Air Pollution and Cardiovascular Risks in Testicular Cancer Survivors: An Exploratory Case-Crossover Study.

Abstract

Objectives: Testicular cancer survivors can experience cardiovascular and respiratory complications due to cancer treatment. We assessed associations between nitrogen dioxide (NO₂) and ozone (O₃) air pollution and health care encounters among survivors of adolescent and young adult (AYA) testicular cancer. Methods: A total of 385 AYA testicular cancer survivors, diagnosed 2000-2016, with cardiovascular and/or respiratory health care encounters (emergency department/urgent care [ED/UC], inpatient) were identified using a statewide Utah-based resource. Continuous and dichotomous (≥moderate air quality index) exposure measures were included for NO₂ and O₃ for the 1-4 days (lag days) before events. A case-crossover framework using conditional logistic regression with robust standard errors computed the association of lag days 0-3 with cardiovascular or respiratory encounters and stratified by encounter type (ED/UC, inpatient). Models that were significant in the full cohort were also stratified on demographic and treatment factors. All models were controlled for temperature and humidity. Results: Survivors contributed 257 cardiovascular and 685 respiratory encounters. NO₂ ≥moderate on lag day 1 was associated with increased odds of any cardiovascular encounter (odds ratio [OR] = 1.97, 95% confidence interval [CI] = 1.08-3.59) and inpatient cardiovascular encounters in the full cohort (OR = 2.48, 95% CI = 1.21-5.10), survivors treated with radical orchiectomy and chemotherapy (OR = 3.00, 95% CI = 1.29-7.00), and Hispanic survivors (OR = 4.32, 95% CI = 1.18-15.85). O₃ ≥moderate on lag day 4 was associated with respiratory ED/UC encounters (OR = 1.34, 95% CI = 1.00-1.79) and O₃ on lag day 4 was associated with any cardiovascular encounter (OR = 1.02/parts per billion [ppb], 95% CI = 1.00-1.03) and inpatient cardiovascular encounters (OR = 1.03/ppb, 95% CI + 1.00-1.05). Conclusions: NO₂ and O₃ are associated with risk for health care encounters among testicular cancer survivors and could increase health disparities in survivorship.