Identifying the role of short-term fine particulate matter air pollution in the heart and lung health outcomes of adolescent and young adult cancer survivors

项目摘要 癌症治疗的心血管（CV）和呼吸系统毒性是癌症患者发病的主要原因。 青少年和年轻成人（AYA）癌症幸存者。这种毒性可能会降低幸存者的中和能力 短期空气污染暴露增加的生理压力，导致心血管疾病的风险增加 和呼吸问题。然而，暴露于空气污染对AYA癌症幸存者的健康影响是 大部分未知。为了填补这一知识空白，我们将研究细颗粒物（PM2.5）是如何与 在被诊断患有五种最常见的AYA癌症的幸存者中， 犹他州（甲状腺、黑色素瘤、乳腺癌、淋巴瘤、睾丸癌），1997年至2016年（N= 9，382）。我们将 采用嵌套在这个预先存在的队列中的病例交叉设计来检查短期PM2.5对 从全州范围的出院定义的心血管和呼吸系统健康事件的风险， 急诊室数据和来自犹他州两个最大的卫生系统的门诊记录， 犹他州。利用犹他州人口数据库的数据，我们可以测量 地址级别。我们将：1）调查短期PM2.5与CV之间的关联， AYA癌症幸存者的呼吸系统健康事件，并比较幸存者的PM2.5相关健康风险 2）确定具有已知毒性的治疗是否改变了无癌样本的肿瘤发生率。 AYA癌症幸存者中短期PM2.5与CV和呼吸系统健康事件之间的关联。我们 将确定从诊断到随访结束的幸存者中这些关联的时间趋势。 将调查幸存者亚组，以确定吸烟、人种/种族和其他因素的差异 相关因素。犹他州由于冬季逆温和夏季野火，PM2.5污染严重。因为 美国空气污染的普遍性以及缺乏关于环境污染物如何影响的数据 癌症幸存者，这个项目代表了一个独特的机会，以确定空气污染是否是一个危险因素， AYA癌症幸存者的心血管和呼吸系统健康问题。我们的研究将提供一个深入的 检查癌症治疗，卫生保健利用和PM2.5暴露，并在既定的基础上扩大 通过增加空气污染对健康事件风险的作用的信息， 在癌症幸存者中。

PROJECT SUMMARY ABSTRACT Cardiovascular (CV) and respiratory toxicity from cancer treatments are a major causes of morbidity among adolescent and young adult (AYA) cancer survivors. This toxicity may reduce a survivor’s ability to neutralize the added physiologic stress from short-term air pollution exposure, leading to a higher risk for cardiovascular and respiratory problems. However, the health effects of exposure to air pollution on AYA cancer survivors are largely unknown. To fill this knowledge gap, we will examine how fine particulate matter (PM2.5) is associated with CV and respiratory health events among survivors diagnosed with the five most common AYA cancers in the state of Utah (thyroid, melanoma, breast, lymphoma, testicular) between 1997 and 2016 (N=9,382). We will employ a case-crossover design nested in this preexisting cohort to examine the effects of short-term PM2.5 on the risk for cardiovascular and respiratory health events defined from statewide hospital discharge and emergency department data, and outpatient records from Utah’s two largest health systems serving >85% of Utah. Using data from the Utah Population Database, we can measure residential PM2.5 exposure at the address level for our sample. We will: 1) Investigate the association between short-term PM2.5 and CV and respiratory health events among AYA cancer survivors, and compare survivors’ risk of PM2.5-associated health events to a cancer-free sample, and 2) Determine whether treatments with known toxicities modify the association between short-term PM2.5 and CV and respiratory health events among AYA cancer survivors. We will identify temporal trends in these associations among survivors from diagnosis to the end of follow-up. Subgroups of survivors will be investigated to determine differences by smoking, race/ethnicity, and other relevant factors. Utah has severe PM2.5 pollution due to winter inversions and summer wildfires. Because of the pervasiveness of air pollution in United States and the lack of data on how environmental pollutants affect cancer survivors, this project represents a unique opportunity to determine whether air pollution is a risk factor for cardiovascular and respiratory health problems among AYA cancer survivors. Our study will provide a deep examination of cancer treatment, health care utilization, and PM2.5 exposure, and expand upon the established perspective of survivorship research by adding information the role air pollution on the risk for health events among cancer survivors.