Air Pollution and Cardiovascular Risks in Testicular Cancer Survivors: An Exploratory Case-Crossover Study

Testicular cancer survivors can experience cardiovascular and respiratory complications due to cancer treatment. We assessed associations between nitrogen dioxide (NO₂) and ozone (O₃) air pollution and health care encounters among survivors of adolescent and young adult (AYA) testicular cancer.

A total of 385 AYA testicular cancer survivors, diagnosed 2000-2016, with cardiovascular and/or respiratory health care encounters (emergency department/urgent care [ED/UC], inpatient) were identified using a statewide Utah-based resource. Continuous and dichotomous (≥moderate air quality index) exposure measures were included for NO₂ and O₃ for the 1-4 days (lag days) before events. A case-crossover framework using conditional logistic regression with robust standard errors computed the association of lag days 0-3 with cardiovascular or respiratory encounters and stratified by encounter type (ED/UC, inpatient). Models that were significant in the full cohort were also stratified on demographic and treatment factors. All models were controlled for temperature and humidity.

Survivors contributed 257 cardiovascular and 685 respiratory encounters. NO₂ ≥moderate on lag day 1 was associated with increased odds of any cardiovascular encounter (odds ratio [OR] = 1.97, 95% confidence interval [CI] = 1.08-3.59) and inpatient cardiovascular encounters in the full cohort (OR = 2.48, 95% CI = 1.21-5.10), survivors treated with radical orchiectomy and chemotherapy (OR = 3.00, 95% CI = 1.29-7.00), and Hispanic survivors (OR = 4.32, 95% CI = 1.18-15.85). O₃ ≥moderate on lag day 4 was associated with respiratory ED/UC encounters (OR = 1.34, 95% CI = 1.00-1.79) and O₃ on lag day 4 was associated with any cardiovascular encounter (OR = 1.02/parts per billion [ppb], 95% CI = 1.00-1.03) and inpatient cardiovascular encounters (OR = 1.03/ppb, 95% CI + 1.00-1.05).

NO₂ and O₃ are associated with risk for health care encounters among testicular cancer survivors and could increase health disparities in survivorship.