Childhood cancer and traffic-related air pollution in Switzerland: A nationwide census-based cohort study

Highlights

• Nationwide cohort study spanning over two decades including 2,960 incident cases.

• Combined dispersion modeling and land-use regression to model ambient NO_2.

• Traffic-related air pollution is associated with an increased risk of childhood AML.

• Analyses of time-lagged exposure suggest relevant window is close to diagnosis.

• Indications of an increased risk also observed for non-Hodgkin lymphoma.

Abstract

Motor vehicle exhaust is a major contributor to air pollution, and exposure to benzene or other carcinogenic components may increase cancer risks. We aimed to investigate the association between traffic-related air pollution and risk of childhood cancer in a nationwide cohort study in Switzerland. We identified incident cases from the Swiss Childhood Cancer Registry diagnosed < 16 years of age between 1990 and 2015 and linked them probabilistically with the census-based Swiss National Cohort study. We developed land use regression models to estimate annual mean ambient levels of nitrogen dioxide (NO₂) and benzene outside 1.4 million children’s homes. We used risk-set sampling to facilitate the analysis of time-varying exposure and fitted conditional logistic regression models adjusting for neighborhood socio-economic position, level of urbanization, and background ionizing radiation. We included 2,960 cancer cases in the analyses. The adjusted hazard ratios (HR) and 95% confidence intervals for exposure to NO₂ per 10 μg/m³ were 1.00 (95%-CI 0.88–1.13) for acute lymphoblastic leukemia (ALL) and 1.31 (95%-CI 1.00–1.71) for acute myeloid leukemia (AML). Using exposure lagged by 1 to 5 years instead of current exposure attenuated the effect for AML. The adjusted HR for exposure to benzene per 1 μg/m³ was 1.03 (95%-CI 0.86–1.23) for ALL and 1.29 (95%-CI 0.86–1.95) for AML. We also observed increased HRs for other diagnostic groups, notably non-Hodgkin lymphoma. Our study adds to the existing evidence that exposure to traffic-related air pollution is associated with an increased risk of childhood leukemia, particularly AML.