Estimation of lung cancer deaths attributable to indoor radon exposure in upper northern Thailand

Radon exposure is the second leading cause of lung cancer, after smoking. In upper northern Thailand (UNT), lung cancer incidence was frequently reported by Thailand National Cancer Institute. Besides smoking, radon exposure may also influence the high lung cancer incidence in this region. Indoor radon concentrations were measured in 192 houses in eight provinces of UNT. Indoor radon concentrations ranged from 11 to 405 Bq m^-3 and estimated annual effective dose ranged from 0.44 to 12.18 mSv y^-1. There were significant differences in indoor radon concentrations between the houses of lung cancer cases and healthy controls (p = 0.033). We estimated that 26% of lung cancer deaths in males and 28% in females were attributable to indoor radon exposure in this region. Other factors influencing indoor radon levels included house characteristics and ventilation. The open window-to-wall ratio was negatively associated with indoor radon levels (B = -0.69, 95% CI -1.37, -0.02) while the bedroom location in the house and building material showed no association. Indoor radon hence induced the fractal proportion of lung cancer deaths in UNT.