Smoky coal, tobacco smoking, and lung cancer risk in Xuanwei, China

Christopher Kim, Robert S. Chapman, Wei Hu, Xingzhou He, Howard D. Hosgood, Larry Z. Liu, Hong Lai, Wei Chen, Debra T. Silverman, Roel Vermeulen, Linwei Tian, Bryan Bassig, Min Shen, Yawei Zhang, Shuangge Ma, Nathaniel Rothman, Qing Lan

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objectives: Lung cancer rates in Xuanwei are the highest in China. In-home use of smoky coal has been associated with lung cancer risk, and the association of smoking and lung cancer risk strengthened after stove improvement. Here, we explored the differential association of tobacco use and lung cancer risk by the intensity, duration, and type of coal used. Materials and methods: We conducted a population-based case-control study of 260 male lung cancer cases and 260 age-matched male controls. Odds ratios (OR) and 95% confidence interval (CI) for tobacco use was calculated by conditional logistic regression. Results: Use of smoky coal was significantly associated with an increased risk of lung cancer, and tobacco use was weakly and non-significantly associated with lung cancer risk. When the association was assessed by coal use, the cigarette-lung cancer risk association was null in hazardous coal users and elevated in less hazardous smoky coal users and non-smoky coal users. The risk of lung cancer per cigarette per day decreased as annual use of coal increased (>0-3. tons: OR: 1.09; 95% CI: 1.03-1.17; >3. tons: OR: 0.99; 95% CI: 0.95-1.03). Among more hazardous coal users, attenuation occured at even low levels of usage (>0-3. tons: OR: 1.02; 95% CI: 0.91-1.14; >3. tons: OR: 0.94; 95% CI: 0.97-1.03). Conclusion: We found evidence that smoky coal attenuated the tobacco and lung cancer risk association in males that lived in Xuanwei, particularly among users of hazardous coal where even low levels of smoky coal attenuated the association. Our results suggest that the adverse effects of tobacco may become more apparent as China's population continues to switch to cleaner fuels for the home, underscoring the urgent need for smoking cessation in China and elsewhere.

Original languageEnglish (US)
Pages (from-to)31-35
Number of pages5
JournalLung Cancer
Volume84
Issue number1
DOIs
StatePublished - Apr 2014

Fingerprint

Coal
China
Lung Neoplasms
Smoking
Odds Ratio
Confidence Intervals
Tobacco Use
Tobacco Products
Tobacco
Smoking Cessation
Population
Case-Control Studies
Logistic Models

Keywords

  • China
  • Coal
  • Epidemiology
  • Global health
  • Indoor air pollution
  • Lung cancer
  • Tobacco

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Smoky coal, tobacco smoking, and lung cancer risk in Xuanwei, China. / Kim, Christopher; Chapman, Robert S.; Hu, Wei; He, Xingzhou; Hosgood, Howard D.; Liu, Larry Z.; Lai, Hong; Chen, Wei; Silverman, Debra T.; Vermeulen, Roel; Tian, Linwei; Bassig, Bryan; Shen, Min; Zhang, Yawei; Ma, Shuangge; Rothman, Nathaniel; Lan, Qing.

In: Lung Cancer, Vol. 84, No. 1, 04.2014, p. 31-35.

Research output: Contribution to journalArticle

Kim, C, Chapman, RS, Hu, W, He, X, Hosgood, HD, Liu, LZ, Lai, H, Chen, W, Silverman, DT, Vermeulen, R, Tian, L, Bassig, B, Shen, M, Zhang, Y, Ma, S, Rothman, N & Lan, Q 2014, 'Smoky coal, tobacco smoking, and lung cancer risk in Xuanwei, China', Lung Cancer, vol. 84, no. 1, pp. 31-35. https://doi.org/10.1016/j.lungcan.2014.01.004
Kim, Christopher ; Chapman, Robert S. ; Hu, Wei ; He, Xingzhou ; Hosgood, Howard D. ; Liu, Larry Z. ; Lai, Hong ; Chen, Wei ; Silverman, Debra T. ; Vermeulen, Roel ; Tian, Linwei ; Bassig, Bryan ; Shen, Min ; Zhang, Yawei ; Ma, Shuangge ; Rothman, Nathaniel ; Lan, Qing. / Smoky coal, tobacco smoking, and lung cancer risk in Xuanwei, China. In: Lung Cancer. 2014 ; Vol. 84, No. 1. pp. 31-35.
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abstract = "Objectives: Lung cancer rates in Xuanwei are the highest in China. In-home use of smoky coal has been associated with lung cancer risk, and the association of smoking and lung cancer risk strengthened after stove improvement. Here, we explored the differential association of tobacco use and lung cancer risk by the intensity, duration, and type of coal used. Materials and methods: We conducted a population-based case-control study of 260 male lung cancer cases and 260 age-matched male controls. Odds ratios (OR) and 95{\%} confidence interval (CI) for tobacco use was calculated by conditional logistic regression. Results: Use of smoky coal was significantly associated with an increased risk of lung cancer, and tobacco use was weakly and non-significantly associated with lung cancer risk. When the association was assessed by coal use, the cigarette-lung cancer risk association was null in hazardous coal users and elevated in less hazardous smoky coal users and non-smoky coal users. The risk of lung cancer per cigarette per day decreased as annual use of coal increased (>0-3. tons: OR: 1.09; 95{\%} CI: 1.03-1.17; >3. tons: OR: 0.99; 95{\%} CI: 0.95-1.03). Among more hazardous coal users, attenuation occured at even low levels of usage (>0-3. tons: OR: 1.02; 95{\%} CI: 0.91-1.14; >3. tons: OR: 0.94; 95{\%} CI: 0.97-1.03). Conclusion: We found evidence that smoky coal attenuated the tobacco and lung cancer risk association in males that lived in Xuanwei, particularly among users of hazardous coal where even low levels of smoky coal attenuated the association. Our results suggest that the adverse effects of tobacco may become more apparent as China's population continues to switch to cleaner fuels for the home, underscoring the urgent need for smoking cessation in China and elsewhere.",
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author = "Christopher Kim and Chapman, {Robert S.} and Wei Hu and Xingzhou He and Hosgood, {Howard D.} and Liu, {Larry Z.} and Hong Lai and Wei Chen and Silverman, {Debra T.} and Roel Vermeulen and Linwei Tian and Bryan Bassig and Min Shen and Yawei Zhang and Shuangge Ma and Nathaniel Rothman and Qing Lan",
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AU - Kim, Christopher

AU - Chapman, Robert S.

AU - Hu, Wei

AU - He, Xingzhou

AU - Hosgood, Howard D.

AU - Liu, Larry Z.

AU - Lai, Hong

AU - Chen, Wei

AU - Silverman, Debra T.

AU - Vermeulen, Roel

AU - Tian, Linwei

AU - Bassig, Bryan

AU - Shen, Min

AU - Zhang, Yawei

AU - Ma, Shuangge

AU - Rothman, Nathaniel

AU - Lan, Qing

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N2 - Objectives: Lung cancer rates in Xuanwei are the highest in China. In-home use of smoky coal has been associated with lung cancer risk, and the association of smoking and lung cancer risk strengthened after stove improvement. Here, we explored the differential association of tobacco use and lung cancer risk by the intensity, duration, and type of coal used. Materials and methods: We conducted a population-based case-control study of 260 male lung cancer cases and 260 age-matched male controls. Odds ratios (OR) and 95% confidence interval (CI) for tobacco use was calculated by conditional logistic regression. Results: Use of smoky coal was significantly associated with an increased risk of lung cancer, and tobacco use was weakly and non-significantly associated with lung cancer risk. When the association was assessed by coal use, the cigarette-lung cancer risk association was null in hazardous coal users and elevated in less hazardous smoky coal users and non-smoky coal users. The risk of lung cancer per cigarette per day decreased as annual use of coal increased (>0-3. tons: OR: 1.09; 95% CI: 1.03-1.17; >3. tons: OR: 0.99; 95% CI: 0.95-1.03). Among more hazardous coal users, attenuation occured at even low levels of usage (>0-3. tons: OR: 1.02; 95% CI: 0.91-1.14; >3. tons: OR: 0.94; 95% CI: 0.97-1.03). Conclusion: We found evidence that smoky coal attenuated the tobacco and lung cancer risk association in males that lived in Xuanwei, particularly among users of hazardous coal where even low levels of smoky coal attenuated the association. Our results suggest that the adverse effects of tobacco may become more apparent as China's population continues to switch to cleaner fuels for the home, underscoring the urgent need for smoking cessation in China and elsewhere.

AB - Objectives: Lung cancer rates in Xuanwei are the highest in China. In-home use of smoky coal has been associated with lung cancer risk, and the association of smoking and lung cancer risk strengthened after stove improvement. Here, we explored the differential association of tobacco use and lung cancer risk by the intensity, duration, and type of coal used. Materials and methods: We conducted a population-based case-control study of 260 male lung cancer cases and 260 age-matched male controls. Odds ratios (OR) and 95% confidence interval (CI) for tobacco use was calculated by conditional logistic regression. Results: Use of smoky coal was significantly associated with an increased risk of lung cancer, and tobacco use was weakly and non-significantly associated with lung cancer risk. When the association was assessed by coal use, the cigarette-lung cancer risk association was null in hazardous coal users and elevated in less hazardous smoky coal users and non-smoky coal users. The risk of lung cancer per cigarette per day decreased as annual use of coal increased (>0-3. tons: OR: 1.09; 95% CI: 1.03-1.17; >3. tons: OR: 0.99; 95% CI: 0.95-1.03). Among more hazardous coal users, attenuation occured at even low levels of usage (>0-3. tons: OR: 1.02; 95% CI: 0.91-1.14; >3. tons: OR: 0.94; 95% CI: 0.97-1.03). Conclusion: We found evidence that smoky coal attenuated the tobacco and lung cancer risk association in males that lived in Xuanwei, particularly among users of hazardous coal where even low levels of smoky coal attenuated the association. Our results suggest that the adverse effects of tobacco may become more apparent as China's population continues to switch to cleaner fuels for the home, underscoring the urgent need for smoking cessation in China and elsewhere.

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