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County-level environmental quality and associations with cancer incidence
Citation:
Jagai, J., L. Messer, K. Rappazzo, C. Gray, S. Grabich, AND D. Lobdell. County-level environmental quality and associations with cancer incidence. Presented at International Society for Environmental Epidemiology, Seattle, WA, August 24 - 28, 2014.
Impact/Purpose:
This abstract utilized the EPA created Environmental Quality Index in examination of adverse health outcomes. This study examined poor environmental quality in relation to cancer incidence at the county level.
Description:
Cancer has been associated with individual ambient environmental exposures such as PM2.5 and arsenic. However, the role of the overall ambient environment is not well-understood. A novel county-level Environmental Quality Index (EQI) was developed for all U.S. counties (n=3,141) from 2000-2005 data representing five environmental domains: air, water, land, built, and sociodemographic. We linked the EQI to Surveillance, Epidemiology, and End Results Program county-level annual age-adjusted cancer incidence rates for 2006-2010. Sex-stratified random intercept multi-level linear regression models, clustered by state, estimated fixed effects of EQI quintiles on all-site cancer incidence, adjusting for county percentage ever smoked (both sexes) and percentage to have had a mammogram and pap smear (females). Results are reported as incidence rate difference (95% confidence interval) comparing highest quintile/worst environmental quality to lowest/best. All cause cancer was strongly positively associated with EQI in both sexes (males: 32.60(16.28,48.91), females: 30.34(20.47,40.21)). In rural-urban continuum codes (RUCC)-stratified models, ranging from metropolitan urbanized (RUCC1) to rural (RUCC4), we observed positive associations between environmental quality and all-cause mortality for most strata of males (RUCC1: 27.01(11.29, 42.74); RUCC2: 11.29(-18.10,40.67), RUCC3: 25.66(3.85,47.47), RUCC4: -12.12(-50.65,26.42)) and all strata of females (RUCC1: 21.76(8.26,35.26); RUCC2: 2.34(1.62,3.06), RUCC3: 1.77(1.19,2.35), RUCC4: 2.06(0.93,3.19)). Associations in the most urbanized areas were strongest. We also examined the top 3 causes of cancer in each sex. Subtype incidence demonstrated results similar to all-cause cancer. Associations by individual environmental domains will also be presented. These results suggest that environmental exposures can greatly influence cancer risk, and associations vary by urbanicity. This abstract does not necessarily reflect EPA policy.