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
⁹ National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
¹⁰ Institute for Biomedical Research and Innovation (IRIB), National Research Council, 90146 Palermo, Italy; Environmental Research Group, King's College London, SE1 9NH, UK.
¹¹ Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, Postfach, 4001 Basel, Switzerland.
¹² Dept. of Hygiene, Epidemiology and Medical Statistics, National and Kapodstrian University of Athens, Medical School 75, Mikras Asias street 115 27 Athens, Greece.
¹³ Environmental Research Group, King's College London, SE1 9NH, UK; Dept. of Hygiene, Epidemiology and Medical Statistics, National and Kapodstrian University of Athens, Medical School 75, Mikras Asias street 115 27 Athens, Greece.
¹⁴ Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark.
¹⁵ Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80177, NL, 3508, TD, Utrecht, the Netherlands.
¹⁶ Environmental Research Group, King's College London, SE1 9NH, UK; Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland.

PMID: 39455045
DOI: 10.1016/j.envres.2024.120236

Abstract

Background: Studies have linked air pollution to lung cancer incidence and mortality, but few have compared these associations, which may differ due to cancer survival variations. We aimed to evaluate the association between long-term air pollution exposure and lung cancer incidence and compare findings with previous lung cancer mortality analyses within the same cohorts.

Methods: We analyzed four population-based administrative cohorts in Denmark (2000-2015), England (2011-2017), Norway (2001-2016) and Rome (2001-2015). We assessed residential exposure to annual average fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), black carbon (BC), and warm-season ozone (O₃) using Europe-wide land use regression models. We used Cox proportional hazard models to evaluate cohort-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence identified using hospital admission records (English and Roman cohorts) or cancer registries (Danish and Norwegian cohorts). We evaluated the associations at low exposure levels using subset analyses and natural cubic splines. Cohort-specific HRs were pooled using random-effects meta-analyses, separately for incidence and mortality.

Results: Over 93,733,929 person-years of follow-up, 111,949 incident lung cancer cases occurred. Incident lung cancer was positively associated with PM_2.5, NO₂ and BC, and negatively associated with O₃. The negative O₃ association became positive after adjustment for NO₂. Associations were almost identical or slightly stronger for lung cancer incidence than mortality in the same cohorts, with respective meta-analytic HRs (95% CIs) of 1.14 (1.06, 1.22) and 1.12 (1.02, 1.22) per 5 μg/m³ increase in PM_2.5, and 1.10 (1.04, 1.16) and 1.09 (1.02, 1.16) per 10 μg/m³ increase in NO₂. Positive associations persisted for both incidence and mortality at low pollution levels with similar magnitude.

Conclusions: We found similarly elevated risks of lung cancer incidence and mortality in association with residential exposure to PM_2.5, NO₂ and BC in meta-analyses of four European administrative cohorts, which persisted at low pollution levels.

Keywords: Air pollution; Black carbon; Lung cancer; Nitrogen dioxide; Ozone; Particulate matter.