An urban-rural and sex differences in cancer incidence and mortality and the relationship with PM2.5 exposure: An ecological study in the southeastern side of Hu line
Introduction
The threat to the public health caused by the exposure to fine particulate matter and air pollution has attracted more and more attentions from the public, governments and health organizations worldwide (Pope et al., 1995, Katsouyanni et al., 2001, Yim and Barrett, 2012). Recent studies show that air pollution has become a major global health risk factor (Gu et al., 2018, Forouzanfar et al., 2016, Cohen et al., 2004, Oliveri Conti et al., 2017), particulate matter with aerodynamic diameter less than 2.5 μm (PM2.5) shortens life expectancy due to its health impact on morbidity and mortality (Mazzi et al., 2017, Dai et al., 2014, Samet et al., 2000), especially for lung cancer (Dehghani et al., 2017, MacNaughton et al., 2017) and cardiovascular diseases (Gurgueira et al., 2002, Zhang et al., 2018; Lee et al., 2014). Cohen et al. (2017) indicated that 4.2 million deaths in 2015 were caused by the exposure to PM2.5, and more than 1.1 million deaths were in China. WHO issued a PM2.5 guideline value of annual mean 10 μg/m3, and interim targets (IT) level 1, 2 and 3 of 35, 25 and 15 μg/m3. At IT-1 level, a 15% higher long-term mortality risk is reported relative to the guideline level (World Health Organization, 2006). However, IT-1 level is not achieved at most of the areas of China, and population-weighted mean of PM2.5 concentration in Chinese cities were 61 μg/m3 at the year of 2013 (Huang et al., 2014, Zhang and Cao, 2015). Therefore, the health impact caused by PM2.5 exposure has become an urgent issue in China (Hu and Jiang, 2014, Li and Gao, 2014, Pui et al., 2014, Liu et al., 2016, Liu et al., 2017).
The studies in the developed areas revealed that air pollution caused by PM2.5 was a serious threat to human health in various aspects, i.e. its enhancement of cardiopulmonary diseases (Yoshinaga et al., 2018, Ali et al., 2017, Wong et al., 2008, Pope et al., 2009, Oh et al., 2011, Madrigano et al., 2013, Cesaroni et al., 2014), premature birth and low birth weight (Han et al., 2018, Brauer et al., 2008, Aguilera et al., 2009, Kloog et al., 2012), and systemic diseases (O'Neill et al., 2005, Dubowsky et al., 2006, Zeka et al., 2006, Pope et al., 2016). In China, many studies showed that short-term exposure of PM2.5 was also associated with the rise of hospital emergency-room visits, cardio-respiratory diseases and mortality in city areas (Chen et al., 2018, Guo et al., 2009, Li et al., 2010, Chen et al., 2011, Huang et al., 2012, Wang et al., 2013, Yang et al., 2012, Lu. et al., 2015, Qiao et al., 2014); while cohort studies show that ambient particulate matter can increase the risks of total, cardiovascular and respiratory mortality (Dong et al., 2012, Zhou et al., 2014, Zhang et al., 2014, Chen et al., 2016, Guo et al., 2016). There are two main causes of these health hazards: one is that the fine particles in PM2.5 are small enough to arrive a large part of human organs (including the respiratory system, the circulatory system, and the reproductive system), and another is that there are numerous kinds of hazardous substances in the PM2.5, i.e. carcinogenic polycyclic aromatic hydrocarbons (PAHs), heavy metals (such as lead, mercury, chromium and cadmium), and pathogenic microorganisms (such as bacteria, viruses and fungi) (Lee et al., 2007, Cao et al., 2014, Zhai et al., 2014). PAHs in PM2.5 are suspected to be a predisposing factor of breast cancer because of its disruption of BRCA-1 gene expression in estrogen receptor (Jeffy et al., 2002). Parikh et al. (Parikh and Wei, 2016) also conclude that PAHs in PM2.5 have a significant impact on the increased incidence of female breast cancer in urban areas. Further, BRCA-1 has been confirmed to be associated with ovarian cancer (Chen and Parmigiani, 2007). Therefore, it could be deduced that cancer is a manifestation of the health effects of PM2.5 in the regions with large population density, since PAHs can almost always be detected in PM2.5 in these regions (Yang et al., 2011).
The PM2.5 concentration in China has been at the elevated level for a long time and the main hazardous substances in PM2.5 such as PAHs and heavy metals have also been identified to have impacts on increased risks for some common disease (Martin et al., 2017, Leontief and Ford, 1971, Contoyannis and Jones, 2004, Huang et al., 2011). Thus, a screen on all most common disease is conducted in this study to understand the health effects of PM2.5 exposure in China. Moreover, we need to consider the geographical and sex factors, because there are spatial differences in the PM2.5 concentration and compositions (mainly between urban and rural area) as well as sex differences in the sensitivity to toxic substances. To assess the health effects caused by PM2.5 in China, firstly, we need to find out which cancers closely associated with high PM2.5 concentration; and then, we need to evaluate sex- and area-specific increased risks of those cancers from high level PM2.5 long-term exposure.
In this study, we first investigated the association between the ten most common cancers in China (identified by the National Central Cancer Registry of China) incidence and mortality with PM2.5 concentration to find out which cancers are closely relative to PM2.5 by using the time series data of yearly incidence and mortality of the ten most common cancers and the annual mean PM2.5 concentration in China from 2000 to 2011. Secondly, we estimated the sex- and area-specific increased cancer incidence/mortality risks from long-term exposure to high PM2.5 concentration by using spatiotemporal series data of the southeastern side of Hu line from 2006 to 2009. Finally, we studied the urban-rural and sex differences in the increased risks of incidence and mortality for the ten most common cancers from long-term exposure to high PM2.5 concentration. The southeastern side of Hu line (Hu, 1990) was selected as our research region, because this part of China has larger population density and more developed social economic level, which mean the air pollution caused by PM2.5 is very serious and the data collected are also more consistent with the actual situation.
Section snippets
Materials and methods
The data collection method and statistical method were presented in section 2.1 and section 2.2, respectively.
Results and discussion
The results of this study were firstly presented in this section, then, the results were discussed in details.
Conclusions
Particulate matter pollution has become an urgent issue in most areas in China because that the annual mean PM2.5 concentration has remained at a high level greater than 35 μg/m3 for a long period. In this paper we used the data of cancer incidence/mortality and PM2.5 concentration to carry out a preliminary exploration of the sex and urban-rural differences in the health effects of PM2.5 pollution in densely populated areas located in the southeastern side of Hu line of China. Pearson
Data sharing statement
The data used in this study all come from published articles, yearbooks and publicly-accessible websites, therefore, all the data are open to everyone. No additional data available.
Author contributions
H.W. contributed to all aspects of this study; Z.G. and Y.L. conducted data analysis. J. R. led this manuscript; L.C., K.C., and Y.L. gave some useful comments and suggestions to this work. All the authors reviewed the manuscript.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgments
This work was supported by the National Key Research and Development Program of China (No. 2016YFC0203300), the National Natural Science Foundation of China (No. 41601550) and the Open Project Program (No. KLME1508) of the Key Laboratory of Meteorological Disaster of Ministry of Education at Nanjing University of Information Science and Technology.
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