Background: Poor air quality has previously been associated with lung cancer development, but the risks associated with regional differences in air quality are poorly understood. We investigated the association of air quality indices with development of lung cancer in all Texas counties. Methods: Lung cancer incidence, air quality indicators (particulate matter <2.5 μm, radon levels, oil well density), and known risk factors were obtained using data from the Texas Commission on Environmental Quality and the Texas Cancer Registry. Linear regression models were constructed to correlate air quality indicators with lung cancer incidence and advanced stage at diagnosis (stage III or IV), while controlling for other patient characteristics. Results: Lung cancer incidence ranged from 27.6 to 103.4 cases per 100,000 people. In the study, 2.5 μm was associated with increased lung cancer incidence (β = 4.38, P < .0001), but not radon levels (β = –2.70, P = .41). Air quality indicators were not significantly associated with an advanced cancer diagnosis. Conclusion: There are wide differences in the incidence of lung cancer across Texas. These differences seem to be related to air quality. Identifying high-risk areas may help to guide strategies such as implementation of targeted lung cancer screening programs.
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