Radiation Exposure and Public Health Impacts: Qinshan Nuclear Power Plant Phase I Before and After Extension

Radiation Exposure and Public Health Impacts: Qinshan Nuclear Power Plant Phase I Before and After Extension | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Radiation Exposure and Public Health Impacts: Qinshan Nuclear Power Plant Phase I Before and After Extension Yihang Li, Yiyao Cao, Jiadi Guo, Junjie Xu, Shunfei Yu, Hua Zou, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7477995/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study evaluates the ambient radiation levels and their impact on public health around the Qinshan Nuclear Power Plant (QNPP) before and after the extended service of its Phase I project. By monitoring the cumulative ambient external exposure dose around QNPP from 2010 to 2023 and analyzing the health data of residents in Haiyan County from 2012 to 2022, changes in cancer mortality-related rates were examined. Results showed that during the study period, ambient radiation around QNPP remained at background levels. Although the annual cumulative ambient dose increased after the extended service, the annual effective dose and excess risk still remained well below the standard limits. From 2012 to 2022, the crude cancer mortality rate and age-standardized mortality rate among residents near QNPP were slightly higher than the average levels in Zhejiang Province, with males having higher rates than females; however, an overall downward trend was observed. The mortality rates of leukemia and thyroid cancer also showed a decreasing trend. In conclusion, the current operation of QNPP has not caused significant radiation impacts on the surrounding environment or public health. Nevertheless, continuous monitoring is necessary to ensure environmental safety and public health. Biological sciences/Cancer Earth and environmental sciences/Environmental sciences Health sciences/Health care Health sciences/Oncology Qinshan Nuclear Power Plant Ambient radiation Cancer mortality Radiation exposure assessment Figures Figure 1 1. Introduction The 2015 Paris Agreement requires parties to formulate NDC emission reduction targets, limiting global warming to within 2°C compared to pre-industrial levels and achieving near-zero carbon electricity generation by the middle of this century. As a dispatchable low-carbon energy source, nuclear power plays a crucial role in this transition 1 . As a party to the Agreement, China is actively advancing its "dual carbon" goals through the development of non-fossil energy sources, including nuclear power 2 . Currently, there are 56 operational nuclear power units in China (excluding the Taiwan region), with a total installed capacity of 58,218.34 MWe (rated installed capacity) 3 . However, numerous epidemiological studies 4 – 12 have indicated that workers and residents living near nuclear power plants face increased health risks even when exposed to radiation levels within regulated dose limits. Moreover, following the Fukushima nuclear accident in Japan, people worldwide have become more concerned about such potential risks 13 and expressed varying degrees of anxiety. For this reason, many countries have implemented radioactive monitoring and radiation risk assessment programs before and after the operation of nuclear power plants 14 , 15 . Located in Haiyan County, Zhejiang Province, China, Qinshan Nuclear Power Plant (QNPP) is the country’s first independently designed and constructed 300 MW pressurized water reactor nuclear power plant. It was commissioned in 1991 with a 30-year design life and approved for a 20-year extension in 2021, allowing safe operation through 2041 16 . While offering high efficiency and low carbon benefits, its operation may involve radioactive releases 17 . To our knowledge, data on environmental radioactivity and radiation exposure impacts before and after the Phase I extension remain scarce. Hence, tracking radiation exposure and radioactivity levels during this period is critical—it enables timely understanding of radioactive conditions, accurate trend identification, and thus ensures environmental safety and public health protection. Public exposure around nuclear power plants primarily includes internal and external radiation 18 . External radiation is mainly caused by radioactive exposure in the external environment 19 , including radiation from artificial sources, plume external exposure, and deposited external exposure from radioactive fallout (fallout ash). These various radiation sources continuously release radiation into the environment, which can significantly affect radiation doses in surrounding areas. Due to the presence of nuclear power units, Haiyan County is more likely to be affected by the combined effects of various radiations. Therefore, we assessed the health impacts of radiation exposure by detecting the cumulative ambient radiation dose in Haiyan County where the nuclear power units are located. This study aims to provide data on cumulative ambient radiation doses around the Phase I project of QNPP before (2010–2021) and after (2022–2023) its extended service. Meanwhile, using authorized health data, it analyzes the cancer mortality rates of residents in Haiyan County, especially the mortality rates of radiation-sensitive cancers. The study period is from 2010 to 2023, covering the monitoring of cumulative external ambient radiation doses around QNPP. Based on the monitoring results of cumulative external ambient radiation doses, it evaluates the annual effective dose ( AED e ) and excess risk ( ER e ) of residents, and analyzes the cancer mortality rates of residents near QNPP. The results of this study can serve as basic data for assessing the impacts of future operation of QNPP on human health risks and the surrounding environment. 2. Methods and Materials 2.1 Ambient radiation sample collection and analysis In this study, thermoluminescent dosimeters (TLDs) were used to measure the cumulative ambient radiation dose. Monitoring stations will be established in three concentric zones centered on the Phase I Project of QNPP, with radii ranging from 0-10 km, 10-20 km, and 20-30 km respectively. Each zone will contain 10 monitoring stations, totaling 30 stations, and their specific locations are shown in Figure 1. Two TLDs (LiF: Mg, Cu, P) were deployed at each station, resulting in 60 TLDs in total. At each station, the TLDs were suspended in parallel approximately 2 meters above ground level on tree trunks, exposed to the open air. Monitoring cycles were quarterly, with all TLDs retrieved, measured, and data recorded at the end of each cycle. 2.2 Quality assurance and quality control Before each placement of the components (TLDs), a Type C thermoluminescent precision annealing furnace is used to anneal them to control residual dose, and instrument operation specifications are strictly followed during measurement. Annually, the Zhejiang Institute of Metrology is entrusted to calibrate and scale the detection system. Meanwhile, the team participates in the national blind sample comparison for external exposure personal dose organized by the National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, and has achieved excellent results multiple times. 2.3 Dose assessment Annual effective dose ( AED , mSv/y) is a radiation protection quantity recognized as a useful tool for assessing radiation exposure risks and formulating radioactive contamination policies. In this study, the annual effective dose caused by environmental exposure ( AED e , mSv/y) was used to quantify the cumulative dose in the environment surrounding the Phase I Project of the QNPP. Age-related AED e and ER e were calculated using Equations (1) and (2) to evaluate risks for radiation-exposed populations. (1) In the equation, CAD represents the environmental cumulative dose (mSv); O denotes the age-related outdoor occupancy factor derived from early studies of the Chinese population 20,21 , with values of O for different age groups shown in Table 1 . Table 1. The age-dependent outdoor occupancy factors. Age(y) 1-2 2-3 3-4 4-5 5-6 6-9 9-12 12-15 15-18 ≥18 O 0.115 0.131 0.122 0.100 0.100 0.069 0.059 0.064 0.064 0.133 Excess risk ( ER e ) refers to the excess incidence rate of specific health effects associated with radiation exposure, estimated using Equation (2). (2) Among them, RF is the hazard-adjusted nominal risk coefficient for cancer and genetic effects following low-dose-rate radiation exposure. The International Commission on Radiological Protection (ICRP) Report 103 recommends a cancer risk coefficient of 5.5×10 -5 /mSv and a genetic effect risk coefficient of 0.2×10 -5 /mSv 22 ; DL is the lifespan (70 years). 2.4 Analysis of cancer mortality Health data of residents in Haiyan County from 2010 to 2022 were obtained from the Zhejiang Provincial Chronic Disease Management System. All diagnosed cancer cases were coded according to the 10th edition of the International Classification of Diseases (ICD-10). Mortality rates for all combined cancer sites (ICD-10: C00-C97), leukemia (ICD-10: C91-95), and thyroid cancer (ICD-10: C73) were analyzed. Leukemia and thyroid cancer were selected for specific study due to their radiosensitivity 23 . Descriptive statistical analyses were performed on overall mortality from malignant tumors and mortality from radiosensitive cancers. The Joinpoint model (Version 5.2.0.0) was used to calculate the annual percentage change (APC) to characterize temporal trends in cancer mortality, where APC > 0 indicates an upward trend and APC < 0 indicates a downward trend. To enable comparative analyses across different age structures, Chinese age-standardized mortality rates for cancer (ASMRC) and World age-standardized mortality rates (ASMRW) were calculated based on the 2000 Chinese standard population and the WHO 2000 standard population, respectively. 2.5 Ethical Statement This manuscript is an extension of an original research project for which a medical ethics review form has been provided. As a retrospective analysis using de-identified and publicly available public health surveillance data (without involving individual private information or clinical decision interference), the ethical review approval of the original project (issued by the Zhejiang Provincial Center for Disease Control and Prevention) is fully applicable. The Zhejiang Provincial Center for Disease Control and Prevention has confirmed that the exemption of ethical approval and informed consent for the original project also covers this study. This research was conducted in strict compliance with the ethical guidelines of the Declaration of Helsinki. 3. Results 3.1 Cumulative ambient dose Table 2. CAD around QNPP and statistical analysis for the temporal trend from 2010 to 2023 Year CAD (mSv) Total First quarter Second quarter Third quarter Fourth quarter 2010 0.051 0.125 0.300 0.112 0.588 2011 0.078 0.072 0.046 0.071 0.267 2012 0.066 0.082 0.059 0.037 0.244 2013 0.105 0.073 0.066 0.066 0.310 2014 0.087 0.076 0.075 0.052 0.290 2015 0.073 0.044 0.12 0.056 0.290 2016 0.078 0.058 0.076 0.066 0.278 2017 0.059 0.008 0.104 0.093 0.264 2018 0.211 0.122 0.167 0.103 0.603 2019 0.059 0.061 0.067 0.124 0.311 2020 0.059 0.182 0.104 0.057 0.402 2021 0.065 0.091 0.133 0.067 0.356 Mean 0.082 0.083 0.110 0.075 0.350 2022 0.151 0.081 0.092 0.204 0.528 2023 0.306 0.063 0.251 0.202 0.822 Mean 0.229 0.072 0.172 0.203 0.675 Table 2 presents the CAD values for the first-phase project of QNPP before (2010–2021) and after (2022–2023) its service life extension. The data from 2012 to 2020 were directly cited from previously published papers by our research team 18 .During 2010-2021, the mean quarterly radiation dose rates were 0.082, 0.083, 0.110, and 0.075 mSv, respectively, with an annual total mean of 0.350 mSv. The annual total data showed relatively small overall fluctuations. For 2022–2023, the mean quarterly values were 0.229, 0.072, 0.172, and 0.203 mSv, respectively, with an annual total mean of 0.675 mSv. Except for the second quarter, the mean values of the remaining quarters were slightly higher than those of the corresponding quarters in 2010-2021. Notably, the annual CAD results before (2010-2021) and after (2022-2023) QNPP’s operation were far lower than the global average annual natural radiation dose (approximately 2.4 mSv/a) 24 and China’s average annual natural background radiation dose for the public (approximately 2.3 mSv/a) 25 . Additionally, both periods were lower than the pre-operation annual environmental radiation cumulative dose of 0.832 mSv at the QNPP 26 . These findings indicate that environmental radiation in the study area remained at background levels. 3.2 Age-related Annual Effective Dose ( AED e ) and Excess Risk ( ER e ) To assess the potential impact of environmental radiation in the study area on human health, we calculated and summarized age-related AED e and ER e , as shown in Table 3. The results indicate that the average AED e caused by CAD before the extended service of QNPP Phase I ranged from 20.7×10 -3 mSv/y to 46.6×10 -3 mSv/y; after the extension, the average AED e slightly increased to 39.8×10 -3 mSv/y to 89.8×10 -3 mSv/y. Among children under 18 years old, 2-3-year-olds had the highest average AED e due to the longest outdoor activity time, and AED e values decreased with age. The average AED e values before and after the extended service of QNPP Phase I were both lower than the dose specified in Chinese national standards (0.25 mSv/y) 27 and the global average annual natural radiation dose (approximately 2.4 mSv/y) 24 . Additionally, the annual average ER e values ranged from 8.0×10 -5 to 17.9×10 -5 before the extension and 15.3×10 -5 to 34.6×10 -5 after the extension, with the same age distribution pattern as AED e . Table 3. Age - Dependent AED e and ER e Induced by Environmental Exposure of People around QNPP from 2010 to 2023. Age(y) AED e (×10 -3 mSv/y) ER e (×10 -5 ) 2010- 2021min 2022- 2023min 2010-2021max 2022-2023max 2010-2021avg 2022-2023avg 2010-2021min 2022-2023min 2010-2021max 2022-2023max 2010-2021avg 2022-2023avg 1-2 28.1 60.7 69.3 94.5 40.3 77.6 10.8 23.4 26.7 36.4 15.5 29.9 2-3 32.0 69.2 79.0 107.7 45.9 88.4 12.3 26.6 30.4 41.5 17.7 34.0 3-4 29.8 64.4 73.6 100.3 42.7 82.4 11.5 24.8 28.3 38.6 16.5 31.7 4-5 24.4 52.8 60.3 82.2 35.0 67.5 9.4 20.3 23.2 31.6 13.5 26.0 5-6 24.4 52.8 60.3 82.2 35.0 67.5 9.4 20.3 23.2 31.6 13.5 26.0 6-9 16.8 36.4 41.6 56.7 24.2 46.6 6.5 14.0 16.0 21.8 9.3 17.9 9-12 14.4 31.2 35.6 48.5 20.7 39.8 5.5 12.0 13.7 18.7 8.0 15.3 12-15 15.6 33.8 38.6 52.6 22.4 43.2 6.0 13.0 14.8 20.3 8.6 16.6 15-18 15.6 33.8 38.6 52.6 22.4 43.2 6.0 13.0 14.8 20.3 8.6 16.6 >18 32.5 70.2 80.2 109.3 46.6 89.8 12.5 27.0 30.9 42.1 17.9 34.6 3.3 Cancer mortality rates around QNPP 3.3.1Mortality rate of all cancer sites combined From 2012 to 2022, a total of 15,781 malignant tumor deaths were reported in the vicinity of QNPP, with a crude mortality rate of 377.38 per 100,000, an ASMRC (age-standardized mortality rate based on China’s 2000 standard population) of 196.11 per 100,000, and an ASMRW (age-standardized mortality rate based on WHO’s 2000 standard population) of 190.21 per 100,000. Of these, 8,357 deaths occurred in males (crude mortality rate: 405.95 per 100,000; ASMRC: 202.18 per 100,000; ASMRW: 199.96 per 100,000), and 7,424 in females (crude mortality rate: 349.68 per 100,000; ASMRC: 195.01 per 100,000; ASMRW: 185.85 per 100,000), indicating a higher mortality rate in males than in females. The crude mortality rate, ASMRC, and ASMRW of malignant tumors among residents around QNPP were slightly higher than those in Zhejiang's cancer registration areas from 2010 to 2014 (crude mortality rate: 186.06 per 100,000; ASMRC: 103.02 per 100,000; ASMRW: 101.73 per 100,000) 28 . This discrepancy may be attributed to natural and social environmental factors, as well as local dietary habits. Notably, the overall mortality rate for all malignant tumors among residents near QNPP exhibited a downward trend during the study period (2012–2022) (ASMRC: APC = −7.0; ASMRW: APC = −6.8), with detailed data presented in Table 4. However, since the 95% confidence intervals (95% CIs) of the Annual Percentage Changes (APCs) all included 1, this downward trend lacked statistical significance and requires further verification through long-term monitoring. 3.3.2. Mortality rate of radiosensitive cancer As shown in Table 5, from 2012 to 2022, a total of 253 leukemia deaths were reported in Haiyan County, with a crude mortality rate of 6.05 per 100,000, an ASMRC of 5.35 per 100,000, and an ASMRW of 6.90 per 100,000 (Table 6). These values were slightly higher than the relevant data of Zhejiang Province in 2022 (crude mortality rate: 4.38 per 100,000; ASMRC: 3.15 per 100,000; ASMRW: 3.39 per 100,000) 29 . The increased leukemia mortality may be attributed to genetic factors, ionizing radiation, chemical exposure, viral infections, and compromised immune function. During the same period, only 14 thyroid cancer deaths were reported in Haiyan County, with a crude mortality rate of 0.33 per 100,000, an ASMRC of 0.32 per 100,000, and an ASMRW of 0.25 per 100,000 (Table 6). These mortality rates were lower than the provincial level in Zhejiang (0.46–0.49 per 100,000) 30 . Table 4. Total mortality from all cancers for residents living near QNPP from 2012 to 2022. (1/100 000). Year All Male Female Deaths Crude rate ASMRC ASMRW Deaths Crude rate ASMRC ASMRW Deaths Crude rate ASMRC ASMRW 2012 1290 343.90 197.86 190.11 722 388.90 225.49 219.42 568 299.80 178.79 169.44 2013 1280 340.38 190.65 184.39 718 377.56 216.17 212.33 562 295.53 173.1 164.16 2014 1567 415.21 229.83 222.22 820 439.94 238.27 236.07 747 391.07 227.69 215.24 2015 1486 392.48 217.52 206.79 805 430.85 233.27 224.62 681 355.11 207.98 195.2 2016 1575 414.90 219.36 211.65 808 431.70 224.38 220.43 767 398.56 219.31 208.18 2017 1608 422.01 220.59 209.76 814 433.62 211.21 205.06 794 410.73 234.15 218.54 2018 1642 429.91 228.16 215.77 822 437.35 220.61 211.77 820 422.70 239.61 224.09 2019 1826 477.41 252.85 237.53 918 488.47 235.27 226.06 908 466.73 273.79 252.75 2020 1801 470.26 241.62 228.9 852 453.38 208.87 202.33 949 486.52 275.97 257.86 2021 773 201.79 68.98 68.62 504 268.57 97.71 96.98 269 137.66 45.22 46.03 2022 933 243.37 81.87 82.17 574 306.12 110.31 111.98 359 183.29 58.18 58.19 Total 15781 377.38 196.11 190.21 8357 405.95 202.18 199.96 7424 349.68 195.01 185.85 APC(%) - -2.7 -7.0 -6.8 - -2.1 -6.3 -6.2 - -3.8 -8.5 -8.1 95CI%(%) - -8.2-3.2 -14.6-1.3 -14.0-1.1 - -5.7-1.7 -11.0-1.3 -10.7-1.4 - -11.7-4.8 -19.1-3.5 -18.2-3.3 Table 5. The mortality rates of leukemia and thyroid cancer for residents living near QNPP from 2012 to 2022. (1/100,000). Year Leukemia Thyroid cancer Deaths Crude rate ASMRC ASMRW Deaths Crude rate ASMRC ASMRW 2012 17 4.53 3.04 2.80 0 0 0 0 2013 20 5.32 4.59 5.32 1 0.27 0.40 0.27 2014 24 6.36 4.98 6.22 3 0.79 1.18 0.87 2015 22 5.81 4.42 4.15 0 0 0 0 2016 21 5.53 3.25 3.18 2 0.53 0.54 0.41 2017 23 6.04 3.90 4.60 2 0.52 0.78 0.59 2018 21 5.50 4.06 3.77 0 0 0 0 2019 29 7.58 4.98 5.08 1 0.26 0.21 0.18 2020 35 9.14 5.18 5.21 0 0 0 0 2021 17 4.44 1.51 1.56 3 0.78 0.25 0.19 2022 24 6.26 2.73 2.72 2 0.52 0.18 0.19 Total 253 6.05 5.35 6.90 14 0.33 0.32 0.25 4. Conclusion Through long-term monitoring of environmental radiation levels before and after the extended service (2010–2023) of the Phase I Project of QNPP and health data of surrounding residents (2012–2022), the following core conclusions were drawn: (1) Changes in environmental radiation dose From 2010 to 2021, the quarterly mean values of CAD around QNPP fluctuated relatively slightly, with an annual total mean of 0.350 mSv. In 2022–2023, the annual total mean CAD slightly increased to 0.675 mSv. However, the annual average CAD in both periods was far lower than the global and Chinese public average natural radiation doses, indicating that environmental radiation remained at background levels. Annual effective doses ( AED e ) and excess risk ( ER e ) for residents were also well below regulatory limits. (2) Trends in cancer mortality Health data from Haiyan County (2012-2022) showed that crude and age-standardized mortality rates for malignant tumors were slightly higher than the Zhejiang provincial average, with males exhibiting higher rates than females, though overall trends were declining. Crude mortality rates for leukemia were slightly higher than the provincial average, while thyroid cancer mortality was lower. The relationship between the diseases and radiation requires long-term observation. The Phase I Project of QNPP has not caused significant radiation impacts on the surrounding environment or public health during its operation. However, continuous monitoring of environmental radiation levels and public health is necessary to address potential delayed risks and ensure long-term environmental safety. Declarations Funding: This research was funded by the Zhejiang Health Science and Technology Plan (No. 2022RC120, 2022KY130, 2024KY892), Key Research and Development Program of Zhejiang Province of China (No. 2024C03229), and Science and Technology Program for Disease Prevention and Control of Zhejiang Province (No. 2025JK155). Data availability: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Author Contribution Y.L.: Investigation, Writing – original draft. Y.C: Investigation, Writing – review & editing. J.G.: Investigation, Writing – original draft. J. X.: Investigation. S. Y.: Investigation. H. Z.: Investigation. A. Z.: Investigation. H. R.: Investigation, Writing – original draft. Data Availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. References IAEA. Nuclear power and climate change: Decarbonization & < (2019). https://www.iaea.org/topics/nuclear-power-and-climate-change National Development and Reform Commission of the People's Republic of China. Working Guidance for Carbon Dioxide Peaking and Carbon Neutrality in Full and Faithful Implementation of the New Development Philosophy, < (2021). https://en.ndrc.gov.cn/policies/202110/t20211024_1300725.html National Development and Reform Commission of the People's Republic of China. National Nuclear Power Operation, < (2024). https://nnsa.mee.gov.cn/ywdt/hyzx/202405/t20240509_1072722.html Ahn, Y. O., Li, Z. M. & Grp, K. S. Cancer Risk in Adult Residents near Nuclear Power Plants in Korea - A Cohort Study of 1992–2010. J. Korean Med. Sci. 27 , 999–1008 (2012). Lin, R. T., Boonhat, H., Lin, Y. Y., Klebe, S. & Takahashi, K. Health Effects of Occupational and Environmental Exposures to Nuclear Power Plants: A Meta-Analysis and Meta-Regression. Curr. Environ. Health Rep. 11 , 329–339 (2024). Baker, P. J. & Hoel, D. G. Meta-analysis of standardized incidence and mortality rates of childhood leukaemia in proximity to nuclear facilities. Eur. J. Cancer Care . 16 , 355–363 (2007). Cardis, E. et al. The 15-country collaborative study of cancer risk among radiation workers in the nuclear industry: Estimates of radiation-related cancer risks. Radiat. Res. 167 , 396–416 (2007). Kim, J., Bang, Y. & Lee, W. J. Living near nuclear power plants and thyroid cancer risk: A systematic review and meta-analysis. Environ. Int. 87 , 42–48 (2016). Mangano, J. J. et al. Elevated childhood cancer incidence proximate to US nuclear power plants. Arch. Environ. Health . 58 , 74–82 (2003). Vrijheid, M. et al. Mortality from diseases other than cancer following low doses of ionizing radiation: results from the 15-Country Study of nuclear industry workers. Int. J. Epidemiol. 36 , 1126–1135 (2007). Wang, S. I., Yaung, C. L., Lee, L. T. & Chiou, S. J. Cancer incidence in the vicinity of nuclear power plants in Taiwan: a population-based study. Environ. Sci. Pollut. Res. 23 , 571–580 (2016). Laurier, D. et al. The International Nuclear Workers Study (In works): a Collaborative Epidemiological Study to Improve Knowledge about Health Effects of Protracted Low-Dose Exposure. Radiat. Prot. Dosimetry . 173 , 21–25 (2017). Butler, D. Reactors, residents and risk. Nature 472 , 400–401 (2011). Cao, J. Z., Yeung, M. R., Wong, S. K., Ehrhardt, J. & Yu, K. N. Adaptation of COSYMA and assessment of accident consequences for Daya Bay nuclear power plant in China. J. Environ. Radioact. 48 , 265–277 (2000). Man, C. K. & Kwok, Y. H. Assessment of risk to Hong Kong due to accidental releases of radionuclides from a nearby nuclear power plant. J. Radioanal. Nucl. Chem. 250 , 485–490 (2001). National Development and Reform Commission of the People's Republic of China. Notice on the approval of the extension of the validity period of the operating License of Unit 1 of Qinshan Nuclear Power Plant , < (2021). https://www.mee.gov.cn/xxgk2018/xxgk/xxgk09/202109/t20210909_913463.html Ren, H. et al. Assessment of radiation exposure and public health before and after the operation of Sanmen nuclear power plant. Frontiers Public. Health 11 (2023). Cao, Y. Y. et al. Long-term investigation of environmental radioactivity levels and public health around the Qinshan Nuclear Power Plant, China. Scientific Reports 12 (2022). Hamlat, S. et al. Independent environmental monitoring and public dose assessment around the Canadian Nuclear Power Plants. J. Radioanal. Nucl. Chem. 317 , 325–335 (2018). Zhao, X. G., Duan, X. L. & Wang, B. B. Environmental Exposure Related Activity Patterns Survey of Chinese Population (Children) . (2016). Duan, X. L. Report of Environmental Exposure Related Activity Patterns Research of Chinese Population . (2013). ICRP. The 2007 Recommendations of the International Commission on Radiological Protection.ICRP publication 103. Ann. ICRP . 37 (2–4), 1–332 (2007). Moon, E. K. et al. Estimates of Radiation Doses and Cancer Risk from Food Intake in Korea. J. Korean Med. Sci. 31 , 9–12 (2016). Charles, M. U. N. S. C. E. A. R. report 2000: sources and effects of ionizing radiation. United Nations Scientific Comittee on the Effects of Atomic Radiation. J. Radiol. Prot. 21 , 83–86 (2001). Pan, Z. Q. Discussion on Some Issues in China's Radiation Levels and Control. Radiation Prot. 21 , 271 (2002). Chen, Q. H., Song, J. F. & Zheng, H. D. Review of Monitoring the Level of γ - Radiation Dose Rate in the Peripheral Environment of Qinshan Nuclear Power Base. Energy Environ. Prot. 028 , 58–60 (2014). Ministry of Ecology and Environment༆. General Administration of Quality Supervision, Inspection and Quarantine of the People’s Republic of China. Regulations for environmental radiation protection of nuclear power plant (Publication No.GB 6249 – 2011, 2011). Zhu, C., Li, H., Wang, Z., Du, L. & Y., Q. & Cancer mortality in Zhejiang cancer registration areas from 2010 to 2014. Chin. J. Clin. Oncol. 44 , 552–557 (2017). Liu, B. et al. Analysis of the Incidence and Mortality of Leukemia in the Cancer Registration Areas of Zhejiang Province from 2010 to 2014. Chin. J. Prev. Med. 53 , 1158–1161 (2019). Cheng, X. D. & Du, L. B. 2022 Zhejiang Provincial Cancer Registry Annual Report . (2023). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7477995","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":520085679,"identity":"a2c6bab2-96fe-45f3-b1a4-aba7f3097eaf","order_by":0,"name":"Yihang Li","email":"","orcid":"","institution":"Zhejiang Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Yihang","middleName":"","lastName":"Li","suffix":""},{"id":520085681,"identity":"b8ddf5f7-1854-4c8a-b3fd-cfb30af1b335","order_by":1,"name":"Yiyao Cao","email":"","orcid":"","institution":"Zhejiang Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Yiyao","middleName":"","lastName":"Cao","suffix":""},{"id":520085683,"identity":"f79dc3f1-2439-452e-9135-6de2d23052af","order_by":2,"name":"Jiadi Guo","email":"","orcid":"","institution":"Zhejiang Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Jiadi","middleName":"","lastName":"Guo","suffix":""},{"id":520085686,"identity":"18768943-2f3f-4b70-8ce9-54765d5ffec7","order_by":3,"name":"Junjie Xu","email":"","orcid":"","institution":"Haiyan County Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Junjie","middleName":"","lastName":"Xu","suffix":""},{"id":520085689,"identity":"99ecf5c5-5aec-4ccf-a7e5-0190128f65e1","order_by":4,"name":"Shunfei Yu","email":"","orcid":"","institution":"Zhejiang Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Shunfei","middleName":"","lastName":"Yu","suffix":""},{"id":520085692,"identity":"4370b233-fb92-4139-9e2f-5ff2d9aa75d4","order_by":5,"name":"Hua Zou","email":"","orcid":"","institution":"Zhejiang Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Zou","suffix":""},{"id":520085693,"identity":"b3bd8aa1-67c1-4e86-ab97-c53c90ba7f18","order_by":6,"name":"An Zhang","email":"","orcid":"","institution":"Zhejiang Provincial Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"An","middleName":"","lastName":"Zhang","suffix":""},{"id":520085696,"identity":"771bdd51-dbcf-4d74-bdad-d5e48f7026ba","order_by":7,"name":"Hong Ren","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAApUlEQVRIiWNgGAWjYBACAxDxgYEZRCUQr4VxBslamHkgWogE5tKHjz22qbGWZ+A/8IDh5w4itFj2paUb5xxLN2xgOJDA2HuGGIed4TGTzm04nMDA2JDAzNhGlBb+b9KWIC3MDERr4WGTZgRpYSNeC5uZZA/QL208DAkHe4nTwvxM4gcwxPj5zyQ++EmMFjhgY+BJOECKBhBgJ1nHKBgFo2AUjBAAAIPFLZKPqRbbAAAAAElFTkSuQmCC","orcid":"","institution":"Zhejiang Provincial Center for Disease Control and Prevention","correspondingAuthor":true,"prefix":"","firstName":"Hong","middleName":"","lastName":"Ren","suffix":""}],"badges":[],"createdAt":"2025-08-28 08:23:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7477995/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7477995/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92185501,"identity":"17163d65-b3d2-4edb-b361-3fa63ef84f76","added_by":"auto","created_at":"2025-09-25 14:10:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":728219,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7477995/v1/3e9f7055d5a9a1c7e5a92523.docx"},{"id":92185506,"identity":"2b4e6b54-9192-441f-a1d4-7621e50a819e","added_by":"auto","created_at":"2025-09-25 14:10:03","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8506,"visible":true,"origin":"","legend":"","description":"","filename":"68e3ccae5bea4ce7b9c84c01213c02c3.json","url":"https://assets-eu.researchsquare.com/files/rs-7477995/v1/d536a42551ccce8baf33d24e.json"},{"id":92185482,"identity":"a5f8c3ef-20a8-4b89-9da3-fe180fd0f7d7","added_by":"auto","created_at":"2025-09-25 14:09:53","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":117866,"visible":true,"origin":"","legend":"","description":"","filename":"68e3ccae5bea4ce7b9c84c01213c02c31enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7477995/v1/a1a78cb7666855286ef5bf0b.xml"},{"id":92185491,"identity":"83cff425-4f3d-46e2-b5c9-d2842d9d26d3","added_by":"auto","created_at":"2025-09-25 14:09:58","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":673566,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7477995/v1/58132987a996bb7f344d5f7a.jpeg"},{"id":92185504,"identity":"2b54db85-ae55-4382-8d78-22949968797f","added_by":"auto","created_at":"2025-09-25 14:10:02","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116116,"visible":true,"origin":"","legend":"","description":"","filename":"68e3ccae5bea4ce7b9c84c01213c02c31structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7477995/v1/e5989a53731589435463ffc2.xml"},{"id":92185488,"identity":"24c72498-c558-439b-8982-1d983888b979","added_by":"auto","created_at":"2025-09-25 14:09:56","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":123715,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7477995/v1/95455910bcd77e7461be1e57.html"},{"id":92185481,"identity":"6bb5a37e-1470-406f-993a-ca255699da30","added_by":"auto","created_at":"2025-09-25 14:09:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88835,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic Diagram of the Distribution of Monitoring Stations Around the Phase I Project of Qinshan Nuclear Power Plant\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7477995/v1/d6b878255ca602aea3fb1906.png"},{"id":93504471,"identity":"7eb0f4e3-4c48-4b78-a0df-47fbbd36bbec","added_by":"auto","created_at":"2025-10-14 14:31:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1058208,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7477995/v1/68096309-3ab6-49a1-8661-922603984a97.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Radiation Exposure and Public Health Impacts: Qinshan Nuclear Power Plant Phase I Before and After Extension","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe 2015 Paris Agreement requires parties to formulate NDC emission reduction targets, limiting global warming to within 2\u0026deg;C compared to pre-industrial levels and achieving near-zero carbon electricity generation by the middle of this century. As a dispatchable low-carbon energy source, nuclear power plays a crucial role in this transition \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. As a party to the Agreement, China is actively advancing its \"dual carbon\" goals through the development of non-fossil energy sources, including nuclear power \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Currently, there are 56 operational nuclear power units in China (excluding the Taiwan region), with a total installed capacity of 58,218.34 MWe (rated installed capacity) \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, numerous epidemiological studies \u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e have indicated that workers and residents living near nuclear power plants face increased health risks even when exposed to radiation levels within regulated dose limits. Moreover, following the Fukushima nuclear accident in Japan, people worldwide have become more concerned about such potential risks \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e and expressed varying degrees of anxiety. For this reason, many countries have implemented radioactive monitoring and radiation risk assessment programs before and after the operation of nuclear power plants \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eLocated in Haiyan County, Zhejiang Province, China, Qinshan Nuclear Power Plant (QNPP) is the country\u0026rsquo;s first independently designed and constructed 300 MW pressurized water reactor nuclear power plant. It was commissioned in 1991 with a 30-year design life and approved for a 20-year extension in 2021, allowing safe operation through 2041 \u003csup\u003e16\u003c/sup\u003e. While offering high efficiency and low carbon benefits, its operation may involve radioactive releases \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. To our knowledge, data on environmental radioactivity and radiation exposure impacts before and after the Phase I extension remain scarce. Hence, tracking radiation exposure and radioactivity levels during this period is critical\u0026mdash;it enables timely understanding of radioactive conditions, accurate trend identification, and thus ensures environmental safety and public health protection.\u003c/p\u003e\u003cp\u003ePublic exposure around nuclear power plants primarily includes internal and external radiation \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. External radiation is mainly caused by radioactive exposure in the external environment \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, including radiation from artificial sources, plume external exposure, and deposited external exposure from radioactive fallout (fallout ash). These various radiation sources continuously release radiation into the environment, which can significantly affect radiation doses in surrounding areas. Due to the presence of nuclear power units, Haiyan County is more likely to be affected by the combined effects of various radiations. Therefore, we assessed the health impacts of radiation exposure by detecting the cumulative ambient radiation dose in Haiyan County where the nuclear power units are located.\u003c/p\u003e\u003cp\u003eThis study aims to provide data on cumulative ambient radiation doses around the Phase I project of QNPP before (2010\u0026ndash;2021) and after (2022\u0026ndash;2023) its extended service. Meanwhile, using authorized health data, it analyzes the cancer mortality rates of residents in Haiyan County, especially the mortality rates of radiation-sensitive cancers. The study period is from 2010 to 2023, covering the monitoring of cumulative external ambient radiation doses around QNPP. Based on the monitoring results of cumulative external ambient radiation doses, it evaluates the annual effective dose (\u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e) and excess risk (\u003cem\u003eER\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e) of residents, and analyzes the cancer mortality rates of residents near QNPP. The results of this study can serve as basic data for assessing the impacts of future operation of QNPP on human health risks and the surrounding environment.\u003c/p\u003e"},{"header":"2. Methods and Materials","content":"\u003cp\u003e2.1 Ambient radiation sample collection and analysis\u003c/p\u003e\n\u003cp\u003eIn this study, thermoluminescent dosimeters (TLDs) were used to measure the cumulative ambient radiation dose. Monitoring stations will be established in three concentric zones centered on the Phase I Project of QNPP, with radii ranging from 0-10 km, 10-20 km, and 20-30 km respectively. Each zone will contain 10 monitoring stations, totaling 30 stations, and their specific locations are shown in Figure 1. Two TLDs (LiF: Mg, Cu, P) were deployed at each station, resulting in 60 TLDs in total. At each station, the TLDs were suspended in parallel approximately 2 meters above ground level on tree trunks, exposed to the open air. Monitoring cycles were quarterly, with all TLDs retrieved, measured, and data recorded at the end of each cycle.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.2 Quality assurance and quality control\u003c/p\u003e\n\u003cp\u003eBefore each placement of the components (TLDs), a Type C thermoluminescent precision annealing furnace is used to anneal them to control residual dose, and instrument operation specifications are strictly followed during measurement. Annually, the Zhejiang Institute of Metrology is entrusted to calibrate and scale the detection system. Meanwhile, the team participates in the national blind sample comparison for external exposure personal dose organized by the National Institute for Radiological Protection, Chinese Center for Disease Control and Prevention, and has achieved excellent results multiple times.\u003c/p\u003e\n\u003cp\u003e2.3 Dose assessment\u003c/p\u003e\n\u003cp\u003eAnnual effective dose (\u003cem\u003eAED\u003c/em\u003e, mSv/y) is a radiation protection quantity recognized as a useful tool for assessing radiation exposure risks and formulating radioactive contamination policies. In this study, the annual effective dose caused by environmental exposure (\u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e, mSv/y) was used to quantify the cumulative dose in the environment surrounding\u0026nbsp;the Phase I Project of the QNPP. Age-related \u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e and \u003cem\u003eER\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e were calculated using Equations (1) and (2) to evaluate risks for radiation-exposed populations.\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"102\" height=\"28\" src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1758808692.png\" alt=\"image\"\u003e\u0026nbsp;(1)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIn the equation, CAD represents the environmental cumulative dose (mSv); O denotes the age-related outdoor occupancy factor derived from early studies of the Chinese population\u0026nbsp;\u003c/em\u003e\u003csup\u003e20,21\u003c/sup\u003e\u003cem\u003e, with values of O for different age groups shown in Table 1\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e The age-dependent outdoor occupancy factors.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.8696%;\"\u003e\n \u003cp\u003eAge(y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e5-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e6-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e9-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.78261%;\"\u003e\n \u003cp\u003e12-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.78261%;\"\u003e\n \u003cp\u003e15-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e\u0026ge;18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10.8696%;\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.78261%;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.78261%;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.69565%;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eExcess risk (\u003cem\u003eER\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e) refers to the excess incidence rate of specific health effects associated with radiation exposure, estimated using Equation (2).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"129\" height=\"28\" src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img175880869296.png\" alt=\"image\"\u003e\u0026nbsp;(2)\u003c/p\u003e\n\u003cp\u003eAmong them, \u003cem\u003eRF\u003c/em\u003e is the hazard-adjusted nominal risk coefficient for cancer and genetic effects following low-dose-rate radiation exposure. The International Commission on Radiological Protection (ICRP) Report 103 recommends a cancer risk coefficient of 5.5\u0026times;10\u003csup\u003e-5\u003c/sup\u003e/mSv and a genetic effect risk coefficient of 0.2\u0026times;10\u003csup\u003e-5\u003c/sup\u003e/mSv\u003c/strong\u003e\u003csup\u003e22\u003c/sup\u003e\u003cstrong\u003e; \u003cem\u003eDL\u003c/em\u003e is the lifespan (70 years).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e2.4 Analysis of cancer mortality\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHealth data of residents in Haiyan County from 2010 to 2022 were obtained from the Zhejiang Provincial Chronic Disease Management System. All diagnosed cancer cases were coded according to the 10th edition of the International Classification of Diseases (ICD-10). Mortality rates for all combined cancer sites (ICD-10: C00-C97), leukemia (ICD-10: C91-95), and thyroid cancer (ICD-10: C73) were analyzed. Leukemia and thyroid cancer were selected for specific study due to their radiosensitivity\u003c/em\u003e\u003csup\u003e23\u003c/sup\u003e\u003cem\u003e. Descriptive statistical analyses were performed on overall mortality from malignant tumors and mortality from radiosensitive cancers.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Joinpoint model (Version 5.2.0.0) was used to calculate the annual percentage change (APC) to characterize temporal trends in cancer mortality, where APC \u0026gt; 0 indicates an upward trend and APC \u0026lt; 0 indicates a downward trend. To enable comparative analyses across different age structures, Chinese age-standardized mortality rates for cancer (ASMRC) and World age-standardized mortality rates (ASMRW) were calculated based on the 2000 Chinese standard population and the WHO 2000 standard population, respectively.\u003c/p\u003e\n\u003cp\u003e2.5 Ethical Statement\u003c/p\u003e\n\u003cp\u003eThis manuscript is an extension of an original research project for which a medical ethics review form has been provided. As a retrospective analysis using de-identified and publicly available public health surveillance data (without involving individual private information or clinical decision interference), the ethical review approval of the original project (issued by the Zhejiang Provincial Center for Disease Control and Prevention) is fully applicable. The Zhejiang Provincial Center for Disease Control and Prevention has confirmed that the exemption of ethical approval and informed consent for the original project also covers this study. This research was conducted in strict compliance with the ethical guidelines of the Declaration of Helsinki.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1 Cumulative ambient dose\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e \u003cem\u003eCAD\u003c/em\u003e around QNPP and statistical analysis for the temporal trend from 2010 to 2023\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCAD\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e(mSv)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThird quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFourth quarter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 2 presents the \u003cem\u003eCAD\u003c/em\u003e values for the first-phase project of QNPP before (2010\u0026ndash;2021) and after (2022\u0026ndash;2023) its service life extension. The data from 2012 to 2020 were directly cited from previously published papers by our research team\u003csup\u003e18\u003c/sup\u003e.During 2010-2021, the mean quarterly radiation dose rates were 0.082, 0.083, 0.110, and 0.075 mSv, respectively, with an annual total mean of 0.350 mSv. The annual total data showed relatively small overall fluctuations. For 2022\u0026ndash;2023, the mean quarterly values were 0.229, 0.072, 0.172, and 0.203 mSv, respectively, with an annual total mean of 0.675 mSv. Except for the second quarter, the mean values of the remaining quarters were slightly higher than those of the corresponding quarters in 2010-2021. Notably, the annual \u003cem\u003eCAD\u003c/em\u003e results before (2010-2021) and after (2022-2023) QNPP\u0026rsquo;s operation were far lower than the global average annual natural radiation dose (approximately 2.4 mSv/a) \u003csup\u003e24\u003c/sup\u003e and China\u0026rsquo;s average annual natural background radiation dose for the public (approximately 2.3 mSv/a) \u003csup\u003e25\u003c/sup\u003e. Additionally, both periods were lower than the pre-operation annual environmental radiation cumulative dose of 0.832 mSv at the QNPP \u003csup\u003e26\u003c/sup\u003e. These findings indicate that environmental radiation in the study area remained at background levels.\u003c/p\u003e\n\u003cp\u003e3.2\u0026nbsp;Age-related Annual Effective Dose (\u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e) and Excess Risk (\u003cem\u003eER\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e)\u003c/p\u003e\n\u003cp\u003eTo assess the potential impact of environmental radiation in the study area on human health, we calculated and summarized age-related \u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u0026nbsp;\u003c/sub\u003eand\u003cem\u003e\u0026nbsp;ER\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e, as shown in Table 3. The results indicate that the average \u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e caused by \u003cem\u003eCAD\u003c/em\u003e before the extended service of QNPP Phase I ranged from 20.7\u0026times;10\u003csup\u003e-3\u003c/sup\u003e mSv/y to 46.6\u0026times;10\u003csup\u003e-3\u003c/sup\u003e mSv/y; after the extension, the average \u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e slightly increased to 39.8\u0026times;10\u003csup\u003e-3\u003c/sup\u003e mSv/y to 89.8\u0026times;10\u003csup\u003e-3\u003c/sup\u003e mSv/y.\u003c/p\u003e\n\u003cp\u003eAmong children under 18 years old, 2-3-year-olds had the highest average \u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e due to the longest outdoor activity time, and \u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e values decreased with age. The average \u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e values before and after the extended service of QNPP Phase I were both lower than the dose specified in Chinese national standards (0.25 mSv/y) \u003csup\u003e27\u003c/sup\u003eand the global average annual natural radiation dose (approximately 2.4 mSv/y) \u003csup\u003e24\u003c/sup\u003e. Additionally, the annual average \u003cem\u003eER\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e values ranged from 8.0\u0026times;10\u003csup\u003e-5\u003c/sup\u003e to 17.9\u0026times;10\u003csup\u003e-5\u003c/sup\u003e before the extension and 15.3\u0026times;10\u003csup\u003e-5\u003c/sup\u003e to 34.6\u0026times;10\u003csup\u003e-5\u003c/sup\u003e after the extension, with the same age distribution pattern as \u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Age - Dependent \u003cem\u003eAED\u003csub\u003ee\u003c/sub\u003e\u003c/em\u003e and \u003cem\u003eER\u003csub\u003ee\u003c/sub\u003e\u003c/em\u003e Induced by Environmental Exposure of People around QNPP from 2010 to 2023.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"906\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(y)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 414px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAED\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ee\u003c/sub\u003e\u003c/strong\u003e\u003cstrong\u003e(\u0026times;10\u003csup\u003e-3\u003c/sup\u003emSv/y)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" style=\"width: 442px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eER\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003csub\u003ee\u003c/sub\u003e\u003c/strong\u003e\u003cstrong\u003e(\u0026times;10\u003csup\u003e-5\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010-\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2021min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022-\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2023min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010-2021max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022-2023max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010-2021avg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022-2023avg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010-2021min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022-2023min\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010-2021max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022-2023max\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2010-2021avg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022-2023avg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e28.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e60.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e69.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e94.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e40.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e77.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e29.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e79.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e107.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e45.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e88.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e3-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e29.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e64.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e73.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e100.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e42.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e82.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e4-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e24.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e82.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e35.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e67.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e5-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e24.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e60.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e82.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e35.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e67.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e31.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e6-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e36.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e9-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e35.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e48.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e39.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e18.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e12-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e15-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e22.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026gt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e32.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e70.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e80.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e109.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e89.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e30.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e42.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.3\u0026nbsp;Cancer mortality rates around QNPP\u003c/p\u003e\n\u003cp\u003e3.3.1Mortality rate of all cancer sites combined\u003c/p\u003e\n\u003cp\u003eFrom 2012 to 2022, a total of 15,781 malignant tumor deaths were reported in the vicinity of QNPP, with a crude mortality rate of 377.38 per 100,000, an ASMRC (age-standardized mortality rate based on China\u0026rsquo;s 2000 standard population) of 196.11 per 100,000, and an ASMRW (age-standardized mortality rate based on WHO\u0026rsquo;s 2000 standard population) of 190.21 per 100,000. Of these, 8,357 deaths occurred in males (crude mortality rate: 405.95 per 100,000; ASMRC: 202.18 per 100,000; ASMRW: 199.96 per 100,000), and 7,424 in females (crude mortality rate: 349.68 per 100,000; ASMRC: 195.01 per 100,000; ASMRW: 185.85 per 100,000), indicating a higher mortality rate in males than in females. The crude mortality rate, ASMRC, and ASMRW of malignant tumors among residents around QNPP were slightly higher than those in Zhejiang\u0026apos;s cancer registration areas from 2010 to 2014 (crude mortality rate: 186.06 per 100,000; ASMRC: 103.02 per 100,000; ASMRW: 101.73 per 100,000) \u003csup\u003e28\u003c/sup\u003e. This discrepancy may be attributed to natural and social environmental factors, as well as local dietary habits. Notably, the overall mortality rate for all malignant tumors among residents near QNPP exhibited a downward trend during the study period (2012\u0026ndash;2022) (ASMRC: APC = \u0026minus;7.0; ASMRW: APC = \u0026minus;6.8), with detailed data presented in Table 4. However, since the 95% confidence intervals (95% CIs) of the Annual Percentage Changes (APCs) all included 1, this downward trend lacked statistical significance and requires further verification through long-term monitoring.\u003c/p\u003e\n\u003cp\u003e3.3.2. Mortality rate of radiosensitive cancer\u003c/p\u003e\n\u003cp\u003eAs shown in Table 5, from 2012 to 2022, a total of 253 leukemia deaths were reported in Haiyan County, with a crude mortality rate of 6.05 per 100,000, an ASMRC of 5.35 per 100,000, and an ASMRW of 6.90 per 100,000 (Table 6). These values were slightly higher than the relevant data of Zhejiang Province in 2022 (crude mortality rate: 4.38 per 100,000; ASMRC: 3.15 per 100,000; ASMRW: 3.39 per 100,000) \u003csup\u003e29\u003c/sup\u003e. The increased leukemia mortality may be attributed to genetic factors, ionizing radiation, chemical exposure, viral infections, and compromised immune function. During the same period, only 14 thyroid cancer deaths were reported in Haiyan County, with a crude mortality rate of 0.33 per 100,000, an ASMRC of 0.32 per 100,000, and an ASMRW of 0.25 per 100,000 (Table 6). These mortality rates were lower than the provincial level in Zhejiang (0.46\u0026ndash;0.49 per 100,000) \u003csup\u003e30\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Total mortality from all cancers for residents living near QNPP from 2012 to 2022. (1/100 000).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeaths\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRW\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeaths\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRW\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeaths\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRW\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e343.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e197.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e190.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e388.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e225.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e219.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e299.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e178.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e169.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e340.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e190.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e184.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e377.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e216.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e212.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e295.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e173.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e164.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e415.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e229.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e222.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e439.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e238.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e236.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e391.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e227.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e215.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e392.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e217.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e206.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e430.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e233.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e224.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e355.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e207.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e195.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e414.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e219.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e211.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e431.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e224.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e220.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e398.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e219.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e208.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e422.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e220.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e209.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e814\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e433.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e211.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e205.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e410.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e234.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e218.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e429.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e228.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e215.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e437.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e220.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e211.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e422.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e239.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e224.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e477.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e252.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e237.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e488.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e235.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e226.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e466.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e273.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e252.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e1801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e470.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e241.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e228.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e453.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e208.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e202.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e486.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e275.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e257.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e201.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e68.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e68.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e268.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e97.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e96.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e137.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e45.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e46.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e243.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e81.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e82.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e306.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e110.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e111.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e183.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e58.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e58.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e15781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e377.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e196.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e190.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e8357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e405.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e202.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e199.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e7424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e349.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e195.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e185.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eAPC(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e95CI%(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-8.2-3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-14.6-1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-14.0-1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-5.7-1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-11.0-1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-10.7-1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e-11.7-4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-19.1-3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e-18.2-3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e The mortality rates of leukemia and thyroid cancer for residents living near QNPP from 2012 to 2022. (1/100,000).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeukemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThyroid cancer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeaths\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRW\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeaths\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASMRW\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e5.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e7.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e5.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e4.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e6.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eThrough long-term monitoring of environmental radiation levels before and after the extended service (2010\u0026ndash;2023) of the Phase I Project of QNPP and health data of surrounding residents (2012\u0026ndash;2022), the following core conclusions were drawn:\u003c/p\u003e\n\u003cp\u003e(1) Changes in environmental radiation dose\u003c/p\u003e\n\u003cp\u003eFrom 2010 to 2021, the quarterly mean values of \u003cem\u003eCAD\u003c/em\u003e around QNPP fluctuated relatively slightly, with an annual total mean of 0.350 mSv. In 2022\u0026ndash;2023, the annual total mean \u003cem\u003eCAD\u003c/em\u003e slightly increased to 0.675 mSv. However, the annual average \u003cem\u003eCAD\u003c/em\u003e in both periods was far lower than the global and Chinese public average natural radiation doses, indicating that environmental radiation remained at background levels. Annual effective doses (\u003cem\u003eAED\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e) and excess risk (\u003cem\u003eER\u003c/em\u003e\u003csub\u003ee\u003c/sub\u003e) for residents were also well below regulatory limits.\u003c/p\u003e\n\u003cp\u003e(2) Trends in cancer mortality\u003c/p\u003e\n\u003cp\u003eHealth data from Haiyan County (2012-2022) showed that crude and age-standardized mortality rates for malignant tumors were slightly higher than the Zhejiang provincial average, with males exhibiting higher rates than females, though overall trends were declining. Crude mortality rates for leukemia were slightly higher than the provincial average, while thyroid cancer mortality was lower. The relationship between the diseases and radiation requires long-term observation.\u003c/p\u003e\n\u003cp\u003eThe Phase I Project of QNPP has not caused significant radiation impacts on the surrounding environment or public health during its operation. However, continuous monitoring of environmental radiation levels and public health is necessary to address potential delayed risks and ensure long-term environmental safety.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eThis research was funded by the Zhejiang Health Science and Technology Plan (No. 2022RC120, 2022KY130, 2024KY892), Key Research and Development Program of Zhejiang Province of China (No. 2024C03229), and Science and Technology Program for Disease Prevention and Control of Zhejiang Province (No. 2025JK155).\u003c/p\u003e\u003cp\u003eData availability: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.L.: Investigation, Writing \u0026ndash; original draft. Y.C: Investigation, Writing \u0026ndash; review \u0026amp; editing. J.G.: Investigation, Writing \u0026ndash; original draft. J. X.: Investigation. S. Y.: Investigation. H. Z.: Investigation. A. Z.: Investigation. H. R.: Investigation, Writing \u0026ndash; original draft.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eIAEA. Nuclear power and climate change: Decarbonization \u0026amp; \u0026lt; (2019). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.iaea.org/topics/nuclear-power-and-climate-change\u003c/span\u003e\u003cspan address=\"https://www.iaea.org/topics/nuclear-power-and-climate-change\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Development and Reform Commission of the People's Republic of China. Working Guidance for Carbon Dioxide Peaking and Carbon Neutrality in Full and Faithful Implementation of the New Development Philosophy, \u0026lt; (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://en.ndrc.gov.cn/policies/202110/t20211024_1300725.html\u003c/span\u003e\u003cspan address=\"https://en.ndrc.gov.cn/policies/202110/t20211024_1300725.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Development and Reform Commission of the People's Republic of China. National Nuclear Power Operation, \u0026lt; (2024). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nnsa.mee.gov.cn/ywdt/hyzx/202405/t20240509_1072722.html\u003c/span\u003e\u003cspan address=\"https://nnsa.mee.gov.cn/ywdt/hyzx/202405/t20240509_1072722.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhn, Y. O., Li, Z. M. \u0026amp; Grp, K. S. Cancer Risk in Adult Residents near Nuclear Power Plants in Korea - A Cohort Study of 1992\u0026ndash;2010. \u003cem\u003eJ. Korean Med. Sci.\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e, 999\u0026ndash;1008 (2012).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin, R. T., Boonhat, H., Lin, Y. Y., Klebe, S. \u0026amp; Takahashi, K. Health Effects of Occupational and Environmental Exposures to Nuclear Power Plants: A Meta-Analysis and Meta-Regression. \u003cem\u003eCurr. Environ. Health Rep.\u003c/em\u003e \u003cb\u003e11\u003c/b\u003e, 329\u0026ndash;339 (2024).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaker, P. J. \u0026amp; Hoel, D. G. Meta-analysis of standardized incidence and mortality rates of childhood leukaemia in proximity to nuclear facilities. \u003cem\u003eEur. J. Cancer Care\u003c/em\u003e. \u003cb\u003e16\u003c/b\u003e, 355\u0026ndash;363 (2007).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCardis, E. et al. The 15-country collaborative study of cancer risk among radiation workers in the nuclear industry: Estimates of radiation-related cancer risks. \u003cem\u003eRadiat. Res.\u003c/em\u003e \u003cb\u003e167\u003c/b\u003e, 396\u0026ndash;416 (2007).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim, J., Bang, Y. \u0026amp; Lee, W. J. Living near nuclear power plants and thyroid cancer risk: A systematic review and meta-analysis. \u003cem\u003eEnviron. Int.\u003c/em\u003e \u003cb\u003e87\u003c/b\u003e, 42\u0026ndash;48 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMangano, J. J. et al. Elevated childhood cancer incidence proximate to US nuclear power plants. \u003cem\u003eArch. Environ. Health\u003c/em\u003e. \u003cb\u003e58\u003c/b\u003e, 74\u0026ndash;82 (2003).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVrijheid, M. et al. Mortality from diseases other than cancer following low doses of ionizing radiation: results from the 15-Country Study of nuclear industry workers. \u003cem\u003eInt. J. Epidemiol.\u003c/em\u003e \u003cb\u003e36\u003c/b\u003e, 1126\u0026ndash;1135 (2007).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang, S. I., Yaung, C. L., Lee, L. T. \u0026amp; Chiou, S. J. Cancer incidence in the vicinity of nuclear power plants in Taiwan: a population-based study. \u003cem\u003eEnviron. Sci. Pollut. Res.\u003c/em\u003e \u003cb\u003e23\u003c/b\u003e, 571\u0026ndash;580 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLaurier, D. et al. The International Nuclear Workers Study (In works): a Collaborative Epidemiological Study to Improve Knowledge about Health Effects of Protracted Low-Dose Exposure. \u003cem\u003eRadiat. Prot. Dosimetry\u003c/em\u003e. \u003cb\u003e173\u003c/b\u003e, 21\u0026ndash;25 (2017).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eButler, D. Reactors, residents and risk. \u003cem\u003eNature\u003c/em\u003e \u003cb\u003e472\u003c/b\u003e, 400\u0026ndash;401 (2011).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCao, J. Z., Yeung, M. R., Wong, S. K., Ehrhardt, J. \u0026amp; Yu, K. N. Adaptation of COSYMA and assessment of accident consequences for Daya Bay nuclear power plant in China. \u003cem\u003eJ. Environ. Radioact.\u003c/em\u003e \u003cb\u003e48\u003c/b\u003e, 265\u0026ndash;277 (2000).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMan, C. K. \u0026amp; Kwok, Y. H. Assessment of risk to Hong Kong due to accidental releases of radionuclides from a nearby nuclear power plant. \u003cem\u003eJ. Radioanal. Nucl. Chem.\u003c/em\u003e \u003cb\u003e250\u003c/b\u003e, 485\u0026ndash;490 (2001).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Development and Reform Commission of the People's Republic of China. \u003cem\u003eNotice on the approval of the extension of the validity period of the operating License of Unit 1 of Qinshan Nuclear Power Plant\u003c/em\u003e, \u0026lt; (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mee.gov.cn/xxgk2018/xxgk/xxgk09/202109/t20210909_913463.html\u003c/span\u003e\u003cspan address=\"https://www.mee.gov.cn/xxgk2018/xxgk/xxgk09/202109/t20210909_913463.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRen, H. et al. Assessment of radiation exposure and public health before and after the operation of Sanmen nuclear power plant. \u003cem\u003eFrontiers Public. Health\u003c/em\u003e \u003cb\u003e11\u003c/b\u003e (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCao, Y. Y. et al. Long-term investigation of environmental radioactivity levels and public health around the Qinshan Nuclear Power Plant, China. \u003cem\u003eScientific Reports\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (2022).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHamlat, S. et al. Independent environmental monitoring and public dose assessment around the Canadian Nuclear Power Plants. \u003cem\u003eJ. Radioanal. Nucl. Chem.\u003c/em\u003e \u003cb\u003e317\u003c/b\u003e, 325\u0026ndash;335 (2018).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao, X. G., Duan, X. L. \u0026amp; Wang, B. B. \u003cem\u003eEnvironmental Exposure Related Activity Patterns Survey of Chinese Population (Children)\u003c/em\u003e. (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDuan, X. L. \u003cem\u003eReport of Environmental Exposure Related Activity Patterns Research of Chinese Population\u003c/em\u003e. (2013).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eICRP. The 2007 Recommendations of the International Commission on Radiological Protection.ICRP publication 103. \u003cem\u003eAnn. ICRP\u003c/em\u003e. \u003cb\u003e37\u003c/b\u003e (2\u0026ndash;4), 1\u0026ndash;332 (2007).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoon, E. K. et al. Estimates of Radiation Doses and Cancer Risk from Food Intake in Korea. \u003cem\u003eJ. Korean Med. Sci.\u003c/em\u003e \u003cb\u003e31\u003c/b\u003e, 9\u0026ndash;12 (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCharles, M. U. N. S. C. E. A. R. report 2000: sources and effects of ionizing radiation. United Nations Scientific Comittee on the Effects of Atomic Radiation. \u003cem\u003eJ. Radiol. Prot.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 83\u0026ndash;86 (2001).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePan, Z. Q. Discussion on Some Issues in China's Radiation Levels and Control. \u003cem\u003eRadiation Prot.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 271 (2002).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen, Q. H., Song, J. F. \u0026amp; Zheng, H. D. Review of Monitoring the Level of γ - Radiation Dose Rate in the Peripheral Environment of Qinshan Nuclear Power Base. \u003cem\u003eEnergy Environ. Prot.\u003c/em\u003e \u003cb\u003e028\u003c/b\u003e, 58\u0026ndash;60 (2014).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinistry of Ecology and Environment༆. \u003cem\u003eGeneral Administration of Quality Supervision, Inspection and Quarantine of the People\u0026rsquo;s Republic of China. Regulations for environmental radiation protection of nuclear power plant\u003c/em\u003e (Publication No.GB 6249\u0026thinsp;\u0026ndash;\u0026thinsp;2011, 2011).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu, C., Li, H., Wang, Z., Du, L. \u0026amp; Y., Q. \u0026amp; Cancer mortality in Zhejiang cancer registration areas from 2010 to 2014. \u003cem\u003eChin. J. Clin. Oncol.\u003c/em\u003e \u003cb\u003e44\u003c/b\u003e, 552\u0026ndash;557 (2017).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu, B. et al. Analysis of the Incidence and Mortality of Leukemia in the Cancer Registration Areas of Zhejiang Province from 2010 to 2014. \u003cem\u003eChin. J. Prev. Med.\u003c/em\u003e \u003cb\u003e53\u003c/b\u003e, 1158\u0026ndash;1161 (2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheng, X. D. \u0026amp; Du, L. B. \u003cem\u003e2022 Zhejiang Provincial Cancer Registry Annual Report\u003c/em\u003e. (2023).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Qinshan Nuclear Power Plant, Ambient radiation, Cancer mortality, Radiation exposure assessment","lastPublishedDoi":"10.21203/rs.3.rs-7477995/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7477995/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study evaluates the ambient radiation levels and their impact on public health around the Qinshan Nuclear Power Plant (QNPP) before and after the extended service of its Phase I project. By monitoring the cumulative ambient external exposure dose around QNPP from 2010 to 2023 and analyzing the health data of residents in Haiyan County from 2012 to 2022, changes in cancer mortality-related rates were examined.\u003c/p\u003e\u003cp\u003eResults showed that during the study period, ambient radiation around QNPP remained at background levels. Although the annual cumulative ambient dose increased after the extended service, the annual effective dose and excess risk still remained well below the standard limits. From 2012 to 2022, the crude cancer mortality rate and age-standardized mortality rate among residents near QNPP were slightly higher than the average levels in Zhejiang Province, with males having higher rates than females; however, an overall downward trend was observed. The mortality rates of leukemia and thyroid cancer also showed a decreasing trend.\u003c/p\u003e\u003cp\u003eIn conclusion, the current operation of QNPP has not caused significant radiation impacts on the surrounding environment or public health. Nevertheless, continuous monitoring is necessary to ensure environmental safety and public health.\u003c/p\u003e","manuscriptTitle":"Radiation Exposure and Public Health Impacts: Qinshan Nuclear Power Plant Phase I Before and After Extension","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-25 14:09:08","doi":"10.21203/rs.3.rs-7477995/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b78b6e72-4082-4265-976e-e847f2e12a98","owner":[],"postedDate":"September 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55281537,"name":"Biological sciences/Cancer"},{"id":55281538,"name":"Earth and environmental sciences/Environmental sciences"},{"id":55281540,"name":"Health sciences/Health care"},{"id":55281541,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2025-10-14T14:23:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-25 14:09:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7477995","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7477995","identity":"rs-7477995","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}