Elsevier

Environmental Research

Volume 170, March 2019, Pages 243-251
Environmental Research

Incidence and mortality for respiratory cancer and traffic-related air pollution in São Paulo, Brazil

https://doi.org/10.1016/j.envres.2018.12.034Get rights and content

Highlights

  • Traffic-related air pollution was associated with respiratory cancer in São Paulo.

  • The effect included incidence and mortality.

  • A statistically significant exposure-response gradient was observed.

  • The rates were more pronounced in the lowest SES index.

Abstract

Background

Multiple lines of evidence have associated exposure to ambient air pollution with an increased risk of respiratory malignancies. However, there is a dearth of evidence from low-middle income countries, including those within South America, where the social inequalities are more marked.

Objectives

To quantify the association between exposures to traffic related air pollution and respiratory cancer incidence and mortality within São Paulo, Brazil. Further, we aim to investigate the role of socioeconomic status (SES) upon these outcomes.

Methods

Cancer incidence between 2002 and 2011 was derived from the population-based cancer registry. Mortality data (between 2002 and 2013) was derived from the Municipal Health Department. A traffic density database and an annual nitrogen dioxide (NO2) land use regression model were used as markers of exposure. Age-adjusted Binomial Negative Regression models were developed, stratifying by SES and gender.

Results

We observed an increased rate of respiratory cancer incidence and mortality in association with increased traffic density and NO2 concentrations, which was higher among those regions with the lowest SES. For cancer mortality and traffic exposure, those in the most deprived region, had an incidence rate ratio (IRR) of 2.19 (95% CI: 1.70, 2.82) when comparing the highest exposure centile (top 90%) to the lowest (lowest 25%). By contrast, in the least deprived area, the IRR for the same exposure contrast was.1.07 (95% CI: 0.95, 1.20). For NO2 in the most deprived regions, the IRR for cancer mortality in the highest exposed group was 1.44 (95% CI: 1.10, 1.88) while in the least deprived area, the IRR for the highest exposed group was 1.11 (95% CI: 1.01, 1.23).

Conclusions

Traffic density and NO2 were associated with an increased rate of respiratory cancer incidence and mortality in São Paulo. Residents from poor regions may suffer more from the impact of traffic air pollution.

Introduction

Ambient air pollution has been well established as a risk factor in the development of lung cancer, with the International Agency for Research on Cancer (IARC) classifying ambient air pollution and its associated particulate matter as a Group 1 carcinogen (IARC, 2013). Further, diesel engine exhaust or emissions are also classified as Group 1 carcinogens based on sufficient evidence of increased risk of lung cancer (IARC, 2012).

The bulk of the evidence investigating air pollution and lung cancer risk has been derived from high-income countries, predominantly in North America and Europe (Beelen et al., 2008a, Hamra et al., 2014, Hystad et al., 2013, Olsson et al., 2011, Puett et al., 2014, Raaschou-Nielsen et al., 2016, Raaschou-Nielsen et al., 2013, Villeneuve et al., 2014, Yorifuji et al., 2016). With the exception of several studies conducted mainly in China (Li et al., 2018, Shao et al., 2019, Yue et al., 2017), there is a dearth of evidence from low and middle income countries (LMIC). Furthermore, a large number of recent studies only utilized mortality data and long-term exposure to conduct their risk analyses (Beelen et al., 2014, Bidoli et al., 2016, Carugno et al., 2016, Crouse et al., 2015, Fischer et al., 2015, Hansell et al., 2016, Lepeule et al., 2012, Yorifuji et al., 2013, Zhou et al., 2015) with relatively few studies using incidence data, with the notable exception of the ESCAPE study which analyzed air pollution and lung cancer incidence in European cohorts (Raaschou-Nielsen et al., 2013).

Previous studies have established that socioeconomic status (SES) can influence the exposure and effects of air pollution (Cesaroni et al., 2010, Deguen and Zmirou-Navier, 2010, Habermann et al., 2014, Havard et al., 2009, Pearce et al., 2006). In 2009, the Environmental Protection Agency (EPA) initiated activities to formalize and ensure that the development of regulations, in the context of environmental and health impacts, take into account environmental justice (Nweke et al., 2011). Thus, when evaluating the relationship between living near areas of high traffic density and exposure to air pollution, a socioeconomic analysis should be considered. According to Galobardes et al. (2007), socioeconomic measures on an area-level are specifically needed to investigate whether these aspects of the place where a person lives affects the person's health. Moreover, understanding the role of SES as an important factor of susceptibility to ambient air pollution is essential to the process of implementing air quality control programs (Samet and White, 2004).

To address the dearth of studies in LMICs and to evaluate the impact of a wider contrast in SES, we performed a study in São Paulo, where a broad contrast in SES exists, to quantify the association between incidence and mortality for respiratory cancers and traffic-related air pollution and its interaction with SES.

Section snippets

Study area

The municipality of São Paulo occupies an area of 1521.11 km2 and has a population of approximately 12 million, making it the largest and most populous city in Brazil (Fig. 1). It is the capital of the state of São Paulo, which is considered the main national industrial center, with a Gross Domestic Product (GDP) per capita of approximately 16 thousand dollars in 2014 (IBGE, 2017). It has a fleet of approximately 8.6 million vehicles (of which approximately 16% are diesel operated) which

Results

Of the incident cases, 21% were laryngeal malignancies (C32), 78% were bronchial and lung malignancies (C34) and less than 1% were tracheal malignancies (C33). Of the mortalities, 15% were related to laryngeal malignancies, 85% bronchial and lung malignancies, and less than 1% tracheal malignancies.

Fig. 2a and b show the traffic density and annual NO2 estimates for São Paulo respectively. In general, traffic density and NO2 were higher in the central regions than the peripheral regions and were

Discussion

This study found an increased rate of respiratory cancer incidence and mortality in association with an increase in traffic density and NO2 concentrations within São Paulo. Stratifying by categories of MHDI showed that the degree of this relationship was even more pronounced in the lowest, indicating that residents of these regions may suffer more from the effects of traffic-related air pollution.

Our results are generally consistent with previous work, although the larger IRRs observed here may

Conclusions

The results of this study show that traffic density and ambient NO2 concentrations were associated with an increased rate of incidence and death for respiratory cancers in São Paulo. This study also indicates that those with lower SES were more vulnerable to the development of respiratory cancers due to traffic pollution. While the reasons for this are not completely clear, it indicates an important at-risk group that warrants additional focus by policy makers and health providers.

Acknowledgments

We thank the National Council for Scientific and Technological Development (CNPq) – Process number 475362/2012-8, and the State of São Paulo Research Foundation (FAPESP) – FAPESP/PPP-SUS 2006/61616-5.

We also acknowledge the São Paulo Municipal Population-Based Cancer Registry and the São Paulo Municipal Health Department for the availability of the databases and the Institute for Risk Assessment Sciences – IRAS, Utrecht University, The Netherlands, as an important partner in this work.

Funding

This work was supported by the Brazilian Ministry of Education – Coordination for the Improvement of Higher Education Personnel (CAPES), Adeylson G. Ribeiro/PDSE Program/Process number 88881.134281/2016-01.

References (61)

  • A.A. Abajobir et al.

    Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of disease study 2016

    Lancet

    (2017)
  • M.C. Arcaya et al.

    Inequalities in health: definitions, concepts, and theories

    Glob. Health Action

    (2015)
  • R. Beelen et al.

    Long-term exposure to traffic-related air pollution and lung cancer risk

    Epidemiology

    (2008)
  • R. Beelen et al.

    Long-term effects of traffic-related air pollution on mortality in a Dutch cohort (NLCS-AIR study)

    Environ. Heal. Perspect.

    (2008)
  • E. Bidoli et al.

    Residential proximity to major roadways and lung cancer mortality. Italy, 1990–2010: an observational study

    Int. J. Environ. Res. Public Health

    (2016)
  • M.R.A. Cardoso et al.

    Estudo da relação entre doenças respiratórias e cardiovasculares e poluição veicular nas regiões metropolitanas do estado de São Paulo com a finalidade de subsidiar a estruturação das atividades do Programa de Vigilância em Saúde e Qualidade do Ar. São Paulo

    (2010)
  • G. Cesaroni et al.

    Long-term exposure to urban air pollution and mortality in a cohort of more than a million adults in Rome

    Environ. Heal. Perspect.

    (2013)
  • G. Cesaroni et al.

    Socioeconomic position and health status of people who live near busy roads: the Rome Longitudinal Study (RoLS)

    Environ. Heal.

    (2010)
  • CETESB - Companhia Ambiental do Estado de São Paulo, 2017. Qualidade do ar no estado de São Paulo 2016. São Paulo. URL...
  • F. Chen et al.

    Lung adenocarcinoma incidence rates and their relation to motor vehicle density

    Cancer Epidemiol. Biomark. Prev.

    (2009)
  • D.L. Crouse et al.

    Ambient PM2.5, O3, and NO2 exposures and associations with mortality over 16 years of follow-up in the Canadian Census Health and Environment Cohort (CanCHEC)

    Environ. Health Perspect.

    (2015)
  • S. Deguen et al.

    Social inequalities resulting from health risks related to ambient air quality--A European review

    Eur. J. Public Health

    (2010)
  • DETRAN. Departamento Estadual de Trânsito de São Paulo

    Frota de veículos em São Paulo

    (2017)
  • Environmental Systems Research Institute (ESRI), 2008. ArcGis Release...
  • P.H. Fischer et al.

    Air Pollution and Mortality in Seven Million Adults: the Dutch Environmental Longitudinal Study (DUELS)

    Environ. Health Perspect.

    (2015)
  • B. Galobardes et al.

    Measuring socioeconomic position in health research

    Br. Med. Bull.

    (2007)
  • M. Habermann et al.

    Socioeconomic inequalities and exposure to traffic-related air pollution in the city of Sao Paulo, Brazil

    Cad Saude Publica

    (2014)
  • G.B. Hamra et al.

    Outdoor particulate matter exposure and lung cancer: a systematic review and meta-analysis

    Environ. Health Perspect.

    (2014)
  • G.B. Hamra et al.

    Lung cancer and exposure to nitrogen dioxide and traffic: a systematic review and meta-analysis

    Environ. Health Perspect.

    (2015)
  • A. Hansell et al.

    Historic air pollution exposure and long-term mortality risks in England and Wales: prospective longitudinal cohort study

    Thorax

    (2016)
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