ASPO Abstracts
The impact of air pollution on the pulmonary morbidity of childhood and adolescent cancer survivors
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research, Molecular Epidemiology & Environment
Conference Year: 2018
Abstract Body:
Purpose: Pulmonary late health effects are a major cause of morbidity and mortality among childhood cancer survivors. Identifying contextual factors that increase the risk for pulmonary complications in this population can aid in the development of strategies to manage late effects. Air pollution is a severe threat to healthy children, but its effects on vulnerable childhood cancer survivors is not known. Methods: Using a case-crossover design, we identified the risk of pulmonary-related and primary pulmonary ED visits and inpatient hospitalizations, separately, from 1999 to 2015 due to exposure to fine particulate matter (PM2.5). We calculated the 2-day lagged PM2.5 averages for both the event and control days. Conditional logistic models controlled for temperature and were stratified by sex, race, and cancer-related variables (e.g. diagnosis, chemotherapy). We also compared risk estimates between survivors and a previously matched population sample using interaction terms. Results: We identified 242 survivors and 379 population sample that had at least one ED visit during the study period. Non-white survivors were at increased risk for primary pulmonary ED visits (OR=2.11, 95% CI=1.17-3.79), compared to both white survivors (OR=1.00, 95% CI=0.88-1.14, p=0.04) and the non-white population sample (OR=0.50, 95% CI=0.21-1.24, p=0.04). Survivors had a higher risk of pulmonary-related hospitalizations (OR=1.22, 95% CI=0.99-1.51) compared to the population sample (OR=0.78, 95% CI=0.56-1.09, p=0.04). Leukemia survivors had the highest risk for any pulmonary ED visit (OR=1.40, 95% CI=1.06-1.86) and inpatient hospitalization (OR=1.81, 95% CI=1.02-3.22) than any other cancer diagnosis. Survivors who were treated with chemotherapy had a significantly increased risk for primary pulmonary hospitalizations (OR=2.22, 95% CI=1.12-4.41). Conclusions: Air pollution poses a significant threat to the pulmonary health of childhood cancer survivors. Reducing exposure may provide one method of reduction the total burden the pulmonary complications in this population. Recommendations for avoiding pollution exposure should be included in future survivorship care guidelines.
Keywords: Survivorship, pulmonary morbidity, epidemiology