Background: The density of particulate matter (PM) in mega-cities in China such as Beijing and Shanghai has exceeded basic standards for health in recent years. Human exposure to PMs has been identified as traceable and controllable factor among all complicated risk factors for lung cancer. While the improvement of air quality needs tremendous efforts and time, certain revision of PM's density might happen associated with the adjustment of built environment. It is also proved that urban built environment is directly relevant to respiratory disease. Studies have respectively explored the indoor and outdoor factors on respiratory diseases. More comprehensive spatial factors need to be analyzed to understand the cumulative effect of built environment upon respiratory system. This interdisciplinary study examines the impact of both indoor (including age of housing, interval after decoration, indoor humidity etc.) and outdoor spatial factors (including density, parking, green spaces etc.) on lung cancer. Methods: A survey of lung cancer patients and a control group has been conducted in 2014 and 2015. A total of 472 interviewees are randomly selected within a pool of local residents who have resided in Shanghai for more than 5 years. Data are collected including their socio-demographic factors, lifestyle factors, and external and internal residential area factors. Regression models are established based on collected data to analyze the associations between lung cancer and urban spatial factors. Results: Regression models illustrate that lung cancer presents significantly associated with a number of spatial factors. Significant outdoor spatial factors include external traffic volume (P=0.003), main plant type (P=0.035 for trees) of internal green space, internal water body (P=0.027) and land use of surrounding blocks (P=0.005 for residential areas of 7-9 floors, P=0.000 for residential areas of 4-6 floors, P=0.006 for business/ commercial areas over 10 floors, P=0.005 for business/commercial areas of 7-9 floors, P=0.043 for business/ commercial areas of 4-6 floors). Indoor spatial factors include age of housing (P=0.003) and indoor humidity (P=0.000). Conclusions: The findings support the hypothesis that both indoor and outdoor spatial factors are independently associated with lung cancer incidence. Certain principles based on the modeling results are proposed to revise the criteria for lung cancer screening of high-risk individuals. It also provides empirical evidence for urban planning and design to improve built environment with more thorough consideration of respiratory health.
In many heavy industrialized countries such as China and India, the impact of air pollution on respiratory health has been headline news in recent years. Among the risk issues examined, exposure to particulate matter (PM) is cited as the prime contributing factor that causes respiratory diseases, yet it is traceable and controllable. In this paper, we report on an empirical study conducted in Shanghai, based on urban spatial determinants as independent variables to investigate its link to occurrence of lung cancer in their neighborhoods. A survey was conducted on a population of 472 lung cancer patients. After reliability and validity tests, only 156 pairs were included in this report. The questionnaire designed for this survey covers 11 outdoor and 6 indoor factors; these include the building density where they live, proximity to pollution sources, volume of traffic nearby, degree of enclosure by surrounding tall buildings, being residential or commercial with reference to their homes, proximity to parks, measured in terms of the plant type, green space per capita, accessibility to public open spaces for outdoor activities and water body; while parameters inside the house cover the age of the house, bedroom sizes, space per occupant, cooling-off time of taking up residency after renovation, humidity and dust inside the houses. Data collected were classified using random forest classification and further refined with Boruta algorithm for feature selection to identify possible correlation between risk of lung cancer to both outdoor and indoor factors of built environment. The results reveal a strong correlation between lung cancer and the environment where they live, so much so that the finding confirms our long-held belief that urban redevelopment could play an important role in reducing the risk of respiratory disease. Since prevention is better than cure, if by design to relocate pollution sources away from residential areas, provision of good public transportation to cut down vehicles on our streets, creation of green spaces to improve airflow pathway to deduce the concentration of PM in the atmosphere in our neighborhoods, we could perhaps reduce or even prevent lung cancer and a range of other respiratory diseases for the residents we served.
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