{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T03:32:54Z","timestamp":1776742374420,"version":"3.51.2"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T00:00:00Z","timestamp":1727049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Northern Thailand experiences high levels of air pollution in the dry season due to agricultural waste burning and forest fires. Some air pollutants can enter the bloodstream, and the liver has the role of detoxifying these along with other harmful substances. In this study, we assessed the effects of long-term exposure to air pollutants on liver cancer mortality in this area.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort of 10,859 primary liver cancer patients diagnosed between 2003 and 2018 and followed up to the end of 2020 were included in the study. Extended time-varying covariates of the annually averaged pollutant concentrations updated each year were utilized. The associations between air pollutants and mortality risk were examined by using a Cox proportional hazard model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Metastatic cancer stage had the highest adjusted hazard ratio (aHR) of 3.57 (95% confidence interval (CI):3.23\u20133.95). Being male (aHR\u2009=\u20091.10; 95% CI: 1.04\u20131.15), over 60\u2009years old (aHR\u2009=\u20091.16; 95% CI: 1.11\u20131.21), having a history of smoking (aHR\u2009=\u20091.16; 95%CI: 1.11\u20131.22), and being exposed to a time-updated local concentration of PM<jats:sub>2.5<\/jats:sub> of 40\u2009\u03bcg\/m<jats:sup>3<\/jats:sup> (aHR\u2009=\u20091.10; 95% CI: 1.05\u20131.15) increased the mortality risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found that air pollution is one of several detrimental factors on the mortality risk of liver cancer.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1389760","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T11:41:21Z","timestamp":1727091681000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Air pollutants and primary liver cancer mortality: a cohort study in crop-burning activities and forest fires area"],"prefix":"10.3389","volume":"12","author":[{"given":"Natthapat","family":"Thongsak","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taned","family":"Chitapanarux","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anon","family":"Chotirosniramit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Somvilai","family":"Chakrabandhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrinee","family":"Traisathit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nawapon","family":"Nakharutai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pimwarat","family":"Srikummoon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salinee","family":"Thumronglaohapun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Titaporn","family":"Supasri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phonpat","family":"Hemwan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Imjai","family":"Chitapanarux","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,9,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref2","unstructured":"2022"},{"key":"ref3","unstructured":"2022"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1038\/nrc1781","article-title":"Predicting the future burden of cancer","volume":"6","author":"Bray","year":"2006","journal-title":"Nat Rev Cancer"},{"key":"ref5","unstructured":"FerlayJ\n            LaversanneM\n            ErvikM\n            LamF\n            ColombetM\n            MeryL\n          2020"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1038\/s41575-019-0186-y","article-title":"A global view of hepatocellular carcinoma: trends, risk, prevention and management","volume":"16","author":"Yang","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1264","DOI":"10.1053\/j.gastro.2011.12.061","article-title":"Epidemiology of viral hepatitis and hepatocellular carcinoma","volume":"142","author":"El-Serag","year":"2012","journal-title":"Gastroenterology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1093\/aje\/kwh161","article-title":"Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults","volume":"159","author":"Coughlin","year":"2004","journal-title":"Am J Epidemiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1136\/gut.2004.052167","article-title":"Diabetes increases the risk of hepatocellular carcinoma in the United States: a population based case control study","volume":"54","author":"Davila","year":"2005","journal-title":"Gut"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"7764817","DOI":"10.1155\/2021\/7764817","article-title":"Main risk factors of type 2 diabetes mellitus with nonalcoholic fatty liver disease and hepatocellular carcinoma","volume":"2021","author":"Qi","year":"2021","journal-title":"J Oncol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1038\/s41416-018-0007-z","article-title":"Tobacco, alcohol use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: the liver Cancer pooling project","volume":"118","author":"Petrick","year":"2018","journal-title":"Br J Cancer"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.cgh.2015.11.019","article-title":"Effects of alcohol consumption on hepatocarcinogenesis in Japanese patients with fatty liver disease","volume":"14","author":"Kawamura","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1002\/cncr.29922","article-title":"Disparity in liver cancer incidence and chronic liver disease mortality by nativity in Hispanics: the multiethnic cohort","volume":"122","author":"Setiawan","year":"2016","journal-title":"Cancer"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.ypmed.2012.05.017","article-title":"Development of a prediction model for 10-year risk of hepatocellular carcinoma in middle-aged Japanese: the Japan public health center-based prospective study cohort II","volume":"55","author":"Michikawa","year":"2012","journal-title":"Prev Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1158\/1055-9965.EPI-07-2806","article-title":"Risk factors for hepatocellular carcinoma in a Japanese population: a nested case-control study","volume":"17","author":"Ohishi","year":"2008","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2748","DOI":"10.1002\/cncr.31406","article-title":"Risk factors for hepatocellular carcinoma by age, sex, and liver disorder status: a prospective cohort study in Korea","volume":"124","author":"Yi","year":"2018","journal-title":"Cancer"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"792","DOI":"10.5009\/gnl19163","article-title":"Systematic review with meta-analysis: low-level alcohol consumption and the risk of liver cancer","volume":"14","author":"Park","year":"2020","journal-title":"Gut Liver"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s12876-021-01978-0","article-title":"Hepatocellular carcinoma in nonalcoholic fatty liver disease with or without cirrhosis: a population-based study","volume":"21","author":"Pinyopornpanish","year":"2021","journal-title":"BMC Gastroenterol"},{"key":"ref20","volume-title":"The health consequences of Smoking-50 years of Progress: A report of the surgeon general","year":"2014"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.jhep.2012.02.022","article-title":"Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma","volume":"57","author":"Palmer","year":"2012","journal-title":"J Hepatol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.jhep.2012.08.009","article-title":"Exposure to ambient particulate matter induces a NASH-like phenotype and impairs hepatic glucose metabolism in an animal model","volume":"58","author":"Zheng","year":"2013","journal-title":"J Hepatol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1759","DOI":"10.1093\/carcin\/bgg147","article-title":"DNA adduct formation and oxidative stress in colon and liver of big blue rats after dietary exposure to diesel particles","volume":"24","author":"Dybdahl","year":"2003","journal-title":"Carcinogenesis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.mrfmmm.2007.06.011","article-title":"DNA damage in rats after a single oral exposure to diesel exhaust particles","volume":"637","author":"Danielsen","year":"2008","journal-title":"Mutat Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"C736","DOI":"10.1152\/ajpcell.00529.2009","article-title":"Airborne particulate matter selectively activates endoplasmic reticulum stress response in the lung and liver tissues","volume":"299","author":"Laing","year":"2010","journal-title":"Am J Physiol Cell Physiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"65","DOI":"10.5487\/TR.2014.30.2.065","article-title":"The role of air pollutants in initiating liver disease","volume":"30","author":"Kim","year":"2014","journal-title":"Toxicol Res"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2488","DOI":"10.1073\/pnas.1818134116","article-title":"Fluorescent reconstitution on deposition of PM2.5 in lung and extrapulmonary organs","volume":"116","author":"Li","year":"2019","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1007\/s11906-003-0008-y","article-title":"Air pollution: the \u201cheart\u201d of the problem","volume":"5","author":"Brook","year":"2003","journal-title":"Curr Hypertens Rep"},{"key":"ref29","volume-title":"Air quality in Thailand: Understanding the regulatory context","author":"Nikam","year":"2021"},{"key":"ref30","unstructured":"2021"},{"key":"ref31","unstructured":"2020"},{"key":"ref32","unstructured":"2019"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e14261","DOI":"10.1016\/j.heliyon.2023.e14261","article-title":"Airborne particulate matter from biomass burning in Thailand: recent issues, challenges, and options","volume":"9","author":"Suriyawong","year":"2023","journal-title":"Heliyon"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2490","DOI":"10.3390\/ijerph16142490","article-title":"Association between ambient particulate matter 2.5 exposure and mortality in patients with hepatocellular carcinoma","volume":"16","author":"Lee","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1159\/000525346","article-title":"Exposure to air pollution and survival in follow-up after hepatocellular carcinoma","volume":"11","author":"Chin","year":"2022","journal-title":"Liver Cancer"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1002\/ijc.30779","article-title":"Particulate matter air pollution and liver cancer survival","volume":"141","author":"Deng","year":"2017","journal-title":"Int J Cancer"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1007\/s10552-020-01317-w","article-title":"Cancer mortality risk, fine particulate air pollution, and smoking in a large, representative cohort of US adults","volume":"31","author":"Coleman","year":"2020","journal-title":"Cancer Causes Control"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/j.jes.2022.05.037","article-title":"Air pollution and liver cancer: a systematic review","volume":"126","author":"Gan","year":"2023","journal-title":"J Environ Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1002\/sim.8399","article-title":"A review of the use of time-varying covariates in the Fine-gray subdistribution hazard competing risk regression model","volume":"39","author":"Austin","year":"2020","journal-title":"Stat Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"D13205","DOI":"10.1029\/2008JD011115","article-title":"Aerosol analysis and forecast in the European Centre for Medium-Range Weather Forecasts integrated forecast system: 2. Data assimilation","volume":"114","author":"Benedetti","year":"2009","journal-title":"J Geophys Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"D06206","DOI":"10.1029\/2008JD011235","article-title":"Aerosol analysis and forecast in the European Centre for Medium-Range Weather Forecasts integrated forecast system: forward modeling","volume":"114","author":"Morcrette","year":"2009","journal-title":"J Geophys Res"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"3515","DOI":"10.5194\/acp-19-3515-2019","article-title":"The CAMS reanalysis of atmospheric composition","volume":"19","author":"Inness","year":"2019","journal-title":"Atmos Chem Phys"},{"key":"ref43","doi-asserted-by":"crossref","DOI":"10.1002\/9781119013563","volume-title":"Statistical analysis with missing data","author":"Little","year":"2002"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"121","DOI":"10.21037\/atm.2018.02.12","article-title":"Time-varying covariates and coefficients in cox regression models","volume":"6","author":"Zhang","year":"2018","journal-title":"Ann Transl Med"},{"key":"ref45","volume-title":"BMI classification percentile and cut off points","author":"Weir","year":"2021"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"7160","DOI":"10.3748\/wjg.v23.i39.7160","article-title":"Characteristics and outcomes of cholangiocarcinoma by region in Thailand: a nationwide study","volume":"23","author":"Chaiteerakij","year":"2017","journal-title":"World J Gastroenterol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.mrgentox.2008.08.015","article-title":"Particulate matter inhibits DNA repair and enhances mutagenesis","volume":"657","author":"Mehta","year":"2008","journal-title":"Mutat Res"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/s0300-483x(03)00305-6","article-title":"Molecular and cellular mechanisms of cadmium carcinogenesis","volume":"192","author":"Waisberg","year":"2003","journal-title":"Toxicology"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1136\/oem.60.8.612","article-title":"Oxidative stress: its role in air pollution and adverse health effects","volume":"60","author":"Kelly","year":"2003","journal-title":"Occup Environ Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1743-8977-5-6","article-title":"DNA damage and cytotoxicity in type II lung epithelial (A549) cell cultures after exposure to diesel exhaust and urban street particles","volume":"5","author":"Danielsen","year":"2008","journal-title":"Part Fibre Toxicol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/jnci\/djv341","article-title":"Fine particle pollution, alanine transaminase, and liver cancer: a Taiwanese prospective cohort study (REVEAL-HBV)","volume":"108","author":"Pan","year":"2015","journal-title":"J Natl Cancer Inst"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"151","DOI":"10.3961\/jpmph.15.014","article-title":"Physical activity-and alcohol-dependent association between air pollution exposure and elevated liver enzyme levels: an elderly panel study","volume":"48","author":"Kim","year":"2015","journal-title":"J Prev Med Public Health"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1097\/EDE.0b013e3182a77600","article-title":"Air pollution and liver enzymes","volume":"24","author":"Markevych","year":"2013","journal-title":"Epidemiology"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1002\/hep.27016","article-title":"Inflammatory and metabolic biomarkers and risk of liver and biliary tract cancer","volume":"60","author":"Aleksandrova","year":"2014","journal-title":"Hepatology"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.canep.2016.01.002","article-title":"Prospective association of liver function biomarkers with development of hepatobiliary cancers","volume":"40","author":"Stepien","year":"2016","journal-title":"Cancer Epidemiol"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1158\/1055-9965.EPI-15-0626","article-title":"Cancer mortality risks from long-term exposure to ambient fine particle","volume":"25","author":"Wong","year":"2016","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.mrfmmm.2005.06.012","article-title":"Oxidative stress-induced DNA damage by particulate air pollution","volume":"592","author":"Risom","year":"2005","journal-title":"Mutat Res"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1038\/nature07205","article-title":"Cancer-related inflammation","volume":"454","author":"Mantovani","year":"2008","journal-title":"Nature"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1038\/ncpcardio1399","article-title":"Adverse cardiovascular effects of air pollution","volume":"6","author":"Mills","year":"2009","journal-title":"Nat Clin Pract Cardiovasc Med"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.crohns.2011.02.017","article-title":"Air pollution: an environmental factor contributing to intestinal disease","volume":"5","author":"Beamish","year":"2011","journal-title":"J Crohns Colitis"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"460","DOI":"10.3322\/caac.21632","article-title":"Outdoor air pollution and cancer: an overview of the current evidence and public health recommendations","volume":"70","author":"Turner","year":"2020","journal-title":"CA Cancer J Clin"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"16037","DOI":"10.3390\/ijerph192316037","article-title":"Air pollution: possible interaction between the immune and nervous system?","volume":"19","author":"Serafini","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1164\/rccm.201508-1633OC","article-title":"Long-term ozone exposure and mortality in a large prospective study","volume":"193","author":"Turner","year":"2016","journal-title":"Am J Respir Crit Care Med"},{"key":"ref64","unstructured":"2023"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"605","DOI":"10.22034\/APJCP.2018.19.3.605","article-title":"Risk factors for cholangiocarcinoma in Thailand: a systematic review and meta-analysis","volume":"19","author":"Kamsa-ard","year":"2018","journal-title":"Asian Pac J Cancer Prev"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1186\/s12885-023-11429-6","article-title":"Prediction of survival and analysis of prognostic factors for hepatocellular carcinoma: a 20-year of imaging diagnosis in upper northern Thailand","volume":"23","author":"Nakharutai","year":"2023","journal-title":"BMC Cancer"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1389760\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T12:46:06Z","timestamp":1727181966000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1389760\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,23]]},"references-count":66,"alternative-id":["10.3389\/fpubh.2024.1389760"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1389760","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,23]]},"article-number":"1389760"}}