19. Association of Air Quality with Incidence of Lung Cancer in a Large Urban/Suburban County

Objective: Lung cancer is the leading cause of cancer-related death in the United States. The incidence of lung cancer varies geographically, but the association of environmental inequities with these disparities requires further study. Our goal was to determine the association of air quality with lung cancer over a 40-year period in a large urban/suburban county, Wayne, in Michigan.
Methods: Lung cancer data was queried from the Michigan Cancer Registry from 1985 to 2018. Air pollutant data were obtained from the United States Environmental Protection Agency from 1980 to 2018. Patient demographics and cancer incidence were recorded. SatScan (V9.7) was used to detect spatial and space-time clusters of lung cancer cases. Sensitivity analysis on maximum percentage of population at risk was conducted by using the Gini index. Phillips-Perron Unit Root Test was used to test stationary levels of both lung and air data. Akaike information criterion was used to find max lag length and bounds testing was used to test significance of cointegration between lung incidence and air quality. Autoregressive Distributed Lag Model (ARDL) was used to identify relationships between air pollutants and incidence of lung cancer.
Results: A total of 58,882 new cases of lung cancer were identified in Wayne County. Mean age was 67.8 years. Thirty-seven percent of patients identified as a racial minority. The Gini index demonstrated 5% was the optimal scanning window for spatial clusters detection and a total of 7 significant clusters were detected in the county (Figure 1). Most clusters were in downtown Detroit and in the heavily industrialized downriver area. Both lung cancer incidence and carbon monoxide (CO) levels showed similarly decreasing temporal trends from 1985 to 2018. Phillips-Perron Unit Root Tests showed both lung cancer (p=0.1463) and CO (0.99) were non-stationary. The ARDL bound testing showed lung cancer and CO levels correlated with at least 1 cointegration with max lag length of 15 (F-statistic = 25.58).
Conclusions: Poor air quality correlated with lung cancer incidence over a four-decade period. A 6 year lag between changes in air quality and lung cancer incidence was observed. Specific regions in Wayne County demonstrated an elevated relative risk of lung cancer when correlated with air pollution. Resident health in areas with poor air quality may benefit from targeted interventions such as campaigns for lung cancer screening and reduction of pollutants.

Hollis Hutchings (1), Qiong Zhang (2), Sue Grady (3), Jessica Cox (4), Andrew Popoff (1), Carl Wilson (5), Shangrui Zhu (3), Ikenna Okereke (6), (1) Department of Surgery, Henry Ford Health, Detroit, MI, (2) Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, (3) Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, MI, (4) School of Medicine, University of Texas Medical Branch, Galveston, TX, (5) Department of Public Health Sciences, Henry Ford Health, Detroit, MI, (6) Henry Ford Health System, Detroit, MI

Harvey Pass

Invited Discussant

Harvey I.  Pass, M.D. is the Stephen E. Banner Professor of Thoracic Oncology and Vice Chair for Research for the Department of Cardiothoracic Surgery at the NYU Langone Medical Center and Professor, Department of Surgery.   Dr. Pass was Chief of Thoracic Oncology for the Surgery Branch, National Cancer Institute, Bethesda (1986-1996) and for the Karmanos Cancer Institute Detroit Michigan (1996-2005). Dr. Pass is an AOA member and has received the NIH Directors Award, the Wagner Medallion from the International Mesothelioma Interest Group, the Landon Research Award from the American Association for Cancer Research, the Pioneer Award from the Mesothelioma Foundation, the International Association for Lung Cancer Merit Award, and the AACR-Johnson & Johnson Lung Cancer Innovation MD Anderson/NYU Science Grants. Dr. Pass has published over 660 peer-reviewed papers, and edited 14 books including four editions of Lung Cancer: Principles and Practice and 2 editions of IASLC Thoracic Oncology. He has been continuously funded by either the NCI, DOD, CDC and other agencies since 1998 for the study of lung cancer and mesothelioma. His present interests include the development of blood based biomarkers for the diagnosis and prognosis of thoracic malignancies.

 

Hollis Hutchings

Abstract Presenter

Hollis Hutchings is a pediatric surgical critical care fellow at Children's Hospital of Michigan in Detroit, MI. Prior to her fellowship, she completed a 1 year clinical research fellowship focused on lung cancer outcomes research under the direction of Dr. Ikenna Okereke. Following her critical care fellowship, she will complete her surgical residency at Henry Ford Hospital in Detroit, MI. She looks forward to pursuing a career in general thoracic surgery in the future.

Specialties: Thoracic, Anatomy and Conditions, Lung--Cancer, Treatment/Procedure/Operation/Surgery, Lung--Cancer