Association between long-term exposure to particulate air pollution with SARS-CoV-2 infections and COVID-19 deaths in California, U.S.A.

Previous studies have reported associations between air pollution and COVID-19 morbidity and mortality, but most have limited their exposure assessment to a large area, have not used individual-level variables, nor studied infections. We examined 3.1 million SARS-CoV-2 infections and 49,691 COVID-19 deaths that occurred in California from February 2020 to February 2021 to evaluate risks associated with long-term neighborhood concentrations of particulate matter less than 2.5 µm in diameter (PM2.5). We obtained individual address data on SARS-CoV-2 infections and COVID-19 deaths and assigned 2000-2018 1km-1km gridded PM2.5 surfaces to census block groups. We included individual covariate data on age and sex, and census block data on race/ethnicity, air basin, Area Deprivation Index, and relevant comorbidities. Our analyses were based on generalized linear mixed models utilizing a Poisson distribution. Those living in the highest quintile of long-term PM2.5 exposure had risks of SARS-CoV-2 infections 20% higher and risks of COVID-19 mortality 51% higher, compared to those living in the lowest quintile of long-term PM2.5 exposure. Those living in the areas of highest long-term PM2.5 exposure were more likely to be Hispanic and more vulnerable, based on the Area Deprivation Index. The increased risks for SARS-CoV-2 Infections and COVID-19 mortality associated with highest long-term PM2.5 concentrations at the neighborhood-level in California were consistent with a growing body of literature from studies worldwide, and further highlight the importance of reducing levels of air pollution to protect public health.

Agricultural pesticides and lymphoproliferative childhood cancer in California.

OBJECTIVES: This study evaluated whether the rates of lymphoproliferative malignancies among children are elevated in areas of intensive agricultural pesticide use in the state of California in the United States. METHODS: The study included all newly diagnosed, statewide cases of childhood lymphoma and acute lymphoblastic leukemia in 1988-1994 among children aged <15 years. Of the 2642 cases (over 6.6 million children in California and 46 million child-years of observation) during this period, 2570 (97.3%) could be successfully geocoded for the analyses. An a priori classification of the >850 chemical agents reported in use during the study was developed by assigning the agents to eight chemical groupings of interest and identifying seven individual high-use agents with high potential toxicity. Rate ratios for neighborhood (block group) levels of pesticide use were estimated with a Poisson regression and adjustment for age, race and ethnicity, and gender. RESULTS: The rates of childhood lymphoma and leukemia were not generally higher in high pesticide-use areas. Those of Hodgkin's disease, although based on small numbers (N=258), were slightly elevated in the areas with the highest use of several pesticide groupings. CONCLUSIONS: The generally null results in this study systematically examining the risk relationships for residential proximity to agricultural pesticide use stand in contrast to existing epidemiologic literature suggesting elevated childhood cancer risks from reported household pesticide use. These differences may be due to different chemical agents or to differences in indoor versus outdoor exposure potential or both. Future studies should use refined methods that better characterize the exposure potential for children to these agents.

Adipose levels of dioxins and risk of breast cancer.

OBJECTIVE: Our objective was to evaluate the breast cancer risk associated with body burden levels of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). METHODS: We conducted a hospital-based case-control study among 79 women diagnosed with invasive breast cancer and 52 controls diagnosed with benign breast conditions. We collected breast adipose tissue and analyzed it for all 17 2,3,7,8-substitituted PCDD/PCDFs. We used unconditional logistic regression to calculate age- and race-adjusted exposure-specific odds ratios (ORs) and 95% confidence intervals (CI) for each individual PCDD/PCDF congener as well as for the summary measures (I-TEQ, Adj-TEQ). RESULTS: Dioxin levels were consistent with reports from other small, contemporary studies of body burdens in the U.S. None of the odds ratios for any of the congeners or summary measures differed significantly from one. Especially for the PCDF congeners, point estimates tended to be below one. One notable exception was octachlorodibenzo-p-dioxin (OCDD), for which the odds ratio for the second and third tertiles appeared modestly elevated (OR = 1.22, 95% CI: 0.47:3.16 and OR = 1.62, 95% CI: 0.64:4.12, respectively), though the test for trend was not significant (p = 0.36). CONCLUSION: Breast cancer risk was not associated with adipose levels of PCDD/PCDFs. More study is suggested among women of color who may have higher body burden levels of these compounds.

Residential mobility in the California Teachers Study: implications for geographic differences in disease rates.

BACKGROUND: Especially for cancers with long latency periods, such as breast cancer, the issue of residential mobility hinders ecologic analyses seeking to examine the role of environmental contaminants in chronic disease etiology. This study describes and evaluates characteristics associated with residential mobility in a sub-sample of the California Teachers Study (CTS) cohort. METHODS: In 2000, lifetime residential histories were collected for a sub-sample of 328 women enrolled in the CTS; women's degree of residential mobility and associated factors were analyzed. RESULTS: While most women moved many times during their lives (average = 8.9), the average number of years at their residence when they enrolled in the study was reasonably long (15.1 years). Age strongly predicted duration at current residence but was not related to the number of lifetime residences. After adjusting for age, California-born women and women living in high socioeconomic status (SES) neighborhoods were significantly more residentially stable. Agreement between self-reported urbanization of recent residences and that based on census data of the geocoded residences was very good (80% concordant). Among women currently living in urban areas, an average of 43.3 years, or 77%, of their lifetimes were spent in urban residences; among women currently living in a rural area, an average of 37.3 years, or 67% of their lifetimes were spent in rural residences. CONCLUSIONS: This suggests that analyses of incidence rates based on current residence, while not capturing a woman's full exposure history, may reasonably reflect some aspect of longer term chronic exposures, especially those related to urbanization, at least in professional women.

Agricultural pesticide use and childhood cancer in California.

BACKGROUND: Household pesticide use has been associated with higher risk for several childhood malignancies, but few studies have evaluated risks associated with residential proximity to agricultural pesticide use. We conducted a population-based case-control study of early childhood cancer (age 0-4 years) among California children born between 1990 and 1997 and mother's residential proximity to agricultural applications of pesticides at the time of the child's birth. METHODS: Included in the study were 2189 case children and 4335 controls matched for birth date and sex. We estimated the in utero exposure potential from specific chemicals and chemical groups used in the 9 months before birth within a half mile of the maternal residence. We computed odds ratios (ORs) using conditional logistic regression. RESULTS: No striking patterns emerged. There were modestly elevated ORs for leukemias associated with probable and possible carcinogen use, and with nearby agricultural applications of organochlorines and organophosphates during pregnancy. Two commonly used pesticides were associated with higher leukemia risk when comparing the highest and lowest categories: metam sodium (OR=2.05; 95% confidence interval=1.01-4.17) and dicofol (1.83; 1.05-3.22). CONCLUSIONS: The few elevated risk associations in this study are consistent with chance, given the large number of comparisons, but they may deserve more careful consideration. Future studies that integrate specific temporal and spatial exposure potential for targeted pesticides will be important in further evaluating risks associated with childhood cancer.

Regional variations in breast cancer among california teachers.

BACKGROUND: Observed regional differences in breast cancer incidence could provide valuable clues to the etiology of this disease. The pattern of historically higher breast cancer rates among residents of California's San Francisco Bay and Southern Coastal areas is evident in the disease experience among members of the California Teachers Study. This large cohort study has followed female professional school employees for cancer incidence since 1995 and has collected extensive information on breast cancer risk factors. METHODS: Between 1996 and 1999, invasive breast cancer was diagnosed in 1562 of the 115,611 cohort members who could be geocoded to a California address in 1995 and who had no previous breast cancer diagnosis. Adjusted hazard rate ratios (HRs) were estimated through multivariate Cox proportional hazards modeling. RESULTS: Rates were higher for cohort members in the San Francisco Bay area (HR = 1.22; 95% confidence interval = 1.06-1.40) and Southern Coastal area (1.16; 1.04-1.30) compared with those in the rest of California. The distributions of variables representing socioeconomic status, urbanization, and personal risk factors were consistent with higher risks for cohort members residing in the San Francisco Bay and Southern Coastal areas. Adjustment for these factors, however, did not explain regional differences in incidence, resulting in HRs that remained elevated for these 2 areas. CONCLUSION: Regional differences in breast cancer incidence in this large, well-defined cohort are not easily explained by known risk factors.

Residential proximity to agricultural pesticide use and incidence of breast cancer in the California Teachers Study cohort.

We examined the association between residential proximity to agricultural pesticide use and breast cancer incidence among members of the California Teachers Study cohort, a large study of professional school employees with extensive information on breast cancer risk factors, followed for cancer incidence since 1995. We identified 1552 invasive breast cancer cases, diagnosed between 1996 and 1999, among 114,835 cohort members. We used California Pesticide Use Reporting data to select pesticides for analysis based on use volume, carcinogenic potential, and exposure potential; a Geographic Information System was used to estimate pesticide applications within a half-mile radius of subjects' residences. We applied Cox proportional hazard models to estimate hazard rate ratios (HR) for selected pesticides, adjusting for age, race, and socioeconomic status. We saw no association between residential proximity to recent agricultural pesticide use and invasive breast cancer incidence. HR estimates for the highest compared to the lowest exposure categories for groups of agents were as follows: probable or likely carcinogens (1.07, 95% confidence interval (CI): 0.86-1.32), possible or suggestive carcinogens (1.06, 95% CI: 0.87-1.29), mammary carcinogens (1.15, 95% CI: 0.90-1.48), and endocrine disruptors (1.03, 95% CI: 0.86-1.25). HR estimates for other groups and individual pesticides did not differ from unity, nor was there a trend for any groupings of or individual pesticides examined. Stratifying by menopausal status or family history of breast cancer did not substantially affect our results. Our analyses suggest that breast cancer incidence is not elevated in areas of recent, high agricultural pesticide use in California.

Prevalence and patterns of environmental tobacco smoke exposures among California teachers.

PURPOSE: This study describes the prevalence and patterns of environmental tobacco smoke (ETS) exposure in a large, well-defined cohort of professional, female school employees in California. DESIGN: This is a cross-sectional study based on survey responses from members of the California Teachers Study (CTS) cohort. SUBJECTS: The analyses focused on lifetime nonsmokers (N = 61,899) in the CTS cohort who responded to detailed questions on lifetime ETS exposures in the home, workplace, and other social settings. MEASURES: Demographic characteristics, smoking status, and ETS exposure were based on self-reported data from two mailed surveys. Prevalence estimates within the cohort were compared with those from the California Behavioral Risk Factor Survey and the California Adult Tobacco Survey. RESULTS: ETS exposures were highest for never smokers born in the 1930s (78% in the home, 66% in the workplace, and 48% in other social settings) and steadily declined among participants born in later years. ETS exposure from spousal smoking peaked during the 1950s (37%). In the 1980s, the workplace (28%) replaced the household (19%) as the primary exposure setting. CONCLUSIONS: Consideration of these patterns in the prevalence of ETS exposures is important in the interpretation and design of tobacco-related health studies.

Active smoking, household passive smoking, and breast cancer: evidence from the California Teachers Study.

BACKGROUND: There is great interest in whether exposure to tobacco smoke, a substance containing human carcinogens, may contribute to a woman's risk of developing breast cancer. To date, literature addressing this question has been mixed, and the question has seldom been examined in large prospective study designs. METHODS: In a 1995 baseline survey, 116 544 members of the California Teachers Study (CTS) cohort, with no previous breast cancer diagnosis and living in the state at initial contact, reported their smoking status. From entry into the cohort through 2000, 2005 study participants were newly diagnosed with invasive breast cancer. We estimated hazard ratios (HRs) for breast cancer associated with several active smoking and household passive smoking variables using Cox proportional hazards models. RESULTS: Irrespective of whether we included passive smokers in the reference category, the incidence of breast cancer among current smokers was higher than that among never smokers (HR = 1.32, 95% confidence interval [CI] = 1.10 to 1.57 relative to all never smokers; HR = 1.25, 95% CI = 1.02 to 1.53 relative to only those never smokers who were unexposed to household passive smoking). Among active smokers, breast cancer risks were statistically significantly increased, compared with all never smokers, among women who started smoking at a younger age, who began smoking at least 5 years before their first full-term pregnancy, or who had longer duration or greater intensity of smoking. Current smoking was associated with increased breast cancer risk relative to all nonsmokers in women without a family history of breast cancer but not among women with such a family history. Breast cancer risks among never smokers reporting household passive smoking exposure were not greater than those among never smokers reporting no such exposure. CONCLUSION: Our study provides evidence that active smoking may play a role in breast cancer etiology and suggests that further research into the connection is warranted, especially with respect to genetic susceptibilities.

Residential exposure to traffic in California and childhood cancer.

BACKGROUND: Motor vehicle emissions are a major source of air pollution in California. Past studies have suggested that traffic-related exposures can increase the risk of childhood cancer, particularly leukemia. METHODS: From California's statewide, population-based cancer registry, we identified cancers diagnosed in children younger than 5 years of age between 1988 and 1997. We matched these cases to California birth certificates. For each case, we randomly selected 2 control birth certificates, matched by birth date and sex. For each mother's residential address at the time of her child's birth, we calculated road density by summing the length of all roads within a 500-foot radius of the residence. Traffic density was based on road lengths and vehicle traffic counts for highways and major roads. RESULTS: The distributions of road and traffic density values were very similar for the 4369 cases and 8730 matched control subjects. For all cancer sites combined, the odds ratio (OR) for the highest road density exposure category, compared with the lowest, was 0.87 (95% confidence interval [CI] = 0.75-1.00). For all sites combined and for leukemia, the ORs were also below 1.0 for the highest traffic density exposure category (0.92 for both). For central nervous system tumors, the OR was 1.22 (CI = 0.87-1.70). CONCLUSIONS: In a large study with good power, we found no increased cancer risk among offspring of mothers living in high traffic density areas for all cancer sites or leukemia.

Parental and birth characteristics in relation to testicular cancer risk among males born between 1960 and 1995 in California (United States).

OBJECTIVE: We explored birth and parental risk factors for testicular cancer, examining risk factors for all testicular cancers and by histologic type. METHODS: We linked 1645 testicular cancer cases to live singleton birth certificates, selecting three random controls per case, matched by sex and date of birth. We used conditional multiple logistic regression to assess the mutually adjusted effects of parental and birth characteristics on testicular cancer risk. RESULTS: Sons of Black mothers had a lower risk than those of White mothers (adjusted odds ratio (AOR) = 0.38, 95% confidence interval (CI)=0.12, 1.22). Increasing maternal age was associated with an increased risk in offspring (AOR=1.03 for each year of maternal age, 95% CI=1.01, 1.05). Sons of primiparous and low-multiparous women had increased risks compared to sons of high-multiparous women (AOR=1.22, 95% CI=1.04, 1.44; and AOR=1.31, 95% CI=1.12, 1.54, respectively). Among seminomas, term infants with birth weights of 1500-2499 g had a higher risk compared to term, normal birth weight infants (AOR=2.69, 95% CI=1.40, 5.17; p-value for homogeneity=0.008). CONCLUSIONS: Markers of higher estrogen exposure in the mother (age and parity) are associated with increased testicular cancer risk, and factors associated with fetal growth retardation may be associated with seminoma testicular cancer.

Childhood cancer incidence rates and hazardous air pollutants in California: an exploratory analysis.

Hazardous air pollutants (HAPs) are compounds shown to cause cancer or other adverse health effects. We analyzed population-based childhood cancer incidence rates in California (USA) from 1988 to 1994, by HAP exposure scores, for all California census tracts. For each census tract, we calculated exposure scores by combining cancer potency factors with outdoor HAP concentrations modeled by the U.S. Environmental Protection Agency. We evaluated the relationship between childhood cancer rates and exposure scores for 25 potentially carcinogenic HAPs emitted from mobile, area, and point sources and from all sources combined. Our study period saw 7,143 newly diagnosed cancer cases in California; of these, 6,989 (97.8%) could be assigned to census tracts and included in our analysis. Using Poisson regression, we estimated rate ratios (RRs) adjusted for age, race/ethnicity, and sex. We found little evidence for elevated cancer RRs for all sites or for gliomas among children living in high-ranking combined-source exposure areas. We found elevated RRs and a significant trend with increasing exposure level for childhood leukemia in tracts ranked highest for exposure to the combined group of 25 HAPs (RR = 1.21; 95% confidence interval, 1.03, 1.42) and in tracts ranked highest for point-source HAP exposure (RR = 1.32; 95% confidence interval, 1.11, 1.57). Our findings suggest an association between increased childhood leukemia rates and high HAP exposure, but studies involving more comprehensive exposure assessment and individual-level exposure data will be important for elucidating this relationship.

Traffic patterns and childhood cancer incidence rates in California, United States.

OBJECTIVE: Some studies have suggested that residential proximity to high traffic areas is associated with increased risk of childhood cancer, although the epidemiologic evidence to date has been mixed. This study takes advantage of available information on population-based cancer reporting and various spatially assigned indices of traffic in a sufficiently large and heterogeneous area to obtain reasonably stable estimates of risk associations. METHODS: The time period 1988-1994 included a total of 7143 newly diagnosed cases of childhood cancer and 46 million child-years of observation in California. Rate ratios, estimated via Poisson regression (with adjustment for age, sex, and race/ethnicity), were computed for estimated traffic level as measured by spatial information on neighborhood vehicle density, road density, and traffic density. RESULTS: Compared to area air monitoring data, traffic density estimates were the most strongly correlated with measures of benzene and 1,3-butadiene. Rate ratios at the 90th percentile of traffic density (neighborhoods with over 320,700 vehicle miles traveled per day per square mile) were 1.08 (95% Cl 0.98-1.20) for all cancers in children, 1.15 (95% CI 0.97-1.37) for the leukemias, and 1.14 (95% CI 0.90-1.45) for the gliomas. There was also little or no evidence for rate differences in areas characterized by high vehicle or road density. CONCLUSION: These data suggest that childhood cancer rates are not higher in high traffic neighborhoods, but future studies which can better refine timing and measures of exposure are needed to more directly address the question of etiologic risks.

Cancer incidence in California flight attendants (United States).

OBJECTIVE: To examine unusual exposure opportunities to flight crews from chemicals, cosmic radiation, and electric and magnetic fields. METHODS: This project evaluated the incidence of cancers of the breast and other sites among Association of Flight Attendants (AFA) members residing in California. AFA membership files were matched to California's statewide cancer registry to identify a total of 129 newly diagnosed invasive cancers among AFA members with California residential histories between 1988 and 1995. RESULTS: Compared to the general population, female breast cancer incidence was over 30% higher than expected, and malignant melanoma incidence was roughly twice that expected. Both of these are cancers that are associated with higher socioeconomic status and have been suggestively associated with various sources of radiation. CONCLUSIONS: Consistent with the results from Nordic studies of cabin crews and a recent meta-analysis of prior studies, these data suggest that follow-up investigations should focus on the potential relative contribution of workplace exposures and lifestyle characteristics to the higher rates of disease for these two cancers.

Childhood cancer and agricultural pesticide use: an ecologic study in California.

We analyzed population-based childhood cancer incidence rates throughout California in relation to agricultural pesticide use. During 1988-1994, a total of 7,143 cases of invasive cancer were diagnosed among children under 15 years of age in California. Building on the availability of high-quality population-based cancer incidence information from the California Cancer Registry, population data from the U.S. Census, and uniquely comprehensive agricultural pesticide use information from California's Department of Pesticide Regulation, we used a geographic information system to assign summary population, exposure, and outcome attributes at the block group level. We used Poisson regression to estimate rate ratios (RRs) by pesticide use density adjusted for race/ethnicity, age, and sex for all types of childhood cancer combined and separately for the leukemias and central nervous system cancers. We generally found no association between pesticide use density and childhood cancer incidence rates. The RR for all cancers was 0.95 [95% confidence interval (CI), 0.80-1.13] for block groups in the 90th percentile and above for use of pesticides classified as probable carcinogens, compared to the block groups with use of < 1 lb/mi(2). The RRs were similar for leukemia and central nervous system cancers. Childhood leukemia rates were significantly elevated (RR = 1.48; 95% CI, 1.03-2.13) in block groups with the highest use of propargite, although we saw no dose-response trend with increasing exposure categories. Results were unchanged by further adjustment for socioeconomic status and urbanization.