Air quality and cancer risk in the All of Us Research Program

Abstract

Abstract Introduction The NIH All of Us Research Program has enrolled over 544,000 participants across the US with unprecedented racial/ethnic diversity, offering opportunities to investigate myriad exposures and diseases. This paper aims to investigate the association between PM2.5 exposure and cancer risks. Materials and Methods This work was performed on data from 325,264 All of Us Research Program participants using the All of Us Researcher Workbench. Cancer case ascertainment was performed using data from electronic health records and the self-reported Personal Medical History questionnaire. PM2.5 exposure was retrieved from NASA’s Earth Observing System Data and Information Center and assigned using participants’ 3-digit zip code prefixes. Multivariate logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Generalized additive models (GAMs) were used to investigate non-linear relationships. Results A total of 32,073 prevalent cancer cases were ascertained from participant EHR data, while 16,688 cases were ascertained from self-reported survey data; 7,692 cancer cases were captured in both the EHR and survey data. Average PM2.5 level from 2006 to 2016 was 9.4 µg/m3 (min 3.0, max 15.1). In analysis of cancer cases from both sources combined (n = 41,069), each unit increase in PM2.5 was associated with increased odds for blood cancer (OR = 1.02, 95% CI: 1.01–1.03), brain cancer (OR = 1.06, 95% CI: 1.03–1.09), breast cancer (OR = 1.03, 95% CI: 1.02–1.04), colon and rectum cancer (OR = 1.02, 95% CI: 1.00-1.04), and endometrial cancer (OR = 1.06, 95% CI: 1.03–1.10). In GAM, higher PM2.5 concentration was associated with increased odds for blood cancer, bone cancer, brain cancer, breast cancer, colon and rectum cancer, endocrine system cancer, lung cancer, pancreatic cancer, prostate cancer, and thyroid cancer. Conclusions We found evidence of an association of PM2.5 with brain, breast, blood, colon and rectum, and endometrial cancers. There is little to no prior evidence in the literature on the impact of PM2.5 on risk of these cancers, warranting further investigation.