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

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.