Evaluating the causal links between long-term exposure to artificial light at night and lung cancer mortality based on the Pearl River Cohort Study with 0.5 million participants

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Artificial light at night (LAN) pollution is a growing public health concern. However, there has been limited epidemiological research on the LAN-lung cancer mortality links. Evidence from large cohorts and causal inference approaches is far more limited. We included 476,328 individuals from 35 randomly selected communities in southern China. A satellite-based approach was used to assess LAN exposure, which was assigned to participants based on their home address. The LAN-lung cancer mortality connections were investigated using marginal structural Cox proportional hazards regression models with inverse probability weightings. The modification effects of sociodemographics on the above relationships were also assessed. During a median follow-up of 9.0 years, the incidence of lung cancer mortality was 6.43 per 10,000 person-years. We found a hazard ratio (HR) of 1.055 [95 ​% confidence interval (CI): 1.010–1.102] for lung cancer mortality following each 10 ​nW/cm 2 /sr increase in long-term LAN exposure. Further stratified analyses revealed that those <65 years, males, and those with primary school and below were more vulnerable to LAN exposure. The LAN-lung cancer mortality relationship was significant in those <65 years (HR ​= ​1.132, 95 %CI: 1.047–1.224) but not in those ≥65 years (HR ​= ​1.041, 95 %CI: 0.984–1.101). The HR for male participants was 1.105 (95 %CI: 1.044–1.169), while the HR for females was 1.033 (95 %CI: 0.958–1.113). A significant positive association was observed only among those with primary school and below. This large cohort study suggests that long-term LAN exposure was linked to increased lung cancer mortality, particularly in certain vulnerable populations. • First insights from causal inference about LAN and lung cancer mortality. • Significant negative effects of LAN were discovered. • <65 years, males, and low-literacy populations were vulnerable.

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