Abstract PR05: Fine particulate matter and mortality among pediatric, adolescent, and young adults with cancer
Authors: Ou Judy Y. , Hanson Heidi A. , Ramsay Joemy M. , Kaddas Heydon , Pope C. Arden , Leiser Claire L. , VanDerslice James A. , Kirchhoff Anne C. 
Published: June 2022

Abstract
Background: Fine particulate matter air pollution (PM2.5) is associated with mortality in the adult population and in adults diagnosed with lung and breast cancer. The effect of PM2.5 on mortality in pediatric, adolescent, and young adults (AYA) diagnosed with cancer is unknown. We examine the association between PM2.5 and mortality among pediatric and AYAs diagnosed with cancer in Utah, a state with severe PM2.5 pollution.
Methods: We identified 2,631 pediatric cancer patients aged 0 to 14 years and 14,575 AYA cancer patients aged 15 to 39 years diagnosed from 1986 to 2016. Patients were followed from first diagnosis date to five or ten years post-diagnosis, death, or emigration out of Utah as indicated by Utah Population Database records. We estimated average PM2.5 at each subject’s ZIP code at diagnosis from the first diagnosis date to the five- and ten-year follow-up dates, death, or emigration. We estimated the effect of five- and ten-year PM2.5 exposure on mortality at five and ten years post-diagnosis. Cox models controlled for parental education, sex, diagnosis year, and cancer stage/severity. Pediatric and AYA cancers were run in separate models. Pediatric cancers were stratified by International Classification of Childhood Cancer categories and AYA cancers were stratified by the WHO Classification for AYA cancers. Models were run for all-cause mortality and cancer-mortality, with noncancer deaths included as competing risks.
Results: We found 571 (20%) deaths among pediatric patients and 3,064 (19.6%) deaths among AYA patients. Most deaths occurred within five years of diagnosis for both groups (83% and 67%, respectively). Cancer was the predominant cause of death among pediatric (94%) and AYA patients (92%). Pediatric patients were exposed to mean PM2.5 of 9.13 μg/m3 and AYA patients were exposed to a mean PM2.5 of 8.31 μg/m3. During five years of follow-up, we found significant associations between PM2.5 and all-cause and cancer mortality for pediatric central nervous system (CNS) patients (all-cause: 1.07 [95%CI: 1.01-1.13], cancer: 1.10 [1.04-1.17]). Among AYAs, we found that five-year PM2.5 exposure was associated with all-cause mortality and cancer-mortality among CNS (all-cause: 1.07 [1.03-1.12], cancer: 1.09 [1.04-1.14]) and carcinoma patients (all-cause: 1.03 [1.01-1.06], cancer: 1.04 [1.02-1.07]). During ten years of follow-up, PM2.5 had a significant association with all-cause and cancer-mortality among pediatric leukemia (all-cause: 1.09 [1.03-1.15], cancer: 1.09 [1.03-1.16]) and CNS patients (all-cause: 1.10 [1.05-1.15], cancer: 1.12 [1.06-1.17]). Among AYAs, ten-year PM2.5 was associated with all-cause and cancer-mortality among CNS (all-cause: 1.05 [1.02-1.09], cancer: 1.06 [1.03-1.10]), melanoma (all-cause: 1.07 [1.02-1.12], cancer: 1.08 [1.02-1.14]), and carcinoma patients (all-cause: 1.06 [1.04-1.08], cancer: 1.07 [1.05-1.09]).
Conclusion: PM2.5 is associated with mortality among pediatric and AYA cancer patients.
This abstract is also being presented as Poster A35.
Citation Format: Judy Y. Ou, Heidi A. Hanson, Joemy M. Ramsay, Heydon Kaddas, C. Arden Pope, Claire L. Leiser, James A. VanDerslice, Anne C. Kirchhoff. Fine particulate matter and mortality among pediatric, adolescent, and young adults with cancer [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr PR05.