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The effects of PM2.5 on lung cancer-related mortality in different regions and races: A systematic review and meta-analysis of cohort studies

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Abstract

Given the increasing environmental pollution around the world, air pollutants such as particulate matters (PM) have been becoming typical carcinogenic factors to cause lung cancer. The PM with aerodynamic diameter less than or equal to 2.5 μm (PM2.5) plays an important role in lung cancer mortality. However, effects of PM2.5 on the mortality of lung cancer patients have not been investigated well. The purpose of this study is to assess the associations between PM2.5 exposure and lung cancer-related mortality, by regions and races. This systematic review was developed and conducted according to PRISMA protocol. A comprehensive literature search for peer-reviewed studies published up to October 2021 was conducted using the electronic databases PubMed, EMBASE, and Cochrane Library. The identified records were carefully evaluated following the PICOS criteria. Relative risks (RRs) and 95% confidence interval (CI) of lung cancer mortality associated with PM2.5 were extracted and meta-analyzed. The Chi-squared test, Begg’s test, and Eggerr analysis were performed to assess the heterogeneity and publication bias. Sensitivity analysis and subgroup analysis were also conducted to make sure the authenticity and stability of the present study. In total, 16 studies met the inclusion criteria. For the overall effects of PM2.5 on lung cancer-related mortality, there was heterogeneity among the included studies (I2 = 62.30%, P < 0.01); thus, the random effects model was chosen to conduct related analysis. The pooled adjusted RR of lung cancer mortality associated with PM2.5 was 1.12 (95% CI: 1.09–1.15) for per 10 µg/m3 increase in PM2.5 concentrations. For different continents, the RRs of subgroup analysis in North-America, Asia, and Europe were 1.16 (1.09–1.22), 1.08 (CI: 1.07–1.09), and 1.14 (CI: 1.04–1.23), respectively. Subgroup analysis by race showed that for Mongoloid RR = 1.08 (1.07–1.09), and for Caucasoid RR = 1.13 (CI: 1.11–1.15). With per 10 µg/m3 increase in PM2.5, the mortality rate of Caucasoid lung cancer patients increased by 1.13 times, greater than that of the Mongoloid. Increase in PM2.5 concentrations is associated positively with the mortality of lung cancer patients. For different regions and races, the adverse effects of PM2.5 are discrepant. Our Findings can provide necessary evidence to protect public health further from air pollution.

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Acknowledgements

External funding for this study was obtained from the Natural science foundation of Henan Province of China (Grant NO. 202300410409) and Joint construction project of the Henan Province medical science and technology research plan (Grant NO. 2018020120). This study was also supported by funds from the National Natural Science Foundation of China (Grant NO. 31400752, 31570917) and the Key Program of Science & Technology of Henan Province (Grant NO. 162102310136). The funders played no role in the design, development, or interpretation of the present work. The views expressed in the article are those of the authors and do not necessarily reflect the position of the funding bodies.

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Author notes

  1. Tengfei Zhang, Wenhao Mao and Jinghong Gao contributed equally to this work.

Authors and Affiliations

  1. Oncology Department, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China

    Tengfei Zhang, Wenhao Mao & Wang Ma

  2. Center of Telemedicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China

    Jinghong Gao & Jie Zhao

  3. National Engineering Laboratory for Internet Medical Systems and Applications, Zhengzhou, 450052, Henan Province, China

    Jinghong Gao, Xiaoqin Song, Lifeng Li, Jinbo Li, Yunkai Zhai & Jie Zhao

  4. Department of Epidemiology, Henan Cancer Hospital and Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450003, Henan Province, China

    Xibin Sun

  5. Department of General ICU, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China

    Xianfei Ding

  6. Management Engineering School, Zhengzhou University, Zhengzhou, 450001, Henan Province, China

    Yunkai Zhai

  7. Medical School, Huanghe Science and Technology University, Zhengzhou, 450061, Henan Province, China

    Tengfei Zhang

  8. The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, Henan Province, China

    Tengfei Zhang

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  1. Tengfei Zhang
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Contributions

TFZ, JHG, WM, and JZ conceptualized, designed, and initiated the study. TFZ, WHM, and JHG drafted the initial manuscript. XQS, LFL, XBS, XFD, JBL, and YKZ involved in the development of methodology and discussion of article structure. All the authors take part in reviewing and revising the manuscript. All authors read and approved the final manuscript as submitted.

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Correspondence to Wang Ma or Jie Zhao.

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Zhang, T., Mao, W., Gao, J. et al. The effects of PM2.5 on lung cancer-related mortality in different regions and races: A systematic review and meta-analysis of cohort studies. Air Qual Atmos Health 15, 1523–1532 (2022). https://doi.org/10.1007/s11869-022-01193-0

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