ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1666928
This article is part of the Research TopicClimate Change, Air Pollution, and Health Inequality: Vulnerability of Marginalized PopulationsView all 23 articles
Acute Air Pollution Exposure and Gastrointestinal Cancer Mortality: A Case-Crossover Study in Coastal China
Provisionally accepted
Wu Zhuchao1,2
Chaohua Wei2Jian Sun3
Beibei Qiu4Weimin Kong3Yang Yang5
Yanqiu Huang6Cheng Li7Lingling Wu8Fudong Liu8*Xiaojie Wang9*- 1Jiangsu Medical College, Yancheng, China
- 2Nanjing Medical University, Nanjing, China
- 3The First people's Hospital of Yancheng, yancheng, China
- 4Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- 5Johns Hopkins University, Baltimore, United States
- 6Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 7Shandong University Cheeloo College of Medicine, Jinan, China
- 8Yancheng Municipal Center for Disease Control and Prevention, yancheng, China
- 9The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Abstract 1 Background 2 Gastrointestinal (GI) cancers account for 43.1% of cancer-related deaths in China, 3 with aging populations exacerbating this burden. While chronic air pollution exposure 4 is linked to GI carcinogenesis, evidence on acute effects remains limited. This study 5 investigates short-term ambient pollutant exposure and GI cancer mortality in a 6 coastal Chinese city with moderate pollution levels. 7 Methods 8 Using death registry data from Yancheng, China (2013–2022; n = 104,216 GI cancer 9 deaths), we employed a time-stratified case-crossover design combined with 10 distributed lag nonlinear models (DLNM) to assess associations between daily PM2.5, 11 PM10, SO2, NO2, and O3 concentrations (lag 0–7 days) and mortality. Stratified 12 analyses by age, sex, and cancer subsite were conducted, with sensitivity analyses 13 evaluating model robustness. 14 Results 15 A 10 μg/m³ increase in PM2.5, PM10, and O3 was associated with acute GI cancer 16 mortality, peaking at lag 0–5 days (relative risk [RR] = 1.011, 95% CI: 1.000–1.022 17 for PM2.5; RR = 1.009, 95% CI: 1.001–1.017 for PM10; RR = 1.008, 95% CI: 18 1.001–1.016 for O3). Elderly males (≥65 years) exhibited heightened vulnerability, 19 with maximal cumulative RRs of 1.018 (PM2.5), 1.010 (PM10), and 1.014 (O3). 20 Esophageal cancer showed acute PM sensitivity (lag 0–4 days: RR = 1.021 for PM2.5), 21 while colorectal cancer mortality correlated with delayed O3 effects (lag 0–7 days: 22
Keywords: PM2.5, PM10, SO2, NO2, O3
Received: 16 Jul 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 Zhuchao, Wei, Sun, Qiu, Kong, Yang, Huang, Li, Wu, Liu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Fudong Liu, Yancheng Municipal Center for Disease Control and Prevention, yancheng, China
Xiaojie Wang, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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