Abstract
BACKGROUND & AIMS: Evidence is sparse and inconclusive on the association between long-term fine (≤2.5 μm) particulate matter (PM(2.5)) exposure and esophageal cancer. We aimed to assess the association of PM(2.5) with esophageal cancer risk and compared the esophageal cancer risk attributable to PM(2.5) exposure and other established risk factors. METHODS: This study included 510,125 participants without esophageal cancer at baseline from China Kadoorie Biobank. A high-resolution (1 × 1 km) satellite-based model was used to estimate PM(2.5) exposure during the study period. Hazard ratios (HR) and 95% CIs of PM(2.5) with esophageal cancer incidence were estimated using Cox proportional hazard model. Population attributable fractions for PM(2.5) and other established risk factors were estimated. RESULTS: There was a linear concentration-response relationship between long-term PM(2.5) exposure and esophageal cancer. For each 10-μg/m(3) increase in PM(2.5), the HR was 1.16 (95% CI, 1.04-1.30) for esophageal cancer incidence. Compared with the first quarter of PM(2.5) exposure, participants in the highest quarter had a 1.32-fold higher risk for esophageal cancer, with an HR of 1.32 (95% CI, 1.01-1.72). The population attributable risk because of annual average PM(2.5) concentration ≥35 μg/m(3) was 23.3% (95% CI, 6.6%-40.0%), higher than the risks attributable to lifestyle risk factors. CONCLUSIONS: This large prospective cohort study of Chinese adults found that long-term exposure to PM(2.5) was associated with an elevated risk of esophageal cancer. With stringent air pollution mitigation measures in China, a large reduction in the esophageal cancer disease burden can be expected.