Abstract：
Despite the significance of the associations of air pollution and greenness with the risk of breast cancer, this topic has not been investigated on a global scale. We conducted an ecological study using 7 years of data from 162 countries. Disability-adjusted life years (DALYs) and incidence data were used to represent the breast cancer disease burden. Particulate matter with a diameter < 2.5 μm (PM2.5), ozone (O3), nitrogen dioxide (NO2), and the normalized difference vegetation index (NDVI) were adopted as our exposures. We employed generalized linear mixed models to explore the relationship between air pollution and greenness on breast cancer disease burden. The rate ratio (RR) and its 95% confidence interval (CI) indicate the effect size. There is a positive association between air pollution and the burden of breast cancer disease. Contrarily, per interquartile range increment in NDVI was negatively associated with DALYs and incidence. In terms of air pollutants and breast cancer, NDVI seems to have a significant influence on the relationship between these two conditions. A higher amount of greenness helps to alleviate the negative association of air pollution on breast cancer. PM2.5 and O3 play a mediating role in the relationship between greenness and breast cancer disease burden. In areas with higher levels of greenness, there is a possibility that the inverse association between air pollutants and the burden of breast cancer may be influenced.
摘要：
尽管空气污染和绿色与乳腺癌风险的关系很重要，该主题尚未在全球范围内进行调查。我们使用来自162个国家的7年数据进行了一项生态研究。残疾调整寿命年(DALYs)和发病率数据被用来代表乳腺癌疾病负担。直径<2.5μm的颗粒物(PM2.5),臭氧(O3)二氧化氮(NO2),并采用归一化植被指数（NDVI）作为我们的暴露量。我们采用广义线性混合模型来探索空气污染与绿色对乳腺癌疾病负担的关系。比率(RR)及其95%置信区间(CI)表示效应大小。空气污染与乳腺癌疾病的负担之间存在正相关。相反，NDVI的每四分位间距增量与DALY和发病率呈负相关。在空气污染物和乳腺癌方面，NDVI似乎对这两个条件之间的关系有显著影响。较高的绿色度有助于减轻空气污染对乳腺癌的负面影响。PM2.5和O3在绿色与乳腺癌疾病负担的关系中起中介作用。在绿色水平较高的地区，空气污染物与乳腺癌负担之间的负相关有可能受到影响.
