Invisible Foes: How Air Pollution and Lifestyle Conspire in the Rise of Colorectal Cancer.

IF 7.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

QJM: An International Journal of Medicine Pub Date : 2025-04-25 DOI:10.1093/qjmed/hcaf074

Di Zhao, Meng Zhu

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引用次数: 0

Abstract

Background: Air pollution is a recognized risk factor for colorectal cancer (CRC), but its specific impact in China, especially among older populations, remains underexplored.

Methods: We used multivariable Cox models with restricted cubic splines (RCS) to assess the dose-response relationship between air pollution and CRC risk. Subgroup analyses by sex, residence (urban vs. rural), and pre-existing health conditions (hypertension, diabetes) were conducted. Mediation analysis assessed the indirect effects of smoking and alcohol on CRC risk.

Results: Exposure to PM2.5, NO2, and SO2 was linked to increased CRC risk. For PM2.5, the hazard ratio (HR) for the highest exposure quartile was 2.35 (95% CI: 1.85-3.03) in urban residents and 1.93 (95% CI: 1.45-2.56) in rural residents. For NO2, the HR per 10 µg/m³ increase was 1.82 (95% CI: 1.56-2.12), and for SO2, it was 1.56 (95% CI: 1.31-1.85). Smoking mediated 14.03% of the effect of PM2.5 on CRC, while alcohol consumption mediated 5.12%. Subgroup analysis showed higher susceptibility in females (HR = 3.47, 95% CI: 2.63-4.63) compared to males (HR = 2.98, 95% CI: 2.25-3.79), and individuals with hypertension (HR = 2.67, 95% CI: 1.98-3.60) or diabetes (HR = 2.10, 95% CI: 1.55-2.86) were at significantly higher risk.

Conclusions: Long-term exposure to PM2.5, NO2, and SO2 significantly increases CRC risk in older Chinese adults, with smoking as a key mediator. Females, urban residents, and those with hypertension or diabetes are especially vulnerable. Public health strategies should focus on reducing pollution in these high-risk groups.

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看不见的敌人：空气污染和生活方式如何共同导致结直肠癌的上升。

背景：空气污染是公认的结直肠癌（CRC）的危险因素，但其在中国的具体影响，特别是在老年人群中，仍未得到充分研究。方法：采用限制三次样条（RCS）多变量Cox模型评估空气污染与结直肠癌风险之间的剂量-反应关系。按性别、居住地（城市与农村）和既往健康状况（高血压、糖尿病）进行亚组分析。中介分析评估了吸烟和饮酒对结直肠癌风险的间接影响。结果：暴露于PM2.5、NO2和SO2与结直肠癌风险增加有关。对于PM2.5，城市居民最高暴露四分位数的风险比（HR）为2.35 (95% CI: 1.85-3.03)，农村居民为1.93 （95% CI: 1.45-2.56）。对于NO2，每增加10µg/m³的HR为1.82 (95% CI: 1.56-2.12)，对于SO2， HR为1.56 （95% CI: 1.31-1.85）。吸烟介导PM2.5对结直肠癌影响的14.03%，而饮酒介导5.12%。亚组分析显示，与男性（HR = 2.98, 95% CI: 2.25-3.79）相比，女性（HR = 3.47, 95% CI: 2.63-4.63）的易感性更高，高血压患者（HR = 2.67, 95% CI: 1.98-3.60）或糖尿病患者（HR = 2.10, 95% CI: 1.55-2.86）的易感性明显更高。结论：长期暴露于PM2.5、NO2和SO2显著增加中国老年人结直肠癌的风险，吸烟是一个关键的中介因素。女性、城市居民以及患有高血压或糖尿病的人尤其容易受到影响。公共卫生战略应侧重于减少这些高危人群的污染。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

QJM: An International Journal of Medicine 医学-医学：内科

CiteScore

6.90

自引率

5.30%

发文量

263

审稿时长

4-8 weeks

期刊介绍： QJM, a renowned and reputable general medical journal, has been a prominent source of knowledge in the field of internal medicine. With a steadfast commitment to advancing medical science and practice, it features a selection of rigorously reviewed articles. Released on a monthly basis, QJM encompasses a wide range of article types. These include original papers that contribute innovative research, editorials that offer expert opinions, and reviews that provide comprehensive analyses of specific topics. The journal also presents commentary papers aimed at initiating discussions on controversial subjects and allocates a dedicated section for reader correspondence. In summary, QJM's reputable standing stems from its enduring presence in the medical community, consistent publication schedule, and diverse range of content designed to inform and engage readers.