Cancer mortality risk, fine particulate air pollution, and smoking in a large, representative cohort of US adults

Purpose Air pollution and smoking are associated with various types of mortality, including cancer. The current study utilizes a publicly accessible, nationally representative cohort to explore relationships between fine particulate matter (PM 2.5 ) exposure, smoking, and cancer mortality. Methods National Health Interview Survey and mortality follow-up data were combined to create a study population of 635,539 individuals surveyed from 1987 to 2014. A sub-cohort of 341,665 never-smokers from the full cohort was also created. Individuals were assigned modeled PM 2.5 exposure based on average exposure from 1999 to 2015 at residential census tract. Cox Proportional Hazard models were utilized to estimate hazard ratios for cancer-specific mortality controlling for age, sex, race, smoking status, body mass, income, education, marital status, rural versus urban, region, and survey year. Results The risk of all cancer mortality was adversely associated with PM 2.5 (per 10 µg/m 3 increase) in the full cohort (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08–1.22) and the never-smokers’ cohort (HR 1.19, 95% CI 1.06–1.33). PM 2.5 -morality associations were observed specifically for lung, stomach, colorectal, liver, breast, cervix, and bladder, as well as Hodgkin lymphoma, non-Hodgkin lymphoma, and leukemia. The PM 2.5 -morality association with lung cancer in never-smokers was statistically significant adjusting for multiple comparisons. Cigarette smoking was statistically associated with mortality for many cancer types. Conclusions Exposure to PM 2.5 air pollution contributes to lung cancer mortality and may be a risk factor for other cancer types. Cigarette smoking has a larger impact on cancer mortality than PM 2.5 , but is associated with similar cancer types.