Long-term exposure to traffic-related air pollution and cancer among survivors of myocardial infarction: A 20-year follow-up study

• Published in: European journal of preventive cardiology 2017-01, Vol.24 (1), p.92-102
• Main Authors: Cohen, Gali, Levy, Ilan, Yuval, Kark, Jeremy D, Levin, Noam, Broday, David M, Steinberg, David M, Gerber, Yariv
• Format: Article
• Language: English
• Subjects: Aged; Air Pollutants - adverse effects; Air Pollution - adverse effects; Cause of Death; Chi-Square Distribution; Environmental Monitoring - methods; Female; Humans; Incidence; Inhalation Exposure - adverse effects; Israel - epidemiology; Linear Models; Longitudinal Studies; Male; Markov Chains; Middle Aged; Monte Carlo Method; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocardial Infarction - mortality; Neoplasms - chemically induced; Neoplasms - diagnosis; Neoplasms - epidemiology; Neoplasms - mortality; Nitrogen Oxides - adverse effects; Proportional Hazards Models; Prospective Studies; Risk Assessment; Risk Factors; Survivors; Time Factors; Vehicle Emissions
• ISSN: 2047-4873; 2047-4881
• DOI: 10.1177/2047487316669415

Background Previous studies suggested a carcinogenic effect of exposure to traffic-related air pollution. Recently, higher rates of cancer incidence were observed among myocardial infarction survivors compared with the general population. We examined the association between chronic exposure to nitrogen oxides, a proxy measure for traffic-related air pollution, and cancer incidence and mortality in a cohort of myocardial infarction patients. Methods Patients aged ≤65 years admitted to hospital in central Israel with a first myocardial infarction in 1992–1993 were followed to 2013 for cancer incidence and cause-specific mortality. Data on sociodemographic and cancer risk factors were obtained, including time-varying information on smoking. Using land use regression models, annual averages of nitrogen oxides during follow-up were estimated individually according to home addresses. Cox proportional hazards models were constructed to study the relationships with cancer outcomes. Results During a mean follow-up of 16 (SD 7) years, 262 incident cancers and 105 cancer deaths were identified among 1393 cancer-free patients at baseline (mean age 54 years; 81% men). In adjusted models, a 10 ppb increase in mean nitrogen oxide exposure was associated with a hazard ratio (HR) of 1.06 (95% confidence interval (CI) 0.96–1.18) for cancer incidence and HR of 1.08 (95% CI 0.93–1.26) for cancer mortality. The association with lung, bladder, kidney or prostate cancer (previously linked to air pollution) was stronger (HR 1.16; 95% CI 1.00–1.33). Conclusions Chronic exposure to traffic-related air pollution may constitute an environmental risk factor for cancer post-myocardial infarction. Variation in the strength of association between specific cancers needs to be explored further.