Cardiovascular and cancer mortality inversely associated with long-term ambient ultraviolet exposure across US Health Service Areas with UK Biobank corroboration
- 1Cytokind Inc., Intervale, New Hampshire, USA
Abstract
OBJECTIVETo assess associations of ambient UV with cardiovascular and cancer mortality across US Health Service Areas (HSAs), prioritise outcomes by signal and attributable burden, assess racial and ethnic variation, with UK Biobank corroboration.
DESIGNEcological analysis of HSAs using linear regression of crude mortality on ambient UV and social vulnerability, with correction for multiple comparisons.
SETTINGUS HSAs and UK Biobank.
DATA SOURCESPublicly available US data and UK Biobank data accessed under Application 82526.
PARTICIPANTS704 808 annual cardiovascular deaths (aged [≥]65) and 565 287 annual cancer deaths (aged [≥]50) from populations of 52.8 and 115.2 million; UK Biobank analyses included 412 665 individuals.
MAIN OUTCOME MEASURESCardiovascular, all-cancer, and body-site-specific cancer mortality; regression slope per interquartile-range increase in UV ({beta} UV/IQR), modelled attributable burden for US data, and hazard ratios for the UK Biobank data.
RESULTSHigher UV was associated with lower cardiovascular ({beta}UV/IQR -68.3 deaths/100 000; P<0.001) and all-cancer mortality (-43.2; P<0.001), corresponding to 36 043 (5.1%) and 49 789 (8.8%) fewer US deaths annually, respectively. Associations varied by race and ethnicity. Cardiovascular findings were directionally consistent between US and UK datasets. All-cancer mortality and 10 of 18 cancers were inversely associated with UV in the US; UK analyses found inverse associations for all-cancer and two individual body-site-specific cancers. Twelve cancers showed directionally concordant associations across the datasets, of which ten were inverse. Lung cancer showed the strongest inverse association in each dataset.
CONCLUSIONSHigher UV was associated with lower cardiovascular and cancer mortality across US HSAs, with modelled attributable burdens exceeding 5%; UK Biobank findings provided partial corroboration. Twelve of 18 site-specific cancers were directionally concordant between datasets. US race-stratified heterogeneity did not follow a skin-colour gradient, suggesting residual confounding.
WHAT IS ALREADY KNOWN ON THIS TOPICAlthough intermittent ultraviolet (UV) exposure is associated with risk of increased skin-cancer incidence including keratinocyte cancers and melanoma, there is no parallel increase in mortality. In contrast, long-term ecological and cohort studies have consistently associated higher UV exposure and sun-seeking behaviour with lower all-cause, cardiovascular, and internal cancer mortality. While large-scale randomised placebo-controlled trials of vitamin D supplements have all failed their primary endpoints to reduce incidence or mortality, shifting attention toward other UV-induced pathways that may better explain the observed net benefits.
Complementary clinical evidence comes from NB-UVB phototherapy, a controlled surrogate of solar UV, which provides mechanistic insight through its association with reduced cardiovascular and cerebrovascular events and its guideline-directed role in dermatological conditions and early-stage cutaneous T-cell lymphoma.
What this study addsThis study provides updated nationwide estimates of the association between long-term ambient ultraviolet radiation and mortality across US Health Service Area and UK Biobank datasets, showing inverse associations with two of the leading causes of death: cardiovascular disease and cancer. Across the observed US interquartile range of ambient UV, higher UV was associated with 36,043 fewer cardiovascular deaths and 49,789 fewer cancer deaths per year, with inverse cancer associations observed across multiple internal cancers and directionally corroborated in an independent UK Biobank dataset across all-cancer and 12 of 18 individual site-cancers.
Prespecified racial subgroup analyses showed that UV-mortality relationships were heterogeneous and non-monotonic across racial groups, rather than following the expected gradient by skin colour seen in clinical phototherapy. This suggests that UV-mortality associations may be shaped by additional biological, behavioural, environmental, or social determinants not fully captured by the Social Vulnerability Index.
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BibTeX
@misc{macmahon2026cardiovascular,
title = {{Cardiovascular and cancer mortality inversely associated with long-term ambient ultraviolet exposure across US Health Service Areas with UK Biobank corroboration}},
author = {J. MacMahon and C. Emig and P. H. Hart and B. Wang and R. Weller and C. Dibben and A. Stevenson},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.06.26364908},
url = {https://www.medrxiv.org/content/10.64898/2026.10.06.26364908v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Cardiovascular and cancer mortality inversely associated with long-term ambient ultraviolet exposure across US Health Service Areas with UK Biobank corroboration
AU - J. MacMahon
AU - C. Emig
AU - P. H. Hart
AU - B. Wang
AU - R. Weller
AU - C. Dibben
AU - A. Stevenson
PY - 2026
DA - 2026/10/06
PB - medRxiv
DO - 10.64898/2026.10.06.26364908
UR - https://www.medrxiv.org/content/10.64898/2026.10.06.26364908v1
AB - OBJECTIVETo assess associations of ambient UV with cardiovascular and cancer mortality across US Health Service Areas (HSAs), prioritise outcomes by signal and attributable burden, assess racial and ethnic variation, with UK Biobank corroboration. DESIGNEcological analysis of HSAs using linear regression of crude mortality on ambient UV and social vulnerability, with correction for multiple comparisons. SETTINGUS HSAs and UK Biobank. DATA SOURCESPublicly available US data and UK Biobank data accessed under Application 82526. PARTICIPANTS704 808 annual cardiovascular deaths (aged [≥]65) and 565 287 annual cancer deaths (aged [≥]50) from populations of 52.8 and 115.2 million; UK Biobank analyses included 412 665 individuals. MAIN OUTCOME MEASURESCardiovascular, all-cancer, and body-site-specific cancer mortality; regression slope per interquartile-range increase in UV ({beta} UV/IQR), modelled attributable burden for US data, and hazard ratios for the UK Biobank data. RESULTSHigher UV was associated with lower cardiovascular ({beta}UV/IQR -68.3 deaths/100 000; P<0.001) and all-cancer mortality (-43.2; P<0.001), corresponding to 36 043 (5.1%) and 49 789 (8.8%) fewer US deaths annually, respectively. Associations varied by race and ethnicity. Cardiovascular findings were directionally consistent between US and UK datasets. All-cancer mortality and 10 of 18 cancers were inversely associated with UV in the US; UK analyses found inverse associations for all-cancer and two individual body-site-specific cancers. Twelve cancers showed directionally concordant associations across the datasets, of which ten were inverse. Lung cancer showed the strongest inverse association in each dataset. CONCLUSIONSHigher UV was associated with lower cardiovascular and cancer mortality across US HSAs, with modelled attributable burdens exceeding 5%; UK Biobank findings provided partial corroboration. Twelve of 18 site-specific cancers were directionally concordant between datasets. US race-stratified heterogeneity did not follow a skin-colour gradient, suggesting residual confounding. WHAT IS ALREADY KNOWN ON THIS TOPICAlthough intermittent ultraviolet (UV) exposure is associated with risk of increased skin-cancer incidence including keratinocyte cancers and melanoma, there is no parallel increase in mortality. In contrast, long-term ecological and cohort studies have consistently associated higher UV exposure and sun-seeking behaviour with lower all-cause, cardiovascular, and internal cancer mortality. While large-scale randomised placebo-controlled trials of vitamin D supplements have all failed their primary endpoints to reduce incidence or mortality, shifting attention toward other UV-induced pathways that may better explain the observed net benefits. Complementary clinical evidence comes from NB-UVB phototherapy, a controlled surrogate of solar UV, which provides mechanistic insight through its association with reduced cardiovascular and cerebrovascular events and its guideline-directed role in dermatological conditions and early-stage cutaneous T-cell lymphoma. What this study addsThis study provides updated nationwide estimates of the association between long-term ambient ultraviolet radiation and mortality across US Health Service Area and UK Biobank datasets, showing inverse associations with two of the leading causes of death: cardiovascular disease and cancer. Across the observed US interquartile range of ambient UV, higher UV was associated with 36,043 fewer cardiovascular deaths and 49,789 fewer cancer deaths per year, with inverse cancer associations observed across multiple internal cancers and directionally corroborated in an independent UK Biobank dataset across all-cancer and 12 of 18 individual site-cancers. Prespecified racial subgroup analyses showed that UV-mortality relationships were heterogeneous and non-monotonic across racial groups, rather than following the expected gradient by skin colour seen in clinical phototherapy. This suggests that UV-mortality associations may be shaped by additional biological, behavioural, environmental, or social determinants not fully captured by the Social Vulnerability Index.
ER -