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Overall environmental quality and lung cancer survival
Citation:
Jagai, J., A. Patel, C. Gray, L. Messer, K. Rappazzo, M. Jimenez, S. Deflorio-Barker, AND D. Lobdell. Overall environmental quality and lung cancer survival. American Public Health Association (APHA) Conf, Atlanta, GA, November 04 - 08, 2017.
Impact/Purpose:
The purpose of this study was to examine the impact of cumulative environmental exposures on lung cancer survival. This study utilized the Environmental Quality Index
Description:
Lung cancer is one of the most prevalent and lethal cancers in the United States. While individual environmental exposures have been associated with lung cancer incidence, the impact of cumulative environmental exposures on survival is not understood. We used the U.S. Environmental Protection Agency’s (USEPA) Environmental Quality Index (EQI) as a measure of cumulative environmental exposures. The EQI is a composite measure of over 200 environmental factors across five environmental domains (air, water, land, sociodemographic, and built environment) for the years 2000-2005. Individual-level data on persons diagnosed with lung cancer from 2000-2005 (n=272,371) was abstracted from the Surveillance, Epidemiology, and End Results Program (SEER), including survival time (through Dec. 31, 2013) and co-variates (age, marital status, sex, histology, stage, race, primary site surgery, radiation as part of first course of treatment). This information was linked to the EQI based on county of residence. We used Cox Proportional Hazards to estimate hazard ratios (HR) and 95% confidence intervals, modeling the EQI and domain-specific indices as quartiles (Q4=worst environment). We adjusted for individual-level covariates and stratified by stage at diagnosis (local, regional, distant) and rural-urban status (metropolitan urbanized, non-metropolitan urbanized, less urbanized, thinly populated). Prior to stratification, overall EQI and individual domains showed mostly null or slight positive or negative associations comparing highest to lowest index quartile (Overall EQI Q4: HR=0.92(0.89,0.95). After stratification, we observed mostly positive associations for the individual domains across different strata (e.g. Non-Metro Urban, Local Stage at diagnosis, Air Domain Q4: HR=1.21(1.11,1.33); Metro Urban, Local Stage at diagnosis, Sociodemographic Domain Q4: HR=1.08(1.03,1.13)). These positive associations were primarily in urban areas and at the localized cancer stage. The results suggest an association between poor environmental quality and decreased lung cancer survival, with potential variation by rural-urban status and stage at diagnosis. This abstract does not necessarily reflect EPA policy. Learning objectives:After the presentation/poster session, the attendant will be able to:1. Describe the association between overall environmental quality and lung cancer survival.2. Understand how the association between overall environmental quality and lung cancer survival varies by urban/rural status. 3. Understand how the association between overall environmental quality and lung cancer survival varies by stage at diagnosis.