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      Socioeconomic, environmental, and geographic factors and US lung cancer mortality, 1999–2009

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          Background: The American Cancer Society estimates that about 25% of all US cancer deaths will be due to lung cancer – more than from cancers of the colon, breast, and prostate combined.

          Methods: We ascertained county-level age-adjusted and age-specific death rates and 95% confidence intervals from the Centers for Disease Control and Prevention Compressed Mortality File. Multiple regression analyses were used to estimate the strength and direction of relationships between county poverty, smoking, fine particulate matter (PM 2.5) air pollution, and US Census divisions and race- and sex-specific lung cancer deaths.

          Results: Poverty, smoking, and particulate matter air pollution were positively and significantly related to lung cancer deaths among white men, but of these, only poverty and smoking were significantly associated with lung cancer deaths among white women. Residence in the South Atlantic, East South Central, and West South Central US Census divisions at the time of death was significantly associated with lung cancer deaths for both white men and white women. As with white men, poverty and smoking were associated with lung cancer deaths among black men, but of these, only adult smoking had a statistically significant association among black women.

          Conclusions: The results support the need for further research, particularly in high-risk areas, to better differentiate factors specific to race and sex and to understand the impact of local risk factors.

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          Most cited references 47

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          GeoDa: An Introduction to Spatial Data Analysis

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            Outdoor Particulate Matter Exposure and Lung Cancer: A Systematic Review and Meta-Analysis

            Background: Particulate matter (PM) in outdoor air pollution was recently designated a Group I carcinogen by the International Agency for Research on Cancer (IARC). This determination was based on the evidence regarding the relationship of PM2.5 and PM10 to lung cancer risk; however, the IARC evaluation did not include a quantitative summary of the evidence. Objective: Our goal was to provide a systematic review and quantitative summary of the evidence regarding the relationship between PM and lung cancer. Methods: We conducted meta-analyses of studies examining the relationship of exposure to PM2.5 and PM10 with lung cancer incidence and mortality. In total, 18 studies met our inclusion criteria and provided the information necessary to estimate the change in lung cancer risk per 10-μg/m3 increase in exposure to PM. We used random-effects analyses to allow between-study variability to contribute to meta-estimates. Results: The meta-relative risk for lung cancer associated with PM2.5 was 1.09 (95% CI: 1.04, 1.14). The meta-relative risk of lung cancer associated with PM10 was similar, but less precise: 1.08 (95% CI: 1.00, 1.17). Estimates were robust to restriction to studies that considered potential confounders, as well as subanalyses by exposure assessment method. Analyses by smoking status showed that lung cancer risk associated with PM2.5 was greatest for former smokers [1.44 (95% CI: 1.04, 1.22)], followed by never-smokers [1.18 (95% CI: 1.00, 1.39)], and then current smokers [1.06 (95% CI: 0.97, 1.15)]. In addition, meta-estimates for adenocarcinoma associated with PM2.5 and PM10 were 1.40 (95% CI: 1.07, 1.83) and 1.29 (95% CI: 1.02, 1.63), respectively. Conclusion: The results of these analyses, and the decision of the IARC Working Group to classify PM and outdoor air pollution as carcinogenic (Group 1), further justify efforts to reduce exposures to air pollutants that can arise from many sources. Citation: Hamra GB, Guha N, Cohen A, Laden F, Raaschou-Nielsen O, Samet JM, Vineis P, Forastiere F, Saldiva P, Yorifuji T, Loomis D. 2014. Outdoor particulate matter exposure and lung cancer: a systematic review and meta-analysis. Environ Health Perspect 122:906–911; http://dx.doi.org/10.1289/ehp.1408092
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              Individual- and area-level socioeconomic status variables as predictors of mortality in a cohort of 179,383 persons.

              The authors have studied whether area-level socioeconomic status predicts mortality independently of individual-level socioeconomic status in 179,383 persons in the American Cancer Society Nutrition Cohort, followed for mortality from 1992 to 2000 (17,383 deaths). They used an area-level variable based on census blocks that was an average of home value, income, education, and occupation. Education was the individual-level socioeconomic status variable. The authors studied socioeconomic status-mortality trends with each socioeconomic status variable adjusted for the other. For all causes, an individual's education was strongly and inversely associated with mortality; a weak but significant inverse trend was also present for area-level socioeconomic status. A similar pattern was seen for all-vascular disease. For all cancers, there was again a significant inverse trend with education but no trend with area-level socioeconomic status. Adjustment for conventional (non-socioeconomic status) individual-level risk factors diminished the effect of both socioeconomic status variables, although significant trends remained for men between education and all-cause, all-cancer, and all-vascular disease mortality. Study data indicate that the predictive value of area-level socioeconomic status variables varies by cause of death but is less important than individual-level socioeconomic status variables. Multivariate models that consider socioeconomic status as a potential confounder may not need to consider area-level socioeconomic status if data are available on individual-level education.

                Author and article information

                Family Medicine and Community Health
                Compuscript (Ireland )
                May 2017
                May 2017
                : 5
                : 1
                : 3-12
                1Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
                2Sociology Department, Tennessee State University, Nashville, TN, USA
                3Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
                4Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN, USA
                5Department of Political Science, Texas Tech University College of Arts and Sciences, Lubbock, TX, USA
                Author notes
                CORRESPONDING AUTHOR: Maria C. Mejia de Grubb, MD, MPH Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX 77030- 3411, USA E-mail: maria.mejiadegrubb@ 123456bcm.edu
                Copyright © 2017 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

                Self URI (journal page): http://fmch-journal.org/
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