Impact of Residential Concentration of PM2.5 Analyzed as Time-Varying Covariate on the Survival Rate of Lung Cancer Patients: A 15-Year Hospital-Based Study in Upper Northern Thailand

Abstract

Air pollutants, especially particulate matter (PM) ≤ 2.5 µm (PM2.5) and PM ≤ 10 µm (PM10), are a major concern in upper northern Thailand. Data from a retrospective cohort comprising 9820 lung cancer patients diagnosed from 2003 to 2018 were obtained from the Chiang Mai Cancer Registry, and used to evaluate mortality and survival rates. Cox proportional hazard models were used to identify the association between the risk of death and risk factors including gender, age, cancer stage, smoking history, alcohol-use history, calendar year of enrollment, and time-updated PM2.5, PM10, NO₂ and O₃ concentrations. The mortality rate was 68.2 per 100 persons per year of follow-up. In a multivariate analysis, gender, age, cancer stage, calendar year of enrollment, and time-varying residential concentration of PM2.5 were independently associated with the risk of death. The lower the annually averaged PM2.5 and PM10 concentrations, the higher the survival probability of the patient. As PM2.5 and PM10 were factors associated with a higher risk of death, lung cancer patients who are inhabitant in the area should reduce their exposure to high concentrations of PM2.5 and PM10 to increase survival rates.