Smoky coal,tobacco smoking,and lung cancer risk in Xuanwei,China |
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Authors: | Christopher Kim Robert S Chapman Wei Hu Xingzhou He H Dean Hosgood Larry Z Liu Hong Lai Wei Chen Debra T Silverman Roel Vermeulen Linwei Tian Bryan Bassig Min Shen Yawei Zhang Shuangge Ma Nathaniel Rothman Qing Lan |
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Institution: | 1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, United States;2. College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand;3. Institute of Environmental Health and Engineering, Chinese Center for Disease Control and Prevention, Beijing 102206, China;4. Weill Medical College of Cornell University, New York, NY 10021, United States;5. Department of Radiology and Ophthalmology, The Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287, United States;6. Forest Laboratories, Inc., Jersey City, NJ 07311, United States;g Institute for Risk Assessment, Utrecht University, Utrecht, The Netherlands;h School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China;i School of Public Health, Yale University, New Haven, CT 06520, United States;j Interfaith Medical Center, Brooklyn, NY 11213, United States;k Albert Einstein College of Medicine, Bronx, NY 10461, United States |
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Abstract: | ObjectivesLung cancer rates in Xuanwei are the highest in China. In-home use of smoky coal has been associated with lung cancer risk, and the association of smoking and lung cancer risk strengthened after stove improvement. Here, we explored the differential association of tobacco use and lung cancer risk by the intensity, duration, and type of coal used.Materials and methodsWe conducted a population-based case-control study of 260 male lung cancer cases and 260 age-matched male controls. Odds ratios (OR) and 95% confidence interval (CI) for tobacco use was calculated by conditional logistic regression.ResultsUse of smoky coal was significantly associated with an increased risk of lung cancer, and tobacco use was weakly and non-significantly associated with lung cancer risk. When the association was assessed by coal use, the cigarette-lung cancer risk association was null in hazardous coal users and elevated in less hazardous smoky coal users and non-smoky coal users. The risk of lung cancer per cigarette per day decreased as annual use of coal increased (>0–3 tons: OR: 1.09; 95% CI: 1.03–1.17; >3 tons: OR: 0.99; 95% CI: 0.95–1.03). Among more hazardous coal users, attenuation occured at even low levels of usage (>0–3 tons: OR: 1.02; 95% CI: 0.91–1.14; >3 tons: OR: 0.94; 95% CI: 0.97–1.03).ConclusionWe found evidence that smoky coal attenuated the tobacco and lung cancer risk association in males that lived in Xuanwei, particularly among users of hazardous coal where even low levels of smoky coal attenuated the association. Our results suggest that the adverse effects of tobacco may become more apparent as China's population continues to switch to cleaner fuels for the home, underscoring the urgent need for smoking cessation in China and elsewhere. |
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Keywords: | Coal Tobacco Lung cancer Indoor air pollution China Global health Epidemiology |
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