尽管空气污染和绿度与乳腺癌风险关联的重要性，但该议题在全球范围内尚未得到研究。我们使用来自162个国家的7年数据进行了生态学研究。残疾调整生命年（DALYs）和发病率数据用于代表乳腺癌疾病负担。细颗粒物（直径<2.5μm）（PM2.5）、臭氧（O3）、二氧化氮（NO2）和归一化植被指数（NDVI）被采用作为我们的暴露因子。我们采用广义线性混合模型探讨了空气污染和绿度对乳腺癌疾病负担的关系。率比（RR）及其95%置信区间（CI）表示效应大小。空气污染与乳腺癌疾病负担之间存在正向关联。相反地，NDVI每上四分位数的增加与DALYs和发病率呈负相关。在空气污染与乳腺癌之间，NDVI似乎在这两种情况之间有显著影响。较高的绿度有助于减轻空气污染对乳腺癌的负面关联。PM2.5和O3在绿度与乳腺癌疾病负担之间发挥介导作用。在绿度水平较高的地区，空气污染物与乳腺癌负担之间的负相关可能受到影响。© 2023. 作者（或机构）。授权给德国施普林格－自然集团旗下的施普林格－瓦拉格有限公司。

Despite the significance of the associations of air pollution and greenness with the risk of breast cancer, this topic has not been investigated on a global scale. We conducted an ecological study using 7 years of data from 162 countries. Disability-adjusted life years (DALYs) and incidence data were used to represent the breast cancer disease burden. Particulate matter with a diameter < 2.5 μm (PM2.5), ozone (O3), nitrogen dioxide (NO2), and the normalized difference vegetation index (NDVI) were adopted as our exposures. We employed generalized linear mixed models to explore the relationship between air pollution and greenness on breast cancer disease burden. The rate ratio (RR) and its 95% confidence interval (CI) indicate the effect size. There is a positive association between air pollution and the burden of breast cancer disease. Contrarily, per interquartile range increment in NDVI was negatively associated with DALYs and incidence. In terms of air pollutants and breast cancer, NDVI seems to have a significant influence on the relationship between these two conditions. A higher amount of greenness helps to alleviate the negative association of air pollution on breast cancer. PM2.5 and O3 play a mediating role in the relationship between greenness and breast cancer disease burden. In areas with higher levels of greenness, there is a possibility that the inverse association between air pollutants and the burden of breast cancer may be influenced.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.