Fine Particulate Matter and Respiratory Healthcare Encounters among Survivors of Childhood Cancers

Some chemotherapies that treat childhood cancers have pulmonary-toxic properties that increase risk for adverse respiratory-health outcomes. PM2.5 causes similar outcomes but its effect among pulmonary compromised cancer survivors is unknown. This case-crossover study identified the PM2.5-associated odds for primary-respiratory hospitalizations and emergency department visits among childhood cancer survivors in Utah. We compared risk among chemotherapy-treated survivors to a cancer-free sample. We calculated 3-day-average PM2.5 by ZIP code and county for event and control days. Conditional logistic regression estimated odds ratios. Models were stratified by cause of admission (infection, respiratory disease, asthma), previous chemotherapy, National Ambient Air Quality Standard (NAAQS), and other variables. Results are presented per 10 µg/m3 of PM2.5. 90% of events occurred at 3-day PM2.5 averages <35.4 µg/m3, the NAAQS 24-h standard. For survivors, PM2.5 was associated with respiratory hospitalizations (OR = 1.84, 95% CI = 1.13–3.00) and hospitalizations from respiratory infection (OR = 2.09, 95% CI = 1.06–4.14). Among chemotherapy-treated survivors, the PM2.5-associated odds of respiratory hospitalization (OR = 2.03, 95% CI = 1.14–3.61) were significantly higher than the cancer-free sample (OR = 0.84, 95% CI = 0.57–1.25). This is the first study to report significant associations between PM2.5 and respiratory healthcare encounters in childhood cancer survivors. Chemotherapy-treated survivors displayed the highest odds of hospitalization due to PM2.5 exposure and their risk is significantly higher than a cancer-free sample.

[1]  A. Kirchhoff,et al.  Statewide Treatment Center Referral Patterns for Adolescent and Young Adult Patients with Cancer in Utah. , 2018, Journal of adolescent and young adult oncology.

[2]  M. Fluchel,et al.  Respiratory emergency department use from diagnosis through survivorship in children, adolescents, and young adults with cancer , 2018, Cancer.

[3]  D. Jupiter,et al.  Emergency Department Visits by Adolescent and Young Adult Cancer Patients Compared with Pediatric Cancer Patients in the United States. , 2018, Journal of adolescent and young adult oncology.

[4]  David Kartchner,et al.  Short‐Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection , 2018, American journal of respiratory and critical care medicine.

[5]  Robert Paine,et al.  Short‐Term Air Pollution and Incident Pneumonia. A Case‐Crossover Study , 2017, Annals of the American Thoracic Society.

[6]  Antonella Zanobetti,et al.  Association of Short-term Exposure to Air Pollution With Mortality in Older Adults , 2017, JAMA.

[7]  C. Sweeney,et al.  Risk of hospitalization among survivors of childhood and adolescent acute lymphoblastic leukemia compared to siblings and a general population sample. , 2017, Cancer epidemiology.

[8]  Rochelle R. Smits‐Seemann,et al.  Infection‐related mortality in Hispanic and non‐Hispanic children with cancer , 2017, Pediatric blood & cancer.

[9]  C. Pui,et al.  Pulmonary Function after Treatment for Childhood Cancer. A Report from the St. Jude Lifetime Cohort Study (SJLIFE). , 2016, Annals of the American Thoracic Society.

[10]  Howard H. Chang,et al.  Assessment of neighbourhood-level socioeconomic status as a modifier of air pollution–asthma associations among children in Atlanta , 2016, Journal of Epidemiology & Community Health.

[11]  A. Jemal,et al.  Cancer treatment and survivorship statistics, 2016 , 2016, CA: a cancer journal for clinicians.

[12]  D. Mulrooney,et al.  Late Effects Surveillance Recommendations among Survivors of Childhood Hematopoietic Cell Transplantation: A Children's Oncology Group Report. , 2016, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[13]  William A Satariano,et al.  The impact of neighborhood social and built environment factors across the cancer continuum: Current research, methodological considerations, and future directions , 2015, Cancer.

[14]  R. Nelson,et al.  Statewide Longitudinal Hospital Use and Charges for Pediatric and Adolescent Patients With Cancer. , 2015, Journal of oncology practice.

[15]  G. Pratt,et al.  Traffic, Air Pollution, Minority and Socio-Economic Status: Addressing Inequities in Exposure and Risk , 2015, International journal of environmental research and public health.

[16]  S. Bhatia,et al.  Long-term pulmonary function in survivors of childhood cancer. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[17]  Siobhan M. Phillips,et al.  Survivors of Childhood Cancer in the United States: Prevalence and Burden of Morbidity , 2015, Cancer Epidemiology, Biomarkers & Prevention.

[18]  G. Armstrong,et al.  Infections among long‐term survivors of childhood and adolescent cancer: A report from the Childhood Cancer Survivor Study , 2014, Cancer.

[19]  E. Suzuki,et al.  Hourly differences in air pollution and risk of respiratory disease in the elderly: a time-stratified case-crossover study , 2014, Environmental Health.

[20]  Ken R. Smith,et al.  Risk of Hospitalization for Survivors of Childhood and Adolescent Cancer , 2014, Cancer Epidemiology, Biomarkers & Prevention.

[21]  Carol Stocks,et al.  Overview of Emergency Department Visits in the United States, 2011 , 2014 .

[22]  J. Spinelli,et al.  Late morbidity leading to hospitalization among 5‐year survivors of young adult cancer: A report of the childhood, adolescent and young adult cancer survivors research program , 2014, International journal of cancer.

[23]  T. Nawrot,et al.  Impact of air pollution on cystic fibrosis pulmonary exacerbations: a case-crossover analysis. , 2013, Chest.

[24]  L. Robison,et al.  Childhood cancer survivorship: an update on evolving paradigms for understanding pathogenesis and screening for therapy-related late effects , 2013, Current opinion in pediatrics.

[25]  R. Steele.  Managing infection in cancer patients and other immunocompromised children. , 2012, The Ochsner journal.

[26]  G. Armstrong,et al.  Hospitalization rates among survivors of childhood cancer in the childhood cancer survivor study cohort , 2012, Pediatric blood & cancer.

[27]  Scott L. DuVall,et al.  Evaluation of record linkage between a large healthcare provider and the Utah Population Database , 2012, J. Am. Medical Informatics Assoc..

[28]  G. Silcox,et al.  Wintertime PM2.5 concentrations during persistent, multi-day cold-air pools in a mountain valley , 2011 .

[29]  K. Ness,et al.  Pulmonary outcomes in survivors of childhood cancer: a systematic review. , 2011, Chest.

[30]  J. Schwartz,et al.  American Journal of Epidemiology Practice of Epidemiology Potential for Bias in Case-crossover Studies with Shared Exposures Analyzed Using Sas , 2022 .

[31]  James A Mulholland,et al.  Short-Term Associations Between Ambient Air Pollutants and Pediatric Asthma Emergency Department Visits , 2010, American journal of respiratory and critical care medicine.

[32]  John R. Hipp,et al.  Social disparities in health: disproportionate toxicity proximity in minority communities over a decade. , 2010, Health & place.

[33]  A. Tobías,et al.  Case-Crossover Analysis of Air Pollution Health Effects: A Systematic Review of Methodology and Application , 2010, Environmental health perspectives.

[34]  J. Schwartz,et al.  Modifiers of short-term effects of ozone on mortality in eastern Massachusetts - A case-crossover analysis at individual level , 2009, Environmental health : a global access science source.

[35]  G. Armstrong,et al.  Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[36]  B. Ostro,et al.  The Effects of Fine Particle Components on Respiratory Hospital Admissions in Children , 2008, Environmental health perspectives.

[37]  Harold E. Nelson,et al.  Site of oncologic specialty care for older adolescents in Utah. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[38]  C. Pope,et al.  Mortality Effects of Longer Term Exposures to Fine Particulate Air Pollution: Review of Recent Epidemiological Evidence , 2007, Inhalation toxicology.

[39]  C. Pope,et al.  Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution , 2006, Circulation.

[40]  Thomas Lumley,et al.  Case–Crossover Analyses of Air Pollution Exposure Data: Referent Selection Strategies and Their Implications for Bias , 2005, Epidemiology.

[41]  David M Stieb,et al.  Coarse Particulate Matter and Hospitalization for Respiratory Infections in Children Younger Than 15 Years in Toronto: A Case-Crossover Analysis , 2005, Pediatrics.

[42]  D. Green,et al.  Development of risk-based guidelines for pediatric cancer survivors: the Children's Oncology Group Long-Term Follow-Up Guidelines from the Children's Oncology Group Late Effects Committee and Nursing Discipline. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[43]  H. Brumberg,et al.  Ambient Air Pollution: Health Hazards to Children , 2013, Pediatrics.

[44]  C. Goss,et al.  Effect of ambient air pollution on pulmonary exacerbations and lung function in cystic fibrosis. , 2004, American journal of respiratory and critical care medicine.

[45]  J. Schwartz.  Air pollution and children's health. , 2004, Pediatrics.

[46]  S. Johnston,et al.  Air pollution and infection in respiratory illness. , 2003, British medical bulletin.

[47]  L. Robison,et al.  Pulmonary complications in survivors of childhood and adolescent cancer , 2002, Cancer.

[48]  T. Bateson,et al.  Selection Bias and Confounding in Case-Crossover Analyses of Environmental Time-Series Data , 2001, Epidemiology.

[49]  C. Pope,et al.  Particulate air pollution and daily mortality on Utah's Wasatch Front. , 1999, Environmental health perspectives.

[50]  W. Bilker,et al.  Factors influencing the optimal control-to-case ratio in matched case-control studies. , 1999, American journal of epidemiology.

[51]  Ateev Mehrotra,et al.  Emergency department visits for nonurgent conditions: systematic literature review. , 2013, The American journal of managed care.

[52]  G. Silcox,et al.  ' s personal copy Wintertime PM 2 . 5 concentrations during persistent , multi-day cold-air pools in a mountain valley , 2011 .

[53]  T. Szczepański,et al.  Decreased numbers of CD4+ T lymphocytes in peripheral blood after treatment of childhood acute lymphoblastic leukemia. , 2006, Leukemia research.

[54]  L. Ries,et al.  Cancer incidence and survival among children and adolescents: United States SEER Program 1975-1995. , 1999 .

[55]  T. Pelliniemi,et al.  Recovery of blood lymphocytes and serum immunoglobulins after treatment of solid tumors in children. , 1994, Pediatric hematology and oncology.