绿色覆盖与癌症发病的因果关联分析  

Causal association between green space and cancer incidence

作　　者：吴新莹 冯一平 常开锋 贾贤杰 薛付忠 WU Xinying;FENG Yiping;CHANG Kaifeng;JIA Xianjie;XUE Fuzhong(Department of Biostatistics,School of Public Health,Cheeloo College of Medicine,Shandong University,Jinan 250012,Shandong,China;Institute for Medical Dataology,Shandong University,Jinan 250002,Shandong,China;Infectious Disease Control Department,Pingyi Center for Disease Control and Prevention,Linyi 273300,Shandong,China;Department of Epidemiology and Health Statistics,School of Public Health,Bengbu Medical College,Bengbu 233000,Anhui,China)

机构地区：[1]山东大学齐鲁医学院公共卫生学院生物统计学系,山东济南250012 [2]山东大学健康医疗大数据研究院,山东济南250002 [3]平邑县疾病预防控制中心传染病防制科,山东平邑273300 [4]蚌埠医学院公共卫生学院流行病与卫生统计学教研室,安徽蚌埠233000

出　　处：《山东大学学报（医学版）》2022年第8期115-119,132,共6页Journal of Shandong University:Health Sciences

基　　金：国家重点研发计划(2020YFC2003500);国家自然科学基金(81773547,82173625)

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917450人。2012—2015年平邑县共发生癌症9157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。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 917450 subjects were included in this study,and 9157 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.

关 键 词：绿色覆盖 癌症 阴性对照暴露 因果关联 发病 

分 类 号：R73-31[医药卫生—肿瘤]