绿色覆盖与癌症发病的因果关联分析

doi:10.6040/j.issn.1671-7554.0.2022.0339

摘要/Abstract

摘要： 目的探讨绿色覆盖与癌症发病之间的因果关联。方法依托山东省健康医疗大数据平台,将平邑县居民电子健康档案、癌症监测数据和电子病历数据进行关联,构建癌症发病队列。以卫星遥感数据来源的归一化植被指数(NDVI)作为暴露指标,以癌症发病作为结局,首先采用广义线性混合模型(GLMM)探索绿色覆盖与癌症发病的关联关系,然后利用基于时间序列的阴性对照暴露(NCE-TS)方法进行因果关联分析。结果队列共纳入917 450人。2012~2015年平邑县共发生癌症9 157例,累积发病率为9.98‰。GLMM结果显示,NDVI每增加0.01,整体癌症发病风险降低26.42%(OR=0.7358,95%CI: 0.6417~0.8298);NCE-TS结果显示,与低水平NDVI区域相比,高水平NDVI区域的人群整体癌症的因果绝对风险降低2.651%(95%CI:-2.745%~-2.564%),肺癌、胃癌、食管癌、肝癌、结直肠癌、乳腺癌和宫颈癌的绝对风险降低0.147%~0.718%。结论绿色覆盖与癌症发病之间存在保护性因果关联,在癌症一级预防中应重视绿色覆盖这一生态环境要素。

关键词: 绿色覆盖, 癌症, 阴性对照暴露, 因果关联, 发病

Abstract: Objective To investigate the causal association between green space and cancer incidence. Methods Based on the Health Care Big Data Platform of Shandong Province, resident electronic health records, cancer surveillance data and electronic medical record data of Pingyi County were linked to construct a cancer incidence cohort. Green space exposure was assessed using normalized difference vegetation index(NDVI)derived from satellite remote sensing data. Outcome was defined as the diagnosis of cancer. The association between NDVI and cancer incidence was explored using generalized linear mixed model(GLMM). Negative control exposure based on time-series studies(NCE-TS)method was used to estimate the causal association. Results A total of 917,450 subjects were included in this study, and 9,157 cancer cases were reported during 2012 and 2015, with a cumulative incidence rate of 9.98‰. GLMM results showed that every 0.01 increase in NDVI was associated with a 26.42% reduction in all-sites cancer(OR=0.7358, 95%CI: 0.6417~0.8298). NCE-TS analysis showed that the causal absolute risk of all-sites cancer among population living in high-level NDVI areas was reduced by 2.651%(95%CI: -2.745%~-2.564%), compared with the low-level NDVI areas. And the absolute risk of lung cancer, stomach cancer, esophageal cancer, liver cancer, colorectal cancer, breast cancer and cervical cancer was reduced by 0.147%~0.718%. Conclusion There is a protective causal association between green space and cancer. As an important ecological environment element, green space should arouse attention in the primary prevention of cancer.

Key words: Green space, Cancer, Negative control exposure, Causal association, Incidence

中图分类号:

R181.3

吴新莹,冯一平,常开锋,贾贤杰,薛付忠. 绿色覆盖与癌症发病的因果关联分析[J]. 山东大学学报 (医学版), 2022, 60(8): 115-119.

WU Xinying, FENG Yiping, CHANG Kaifeng, JIA Xianjie, XUE Fuzhong. Causal association between green space and cancer incidence[J]. Journal of Shandong University (Health Sciences), 2022, 60(8): 115-119.

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