Exploring geographic variation in lung cancer incidence in Kentucky using a spatial scan statistic: elevated risk in the Appalachian coal-mining region

The hospitalisation risk of chronic circulatory and respiratory diseases associated with coal mining in the general population in Queensland, Australia

Queensland is the main coal mining state in Australia where populations in coal mining areas have been historically exposed to coal mining emissions. Although a higher risk of chronic circulatory and respiratory diseases has been associated with coal mining globally, few studies have investigated these associations in the Queensland general population. This study estimates the association of coal production with hospitalisations for chronic circulatory and respiratory diseases in Queensland considering spatial and temporal variations during 1997-2014. An ecological analysis used a Bayesian hierarchical spatiotemporal model to estimate the association of coal production with standardised rates of each, chronic circulatory and respiratory diseases, adjusting for sociodemographic factors and considering the spatial structure of Queensland's statistical areas (SA2) in the 18-year period. Two specifications; with and without a space-time interaction effect were compared using the integrated nested Laplace approximation -INLA approach. The posterior mean of the best fit model was used to map the spatial, temporal and spatiotemporal trends of risk. The analysis considered 2,831,121 hospitalisation records. Coal mining was associated with a 4 % (2.4-5.5) higher risk of hospitalisation for chronic respiratory diseases in the model with a space-time interaction effect which had the best fit. An emerging higher risk of either chronic circulatory and respiratory diseases was identified in eastern areas and some coal-mining areas in central and southeast Queensland. There were important disparities in the spatiotemporal trend of risk between coal -and non-coal mining areas for each, chronic circulatory and respiratory diseases. Coal mining is associated with an increased risk of chronic respiratory diseases in the Queensland general population. Bayesian spatiotemporal analyses are robust methods to identify environmental determinants of morbidity in exposed populations. This methodology helps identifying at-risk populations which can be useful to support decision-making in health. Future research is required to investigate the causality links between coal mining and these diseases.

Analyses of oxidative DNA damage among coal vendors via single cell gel electrophoresis and quantification of 8-hydroxy-2'-deoxyguanosine

Looking at the development status of Nigeria and other developing nations, most low-income and rural households often use coal as a source of energy which necessitates its trade very close to the communities. Moreover, the effects of exposure to coal mining activities are rarely explored or yet to be studied, not to mention the numerous street coal vendors in Nigeria. This study investigated the oxidative stress levels in serum and urine through the biomarker 8-OHdG and DNA damage via single cell gel electrophoresis (alkaline comet assay). Blood and urine levels of 8-OHdG from 130 coal vendors and 130 population-based controls were determined by ELISA. Alkaline comet assay was also performed on white blood cells for DNA damage. The average values of 8-OHdG in serum and urine of coal vendors were 22.82 and 16.03 ng/ml respectively, which were significantly greater than those detected in controls (p < 0.001; 15.46 and 10.40 ng/ml of 8-OHdG in serum and urine respectively). The average tail length, % DNA in tail and olive tail moment were 25.06 μm, 18.71% and 4.42 respectively for coal vendors. However, for controls, the average values were 4.72 μm, 3.63% and 1.50 for tail length, % DNA in tail and olive tail moment respectively which were much lower than coal vendors (p < 0.001). Therefore, prolonged exposure to coal dusts could lead to higher serum and urinary 8-OHdG and significant DNA damage in coal vendors observed in tail length, % DNA in tail, and olive tail moment by single cell gel electrophoresis. It is therefore established that coal vendors exhibit a huge risk from oxidative stress and assessment of 8-OHdG with single cell gel electrophoresis has proven to be a feasible tool as biomarkers of DNA damage.

Role of geographic characteristics in the spatial cluster detection of cancer: Evidence in South Korea, 1999-2013

BACKGROUND

Identification of high-risk areas of cancer, referred to as spatial clusters, can inform targeted policies for cancer control. Although cancer cluster detection could be affected by various geographic characteristics including sociodemographic and environmental factors which impacts could also vary over time, studies accounting for such influence remain limited. This study aims to assess the role of geographic characteristics in the spatial cluster detection for lung and stomach cancer over an extended period.

METHODS

We obtained sex-specific age-standardized incidence and mortality rates of lung and stomach cancer as well as geographic characteristics across 233 districts in South Korea for three five-year periods between 1999 and 2013. We classified geographic characteristics of each district into four categories: demography, socioeconomic status, behaviors, and physical environments. Specifically, we quantified physical environments using measures of greenness, concentrations of particulate matter and nitrogen dioxide, and air pollution emissions. Finally, we conducted cluster detection analyses using weighted normal spatial scan statistics with the residuals from multiple regression analyses performed with the four progressive sets of geographic attributes.

RESULTS

We found that the size of clusters reduced as we progressively adjusted for geographic covariates. Among the four categories, physical environments had the greatest impact on the reduction or disappearance of clusters particularly for lung cancer consistently over time. Whereas older population affected a decrease of lung cancer clusters in the early period, the contribution of education was large in the recent period. The impact was less clear in stomach cancer than lung cancer.

CONCLUSION

Our findings highlight the importance of geographic characteristics in explaining the existing cancer clusters and identifying new clusters, which jointly provides practical guidance to cancer control.

Self-Reported Consumption of Bottled Water v. Tap Water in Appalachian and Non-Appalachian Kentucky

Introduction

Quantitative studies on drinking water perceptions in Appalachia are limited. High-profile water infrastructure failures in the U.S. and Eastern Kentucky, coupled with human-made and natural disasters in the Appalachian Region, have likely impacted opinions regarding tap water.

Purpose

To use existing unexplored data to describe baseline tap water v. bottled water consumption in Kentucky.

Methods

Telephone-based cross-sectional data were obtained from the 2013 Kentucky Health Issues Poll (KHIP) directed by the Foundation for a Healthy Kentucky. Among many items in KHIP, self-reported consumption of bottled water over tap water, reasons for bottled water use, and demographic data were obtained.

Results

Among Appalachian (n=356) and non-Appalachian (n=1,125) Kentucky respondents, a significantly higher frequency of Appalachian Kentuckians reported drinking bottled water more often than tap water relative to non-Appalachian Kentuckians (57% v. 34%; X2 p < 0.001). Appalachian residency significantly predicted bottled water consumption in simple and multivariable logistic regression adjusted for significant covariates (i.e., age, sex, and race). Among persons consuming bottled water more than tap water, Appalachian Kentuckians reported significantly more concerns regarding tap water taste or smell (p = 0.005) and safety (p = 0.008) than non-Appalachians.

Implications

These results from 2013 data pre-date headline news items related to public water and likely underestimate current bottled water preferences. New data are needed, and these results warrant further investigation into tap water aesthetics in Appalachia, bottled water consumption impacts on personal finances, and approaches to build public trust for public drinking water among multiple populations including Appalachian Kentuckians.

Geographic Patterns in U.S. Lung Cancer Mortality and Cigarette Smoking

BACKGROUND

Despite the success of smoking cessation campaigns, lung cancer remains the leading cause of cancer death in the U.S. Variations in smoking behavior and lung cancer mortality are evident by sex and region.

METHODS

Applying geospatial methods to lung cancer mortality data from the National Vital Statistics System and county-level estimates of smoking prevalences from the NCI's Small Area Estimates of Cancer-Related Measures, we evaluated patterns in lung cancer mortality rates (2005-2018) in relation to patterns in ever cigarette smoking prevalences (1997-2003).

RESULTS

Overall, ever smoking spatial patterns were generally associated with lung cancer mortality rates, which were elevated in the Appalachian region and lower in the West for both sexes. However, we also observed geographic variation in mortality rates that is not explained by smoking. Using Lee's L statistic for assessing bivariate spatial association, we identified counties where the ever smoking prevalence was low and lung cancer rates were high. We observed a significant cluster of counties (n = 25; P values ranging from 0.001 to 0.04) with low ever smoking prevalence and high mortality rates among females around the Mississippi River region south of St. Louis, Missouri and a similar and smaller cluster among males in Western Mississippi (n = 12; P values ranging from 0.002 to 0.03) that has not been previously described.

CONCLUSIONS

Our analyses identified U.S. counties where factors other than smoking may be driving lung cancer mortality.

IMPACT

These novel findings highlight areas where investigation of environmental and other risk factors for lung cancer is needed.

Mapping the Morbidity Risk Associated with Coal Mining in Queensland, Australia

The populations in the vicinity of surface coal mining activities have a higher risk of morbidity due to diseases, such as cardiovascular, respiratory and hypertensive diseases, as well as cancer and diabetes mellitus. Despite the large and historical volume of coal production in Queensland, the main Australian coal mining state, there is little research on the association of coal mining exposures with morbidity in non-occupational populations in this region. This study explored the association of coal production (Gross Raw Output—GRO) with hospitalisations due to six disease groups in Queensland using a Bayesian spatial hierarchical analysis and considering the spatial distribution of the Local Government Areas (LGAs). There is a positive association of GRO with hospitalisations due to circulatory diseases (1.022, 99% CI: 1.002–1.043) and respiratory diseases (1.031, 95% CI: 1.001–1.062) for the whole of Queensland. A higher risk of circulatory, respiratory and chronic lower respiratory diseases is found in LGAs in northwest and central Queensland; and a higher risk of hypertensive diseases, diabetes mellitus and lung cancer is found in LGAs in north, west, and north and southeast Queensland, respectively. These findings can be used to support public health strategies to protect communities at risk. Further research is needed to identify the causal links between coal mining and morbidity in non-occupational populations in Queensland.

Examining lung cancer screening utilization with public-use data: Opportunities and challenges

Lung cancer screening with low-dose computed tomography is recommended for high-risk smokers who meet specific eligibility criteria. Current guidelines suggest that eligible adults with a heavy smoking history will benefit from annual low dose computed tomography but due to several associated risks (e.g., false-positives, radiation exposure, overdiagnosis) a shared decision-making consultation is required by the Centers for Medicare & Medicaid Services, and endorsed by the United States Preventive Services Task Force. In order to examine potential for tracking LCS uptake, adherence, and patient-provider communication at a national level, we reviewed four regularly publicly available national surveys (National Health Interview Survey [NHIS], Behavioral Risk Factor Surveillance System [BRFSS], National Health and Nutrition Examination Survey [NHANES], and Health Information National Trends Survey [HINTS]) to assess available data; an overview of 37 publications using these sources is also provided. The results show that none of the surveys include items that fully assess current LCS guidelines. Implications for future research-including the potential to examine factors associated with LCS uptake and patient-provider communication-are addressed.

Description of a Lung Cancer Hotspot: Disparities in Lung Cancer Histology, Incidence, and Survival in Kentucky and Appalachian Kentucky

INTRODUCTION

Kentucky is recognized as the state with the highest lung cancer burden for more than 2 decades, but how lung cancer differs in Kentucky relative to other US populations is not fully understood.

PATIENTS AND METHODS

We examined lung cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program by Kentucky and the other SEER regions for patients diagnosed between 2012 and 2016. Our analyses included histologic types, incidence rates, stage at diagnosis, and survival in Kentucky and Appalachian Kentucky relative to other SEER regions.

RESULTS

We found that both squamous cell carcinomas and small-cell lung cancers represent larger proportions of lung cancer diagnoses in Kentucky and Appalachian Kentucky than they do in the SEER registries. Furthermore, age-adjusted cancer incidence rates were higher in Kentucky for every subtype of lung cancer examined. Most notably, for Appalachian women the rate of small-cell carcinomas was 3.5-fold higher, and for Appalachian men the rate of squamous cell carcinoma was 3.1-fold higher, than the SEER rates. In Kentucky, lung cancers were diagnosed at later stages and lung cancer survival was lower for adenocarcinoma and neuroendocrine carcinomas than in SEER registries. Squamous cell carcinomas and small-cell carcinomas were most lethal in Appalachian Kentucky.

CONCLUSION

Together, these data highlight the considerable disparities among lung cancer cases in the United States and demonstrate the continuing high burden and poor survival of lung cancer in Kentucky and Appalachian Kentucky. Strategies to identify and rectify causes of these disparities are discussed.

Water and Soil Pollution: Ecological Environmental Study Methodologies Useful for Public Health Projects. A Literature Review

Health risks at population level may be investigated with different types of environmental studies depending on access to data and funds. Options include ecological studies, case-control studies with individual interviews and human sample analysis, risk assessment or cohort studies. Most public health projects use data and methodologies already available due to the cost of ad-hoc data collection. The aim of the article is to perform a literature review of environmental exposure and health outcomes with main focus on methodologies for assessing an association between water and/or soil pollutants and cancer. A systematic literature search was performed in May 2019 using PubMed. Articles were assessed by four independent reviewers. Forty articles were identified and divided into four groups, according to the data and methods they used, i.e.: (1) regression models with data by geographical area; (2) regression models with data at individual level; (3) exposure intensity threshold values for evaluating health outcome trends; (4) analyses of distance between source of pollutant and health outcome clusters. The issue of exposure assessment has been investigated for over 40 years and the most important innovations regard technologies developed to measure pollutants, statistical methodologies to assess exposure, and software development. Thanks to these changes, it has been possible to develop and apply geo-coding and statistical methods to reduce the ecological bias when considering the relationship between humans, geographic areas, pollutants, and health outcomes. The results of the present review may contribute to optimize the use of public health resources.

Exceptional Survival Among Kentucky Stage IV Non-small Cell Lung Cancer Patients: Appalachian Versus Non-Appalachian Populations

PURPOSE

To determine differences in exceptional survival (ES)-survival of 5 years or more past diagnosis-between stage IV non-small cell lung cancer (NSCLC) patients residing in the Appalachian versus non-Appalachian regions of Kentucky.

METHODS

This was a population-based, retrospective case-control study of Kentucky patients, diagnosed with stage IV NSCLC between January 1, 2000, and December 31, 2011. The data were drawn from the Kentucky Cancer Registry.

FINDINGS

Findings from the multivariable logistic regression revealed no significant differences in the odds of ES between patients who resided in Appalachian versus non-Appalachian Kentucky. Being female and undergoing surgery only as the first course of treatment were associated with higher odds of ES. Increasing age, unspecified histology, having poorly differentiated or undifferentiated carcinomas, and receiving radiation therapy only as the first course of treatment were associated with decreased odds of ES.

CONCLUSION

Differences in the odds of ES among stage IV NSCLC patients were not related to residence in Appalachian versus non-Appalachian Kentucky. ES was associated with other nongenetic and treatment factors that warrant further investigations.

Health inequality: a longitudinal study on geographic variations in lung cancer incidence and mortality in Taiwan

Background

This study is aimed toward an analysis of the variations in lung cancer incidence and mortality, adjusted by population factors (age, gender, and year), between administrative areas.

Methods

This is a retrospective study, using 2005–2014 data in each administrative area from the Taiwan Cancer Registry database organized by the Health Promotion Administration. The yearly age-standardized (overall) and crude (stratified by gender and age) incidence/mortality (and their growth rates) for each administrative area were collected and calculated. We used a mixed model to analyze the repeated measurements of yearly incidence and mortality rates and used general linear regression to analyze their growth rates.

Results

It was found that male and elderly populations had significantly higher lung cancer incidence and mortality in Taiwan. After adjusting for gender, age, and calendar year, there were no significant variations in incidence among the administrative areas, while the mortality in Yilan County was significantly higher than that in Taipei City (the capital city of Taiwan). On the other hand, the incidence in the female and younger population and mortality growth rates were higher. The incidence growth rate in Keelung City was significantly lower than that in Taipei City, while there were no significant variations in mortality growth rate among administrative areas.

Conclusions

This study found an inequality in the lung cancer burden among cities in Taiwan, which can serve as the basis for future resource allocations for lung cancer prevention and treatment in Taiwan.

Taxonomic diversity of sputum microbiome in lung cancer patients and its relationship with chromosomal aberrations in blood lymphocytes

Here we report a pilot-sized study to compare the taxonomic composition of sputum microbiome in 17 newly-diagnosed lung cancer (LC) patients and 17 controls. Another object was to compare the representation of individual bacterial genera and species in sputum with the frequency of chromosomal aberrations in the blood lymphocytes of LC patients and in controls. Both groups were male; average age 56.1 ± 11.5 in patients and 55.7 ± 4.1 in controls. Differences in the species composition of bacterial communities in LC patients and controls were significant (pseudo-F = 1.94; p = 0.005). Increased prevalence in LC patients was detected for the genera Haemophilus and Bergeyella; whereas a decrease was observed for the genera Atopobium, Stomatobaculum, Treponema and Porphyromonas. Donors with high frequencies of chromosomal aberrations had a significant reduction in the microbiome of representatives of the genus Atopobium in the microbiome and a simultaneous increase in representatives of the species Alloprevotella compared to donors with a low level of chromosomal aberrations in lymphocytes. Thus, a comparison of the bacterial composition in the sputum of donors with cytogenetic damages in theirs lymphocytes, warrants further investigations on the potential role of microorganisms in the process of mutagenesis in somatic cells of the host body.

Early life exposures associated with risk of small intestinal neuroendocrine tumors

Small intestinal neuroendocrine tumors (SINT) are rare with incidence increasing over the past 40 years. The purpose of this work is to examine the role of environmental exposures in the rise of SINT incidence using the Utah Population Database, a resource of linked records including life events, cancer diagnoses and residential histories. SINT cases born in Utah were identified through the Utah Cancer Registry with: diagnosis years of 1948 to 2014 and age at diagnosis of 23 to 88 years. Controls were matched to cases 10:1 based on sex, birth year and residence time in Utah. Cases and controls were geocoded to their birth locale. An isotonic spatial scan statistic was used to test for the occurrence and location(s) of SINT clusters. Potential environmental exposures and economic conditions in the birth locales at the time of the birth (1883–1982) were generated using historical references. Conditional logistic regression was used to estimate odd ratios. We report a spatial cluster central to historic coal mining communities, associated with a 2.86 relative risk (p = 0.016) of SINT. Aspatial analyses of industry and mining exposures further suggest elevated risk for early life exposure near areas involved in the construction industry (OR 1.98 p = 0.024). Other exposures approached significance including coal, uranium and hard rock mining during the earliest period (1883–1929) when safety from exposures was not considered. We do observe a lower risk (OR 0.58 p = 0.033) associated with individuals born in rural areas in the most recent period (1945–1982). Environmental exposures early in life, especially those from industries such as mining, may confer an elevated risk of SINT.

Impacts of Coal Use on Health

This article reviews evidence for the public health impacts of coal across the extraction, processing, use, and waste disposal continuum. Surface coal mining and processing impose public health risks on residential communities through air and water pollution. Burning coal in power plants emits more nitrogen oxides, sulfur dioxide, particulate matter, and heavy metals per unit of energy than any other fuel source and impairs global public health. Coal ash disposal exposes communities to heavy metals and particulate matter waste. Use of coal in domestic households causes public health harm concentrated in developing nations. Across the coal continuum, adverse impacts are disproportionately felt by persons of poor socioeconomic status, contributing to health inequities. Despite efforts to develop renewable energy sources, coal use has not declined on a global scale. Concentrated efforts to eliminate coal as an energy source are imperative to improve public health and avert serious climate change consequences.

Challenges of using nationally representative, population-based surveys to assess rural cancer disparities

Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of "rural" in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.

Spatiotemporal Analysis of Lung Cancer Histological Types in Kentucky, 1995-2014

Recent metabolic and genetic research has demonstrated that risk for specific histological types of lung cancer varies in relation to cigarette smoking and obesity. This study investigated the spatial and temporal distribution of lung cancer histological types in Kentucky, a largely rural state with high rates of smoking and obesity, to discern population-level trends that might reflect variation in these and other risk factors. The Kentucky Cancer Registry provided residential geographic coordinates for lung cancer cases diagnosed from 1995 through 2014. We used multinomial and discrete Poisson spatiotemporal scan statistics, adjusted for age, gender, and race, to characterize risk for specific histological types—small cell, adenocarcinoma, squamous cell, and other types—throughout Kentucky and compared to maps of risk factors. Toward the end of the study period, adenocarcinoma was more common among all population subgroups in north-central Kentucky, where smoking and obesity are less prevalent. During the same time frame, squamous cell, small cell, and other types were more common in rural Appalachia, where smoking and obesity are more prevalent, and in some high poverty urban areas. Spatial and temporal patterns in the distribution of histological types of lung cancer are likely related to regional variation in multiple risk factors. High smoking and obesity rates in the Appalachian region, and likely in high poverty urban areas, appeared to coincide with high rates of squamous cell and small cell lung cancer. In north-central Kentucky, environmental exposures might have resulted in higher risk for adenocarcinoma specifically.

Interval Estimation for Age-Adjusted Rate Ratios Using Bayesian Convolution Model

Spatial correlation raises challenges in estimating confidence intervals for region specific event rates and rate ratios between geographic units that are nested. Methods have been proposed to incorporate spatial correlation by assuming various distributions for the structure of autocorrelation patterns. However, the derivation of these statistics based on approximation may have to condition on the distributional assumption underlying the data generating process, which may not hold for certain situations. This paper explores the feasibility of utilizing a Bayesian convolution model (BCM), which includes an uncorrelated heterogeneity (UH) and a conditional autoregression (CAR) component to accommodate both uncorrelated and correlated spatial heterogeneity, to estimate the 95% confidence intervals for age-adjusted rate ratios among geographic regions with existing spatial correlations. A simulation study is conducted and a BCM method is applied to two cancer incidence datasets to calculate age-adjusted rate/ratio for the counties in the State of Kentucky relative to the entire state. In comparison to three existing methods, without and with spatial correlation, the Bayesian convolution model-based estimation provides moderate shrinkage effect for the point estimates based on the neighbor structure across regions and produces a wider interval due to the inclusion of uncertainty in the spatial autocorrelation parameters. The overall spatial pattern of region incidence rate from BCM approach appears to be like the direct estimates and other methods for both datasets, even though "smoothing" occurs in some local regions. The Bayesian Convolution Model allows flexibility in the specification of risk components and can improve the accuracy of interval estimates of age-adjusted rate ratios among geographical regions as it considers spatial correlation.

A case-control study of trace-element status and lung cancer in Appalachian Kentucky

Appalachian Kentucky (App KY) leads the nation in lung cancer incidence and mortality. Trace elements, such as As, have been associated with lung cancers in other regions of the country and we hypothesized that a population-based study would reveal higher trace element concentrations in App KY individuals with cancer compared to controls. Using toenail and drinking water trace element concentrations, this study investigated a possible association between lung cancer incidence and trace-element exposure in residents of this region. This population-based case-control study had 520 subjects, and 367 subjects provided toenail samples. Additionally, we explored the relationship between toenail and fingernail trace-element concentrations to determine if fingernails could be used as a surrogate for toenails when patients are unable to provide toenail samples. We found that, contrary to our initial hypothesis, trace element concentrations (Al, As, Cr, Mn, Co, Fe, Ni, Cu, Se, and Pb) were not higher in cancer cases than controls with the exception of Zn where concentrations were slightly higher in cases. In fact, univariate logistic regression models showed that individuals with lower concentrations of several elements (Al, Mn, Cr, and Se) were more likely to have lung cancer, although only Mn was significant in multivariate models which controlled for confounding factors. While drinking water concentrations of Al, Cr and Co were positively related to cancer incidence in univariate models, only Co remained significant in multivariate models. However, since the drinking water concentrations were extremely low and not reflected in the toenail concentrations, the significance of this finding is unclear. We also found that fingernail concentrations were not consistently predictive of toenail concentrations, indicating that fingernails should not be used as surrogates for toenails in future studies.

Global Epidemiology of Lung Cancer

While lung cancer has been the leading cause of cancer-related deaths for many years in the United States, incidence and mortality statistics - among other measures - vary widely worldwide. The aim of this study was to review the evidence on lung cancer epidemiology, including data of international scope with comparisons of economically, socially, and biologically different patient groups. In industrialized nations, evolving social and cultural smoking patterns have led to rising or plateauing rates of lung cancer in women, lagging the long-declining smoking and cancer incidence rates in men. In contrast, emerging economies vary widely in smoking practices and cancer incidence but commonly also harbor risks from environmental exposures, particularly widespread air pollution. Recent research has also revealed clinical, radiologic, and pathologic correlates, leading to greater knowledge in molecular profiling and targeted therapeutics, as well as an emphasis on the rising incidence of adenocarcinoma histology. Furthermore, emergent evidence about the benefits of lung cancer screening has led to efforts to identify high-risk smokers and development of prediction tools. This review also includes a discussion on the epidemiologic characteristics of special groups including women and nonsmokers. Varying trends in smoking largely dictate international patterns in lung cancer incidence and mortality. With declining smoking rates in developed countries and knowledge gains made through molecular profiling of tumors, the emergence of new risk factors and disease features will lead to changes in the landscape of lung cancer epidemiology.

A Bayesian adaptive phase II clinical trial design accounting for spatial variation

Conventional phase II clinical trials evaluate the treatment effects under the assumption of patient homogeneity. However, due to inter-patient heterogeneity, the effect of a treatment may differ remarkably among subgroups of patients. Besides patient’s individual characteristics such as age, gender, and biomarker status, a substantial amount of this heterogeneity could be due to the spatial variation across geographic regions because of unmeasured or unknown spatially varying environmental and social exposures. In this article, we propose a hierarchical Bayesian adaptive design for two-arm randomized phase II clinical trials that accounts for the spatial variation as well as patient’s individual characteristics. We treat the treatment efficacy as an ordinal outcome and quantify the desirability of each possible category of the ordinal efficacy using a utility function. A cumulative probit mixed model is used to relate efficacy to patient-specific covariates and geographic region spatial effects. Spatial dependence between regions is induced through the conditional autoregressive priors on the spatial effects. A two-stage design is proposed to adaptively assign patients to desirable treatments according to each patient’s spatial information and individual covariates and make treatment recommendations at the end of the trial based on the overall treatment effect. Simulation studies show that our proposed design has good operating characteristics and significantly outperforms an alternative phase II trial design that ignores the spatial variation.

Mortality and morbidity in populations in the vicinity of coal mining: a systematic review

BACKGROUND

Evidence of the association of coal mining with health outcomes such as increased mortality and morbidity in the general population has been provided by epidemiological studies in the last 25 years. Given the diverse sources of data included to investigate different health outcomes in the exposed populations, the International Classification of Diseases (ICD) can be used as a single classification standard to compare the findings of studies conducted in different socioeconomic and geographic contexts. The ICD classifies diagnoses of diseases and other disorders as codes organized by categories and chapters.

OBJECTIVES

Identify the ICD codes found in studies of morbidity and/or mortality in populations resident or in proximity of coal mining and assess the methods of these studies conducting a systematic review.

METHODS

A systematic database search of PubMed, EMBASE and Scopus following the PRISMA protocol was conducted to assess epidemiological studies from 1990 to 2016. The health outcomes were mapped to ICD codes and classified by studies of morbidity and/or mortality, and the categories and chapters of the ICD.

RESULTS

Twenty-eight epidemiological studies with ecological design from the USA, Europe and China were included. The exposed populations had increased risk of mortality and/or morbidity by 78 ICD diagnosis categories and 9 groups of ICD categories in 10 chapters of the ICD: Neoplasms, diseases of the circulatory, respiratory and genitourinary systems, metabolic diseases, diseases of the eye and the skin, perinatal conditions, congenital and chromosomal abnormalities, and external causes of morbidity. Exposed populations had non-increased risk of 9 ICD diagnosis categories of diseases of the genitourinary system, and prostate cancer.

CONCLUSIONS

There is consistent evidence of the association of coal mining with a wide spectrum of diseases in populations resident or in proximity of the mining activities. The methods of the studies included in this review can be integrated with individual-level and longitudinal studies to provide further evidence of the exposure pathways linked to increased risk in the exposed populations.

Intrastate Variations in Rural Cancer Risk and Incidence: An Illinois Case Study

CONTEXT

Although rural-urban cancer disparities have been explored with some depth, disparities within seemingly homogeneous rural areas have received limited attention. However, exploration of intrarural cancer incidence may have important public health implications for risk assessment, cancer control, and resource allocation.

OBJECTIVE

The objective of this study was to explore intrastate rural cancer risk and incidence differences within Illinois.

DESIGN

Illinois's 83 rural counties were categorized into northern, central, and southern regions (IL-N, IL-C, and IL-S, respectively). Chi-square test for independence and analysis of variance calculations were performed to assess regional differences in demographic characteristics, socioeconomic deprivation, smoking history, obesity, cancer-screening adherence, and density of general practitioners. Age-adjusted incidence rates were calculated for 5 cancer categories: all cancers combined, lung, colorectal, breast (female), and prostate cancers. Unadjusted and adjusted incidence rate ratios (IRRs) were calculated to evaluate regional differences in rates for each cancer category.

RESULTS

Socioeconomic deprivation varied by region: 4.5%, 6.9%, and 40.6% of IL-N, IL-C, and IL-S counties, respectively (P < .001). Smoking history also significantly differed by region. Mean former/current smoking prevalence in IL-N, IL-C, and IL-S counties was 46.4%, 48.2%, and 51.4%, respectively (P = .006). In unadjusted analysis, IL-C (IRR = 1.12; 95% confidence interval [CI], 1.02-1.23) and IL-S (IRR = 1.24; 95% CI, 1.13-1.35) had increased lung cancer incidence compared with IL-N. Elevated risk remained in IL-S after adjusting for relevant factors such as smoking and socioeconomic deprivation (IRR = 1.14; 95% CI, 1.04-1.26).

CONCLUSIONS

Socioeconomic deprivation, health behaviors, and lung cancer incidence varied across rural regions. Our findings underscore the importance of identifying cancer risk heterogeneity, even within a state, to effectively target risk factor reduction and cancer control interventions.

Systematic review of community health impacts of mountaintop removal mining

BACKGROUND

The objective of this evaluation is to understand the human health impacts of mountaintop removal (MTR) mining, the major method of coal mining in and around Central Appalachia. MTR mining impacts the air, water, and soil and raises concerns about potential adverse health effects in neighboring communities; exposures associated with MTR mining include particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs), metals, hydrogen sulfide, and other recognized harmful substances.

METHODS

A systematic review was conducted of published studies of MTR mining and community health, occupational studies of MTR mining, and any available animal and in vitro experimental studies investigating the effects of exposures to MTR-mining-related chemical mixtures. Six databases (Embase, PsycINFO, PubMed, Scopus, Toxline, and Web of Science) were searched with customized terms, and no restrictions on publication year or language, through October 27, 2016. The eligibility criteria included all human population studies and animal models of human health, direct and indirect measures of MTR-mining exposure, any health-related effect or change in physiological response, and any study design type. Risk of bias was assessed for observational and experimental studies using an approach developed by the National Toxicology Program (NTP) Office of Health Assessment and Translation (OHAT). To provide context for these health effects, a summary of the exposure literature is included that focuses on describing findings for outdoor air, indoor air, and drinking water.

RESULTS

From a literature search capturing 3088 studies, 33 human studies (29 community, four occupational), four experimental studies (two in rat, one in vitro and in mice, one in C. elegans), and 58 MTR mining exposure studies were identified. A number of health findings were reported in observational human studies, including cardiopulmonary effects, mortality, and birth defects. However, concerns for risk of bias were identified, especially with respect to exposure characterization, accounting for confounding variables (such as socioeconomic status), and methods used to assess health outcomes. Typically, exposure was assessed by proximity of residence or hospital to coal mining or production level at the county level. In addition, assessing the consistency of findings was challenging because separate publications likely included overlapping case and comparison groups. For example, 11 studies of mortality were conducted with most reporting higher rates associated with coal mining, but many of these relied on the same national datasets and were unable to consider individual-level contributors to mortality such as poor socioeconomic status or smoking. Two studies of adult rats reported impaired microvascular and cardiac mitochondrial function after intratracheal exposure to PM from MTR-mining sites. Exposures associated with MTR mining included reports of PM levels that sometimes exceeded Environmental Protection Agency (EPA) standards; higher levels of dust, trace metals, hydrogen sulfide gas; and a report of increased public drinking water violations.

DISCUSSION

This systematic review could not reach conclusions on community health effects of MTR mining because of the strong potential for bias in the current body of human literature. Improved characterization of exposures by future community health studies and further study of the effects of MTR mining chemical mixtures in experimental models will be critical to determining health risks of MTR mining to communities. Without such work, uncertainty will remain regarding the impact of these practices on the health of the people who breathe the air and drink the water affected by MTR mining.

Geographic Variations and Time Trends in Cancer Treatments in Taiwan

Background

Targeted therapies have become important treatment options for cancer care in many countries. This study aimed to examine recent trends in utilization of antineoplastic drugs, particularly the use of targeted therapies for treatment of cancer, by geographic region in Taiwan (northern, midwestern, southern, and eastern regions and the outer islands).

Methods

This was a retrospective observational study of antineoplastic agents using 2009-2012 quarterly claims data from Taiwan’s National Health Insurance Research Database. Yearly market shares by prescription volume and costs for targeted therapies among total antineoplastic agents by region were estimated. We used multivariate regression model and ANOVA to examine variations in utilization of targeted therapies between geographic regions and used ARIMA models to estimate longitudinal trends.

Results

Population-adjusted use and costs of antineoplastic drugs (including targeted therapies) were highest in the southern region of Taiwan and lowest in the outer islands. We found a 4-fold difference in use of antineoplastic drugs and a 49-fold difference in use of targeted therapies between regions if the outer islands were included. There were minimal differences in use of antineoplastic drugs between other regions with about a 2-fold difference in use of targeted therapies. Without considering the outer islands, the market share by prescription volume and costs of targeted therapies increased almost 2-fold (1.84-1.90) and 1.5-fold (1.26-1.61) respectively between 2009 and 2012. Furthermore, region was not significantly associated with use of antineoplastic agents or use of targeted therapies after adjusting for confounders. Region was associated with costs of antineoplastic agents but it was not associated with costs of targeted therapies after confounding adjustments.

Conclusions

Use of antineoplastic drugs overall and use of targeted therapies for treatment of cancer varied somewhat between regions in Taiwan; use was notably low in the outer islands. Strategies might be needed to ensure access to cancer care in each region as economic burden of cancer care increase due to growing use of targeted therapies.

Lung cancer and tobacco smoking in Crete, Greece: reflections from a population-based cancer registry from 1992 to 2013

Background

The Cancer Registry of Crete is a regional population database that collects cancer morbidity/mortality data along with several risk factors. The current study assessed the geographical variation of lung cancer among ever and never smokers in Crete during the last 20 years.

Method

Lung cancer patient records (1992–2013) including information on medical history and smoking habits were obtained from the Cancer Registry of Crete. Age-Adjusted Incidence Rates (AAIR), prevalence of smoking among lung cancer patients and the Population-Attributable Fraction (PAF%) of tobacco smoking were estimated. Kaplan-Meier curves, grouped per smoking status were constructed, and spatio-temporal analyses were carried out to assess the geographical variations of lung cancer and smoking (a = 0.05).

Results

New lung cancer cases in Crete accounted for 9% of all cancers (AAIR_{both genders} = 40.2/100,000/year, AAIR_males = 73.1/100,000/year, AAIR_females = 11.8/100,000/year). Ever smokers presented significantly higher incidence compared to ex-smokers (p = 0.02) and never smokers (p < 0.001). The highest increase was observed in ever smokers (AAIR₁₉₉₂ = 19.2/100,000/year, AAIR₂₀₁₃ = 25.4/100,000/year, p = 0.03), while never smokers presented the lowest increase from 1992 to 2013 (AAIR₁₉₉₂ = 5.3/100,000/year, AAIR₂₀₁₃ = 6.8/100,000/year, p = 0.2). The PAF% of lung cancer mortality is 86% for both genders (males: 89%, females: 78%). AAIRs ranged from 25 to 50/100,000/year, while significant geographical differences were observed among the municipalities of Crete (p = 0.02). Smokers living in the south-east urban regions presented higher risk of dying from lung cancer (RR = 2.2; 95%CI = 1.3–3.5).

Conclusions

The constant increase of lung cancer rates among both genders, especially in females, outlines the need for targeted, geographically-oriented, life-style preventive measures. Design of population-based screening programs, tobacco awareness campaigns and smoking cessation programs in lung cancer hot spots could be guide by these findings.

Confidence intervals for rate ratios between geographic units

Background

Ratios of age-adjusted rates between a set of geographic units and the overall area are of interest to the general public and to policy stakeholders. These ratios are correlated due to two reasons—the first being that each region is a component of the overall area and hence there is an overlap between them; and the second is that there is spatial autocorrelation between the regions. Existing methods in calculating the confidence intervals of rate ratios take into account the first source of correlation. This paper incorporates spatial autocorrelation, along with the correlation due to area overlap, into the rate ratio variance and confidence interval calculations.

Results

The proposed method divides the rate ratio variances into three components, representing no correlation, overlap correlation, and spatial autocorrelation, respectively. Results applied to simulated and real cancer mortality and incidence data show that with increasing strength and scales in spatial autocorrelation, the proposed method leads to substantial improvements over the existing method. If the data do not show spatial autocorrelation, the proposed method performs as well as the existing method.

Conclusions

The calculations are relatively easy to implement, and we recommend using this new method to calculate rate ratio confidence intervals in all cases.

Comparison of Mortality Disparities in Central Appalachian Coal- and Non-Coal-Mining Counties

OBJECTIVE

Determine whether select cause of death mortality disparities in four Appalachian regions is associated with coal mining or other factors.

METHODS

We calculated direct age-adjusted mortality rates and associated 95% confidence intervals by sex and study group for each cause of death over 5-year time periods from 1960 to 2009 and compared mean demographic and socioeconomic values between study groups via two-sample t tests.

RESULTS

Compared with non-coal-mining areas, we found higher rates of poverty in West Virginia and Virginia (VA) coal counties. All-cause mortality rates for males and females were higher in coal counties across all time periods. Virginia coal counties had statistically significant excesses for many causes of death.

CONCLUSIONS

We found elevated mortality and poverty rates in coal-mining compared with non-coal-mining areas of West Virginia and VA. Future research should examine these findings in more detail at the individual level.

Review: Increasing Awareness and Education on Health Disparities for Health Care Providers

The focus of this review is to highlight health care disparities and trends in several common diseases in selected populations while offering evidence-based approaches to mitigating health care disparities. Health care disparities cross many barriers and affect multiple populations and diseases. Ethnic minorities, the elderly, and those of lower socioeconomic status (SES) are more at-risk than others. However, many low SES Whites and higher SES racial minorities have poorer health than their racial or SES peers. Also, recent immigrant groups and Hispanics, in particular, maintain high health ratings. The so-called Hispanic Paradox provides an example of how culture and social background can be used to improve health outcomes. These groups have unique determinants of disparity that are based on a wide range of cultural and societal factors. Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient's cultural background to promote healthy behaviors.

Bhas 42 cell transformation activity of cigarette smoke condensate is modulated by selenium and arsenic

Cigarette smoking remains a major health risk worldwide. Development of newer tobacco products requires the use of quantitative toxicological assays. Recently, v-Ha-ras transfected BALB/c3T3 (Bhas 42) cell transformation assay was established that simulates the two-stage animal tumorigenesis model and measures tumor initiating and promoting activities of chemicals. The present study was performed to assess the feasibility of using this Bhas 42 cell transformation assay to determine the initiation and promotion activities of cigarette smoke condensate (CSC) and its water soluble fraction. Further, the modulating effects of selenium and arsenic on cigarette smoke-induced cell transformation were investigated. Dimethyl sulfoxide (DMSO) and water extracts of CSC (CSC-D and CSC-W, respectively) were tested at concentrations of 2.5-40 µg mL(-1) in the initiation or promotion assay formats. Initiation protocol of the Bhas 42 assay showed a 3.5-fold increase in transformed foci at 40 µg mL(-1) of CSC-D but not CSC-W. The promotion phase of the assay yielded a robust dose response with CSC-D (2.5-40 µg mL(-1)) and CSC-W (20-40 µg mL(-1)). Preincubation of cells with selenium (100 nM) significantly reduced CSC-induced increase in cell transformation in initiation assay. Co-treatment of cells with a sub-toxic dose of arsenic significantly enhanced cell transformation activity of CSC-D in promotion assay. The results suggest a presence of both water soluble and insoluble tumor promoters in CSC, a role of oxidative stress in CSC-induced cell transformation, and usefulness of Bhas 42 cell transformation assay in comparing tobacco product toxicities and in studying the mechanisms of tobacco carcinogenesis.

General mortality patterns in appalachian coal-mining and non-coal-mining counties

OBJECTIVE

To determine whether mortality disparities in Appalachia are due to coal mining or other factors.

METHODS

Unadjusted and covariate adjusted rate ratio models calculated total, all external, and all cancer mortality rates from 1960 to 2009 for cumulative total, surface, and underground coal production in coal-mining counties compared with non-coal-mining counties.

RESULTS

No coal-related statistically significant elevations in total or all external mortality were found. Control for covariates attenuated rate ratios for all levels of coal mining. All forms of coal were statistically significant in the adjusted rate ratio models for all cancer mortality, with 4% to 6% excesses in the highest quartiles of production.

CONCLUSIONS

Total and all external mortalities do not seem to be related to coal production in Appalachia, but all cancer mortality should be further examined. Additional causes of death should also be considered.

Manuscript title: Geospatial analysis of Cancer risk and residential proximity to coal mines in Illinois

BACKGROUND

Studies have indicated a population-level association between coal mining and cancer incidence and mortality, but few studies specifically examined residential proximity to this exposure using spatial analysis. We utilized a Geographic Information Systems (GIS) approach to perform spatial and statistical analyses to test two coal mining exposure variables and their associations with cancer incidence and mortality in Illinois--the fourth highest coal producing state in the United States.

METHODS

Data included age-adjusted county-level cancer incidence and mortality for five cancers: all malignant, lung, colorectal, breast (female) and prostate. Coal mining exposure was defined by two variables: coal production group and distance-weighted exposure. Spatial analyses were performed to identify spatial clustering. Correlation and stepwise regression analyses were performed to explore the relationship between cancer incidence and mortality and coal mining exposures. Covariates considered in regression analyses included socioeconomic deprivation, former/current smoking prevalence, race, and rurality.

RESULTS

Global spatial autocorrelation indicated significant spatial clustering of incidence, mortality and aggregated coal production. Distance-weighted exposure was significantly correlated with coal production group, age-adjusted all cancer incidence and age-adjusted all cancer mortality. Regression analyses indicated an association between recent coal production and colorectal cancer incidence (p=0.009) and mortality (p=0.035) and prostate cancer mortality (p=0.047). Distance weighted exposure was associated with lung cancer incidence (p=0.004) and mortality (p<0.001), and all cancer mortality (p<0.001).

CONCLUSION

Coal production, incidence and mortality are spatially clustered in Illinois. Exposures to coal mining were associated with elevated risk of multiple cancers, most notably lung and colorectal. The environmental impact of the mining industry is substantial, and exposure of individuals residing near coal mines to known carcinogens is plausible. Future studies are needed to further elucidate the population exposure dynamics of coal mining, and should be explored using individual-level exposures and cancer outcomes.

Evaluation of the performance of smoothing functions in generalized additive models for spatial variation in disease

Generalized additive models (GAMs) with bivariate smoothing functions have been applied to estimate spatial variation in risk for many types of cancers. Only a handful of studies have evaluated the performance of smoothing functions applied in GAMs with regard to different geographical areas of elevated risk and different risk levels. This study evaluates the ability of different smoothing functions to detect overall spatial variation of risk and elevated risk in diverse geographical areas at various risk levels using a simulation study. We created five scenarios with different true risk area shapes (circle, triangle, linear) in a square study region. We applied four different smoothing functions in the GAMs, including two types of thin plate regression splines (TPRS) and two versions of locally weighted scatterplot smoothing (loess). We tested the null hypothesis of constant risk and detected areas of elevated risk using analysis of deviance with permutation methods and assessed the performance of the smoothing methods based on the spatial detection rate, sensitivity, accuracy, precision, power, and false-positive rate. The results showed that all methods had a higher sensitivity and a consistently moderate-to-high accuracy rate when the true disease risk was higher. The models generally performed better in detecting elevated risk areas than detecting overall spatial variation. One of the loess methods had the highest precision in detecting overall spatial variation across scenarios and outperformed the other methods in detecting a linear elevated risk area. The TPRS methods outperformed loess in detecting elevated risk in two circular areas.

Spatial epidemiology of Escherichia coli O157:H7 in dairy cattle in relation to night roosts Of Sturnus vulgaris (European Starling) in Ohio, USA (2007-2009)

The goal of our study was to use spatial scan statics to determine whether the night roosts of European starlings (Sturnus vulgaris) act as point sources for the dissemination of Escherichia coli O157:H7 among dairy farms. From 2007 to 2009, we collected bovine faecal samples (n = 9000) and starling gastrointestinal contents (n = 430) from 150 dairy farms in northeastern Ohio, USA. Isolates of E. coli O157:H7 recovered from these samples were subtyped using multilocus variable-number tandem repeat analysis (MLVA). Generated MLVA types were used to construct a dendrogram based on a categorical multistate coefficient and unweighted pair-group method with arithmetic mean (UPGMA). Using a focused spatial scan statistic, we identified statistically significant spatial clusters among dairy farms surrounding starling night roosts, with an increased prevalence of E. coli O157:H7-positive bovine faecal pats, increased diversity of distinguishable MLVA types and a greater number of isolates with MLVA types from bovine-starling clades versus bovine-only clades. Thus, our findings are compatible with the hypothesis that starlings have a role in the dissemination of E. coli O157:H7 among dairy farms, and further research into starling management is warranted.

An examination of the effects of mountaintop removal coal mining on respiratory symptoms and COPD using propensity scores

Previous research on public health consequences of mountaintop removal (MTR) coal mining has been limited by the observational nature of the data. The current study used propensity scores, a method designed to overcome this limitation, to draw more confident causal inferences about mining effects on respiratory health using non-experimental data. These data come from a health survey of 682 adults residing in two rural areas of Virginia, USA characterized by the presence or absence of MTR mining. Persons with a history of occupational exposure as coal miners were excluded. Nine covariates including age, sex, current and former smoking, overweight, obesity, high school education, college education, and exposure to coal as a home-heating source were selected to estimate propensity scores. Propensity scores were tested for balance and then used as weights to create quasi-experimental exposed and unexposed groups. Results indicated that persons in the mountaintop mining group had significantly (p < 0.0001) elevated prevalence of respiratory symptoms and chronic obstructive pulmonary disease. The results suggest that impaired respiratory health results from exposure to MTR environments and not from other risks.

Fewer hospitalizations for chronic obstructive pulmonary disease in communities with smoke-free public policies

OBJECTIVES

We determined the impact of smoke-free municipal public policies on hospitalizations for chronic obstructive pulmonary disease (COPD).

METHODS

We conducted a secondary analysis of hospital discharges with a primary diagnosis of COPD in Kentucky between July 1, 2003, and June 30, 2011 using Poisson regression. We compared the hospitalization rates of regions with and without smoke-free laws, adjusting for personal and population covariates, seasonality, secular trends over time, and geographic region.

RESULTS

Controlling for covariates such as sex, age, length of stay, race/ethnicity, education, income, and urban-rural status, among others, we found that those living in a community with a comprehensive smoke-free law or regulation were 22% less likely to experience hospitalizations for COPD than those living in a community with a moderate-weak law or no law. Those living in a community with an established law were 21% less likely to be hospitalized for COPD than those with newer laws or no laws.

CONCLUSIONS

Strong smoke-free public policies may provide protection against COPD hospitalizations, particularly after 12 months, with the potential to save lives and decrease health care costs.

Population cancer risks associated with coal mining: a systematic review

Background

Coal is produced across 25 states and provides 42% of US energy. With production expected to increase 7.6% by 2035, proximate populations remain at risk of exposure to carcinogenic coal products such as silica dust and organic compounds. It is unclear if population exposure is associated with increased risk, or even which cancers have been studied in this regard.

Methods

We performed a systematic review of English-language manuscripts published since 1980 to determine if coal mining exposure was associated with increased cancer risk (incidence and mortality).

Results

Of 34 studies identified, 27 studied coal mining as an occupational exposure (coal miner cohort or as a retrospective risk factor) but only seven explored health effects in surrounding populations. Overall, risk assessments were reported for 20 cancer site categories, but their results and frequency varied considerably. Incidence and mortality risk assessments were: negative (no increase) for 12 sites; positive for 1 site; and discordant for 7 sites (e.g. lung, gastric). However, 10 sites had only a single study reporting incidence risk (4 sites had none), and 11 sites had only a single study reporting mortality risk (2 sites had none). The ecological study data were particularly meager, reporting assessments for only 9 sites. While mortality assessments were reported for each, 6 had only a single report and only 2 sites had reported incidence assessments.

Conclusions

The reported assessments are too meager, and at times contradictory, to make definitive conclusions about population cancer risk due to coal mining. However, the preponderance of this and other data support many of Hill’s criteria for causation. The paucity of data regarding population exposure and risk, the widespread geographical extent of coal mining activity, and the continuing importance of coal for US energy, warrant further studies of population exposure and risk.

Personal and family health in rural areas of Kentucky with and without mountaintop coal mining

PURPOSE

This study investigates health disparities for adults residing in a mountaintop coal mining area of Appalachian Kentucky. Mountaintop mining areas are characterized by severe economic disadvantage and by mining-related environmental hazards.

METHODS

A community-based participatory research study was implemented to collect information from residents on health conditions and symptoms for themselves and other household members in a rural mountaintop mining area compared to a rural nonmining area of eastern Kentucky. A door-to-door health interview collected data from 952 adults. Data were analyzed using prevalence rate ratio models.

FINDINGS

Adjusting for covariates, significantly poorer health conditions were observed in the mountaintop mining community on: self-rated health status, illness symptoms across multiple organ systems, lifetime and current asthma, chronic obstructive pulmonary disease, and hypertension. Respondents in mountaintop mining communities were also significantly more likely to report that household members had experienced serious illness, or had died from cancer in the past 5 years. Significant differences were not observed for self-reported cancer, angina, or stroke, although differences in cardiovascular symptoms and household cancer were reported.

CONCLUSIONS

Efforts to reduce longstanding health problems in Appalachia must focus on mountaintop mining portions of the region, and should seek to eliminate socioeconomic and environmental disparities.

Prognostic significance of NSE mRNA in advanced NSCLC treated with gefitinib

PURPOSE

Current knowledge of the prognostic biomarkers of advanced non-small cell lung cancer (NSCLC) treated with gefitinib is poor. NSE mRNA as a potential prognostic biomarker of the effectiveness of gefitinib treatment in NSCLC, especially in the Chinese population, needs to be further validated.

PATIENTS AND METHODS

We retrospectively reviewed 168 advanced NSCLC patients treated with gefitinib between May 2006 and July 2010. NSE mRNA was measured using quantitative RT-PCR analysis for correlation with the clinical outcomes.

RESULTS

We found that NSE mRNA expression was inversely correlated with sensitivity to gefitinib in NSCLC patients. Patients without elevated NSE mRNA had a more RR (CR + RR) 45.1 % than elevated 18.9 % (P = 0.0005). Moreover, the time to progression was 6.0 versus 4.2 months, respectively. Log-rank test was marginally significant (χ(2) = 12.11, P = 0.0007) and Cox multivariate analysis revealed that NSE mRNA (HR = 3.076; 95 % CI 1.943-4.870; P < 0.0001) was an independent prognostic factor of NSCLC patients in the Chinese population.

CONCLUSION

For NSCLC patients treated with gefitinib, patients without elevated NSE mRNA had a better prognosis than those with elevated NSE mRNA. Pretreatment NSE mRNA holds great potential as a prognostic biomarker in advanced NSCLC. Therefore, it is proposed that NSE mRNA should be routinely detected to screen patients who are more likely to benefit from gefitinib-based treatment.