Abstract
ObjectivePM2.5, which is a major contributor to air pollution, has large effects on lung cancer mortality. We want to analyse the long-term trends in lung cancer burden attributable to PM2.5 exposure and provide evidence that can be used for preventive measures and health resource planning.MethodsMortality data related to lung cancer were obtained from the Global Burden of Disease (GBD) 2019 project. A joinpoint regression analysis was used to assess the magnitude and direction of the trends in mortality from 1990 to 2019, and the age-period-cohort method was used to analyse the temporal trends in the mortality rate of lung cancer attributable to PM2.5 exposure by age, period, and cohort.ResultsFrom 1990 to 2019, the age-standardized mortality rate (ASMR) attributable to PM2.5 exposure trended slowly upwards, and the ASMR due to ambient PM2.5 exposure (APE) increased significantly, that due to household PM2.5 exposure (HPE) decreased. The longitudinal age curves show that the mortality rates due to PM2.5 exposure among younger individuals were low, and they significantly increased from their levels among those in the 45–49 age group to their levels among those in the over-85 age group. From 1990 to 2019, the period RRs due to APE increased, but those due to HPE decreased. Similar trends were observed in the cohort RRs. The overall net drift per year attributable to PM2.5 exposure was below 0. The local drift values increased with age and were above 0 for the over-80 age groups. The overall net drifts per year were above zero for APE and below zero for HPE. The corresponding results among males were higher than those among females.ConclusionsIn China, the type of air pollution responsible for lung cancer has changed from household air pollution to ambient air pollution. PM2.5 exposure is more harmful among males and older people. Ambient air pollution should be emphasized, and China should strengthen its implementation of effective public policies and other interventions.
Highlights
Air pollution is an important global health problem, and the severity of air pollution in China has attracted attention worldwide [1]
In a large cohort study on long-term ambient PM2.5 exposure (APE) in Canada, Bai et al found that each 5 μg/m3 increase in the ambient PM2.5 concentration was associated with a 2% increase in the risk of lung cancer after adjusting for a series of individual and area-level risk factors [6]
In the AHSMOG-2 Study, Gharibvand L et al found that each 10-μg/m3 increase in ambient PM2.5 concentration was associated with a 43% increase in the risk of lung cancer [7]
Summary
Air pollution is an important global health problem, and the severity of air pollution in China has attracted attention worldwide [1]. As the most widely studied air pollutant, PM2.5 is increasingly used as an indicator of pollution, with annual average concentrations ranging from less than 10 to more than 100 μg/ m3 globally; it is associated with the risk of many noncommunicable diseases, such as cardiovascular disease [3], chronic obstructive pulmonary disease (COPD) [4] and diabetes [5], and it led to 8.3 million premature deaths in 2017. After evaluating this component of air pollution, the International Agency for Research on Cancer (IARC) unanimously agreed that PM2.5 is carcinogenic to humans (Group 1 carcinogen) [2]. The estimated number of lung cancer deaths attributable to HPE in China was 271,089 in 2017, which was the largest number in the world [9]
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