Long-Term Exposure to Fine Particulate Matter and Incidence of Esophageal Cancer: A Prospective Study of 0.5 Million Chinese Adults
Dong Sun, Cong Liu, Yunqing Zhu, Canqing Yu, Yu Guo, Dianjianyi Sun, Yuanjie Pang, Pei Pei, Huaidong Du, Ling Yang, Yiping Chen, Xia Meng, Yang Liu, Jun Zhang, D. R. Schmidt, Daniel Avery, Junshi Chen, Zhengming Chen, Jun Lv, Haidong Kan, Liming Li, Junshi Chen, Zhengming Chen, Robert Clarke, Rory Collins, Yu Guo, Liming Li, Richard Peto, Robin Walters, Daniel Avery, Derrick Bennett, Ruth Boxall, Sue Burgess, Ka Hung Chan, Yu‐Mei Chang, Yiping Chen, Johnathan Clarke, Huaidong Du, Ahmed Edris Mohamed, Zammy Fairhurst-Hunter, Hannah Fry, Simon Gilbert, Alex Hacker, Mike Hill, Michael V. Holmes, Pek Kei Im, Andri Iona, Maria Kakkoura, Christiana Kartsonaki, Rene Kerosi, Kuang Lin, Mohsen Mazidi, Iona Y. Millwood, Sam Morris, Qunhua Nie, Alfred Pozarickij, Paul Ryder, Saredo Said, Sam Sansome, D. R. Schmidt, Paul Sherliker, Rajani Sohoni, Becky Stevens, Iain Turnbull, Lin Wang, Neil Wright, Ling Yang, Xiaoming Yang, Pang Yao, Xiao Han, Can Hou, Jun Lv, Pei Pei, Chao Liu, Canqing Yu, Qingmei Xia, Zengchang Pang, Ruqin Gao, Shanpeng Li, Haiping Duan, Shaojie Wang, Yongmei Liu, Huaidong Du, Yajing Zang, Liang Cheng, Xiaocao Tian, Hua Zhang, Yaoming Zhai, Feng Ning, Xiaohui Sun, Feifei Li, Jun Lv, Junzheng Wang, Wei Hou, Wei Sun, Shichun Yan, Xiaoming Cui, Chi Wang, Zhenyuan Wu, Yanjie Li
Abstract
Background & AimsEvidence is sparse and inconclusive on the association between long-term fine (≤2.5 μm) particulate matter (PM2.5) exposure and esophageal cancer. We aimed to assess the association of PM2.5 with esophageal cancer risk and compared the esophageal cancer risk attributable to PM2.5 exposure and other established risk factors.MethodsThis study included 510,125 participants without esophageal cancer at baseline from China Kadoorie Biobank. A high-resolution (1 × 1 km) satellite-based model was used to estimate PM2.5 exposure during the study period. Hazard ratios (HR) and 95% CIs of PM2.5 with esophageal cancer incidence were estimated using Cox proportional hazard model. Population attributable fractions for PM2.5 and other established risk factors were estimated.ResultsThere was a linear concentration–response relationship between long-term PM2.5 exposure and esophageal cancer. For each 10-μg/m3 increase in PM2.5, the HR was 1.16 (95% CI, 1.04–1.30) for esophageal cancer incidence. Compared with the first quarter of PM2.5 exposure, participants in the highest quarter had a 1.32-fold higher risk for esophageal cancer, with an HR of 1.32 (95% CI, 1.01–1.72). The population attributable risk because of annual average PM2.5 concentration ≥35 μg/m3 was 23.3% (95% CI, 6.6%–40.0%), higher than the risks attributable to lifestyle risk factors.ConclusionsThis large prospective cohort study of Chinese adults found that long-term exposure to PM2.5 was associated with an elevated risk of esophageal cancer. With stringent air pollution mitigation measures in China, a large reduction in the esophageal cancer disease burden can be expected. Evidence is sparse and inconclusive on the association between long-term fine (≤2.5 μm) particulate matter (PM2.5) exposure and esophageal cancer. We aimed to assess the association of PM2.5 with esophageal cancer risk and compared the esophageal cancer risk attributable to PM2.5 exposure and other established risk factors. This study included 510,125 participants without esophageal cancer at baseline from China Kadoorie Biobank. A high-resolution (1 × 1 km) satellite-based model was used to estimate PM2.5 exposure during the study period. Hazard ratios (HR) and 95% CIs of PM2.5 with esophageal cancer incidence were estimated using Cox proportional hazard model. Population attributable fractions for PM2.5 and other established risk factors were estimated. There was a linear concentration–response relationship between long-term PM2.5 exposure and esophageal cancer. For each 10-μg/m3 increase in PM2.5, the HR was 1.16 (95% CI, 1.04–1.30) for esophageal cancer incidence. Compared with the first quarter of PM2.5 exposure, participants in the highest quarter had a 1.32-fold higher risk for esophageal cancer, with an HR of 1.32 (95% CI, 1.01–1.72). The population attributable risk because of annual average PM2.5 concentration ≥35 μg/m3 was 23.3% (95% CI, 6.6%–40.0%), higher than the risks attributable to lifestyle risk factors. This large prospective cohort study of Chinese adults found that long-term exposure to PM2.5 was associated with an elevated risk of esophageal cancer. With stringent air pollution mitigation measures in China, a large reduction in the esophageal cancer disease burden can be expected.