A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed.

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BACKGROUND: Individual environmental exposures are associated with cancer development; however, environmental exposures occur simultaneously. The Environmental Quality Index (EQI) is a county‐level measure of cumulative environmental exposures that occur in 5 domains.METHODS: The EQI was linked to county‐level annual age‐adjusted cancer incidence rates from the Surveillance, Epidemiology, and End Results (SEER) Program state cancer profiles. All‐site cancer and the top 3 site‐specific cancers for male and female subjects were considered. Incident rate differences (IRDs; annual rate difference per 100,000 persons) and 95% confidence intervals (CIs) were estimated using fixed‐slope, random intercept multilevel linear regression models. Associations were assessed with domain‐specific indices and analyses were stratified by rural/urban status.RESULTS: Comparing the highest quintile/poorest environmental quality with the lowest quintile/best environmental quality for overall EQI, all‐site county‐level cancer incidence rate was positively associated with poor environmental quality overall (IRD, 38.55; 95% CI, 29.57‐47.53) and for male (IRD, 32.60; 95% CI, 16.28‐48.91) and female (IRD, 30.34; 95% CI, 20.47‐40.21) subjects, indicating a potential increase in cancer incidence with decreasing environmental quality. Rural/urban stratified models demonstrated positive associations comparing the highest with the lowest quintiles for all strata, except the thinly populated/rural stratum and in the metropolitan/urbanized stratum. Prostate and breast cancer demonstrated the strongest positive associations with poor environmental quality.CONCLUSION: We observed strong positive associations between the EQI and all‐site cancer incidence rates, and associations differed by rural/urban status and environmental domain. Research focusing on single environmental exposures in cancer development may not address the broader environmental context in which cancers develop, and future research should address cumulative environmental exposures. Cancer 2017;123:2901–8. © 2017 American Cancer Society.

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Although studies have investigated cadmium and prostate cancer (PC) incidence and mortality, the role of cadmium in PC progression might be more clinically relevant. In this observational study, we assessed the association between air cadmium exposure and PC aggressiveness, with PC stage defined as metastatic or localized and Gleason grade defined as high (Gleason score ≥ 8) or low (Gleason score ≤ 6) among PC patients from the 2010–2014 US Surveillance, Epidemiology, and End Results database. The 2005 and 2011 National Air Toxics Assessment provided county-level air cadmium concentrations. Results were presented as odds ratios (OR) with 95% confidence intervals (CI) and were calculated using random intercept mixed effects logistic regression, comparing the 80th to 20th percentile of exposure. We adjusted for age, sociodemographic status, smoking prevalence, and overall air quality at the county level, and stratified by race, age, and degree of urbanization. The cohort consisted of 230,540 cases from 493 counties. Strong associations were observed in nonmetropolitan, urban areas: (OR 1.26, CI 1.14–1.39) for metastatic vs. localized and (OR 1.41, CI 1.27–1.57) for high- vs. low-grade PC where 40 million Americans reside. This study may be hypothesis-generating to inform future studies and public health measures.