Abstract：
Exposure to ambient ozone (O3) is linked to increased mortality risks from various diseases, but epidemiological investigations delving into its potential implications for cancer mortality are limited. We aimed to examine the association between short-term O3 exposure and site-specific cancer mortality and investigate vulnerable subgroups in Brazil. In total 3,459,826 cancer death records from 5570 Brazilian municipalities between 2000 and 2019, were included. Municipal average daily O3 concentration was calculated from a global estimation at 0.25°×0.25° spatial resolution. The time-stratified case-crossover design was applied to assess the O3-cancer mortality association. Subgroup analyses by age, sex, season, time-period, region, urban hierarchy, climate classification, quantiles of GDP per capita and illiteracy rates were performed. A linear and non-threshold exposure-response relationship was observed for short-term exposure to O3 with cancer mortality, with a 1.00% (95% CI: 0.79%-1.20%) increase in all-cancer mortality risks for each 10-μg/m3 increment of three-day average O3. Kidney cancer was most strongly with O3 exposure, followed by cancers of the prostate, stomach, breast, lymphoma, brain and lung. The associated cancer risks were relatively higher in the warm season and in southern Brazil, with a decreasing trend over time. When restricting O3 concentration to the national minimum value during 2000-2019, a total of 147,074 (116,690-177,451) cancer deaths could be avoided in Brazil, which included 17,836 (7014-28,653) lung cancer deaths. Notably, these associations persisted despite observed adaptation within the Brazilian population, highlighting the need for a focus on incorporating specific measures to mitigate O3 exposure into cancer care recommendations.
摘要：
暴露于环境臭氧（O3）与各种疾病的死亡风险增加有关，但深入研究其对癌症死亡率的潜在影响的流行病学调查是有限的.我们旨在研究短期O3暴露与特定部位癌症死亡率之间的关系，并调查巴西的脆弱亚组。2000年至2019年期间，来自5570个巴西城市的3,459,826个癌症死亡记录被包括在内。市政平均每日O3浓度是根据0.25°×0.25°空间分辨率的全球估算值计算得出的。时间分层病例交叉设计用于评估O3-癌症死亡率关联。按年龄分组分析，性别,季节,时间段,区域,城市等级制度，气候分类,进行了人均GDP和文盲率的分位数计算。观察到短期暴露于O3与癌症死亡率的线性和非阈值暴露-反应关系，3天平均O3每增加10μg/m3，所有癌症死亡风险增加1.00％（95％CI：0.79％-1.20％）。O3暴露后肾癌最严重，其次是前列腺癌，胃,乳房,淋巴瘤脑和肺。在温暖的季节和巴西南部，相关的癌症风险相对较高，随着时间的推移呈下降趋势。当在2000-2019年期间将O3浓度限制在国家最小值时，巴西总共可以避免147,074例（116,690-177,451例）癌症死亡。其中包括17,836（7014-28,653）例肺癌死亡。值得注意的是,尽管在巴西人口中观察到适应，但这些协会仍然存在，强调需要将减少O3暴露的具体措施纳入癌症护理建议。
