Long-term exposure to fine particulate matter and site-specific cancer mortality: A difference-in-differences analysis in Jiangsu province, China.

ABSTRACT

BACKGROUND: Accumulating studies have reported that chronic exposure to ambient fine particulate matter (PM2.5) can lead to adverse effects on lung cancer mortality; however, such chronic effects are less clear for mortality from other site-specific cancers. OBJECTIVE: To explore the causal effect of long-term PM2.5 exposure on mortality from all-site and a variety of site-specific cancers in Jiangsu province, China during 2015-2020 using a difference-in-differences analysis. METHODS: For each of 53 county-based spatial units in Jiangsu province, we calculated annual death counts for all-site cancer and 23 site-specific cancers. Using a validated high-resolution PM2.5 grid dataset, long-term PM2.5 exposure of a spatial unit within a given year was evaluated as the average of population-weighted annual concentrations during recent 10 years. Conditional Poisson regression models were employed to evaluate exposure-response associations adjusting for spatial and temporal variables, seasonal temperatures, relative humidity, and gross domestic product (GDP). RESULTS: During the study period, we identified 947,337 adult cancer deaths in Jiangsu province. Each 1 µg/m3 increment in PM2.5 exposure was significantly associated with a 2.7% increase in the risk of all-site cancer mortality. PM2.5-mortality associations were also observed in cancer of lip, oral cavity and pharynx, stomach, colorectum, pancreas, lung, bone and joints, ovary, prostate, and lymphoma (all adjusted P < 0.05), with the relative risks ranging from 1.028 (95% confidence interval [CI] 1.011, 1.046) for stomach cancer to 1.201 (95% CI 1.120, 1.308) for bone and joints cancers. Exposure-response curves showed that these associations were close to linearity, though most of them had increasing slopes at high exposure levels. Overall, women and subjects in low GDP regions were more vulnerable to PM2.5 exposures. CONCLUSIONS: Long-term exposure to ambient PM2.5 contributes to a higher risk of mortality from multiple site-specific cancers.