B56-09 Association of County-Level Climate Change Skepticism With Lung Cancer Incidence and Mortality in the US

Abstract Rationale Lung cancer is the third most common cancer and the leading cause of cancer death among both men and women in the United States. Climate change and natural hazards have been associated with increased lung cancer incidence and mortality. However, the impact of climate change skepticism and natural hazards on lung cancer at the county level remains unclear. Methods This cross-sectional study analyzed county-level lung cancer incidence (2017-2021) and mortality (2018-2022) data from State Cancer Profiles. Climate change skepticism data were obtained from the Yale Program on Climate Change Communication. Community hazard risk was assessed using the National Risk Index. Negative binomial regression models were used to examine the associations of lung cancer incidence and mortality with climate change skepticism and community hazard risk, stratified by age, sex, race, and urbanization. Mediation analyses were performed to evaluate potential pathways (PM2.5, influenza and pneumococcal vaccination rates, and smoking rate) by which climate change skepticism may impact lung cancer incidence and mortality, adjusting for community vulnerability. Results During the study period, the age-adjusted incidence and mortality rates per 100,000 population were 53.1 (95% CI: 53.0-53.2) and 32.4 (95% CI: 32.3-32.5), respectively. Counties with greater climate change skepticism were associated with higher lung cancer incidence (4th vs. 1st quartile, rate ratio RR: 1.30; 95% CI: 1.26-1.33) and mortality (RR: 1.38; 95% CI: 1.34-1.43). Among the mediators included in the analysis, smoking significantly mediated the associations between climate change skepticism and lung cancer outcomes, with 73% and 63% of the effects on incidence and mortality, respectively, mediated by higher smoking rates in urban counties, and 46% and 44% in rural counties. Interestingly, a paradoxical relationship was observed between lung cancer incidence and mortality and the National Risk Index. Conclusions County-level climate change skepticism is associated with higher lung cancer incidence and mortality. People living in areas with greater climate change skepticism may be more likely to distrust scientific health recommendations, such as smoking cessation. Addressing climate change skepticism and its impact on health behaviors is essential for reducing the lung cancer burden and strengthening public health efforts to mitigate health disparities. This abstract is funded by: None