Associations between ambient air pollution and cardiovascular and respiratory healthcare visits in adolescent and young adult cancer survivors

Background: Cancer therapies have well-documented adverse effects on cardiovascular and respiratory health which could increase cancer survivors’ susceptibility to poor air quality. We describe the risk of cardiovascular and respiratory healthcare visits following acute air pollution exposures among adolescent and young adult (AYA) cancer survivors. Methods: We identified all Utah AYAs diagnosed at 15-39 years of age with thyroid, melanoma, lymphoma, breast, or testicular cancer from 1998-2016 (N=8,016). AYAs were linked by residential location to daily particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) for 2000-2016. Case-crossover models in a distributed lag non-linear model framework estimated odds ratios (ORs) and 95% confidence intervals (95% CIs) for cardiovascular and respiratory healthcare visits with exposure over the 6 days preceding an event, adjusting for temperature and relative humidity. Results: A total of 3,143 AYAs (39%) experienced ≥1 respiratory/cardiovascular event. O3 was associated with cardiovascular events (ORlag4=1.08, 95% CI: 1.02-1.14; ORlag5=1.05, 95% CI:1.01-1.09) and NO2 was associated with respiratory events (ORlag1=1.05, 95% CI: 1.01-1.10). Breast cancer survivors showed elevated risk for cardiovascular and respiratory visits; melanoma, lymphoma, and testis survivors displayed increased risk for cardiovascular visits. Conclusions: O3 was linked with elevated risk of cardiovascular events while respiratory events were associated with NO2. Associations between air pollutants and healthcare visits varied by primary diagnosis site, indicating that susceptibility to air pollution could differ due to cancer-specific treatment factors. Impact: AYAs face increased risk for cardiovascular and respiratory events with exposure to ambient air pollution and may benefit from interventions to reduce exposures.