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Fine Particulate Matter and Respiratory Healthcare Encounters among Survivors of Childhood Cancers

1
Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
2
Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA
3
Department of Surgery, University of Utah, Salt Lake City, UT 84132, USA
4
Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
5
Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, UT 84108, USA
6
Department of Economics, Brigham Young University, Provo, UT 84602, USA
7
Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(6), 1081; https://doi.org/10.3390/ijerph16061081
Received: 27 February 2019 / Revised: 22 March 2019 / Accepted: 24 March 2019 / Published: 26 March 2019
(This article belongs to the Section Children Health)
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Abstract

Some chemotherapies that treat childhood cancers have pulmonary-toxic properties that increase risk for adverse respiratory-health outcomes. PM2.5 causes similar outcomes but its effect among pulmonary compromised cancer survivors is unknown. This case-crossover study identified the PM2.5-associated odds for primary-respiratory hospitalizations and emergency department visits among childhood cancer survivors in Utah. We compared risk among chemotherapy-treated survivors to a cancer-free sample. We calculated 3-day-average PM2.5 by ZIP code and county for event and control days. Conditional logistic regression estimated odds ratios. Models were stratified by cause of admission (infection, respiratory disease, asthma), previous chemotherapy, National Ambient Air Quality Standard (NAAQS), and other variables. Results are presented per 10 µg/m3 of PM2.5. 90% of events occurred at 3-day PM2.5 averages <35.4 µg/m3, the NAAQS 24-h standard. For survivors, PM2.5 was associated with respiratory hospitalizations (OR = 1.84, 95% CI = 1.13–3.00) and hospitalizations from respiratory infection (OR = 2.09, 95% CI = 1.06–4.14). Among chemotherapy-treated survivors, the PM2.5-associated odds of respiratory hospitalization (OR = 2.03, 95% CI = 1.14–3.61) were significantly higher than the cancer-free sample (OR = 0.84, 95% CI = 0.57–1.25). This is the first study to report significant associations between PM2.5 and respiratory healthcare encounters in childhood cancer survivors. Chemotherapy-treated survivors displayed the highest odds of hospitalization due to PM2.5 exposure and their risk is significantly higher than a cancer-free sample. View Full-Text
Keywords: air pollution; children; cancer survivorship; late effects air pollution; children; cancer survivorship; late effects
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Ou, J.Y.; Hanson, H.A.; Ramsay, J.M.; Leiser, C.L.; Zhang, Y.; VanDerslice, J.A.; Pope, C.A., III; Kirchhoff, A.C. Fine Particulate Matter and Respiratory Healthcare Encounters among Survivors of Childhood Cancers. Int. J. Environ. Res. Public Health 2019, 16, 1081.

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