Fine Particulate Matter Exposure and Sinonasal Malignant Neoplasm

Exposure to fine particulate matter with an aerodynamic diameter of 2.5 µm or less (PM2.5) has been associated with multiple malignant neoplasms, but its relationship with sinonasal malignant neoplasm (SNM) remains poorly characterized.

To evaluate the association between regional PM2.5 exposure and first observed SNM diagnosis.

This national case-control study used commercial outpatient claims with eligible index dates from January 2007 to December 2020. Cases were defined by the first eligible SNM diagnosis after a 1-year enrollment washout period. Controls without any SNM diagnosis throughout claims history were randomly sampled at an approximate 1:5 case to control ratio. Regional PM2.5 exposure was derived from NASA 1-km gridded models integrating satellite, meteorologic, land-use, and atmospheric data, aggregated to each participant's residential metropolitan statistical area and index date. Associations were evaluated using mixed-effects logistic regression with a metropolitan statistical area-level random intercept, adjusted for demographic characteristics, comorbidities, regional smoking prevalence, and socioeconomic deprivation. The analysis was conducted from March 2025 to August 2026.

Mean regional PM2.5 exposure during the 6-month, 1-year, and 5-year periods preceding the index date.

First observed SNM diagnosis after a 1-year enrollment washout period.

The analytic cohort included 21 295 individuals: 3600 patients with SNM (mean [SD] age, 51.5 [10.6] years; 1656 [46.0%] female and 1944 [54.0%] male participants) and 17 695 controls (41.5 [14.0] years; 9663[54.6%] female and 8032 [45.39%] male participants). Mean (SD) PM2.5 concentrations were higher among cases than controls across the 6-month (8.57 [2.52] vs 8.36 [2.50] μg/m3), 1-year (8.69 [2.45] vs 8.45 [2.43] μg/m3), and 5-year (9.36 [2.67] vs 9.08 [2.67] μg/m3) windows. In fully adjusted models, each SD increase in PM2.5 was associated with higher odds of first observed SNM diagnosis (adjusted odds ratio, 1.25 [95% CI, 1.05-1.49] for 6-month average exposure, 1.31 [95% CI, 1.08-1.59] for 1-year average exposure, and 1.36 [95% CI, 1.11-1.66] for 5-year average exposure).

In this case-control study, greater regional PM2.5 exposure was associated with higher odds of a first observed SNM diagnosis, with larger estimates for longer averaging windows. Further epidemiologic and mechanistic investigation is warranted.