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Urban-rural status affects associations between overall environmental quality and cancer incidence
Citation:
Jagai, J., L. Messer, K. Rappazzo, C. Gray, S. Grabich, AND D. Lobdell. Urban-rural status affects associations between overall environmental quality and cancer incidence. American Public Health Association, New Orleans, LA, November 15 - 19, 2014.
Impact/Purpose:
This abstract utilized the EPA created Environmental Quality Index (EQI) in examination of adverse health outcomes. This study examined poor environmental quality in relation to cancer incidence at the county level.
Description:
The relationship between environmental conditions and human health varies by urbanicity. To estimate ambient environmental conditions, an Environmental Quality Index (EQI) for 2000-2005 was constructed by the Environmental Protection Agency using county-level data representing five environmental domains (air, water, land, built and sociodemographic) for each U.S. county (n=3141). Annual county-level, age-adjusted, cancer incidence rate data for 2006-2010 from Surveillance, Epidemiology, and End Results Program (SEER) was modeled with EQI quintiles. A random intercept multi-level linear regression clustered by state estimated fixed effects of EQI quintiles on all-site cancer incidence by sex, adjusted for percentage of population ever smoked (both sexes), and percentage to have had a mammogram and a pap smear (females). Results are reported as incidence rate difference (IRD) (95% confidence interval) comparing highest quintile/worst environmental quality to lowest/best environmental quality. 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)). Models were also stratified by four rural-urban continuum codes (RUCC) ranging from metropolitan urbanized (RUCC1) to rural (RUCC4). We observed positive associations between all cause cancer and EQI for most strata for 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 across all strata for 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)). The strength of association varied by urbanization with the strongest observed in the most urbanized areas for both sexes. In addition, we assessed associations with the top three causes of cancer for both sexes. Cancer incidence is associated with ambient environmental quality and the strength of association varies by level of urbanization, which has implications for public health programs intervention planning in more or less urban areas. This abstract does not necessarily reflect EPA policy.