{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T14:16:26Z","timestamp":1794492986141,"version":"4.9.1"},"reference-count":42,"publisher":"BMJ","funder":[{"name":"Capital\u2019s Funds for Health Improvement and Research","award":["2024-1G-4023"],"award-info":[{"award-number":["2024-1G-4023"]}]},{"name":"Natural Science Foundation of Inner Mongolia Autonomous Region of China","award":["2025LHMS08002"],"award-info":[{"award-number":["2025LHMS08002"]}]},{"name":"Beijing Natural Science Foundation","award":["JQ24052"],"award-info":[{"award-number":["JQ24052"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["42588101"],"award-info":[{"award-number":["42588101"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Science and Technology Program of the Joint Fund of Scientific Research for the Public Hospitals of Inner Mongolia Academy of Medical Sciences","award":["2023GLLH0132"],"award-info":[{"award-number":["2023GLLH0132"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2026,8,17]]},"abstract":"\n Background<\/jats:title>\n \n In recent years, China has experienced declining fine particulate matter (PM\n 2.5<\/jats:sub>\n ) levels but rising ozone (O\n 3<\/jats:sub>\n ) levels. We aimed to examine the independent and joint associations of long-term exposure to PM\n 2.5<\/jats:sub>\n and O\n 3<\/jats:sub>\n with all-cause mortality among patients with lung cancer and to estimate potential survival gains.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We included 172\u2009845 lung cancer patients diagnosed in 2003\u20132022 from the Beijing Cancer Registry. Three-year average pre-diagnosis PM\n 2.5<\/jats:sub>\n and O\n 3<\/jats:sub>\n were assigned using the ChinaHighAirPollutants dataset. Cox proportional hazards models were used to estimate associations of PM\n 2.5<\/jats:sub>\n and O\n 3<\/jats:sub>\n with mortality. Joint exposure-response patterns were examined using a two-dimensional tensor-product spline and quantified by the multiplicative interaction index. Model-estimated avoided deaths and extended expected lifespan (EEL) were calculated using counterfactual simulations based on 2013 exposure levels.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Both PM\n 2.5<\/jats:sub>\n and O\n 3<\/jats:sub>\n were associated with increased mortality among patients with lung cancer, with HRs of 1.111 for PM\n 2.5<\/jats:sub>\n (95% CI 1.083 to 1.140)\u2009and 1.117 for O\n 3<\/jats:sub>\n (95%\u2009CI 1.070 to 1.166) per 10 \u03bcg\/m\n 3<\/jats:sup>\n increase. A significant multiplicative interaction was observed between PM\n 2.5<\/jats:sub>\n and O\n 3<\/jats:sub>\n , with statistically significant positive interactions mainly occurring at higher O\n 3<\/jats:sub>\n concentrations (>105\u2009\u00b5g\/m\n 3<\/jats:sup>\n ). During 2016\u20132022, reductions in pre-diagnosis PM\n 2.5<\/jats:sub>\n exposure were associated with 13\u2009229 model-estimated avoided deaths and a 7.8-month increase in 5-year EEL. However, O\n 3<\/jats:sub>\n and the PM\n 2.5<\/jats:sub>\n -O\n 3<\/jats:sub>\n interaction offset approximately 40% of these benefits.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n \n PM\n 2.5<\/jats:sub>\n reduction was associated with substantial survival gains among lung cancer patients, but rising O\n 3<\/jats:sub>\n and pollutant interactions partly offset these benefits, supporting coordinated multipollutant control.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/thorax-2026-225199","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:20:39Z","timestamp":1790176839000},"page":"thorax-2026-225199","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["PM\n 2.5<\/sub>\n , O\n 3<\/sub>\n and survival gains from China\u2019s clean air actions among patients with lung cancer: a 20-year registry-based cohort study in Beijing"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9514-3789","authenticated-orcid":false,"given":"Lei","family":"Yang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China"},{"name":"Peking University Cancer Hospital (Inner Mongolia Campus)\/Affiliated Cancer Hospital of Inner Mongolia Medical University, Inner Mongolia Cancer Center, Hohhot, China"},{"name":"School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5377-0039","authenticated-orcid":false,"given":"Ning","family":"Kang","sequence":"additional","affiliation":[{"name":"Institute of Reproductive and Child Health \/ National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics \/ Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Center, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7045-2307","authenticated-orcid":false,"given":"Tao","family":"Xue","sequence":"additional","affiliation":[{"name":"Institute of Reproductive and Child Health \/ National Health Commission Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics \/ Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Center, Beijing, China"},{"name":"National Institute of Health Data Science at Peking University\/Institute of Medical Technology, Peking University Health Science Centre, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Liu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huichao","family":"Li","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Zhang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Cao","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaohua","family":"Ma","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Molecular Oncology, Beijing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery I, Peking University Cancer Hospital & Institute, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiafu","family":"Ji","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), 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