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Identification of high-risk areas of cancer, referred to as spatial clusters, can inform targeted policies for cancer control. Although cancer cluster detection could be affected by various geographic characteristics including sociodemographic and environmental factors which impacts could also vary over time, studies accounting for such influence remain limited. This study aims to assess the role of geographic characteristics in the spatial cluster detection for lung and stomach cancer over an extended period. We obtained sex-specific age-standardized incidence and mortality rates of lung and stomach cancer as well as geographic characteristics across 233 districts in South Korea for three five-year periods between 1999 and 2013. We classified geographic characteristics of each district into four categories: demography, socioeconomic status, behaviors, and physical environments. Specifically, we quantified physical environments using measures of greenness, concentrations of particulate matter and nitrogen dioxide, and air pollution emissions. Finally, we conducted cluster detection analyses using weighted normal spatial scan statistics with the residuals from multiple regression analyses performed with the four progressive sets of geographic attributes. We found that the size of clusters reduced as we progressively adjusted for geographic covariates. Among the four categories, physical environments had the greatest impact on the reduction or disappearance of clusters particularly for lung cancer consistently over time. Whereas older population affected a decrease of lung cancer clusters in the early period, the contribution of education was large in the recent period. The impact was less clear in stomach cancer than lung cancer. Our findings highlight the importance of geographic characteristics in explaining the existing cancer clusters and identifying new clusters, which jointly provides practical guidance to cancer control. • Spatial cluster detection of cancer by accounting for geographic characteristics. • Reduction or disappearance of lung cancer clusters by physical environments. • Large impact of greenness and air pollution emissions in recent periods. • Less impacts of geographic characteristics on stomach cancer than lung cancer. [ABSTRACT FROM AUTHOR]

Background We investigated if certain persistent organic pollutants (POPs), namely polychlorinated biphenyls (PCBs) and organochlorine (OC) pesticides, predicted total, cardiovascular disease (CVD), and cancer mortality among the elderly, with the hypothesis that associations differ by the amount of fat mass. Methods We studied serum concentrations of 11 PCBs in 633 elders (age≥70 years) and of 5 OC pesticides in 675 elders within the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Mean follow-up was 4.1-years. Results Neither PCBs nor OC pesticides were associated with total mortality when fat mass was not considered in analyses. However, associations of PCBs and OC pesticides with total mortality depended on fat mass ( P interaction <0.01 and 0.06, respectively). PCBs associated inversely with total mortality for high fat mass, but not for lower fat mass. On the contrary, OC pesticides associated positively with total mortality for low fat mass and this association weakened at higher fat mass. The interaction was also observed with CVD mortality. In elders with low fat mass, higher PCBs associated with 2–3 fold higher risk of CVD mortality, while this association was absent in elders with more fat mass ( P interaction =0.03). The positive association between OC pesticides and CVD mortality was also observed only among elderly with low fat mass ( P interaction =0.03). Conclusions The possibility of interaction between POPs and the amount of fat mass on risk of mortality from chronic diseases is clinically important in modern societies with an obesity epidemic and requires confirmation in other studies with larger sample size. [ABSTRACT FROM AUTHOR]

Since 1971, the annual National Ambient Air Quality Standard (NAAQS) for nitrogen dioxide (NO 2) has remained at 53 ppb, the impact of long-term NO 2 exposure on mortality is poorly understood. We examined associations between long-term NO 2 exposure (12-month moving average of NO 2) below the annual NAAQS and cause-specific mortality among the older adults in the U.S. Cox proportional-hazard models were used to estimate Hazard Ratio (HR) for cause-specific mortality associated with long-term NO 2 exposures among about 50 million Medicare beneficiaries living within the conterminous U.S. from 2001 to 2008. A 10 ppb increase in NO 2 was associated with increased mortality from all-cause (HR: 1.06; 95% CI: 1.05–1.06), cardiovascular (HR: 1.10; 95% CI: 1.10–1.11), respiratory disease (HR: 1.09; 95% CI: 1.08–1.11), and cancer (HR: 1.01; 95% CI: 1.00–1.02) adjusting for age, sex, race, ZIP code as strata ZIP code- and state-level socio-economic status (SES) as covariates, and PM 2.5 exposure using a 2-stage approach. NO 2 was also associated with elevated mortality from ischemic heart disease, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, and lung cancer. We found no evidence of a threshold, with positive and significant HRs across the range of NO 2 exposures for all causes of death examined. Exposure-response curves were linear for all-cause, supra-linear for cardiovascular-, and sub-linear for respiratory-related mortality. HRs were highest consistently among Black beneficiaries. Long-term NO 2 exposure is associated with elevated risks of death by multiple causes, without evidence of a threshold response. Our findings raise concerns about the sufficiency of the annual NAAQS for NO 2. [Display omitted] • Long-term NO 2 exposure was associated with increased mortality from cardiovascular disease, respiratory disease, and cancer. • NO 2 -mortality associations were without a lower threshold, suggesting that any long-term exposure is associated with mortality risk. • The increased mortality associated with NO 2 exposure was considerably higher among the Black beneficiaries than other races. [ABSTRACT FROM AUTHOR]

Abstract: Few studies investigated the association between chronic arsenic exposure and the mortality of cancers by estimating individual urinary arsenic methylation profiles. Therefore, we compared with the general population in Taiwan to calculate the standardized mortality ratio (SMR) in arseniasis-endemic area of Taiwan from 1996 to 2010 and evaluated the dose-response relationships between environmental arsenic exposure indices or urinary arsenic profiles and the mortality of cause-specific cancer. A cohort of 1563 residents was conducted and collected their urine sample and information regarding arsenic exposure from a questionnaire. All-cause death was identified using the National Death Registry of Taiwan. Urinary arsenic profiles were measured using high performance liquid chromatography–hydride generator–atomic absorption spectrometry. We used Cox proportional hazard models to evaluate the mortality risks. In results, 193 all-site cancer deaths, and 29, 71, 43 deaths respectively for liver, lung and bladder cancers were ascertained. The SMRs were significantly high in arseniasis-endemic areas for liver, lung, and bladder cancers. People with high urinary InAs% or low DMA% or low secondary methylation index (SMI) were the most likely to suffer bladder cancer after adjusting other risk factors. Even stopping exposure to arsenic from the artesian well water, the mortality rates of the residents were higher than general population. Finally, urinary InAs%, DMA% and SMI could be the potential biomarkers to predict the mortality risk of bladder cancer. [Copyright &y& Elsevier]

Considering the serious health burden caused by adverse weather events, increasing researches focused on the relationship between temperature variability (TV) and cause-specific mortality, but its association with cancer was not well explored. We aimed to investigate the impacts of TV on cancer mortality and examine the modifying effects of weather type and geographical location as well as other characteristics. Daily city-specific data of cancer deaths, mean temperature (Tmean), maximum and minimum temperatures (Tmax and Tmin), relative humidity (RH), rainfall, and air pollutants were collected during 2016–2017 in 13 cities in Jiangsu Province, China. TV 0-t was defined as the standard deviation of the daily Tmax and Tmin on the exposure 0-t days. A two-stage analysis was applied. First, a time-stratified case-crossover design was used to examine the odds ratio (OR) and attributable fraction of cancer mortality per 1 °C increase in TV by adjusting for potential confounders. Random effect meta-analysis was used to summarize the pooled ORs. Second, stratified analysis was performed for weather type, geographical location, demographics, and other city-level characteristics. The weather was defined as four types according to days during warm or cold season combined with high or low RH. A total of 303670 cases were included in our study. Meta-analysis showed that the ORs of cancer mortality per 1 °C increase in TV 0-t significantly increased and peaked in TV 0-2 (OR=1.0098, 95% CI: 1.0039–1.0157). The attributable fraction of TV 0-2 on cancer mortality was 4.74%, accounting for 14395 deaths in the study period. Significant ORs of TV-related cancer mortality were found during the warm season combined with high RH and in the northern region of Jiangsu. Susceptible groups of TV-related cancer mortality were identified as female patients, patients aged 45–65 years, and those living in cities with lower per capita green area. TV can significantly increase the risk of cancer mortality, especially during warm and humid days and in the northern region of Jiangsu. Findings are of great significance to formulate urban planning, resource allocation, and health intervention to prolong the life of cancer patients. • Temperature variability (TV) significantly increased the risk of cancer mortality. • TV-related cancer deaths were higher on warm and humid days and northern region. • Females patients and patients aged 45–65 years were more susceptible to TV. • A high level of per capita green area decreased the impacts of TV on cancer death. [ABSTRACT FROM AUTHOR]