title: Time trend and geographic patterns of lung adenocarcinoma in the United States, 1973-2002.
abstract: OBJECTIVE
  To find the major factor explaining the substantial increase in incidence of adenocarcinoma of the lung (ADL), we observed its temporal trend, distributions in geographic areas and populations, and compared them with the distributions of air pollution and low-tar cigarette consumption in time, place, and populations.
  
  
  METHODS
  The temporal and spatial patterns of ADL were compared with the level of nitrogen oxides (NO(x)) emissions as well as the use of low-tar cigarettes.
  
  
  RESULTS
  Similar increasing trends followed by declining trends were seen in emission levels of NO(x) and ADL incidence rates. These trends peak about 20 years earlier for NO(x) levels than for ADL incidence. Incidence rates of ADL in high NO(x) emission areas were substantially higher than those in low NO(x) emission areas. Incidence rates of ADL in Black males are about 50% higher than in White males and can be explained by the differences in air quality related to residence site and size.
  
  
  CONCLUSIONS
  The descriptive epidemiologic data help generate the hypothesis that long-term exposure to low-dose NO(x) may play a major role in causing steep increases in past ADL incidence rates. There is an urgent need to conduct further studies to determine whether the association is a causal relationship between long-term, low-dose exposure to NO(x) and ADL.
authors: Department of Community Medicine, Mercer University, 1550 College Street, Macon, GA 31207, USA. Chen_fd@mercer.edu
authors: Fan
authors: F
authors: Chen
authors: Phillip
authors: P
authors: Cole
authors: William F
authors: WF
authors: Bina
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000393:Air Pollutants / Q000009:adverse effects; D000397:Air Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data; D018288:Carcinoma, Small Cell / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D009589:Nitrogen Oxides / Q000009:adverse effects; D044469:Racial Groups; D012307:Risk Factors; D018426:SEER Program; D012907:Smoking / Q000009:adverse effects*; D013638:Tars; D013995:Time; D014481:United States / Q000453:epidemiology
chemical_list: D000393:Air Pollutants; D009589:Nitrogen Oxides; D013638:Tars; C024746:tobacco tar