PO.PS01.12 · 人群科学
长期暴露于野火烟雾PM2.5与老年肺癌患者的生存
Long-term exposure to wildfire smoke PM 2.5 and survival of older lung cancer patients
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
重要性：细颗粒物（PM2.5）是肺癌发病率和死亡率的关键风险因素。然而，源自野火烟雾的PM2.5——在气候变化驱动下已成为美国总PM2.5中日益重要的贡献者——对肺癌患者死亡率的具体影响仍不明确。
目的：探究长期暴露于野火烟雾PM2.5与非烟雾PM2.5对老年肺癌患者全因死亡率的影响。
设计、机构与参与者：本队列研究纳入了SEER-Medicare数据库中2006年至2019年间原发性肺癌确诊的≥65岁患者，并根据患者居住地邮政编码关联了野火烟雾与非烟雾PM2.5的暴露估算值。
暴露：野火烟雾与非烟雾PM2.5的三年移动平均暴露量。
主要结局与测量指标：研究结局为原发性肺癌诊断后的全因死亡。采用时变Cox比例风险模型估算死亡风险的风险比（HR）。
结果：在503,409名患者、1,542,491人年的随访中，野火烟雾PM2.5每增加1μg/m³与死亡风险升高9.3%相关（HR：1.09，95% CI：1.08-1.11），显著高于非烟雾PM2.5（HR：1.020，95% CI：1.018-1.022）。反映野火烟雾PM2.5暴露持续时间和频率的烟雾天数和烟雾波次数也与死亡风险呈正相关。在女性、非小细胞肺癌以外类型的肺癌患者、有合并症的患者以及诊断后未接受首程治疗的患者中，观察到野火烟雾PM2.5的效应更大。
结论：野火烟雾对老年肺癌患者构成的风险显著大于非烟雾PM2.5。在气候变化的背景下，加强野火管理并减少临床诊疗中的野火烟雾暴露可改善老年肺癌患者的生存。
与烟雾及非烟雾PM2.5相关的死亡HR及相应年度超额死亡人数 三年移动平均野火烟雾PM2.5暴露 风险比（95% CI） 年度超额死亡人数（95% CI） 浓度，每增加1μg/m³ 烟雾PM2.5 1.0927（1.0801，1.1055） 2,908（2,513，3,310） 非烟雾PM2.5 1.0202（1.0182，1.0222） 634（571，696） 烟雾事件持续时间与频率，每增加一天/事件 烟雾天数 1.0040（1.0037，1.0043） 125（116，135） 烟雾波次数 1.0209（1.0185，1.0233） 656（580，731）
查看英文原文 English abstract
Importance Fine particulate matter (PM 2.5 ) is a key risk factor of lung cancer incidence and mortality. However, the specific effect of PM 2.5 originating from wildfire smoke, an increasingly important contributor to total PM 2.5 in the US driven by climate change, on mortality of patients with lung cancer remain unclear.
Objective To explore the effect of long-term exposure to wildfire smoke versus non-smoke PM 2.5 on all-cause mortality of older lung cancer patients.
Design, Setting, and Participants This cohort study included patients ≥65 years with primary diagnosis of lung cancer from the SEER-Medicare database from 2006 to 2019 linked with estimates of exposure to wildfire smoke and non-smoke PM 2.5 based on patients' residential zip codes.
Exposures Three-year moving average exposures to wildfire smoke and non-smoke PM 2.5 .
Main Outcomes and Measures The study outcome was all-cause mortality after primary lung cancer diagnosis. A time-varying Cox proportional hazards model was applied to estimate hazard ratios (HRs) for mortality risk.
Results Among 503,409 patients with 1,542,491 person-years of follow up, each 1-μg/m³ increase in wildfire smoke PM 2.5 was associated with a 9.3% increased mortality risk (HR: 1.09, 95% CI: 1.08-1.11), substantially greater than that of non-smoke PM 2.5 (HR: 1.020, 95% CI: 1.018-1.022). The number of smoke days and of smoke waves, reflecting duration and frequency of wildfire smoke PM 2.5 exposure, were also positively associated with mortality risk. Larger effect of wildfire smoke PM 2.5 was observed among women, patients with lung cancer other than non-small cell lung cancer, patients with comorbidities, and those not receiving first course treatment after diagnosis.
Conclusions Wildfire smoke posed a substantially larger risk in older lung cancer patients than non-smoke PM 2.5 . Under a changing climate, strengthening wildfire management and reducing wildfire smoke exposure in clinical care could improve survival of older lung cancer patients.
HR for mortality and corresponding annual excess deaths associated with smoke and non-smoke PM2.5 Three-year moving average wildfire smoke PM 2.5 exposure Hazard ratio (95% CI) Annual excess deaths (95% CI) Concentration, per 1-μg/m 3 increase Smoke PM 2.5 1.0927 (1.0801, 1.1055) 2,908 (2,513, 3,310) Non-smoke PM 2.5 1.0202 (1.0182, 1.0222) 634 (571, 696) Smoke-event duration and frequency, per day/event increase Number of smoke days 1.0040 (1.0037, 1.0043) 125 (116, 135) Number of smoke waves 1.0209 (1.0185, 1.0233) 656 (580, 731)
利益披露 Disclosure
M. Zhang, None..
J. P. Wisnivesky, None..
M. Qiu, None..
M. Danesh Yazdi, None..
R. J. Wright, None..
J. D. Schwartz, None..
R. O. Wright, None..
Y. Wei, None.