Open Access Open Badges Research article

Health effects of air pollution on length of respiratory cancer survival

Xiaohui Xu1*, Sandie Ha1, Haidong Kan2, Hui Hu1, Barbara A Curbow3 and Claudia TK Lissaker1

Author Affiliations

1 Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL 32610, USA

2 Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China

3 Department of Behavioral Science and Community Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA

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BMC Public Health 2013, 13:800  doi:10.1186/1471-2458-13-800

Published: 3 September 2013



Air pollution has been extensively and consistently linked with mortality. However, no study has investigated the health effects of air pollution on length of survival among diagnosed respiratory cancer patients.


In this study, we conducted a population-based study to investigate if air pollution exposure has adverse effects on survival time of respiratory cancer cases in Los Angeles (LA), CA and Honolulu, HI. We selected all White respiratory cancer patients in the two study areas from the 1992–2008 Surveillance Epidemiology and End Results cancer data. Death from respiratory cancer and length of survival were the main outcomes.


Kaplan-Meier survival analysis shows that all respiratory cancer cases exposed to high air pollution referring to the individuals from LA had a significantly shorter survival time than the low pollution exposure group referring to those from Honolulu without adjusting for other covariates (p <0.0001). Moreover, the results from the Cox Proportional-Hazards models suggest that exposure to particles less than 10 micrometers in diameter (PM10) was associated with an increased risk of cancer death (HR = 1.48, 95% CI: 1.44-1.52 per 10 μg/m3 increase in PM10) after adjusting for demographic factors and cancer characteristics. Similar results were observed for particles less than 2.5 micrometers in diameter and ozone.


Our study indicates that air pollution may have deleterious effects on the length of survival among White respiratory cancer patients. This study calls for attention to preventive effort from air pollution for this susceptible population in standard cancer patient care. The findings from this study warrant further investigation.

Air pollution; Cancer; Cancer survival; Respiratory cancer; Lung cancer