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Villeneuve PJ, Gill GK, Cottagiri SA, Dales R, Rainham D, Ross NA, Dogan H, Griffith LE, Raina P, Crouse DL. Does urban greenness reduce loneliness and social isolation among Canadians? A cross-sectional study of middle-aged and older adults of the Canadian Longitudinal Study on Aging (CLSA). Can J Public Health 2024; 115:282-295. [PMID: 38158519 PMCID: PMC11006650 DOI: 10.17269/s41997-023-00841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Urban greenness has been shown to confer many health benefits including reduced risks of chronic disease, depression, anxiety, and, in a limited number of studies, loneliness. In this first Canadian study on this topic, we investigated associations between residential surrounding greenness and loneliness and social isolation among older adults. METHODS This cross-sectional analysis of the Canadian Longitudinal Study on Aging included 26,811 urban participants between 45 and 86 years of age. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants' residential addresses using a buffer distance of 500 m. We evaluated associations between the NDVI and (i) self-reported loneliness using the Center for Epidemiological Studies Depression Scale, (ii) whether participants reported "feeling lonely living in the local area", and (iii) social isolation. Logistic regression models were used to characterize associations between greenness and loneliness/social isolation while adjusting for individual socio-economic and health behaviours. RESULTS Overall, 10.8% of participants perceived being lonely, while 6.5% reported "feeling lonely in their local area". Furthermore, 16.2% of participants were characterized as being socially isolated. In adjusted models, we observed no statistically significant difference (odds ratio (OR) = 0.99; 95% confidence interval (CI) 0.93-1.04) in self-reported loneliness in relation to an interquartile range (IQR) increase of NDVI (0.06). However, for the same change in greenness, there was a 15% (OR = 0.85; 95% CI 0.72-0.99) reduced risk for participants who strongly agreed with "feeling lonely living in the local area". For social isolation, for an IQR increase in the NDVI, we observed a 7% (OR = 0.93; 95% CI 0.88-0.97) reduction in prevalence. CONCLUSION Our findings suggest that urban greenness plays a role in reducing loneliness and social isolation among Canadian urbanites.
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Affiliation(s)
- Paul J Villeneuve
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada.
| | - Gagan K Gill
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Susanna A Cottagiri
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Robert Dales
- Population Studies Division, Environmental Health Science & Research Bureau, Health Canada, Ottawa, ON, Canada
- University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel Rainham
- Faculty of Health, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Nancy A Ross
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Habibe Dogan
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON, Canada
- McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada
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Weichenthal S, Pinault L, Christidis T, Burnett RT, Brook JR, Chu Y, Crouse DL, Erickson AC, Hystad P, Li C, Martin RV, Meng J, Pappin AJ, Tjepkema M, van Donkelaar A, Weagle CL, Brauer M. How low can you go? Air pollution affects mortality at very low levels. Sci Adv 2022; 8:eabo3381. [PMID: 36170354 PMCID: PMC9519036 DOI: 10.1126/sciadv.abo3381] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/11/2022] [Indexed: 05/29/2023]
Abstract
The World Health Organization (WHO) recently released new guidelines for outdoor fine particulate air pollution (PM2.5) recommending an annual average concentration of 5 μg/m3. Yet, our understanding of the concentration-response relationship between outdoor PM2.5 and mortality in this range of near-background concentrations remains incomplete. To address this uncertainty, we conducted a population-based cohort study of 7.1 million adults in one of the world's lowest exposure environments. Our findings reveal a supralinear concentration-response relationship between outdoor PM2.5 and mortality at very low (<5 μg/m3) concentrations. Our updated global concentration-response function incorporating this new information suggests an additional 1.5 million deaths globally attributable to outdoor PM2.5 annually compared to previous estimates. The global health benefits of meeting the new WHO guideline for outdoor PM2.5 are greater than previously assumed and indicate a need for continued reductions in outdoor air pollution around the world.
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Affiliation(s)
- Scott Weichenthal
- McGill University, Montreal, QC, Canada
- Health Canada, Ottawa, ON, Canada
| | | | | | - Richard T. Burnett
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Yen Chu
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Chi Li
- Dalhousie University, Halifax, NS, Canada
| | - Randall V. Martin
- Dalhousie University, Halifax, NS, Canada
- Washington University, Saint Louis, WA, USA
| | - Jun Meng
- Washington University, Saint Louis, WA, USA
- Air Quality Research Division, Environment and Climate Change Canada, Toronto, ON, Canada
| | | | | | - Aaron van Donkelaar
- Dalhousie University, Halifax, NS, Canada
- Washington University, Saint Louis, WA, USA
| | | | - Michael Brauer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- University of British Columbia, Vancouver, BC, Canada
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Brauer M, Brook JR, Christidis T, Chu Y, Crouse DL, Erickson A, Hystad P, Li C, Martin RV, Meng J, Pappin AJ, Pinault LL, Tjepkema M, van Donkelaar A, Weagle C, Weichenthal S, Burnett RT. Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE): Phase 2. Res Rep Health Eff Inst 2022; 2022:1-91. [PMID: 36224709 PMCID: PMC9556709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
INTRODUCTION Mortality is associated with long-term exposure to fine particulate matter (particulate matter ≤2.5 μm in aerodynamic diameter; PM2.5), although the magnitude and form of these associations remain poorly understood at lower concentrations. Knowledge gaps include the shape of concentration-response curves and the lowest levels of exposure at which increased risks are evident and the occurrence and extent of associations with specific causes of death. Here, we applied improved estimates of exposure to ambient PM2.5 to national population-based cohorts in Canada, including a stacked cohort of 7.1 million people who responded to census year 1991, 1996, or 2001. The characterization of the shape of the concentration-response relationship for nonaccidental mortality and several specific causes of death at low levels of exposure was the focus of the Mortality-Air Pollution Associations in Low Exposure Environments (MAPLE) Phase 1 report. In the Phase 1 report we reported that associations between outdoor PM2.5 concentrations and nonaccidental mortality were attenuated with the addition of ozone (O3) or a measure of gaseous pollutant oxidant capacity (Ox), which was estimated from O3 and nitrogen dioxide (NO2) concentrations. This was motivated by our interests in understanding both the effects air pollutant mixtures may have on mortality and also the role of O3 as a copollutant that shares common sources and precursor emissions with those of PM2.5. In this Phase 2 report, we further explore the sensitivity of these associations with O3 and Ox, evaluate sensitivity to other factors, such as regional variation, and present ambient PM2.5 concentration-response relationships for specific causes of death. METHODS PM2.5 concentrations were estimated at 1 km2 spatial resolution across North America using remote sensing of aerosol optical depth (AOD) combined with chemical transport model (GEOS-Chem) simulations of the AOD:surface PM2.5 mass concentration relationship, land use information, and ground monitoring. These estimates were informed and further refined with collocated measurements of PM2.5 and AOD, including targeted measurements in areas of low PM2.5 concentrations collected at five locations across Canada. Ground measurements of PM2.5 and total suspended particulate matter (TSP) mass concentrations from 1981 to 1999 were used to backcast remote-sensing-based estimates over that same time period, resulting in modeled annual surfaces from 1981 to 2016. Annual exposures to PM2.5 were then estimated for subjects in several national population-based Canadian cohorts using residential histories derived from annual postal code entries in income tax files. These cohorts included three census-based cohorts: the 1991 Canadian Census Health and Environment Cohort (CanCHEC; 2.5 million respondents), the 1996 CanCHEC (3 million respondents), the 2001 CanCHEC (3 million respondents), and a Stacked CanCHEC where duplicate records of respondents were excluded (Stacked CanCHEC; 7.1 million respondents). The Canadian Community Health Survey (CCHS) mortality cohort (mCCHS), derived from several pooled cycles of the CCHS (540,900 respondents), included additional individual information about health behaviors. Follow-up periods were completed to the end of 2016 for all cohorts. Cox proportional hazard ratios (HRs) were estimated for nonaccidental and other major causes of death using a 10-year moving average exposure and 1-year lag. All models were stratified by age, sex, immigrant status, and where appropriate, census year or survey cycle. Models were further adjusted for income adequacy quintile, visible minority status, Indigenous identity, educational attainment, labor-force status, marital status, occupation, and ecological covariates of community size, airshed, urban form, and four dimensions of the Canadian Marginalization Index (Can-Marg; instability, deprivation, dependency, and ethnic concentration). The mCCHS analyses were also adjusted for individual-level measures of smoking, alcohol consumption, fruit and vegetable consumption, body mass index (BMI), and exercise behavior. In addition to linear models, the shape of the concentration-response function was investigated using restricted cubic splines (RCS). The number of knots were selected by minimizing the Bayesian Information Criterion (BIC). Two additional models were used to examine the association between nonaccidental mortality and PM2.5. The first is the standard threshold model defined by a transformation of concentration equaling zero if the concentration was less than a specific threshold value and concentration minus the threshold value for concentrations above the threshold. The second additional model was an extension of the Shape Constrained Health Impact Function (SCHIF), the eSCHIF, which converts RCS predictions into functions potentially more suitable for use in health impact assessments. Given the RCS parameter estimates and their covariance matrix, 1,000 realizations of the RCS were simulated at concentrations from the minimum to the maximum concentration, by increments of 0.1 μg/m3. An eSCHIF was then fit to each of these RCS realizations. Thus, 1,000 eSCHIF predictions and uncertainty intervals were determined at each concentration within the total range. Sensitivity analyses were conducted to examine associations between PM2.5 and mortality when in the presence of, or stratified by tertile of, O3 or Ox. Additionally, associations between PM2.5 and mortality were assessed for sensitivity to lower concentration thresholds, where person-years below a threshold value were assigned the mean exposure within that group. We also examined the sensitivity of the shape of the nonaccidental mortality-PM2.5 association to removal of person-years at or above 12 μg/m3 (the current U.S. National Ambient Air Quality Standard) and 10 μg/m3 (the current Canadian and former [2005] World Health Organization [WHO] guideline, and current WHO Interim Target-4). Finally, differences in the shapes of PM2.5-mortality associations were assessed across broad geographic regions (airsheds) within Canada. RESULTS The refined PM2.5 exposure estimates demonstrated improved performance relative to estimates applied previously and in the MAPLE Phase 1 report, with slightly reduced errors, including at lower ranges of concentrations (e.g., for PM2.5 <10 μg/m3). Positive associations between outdoor PM2.5 concentrations and nonaccidental mortality were consistently observed in all cohorts. In the Stacked CanCHEC analyses (1.3 million deaths), each 10-μg/m3 increase in outdoor PM2.5 concentration corresponded to an HR of 1.084 (95% confidence interval [CI]: 1.073 to 1.096) for nonaccidental mortality. For an interquartile range (IQR) increase in PM2.5 mass concentration of 4.16 μg/m3 and for a mean annual nonaccidental death rate of 92.8 per 10,000 persons (over the 1991-2016 period for cohort participants ages 25-90), this HR corresponds to an additional 31.62 deaths per 100,000 people, which is equivalent to an additional 7,848 deaths per year in Canada, based on the 2016 population. In RCS models, mean HR predictions increased from the minimum concentration of 2.5 μg/m3 to 4.5 μg/m3, flattened from 4.5 μg/m3 to 8.0 μg/m3, then increased for concentrations above 8.0 μg/m3. The threshold model results reflected this pattern with -2 log-likelihood values being equal at 2.5 μg/m3 and 8.0 μg/m3. However, mean threshold model predictions monotonically increased over the concentration range with the lower 95% CI equal to one from 2.5 μg/m3 to 8.0 μg/m3. The RCS model was a superior predictor compared with any of the threshold models, including the linear model. In the mCCHS cohort analyses inclusion of behavioral covariates did not substantially change the results for both linear and nonlinear models. We examined the sensitivity of the shape of the nonaccidental mortality-PM2.5 association to removal of person-years at or above the current U.S. and Canadian standards of 12 μg/m3 and 10 μg/m3, respectively. In the full cohort and in both restricted cohorts, a steep increase was observed from the minimum concentration of 2.5 μg/m3 to 5 μg/m3. For the full cohort and the <12 μg/m3 cohort the relationship flattened over the 5 to 9 μg/m3 range and then increased above 9 μg/m3. A similar increase was observed for the <10 μg/m3 cohort followed by a clear decline in the magnitude of predictions over the 5 to 9 μg/m3 range and an increase above 9 μg/m3. Together these results suggest that a positive association exists for concentrations >9 μg/m3 with indications of adverse effects on mortality at concentrations as low as 2.5 μg/m3. Among the other causes of death examined, PM2.5 exposures were consistently associated with an increased hazard of mortality due to ischemic heart disease, respiratory disease, cardiovascular disease, and diabetes across all cohorts. Associations were observed in the Stacked CanCHEC but not in all other cohorts for cerebrovascular disease, pneumonia, and chronic obstructive pulmonary disease (COPD) mortality. No significant associations were observed between mortality and exposure to PM2.5 for heart failure, lung cancer, and kidney failure. In sensitivity analyses, the addition of O3 and Ox attenuated associations between PM2.5 and mortality. When analyses were stratified by tertiles of copollutants, associations between PM2.5 and mortality were only observed in the highest tertile of O3 or Ox. Across broad regions of Canada, linear HR estimates and the shape of the eSCHIF varied substantially, possibly reflecting underlying differences in air pollutant mixtures not characterized by PM2.5 mass concentrations or the included gaseous pollutants. Sensitivity analyses to assess regional variation in population characteristics and access to healthcare indicated that the observed regional differences in concentration-mortality relationships, specifically the flattening of the concentration-mortality relationship over the 5 to 9 μg/m3 range, was not likely related to variation in the makeup of the cohort or its access to healthcare, lending support to the potential role of spatially varying air pollutant mixtures not sufficiently characterized by PM2.5 mass concentrations. CONCLUSIONS In several large, national Canadian cohorts, including a cohort of 7.1 million unique census respondents, associations were observed between exposure to PM2.5 with nonaccidental mortality and several specific causes of death. Associations with nonaccidental mortality were observed using the eSCHIF methodology at concentrations as low as 2.5 μg/m3, and there was no clear evidence in the observed data of a lower threshold, below which PM2.5 was not associated with nonaccidental mortality.
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Affiliation(s)
- M Brauer
- The University of British Columbia, Vancouver, British Columbia, Canada
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - J R Brook
- University of Toronto, Toronto, Ontario, Canada
| | - T Christidis
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Y Chu
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - D L Crouse
- University of New Brunswick, Fredericton, New Brunswick, Canada
| | - A Erickson
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - P Hystad
- Oregon State University, Corvallis, Oregon
| | - C Li
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - R V Martin
- Dalhousie University, Halifax, Nova Scotia, Canada
- Washington University, Saint Louis, Missouri
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts
| | - J Meng
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - A J Pappin
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - L L Pinault
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - M Tjepkema
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | | | - C Weagle
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - R T Burnett
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada
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Boogaard H, Patton AP, Atkinson RW, Brook JR, Chang HH, Crouse DL, Fussell JC, Hoek G, Hoffmann B, Kappeler R, Kutlar Joss M, Ondras M, Sagiv SK, Samoli E, Shaikh R, Smargiassi A, Szpiro AA, Van Vliet EDS, Vienneau D, Weuve J, Lurmann FW, Forastiere F. Long-term exposure to traffic-related air pollution and selected health outcomes: A systematic review and meta-analysis. Environ Int 2022; 164:107262. [PMID: 35569389 DOI: 10.1016/j.envint.2022.107262] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 05/26/2023]
Abstract
The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest. Following its well-cited 2010 critical review, the Health Effects Institute (HEI) appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected adverse health outcomes. Health outcomes were selected based on evidence of causality for general air pollution (broader than TRAP) cited in authoritative reviews, relevance for public health and policy, and resources available. The Panel used a systematic approach to search the literature, select studies for inclusion in the review, assess study quality, summarize results, and reach conclusions about the confidence in the evidence. An extensive search was conducted of literature published between January 1980 and July 2019 on selected health outcomes. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP. In total, 353 studies were included in the review. Respiratory effects in children (118 studies) and birth outcomes (86 studies) were the most commonly studied outcomes. Fewer studies investigated cardiometabolic effects (57 studies), respiratory effects in adults (50 studies), and mortality (48 studies). The findings from the systematic review, meta-analyses, and evaluation of the quality of the studies and potential biases provided an overall high or moderate-to-high level of confidence in an association between long-term exposure to TRAP and the adverse health outcomes all-cause, circulatory, ischemic heart disease and lung cancer mortality, asthma onsetin chilldren and adults, and acute lower respiratory infections in children. The evidence was considered moderate, low or very low for the other selected outcomes. In light of the large number of people exposed to TRAP - both in and beyond the near-road environment - the Panel concluded that the overall high or moderate-to-high confidence in the evidence for an association between long-term exposure to TRAP and several adverse health outcomes indicates that exposures to TRAP remain an important public health concern and deserve greater attention from the public and from policymakers.
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Affiliation(s)
- H Boogaard
- Health Effects Institute, Boston, MA, United States.
| | - A P Patton
- Health Effects Institute, Boston, MA, United States
| | - R W Atkinson
- Epidemiology, Population Health Research Institute and MRC-PHE Centre for Environment and Health, St. George's, University of London, London, United Kingdom
| | - J R Brook
- Occupational and Environmental Health Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - H H Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - D L Crouse
- Health Effects Institute, Boston, MA, United States
| | - J C Fussell
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - G Hoek
- Institute for Risk Assessment Sciences, Environmental Epidemiology, Utrecht University, Utrecht, the Netherlands
| | - B Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - R Kappeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - M Kutlar Joss
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - M Ondras
- Health Effects Institute, Boston, MA, United States
| | - S K Sagiv
- Center for Environmental Research and Children's Health, Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA, United States
| | - E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - R Shaikh
- Health Effects Institute, Boston, MA, United States
| | - A Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - A A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | | | - D Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - J Weuve
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - F W Lurmann
- Sonoma Technology, Inc, Petaluma, CA, United States
| | - F Forastiere
- School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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Lang JJ, Pinault L, Colley RC, Prince SA, Christidis T, Tjepkema M, Crouse DL, de Groh M, Ross N, Villeneuve PJ. Neighbourhood walkability and mortality: Findings from a 15-year follow-up of a nationally representative cohort of Canadian adults in urban areas. Environ Int 2022; 161:107141. [PMID: 35183941 DOI: 10.1016/j.envint.2022.107141] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/17/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Using a nationally representative cohort of Canadian adults, we assessed associations between neighbourhood walkability and cause-specific mortality and investigated whether they differed by socioeconomic status. METHODS The study population was drawn from the 2001 Canadian Census Health and Environment Cohort, which contains individual-level data from a random sample of 20% of Canadian households mandated to complete the long-form census. We included those aged ≥ 25 years at baseline who lived in urban and suburban areas. The national death registry was used to ascertain annual vital status. Linkages to annual income tax data provided place of residence. The Canadian Active Living Environments, a national index that summarizes walkability across Canadian neighbourhoods, was assigned to individuals' residential history. The Cox proportional hazards model was used to assess associations between walkability and cause-specific mortality. RESULTS A total of 1.8 million participants (52.5% female) accrued 27.3 million person-years and 265 710 deaths during the 15-year follow-up. The adjusted hazard ratio (HR) for living in a highly walkable neighbourhood relative to living in the least walkable neighbourhoods was associated with a 9% (HR: 0.91 [0.88, 0.95]) and 3% (HR: 0.97 [0.94, 0.99]) reduced risk of cardiovascular and all non-accidental mortality, respectively. The strongest benefits of walkability were found among individuals within the lowest education and household income categories, and who lived in the most deprived neighbourhoods. There were no significant associations (most [class 5] versus least [class 1] walkable HR: 0.84 [0.61-1.16]) seen for accidental traffic mortality. CONCLUSIONS Canadian adults who live in walkable neighbourhoods have lower rates of cardiovascular and non-accidental mortality, with the greatest benefits seen in those from the lowest socioeconomic groups.
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Affiliation(s)
- Justin J Lang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Canada; School of Mathematics and Statistics, Carleton University, Canada.
| | | | | | - Stephanie A Prince
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
| | | | | | - Dan L Crouse
- Health Effects Institute, Massachusetts, United States
| | - Margaret de Groh
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Canada
| | - Nancy Ross
- McGill University, Department of Geography, Canada
| | - Paul J Villeneuve
- School of Mathematics and Statistics, Carleton University, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Crouse DL, Pinault L, Christidis T, Lavigne E, Thomson EM, Villeneuve PJ. Residential greenness and indicators of stress and mental well-being in a Canadian national-level survey. Environ Res 2021; 192:110267. [PMID: 33027630 DOI: 10.1016/j.envres.2020.110267] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Residential proximity to greenness in urban areas has been shown to confer a number of health benefits, including improved mental health. We investigated whether greenness was associated with self-reported stress, distress, and mental health among adult participants of multiple cycles of a national Canadian health survey, and whether these associations varied by sex, age, income, and neighbourhood characteristics. METHODS Our study population included 397,900 participants of the Canadian Community Health Survey, 18 years of age or older, who lived in census metropolitan areas between 2000 and 2015. We used the Normalized Difference Vegetation Index (NDVI) to characterize participants' exposure to greenness within 250 m, 500 m, and 1 km buffers from a representative location of their postal code. Health outcomes included: self-reported perceptions of life stress, psychological distress, and self-rated mental health. We used multiple regression models, adjusted for relevant individual and neighbourhood-level variables to estimate associations (and 95% confidence intervals) between each outcome and exposure to greenness. FINDINGS In models with all participants, we observed 6% lower odds of poor self-rated mental health per increase in the interquartile range (i.e., 0.12) of NDVI within a 500 m buffer. Across the three outcomes, we found substantial heterogeneity in effect size across categories of sex, age, and community-level indicators of deprivation and urban form. For example, each incremental increase in greenness exposure was associated with a reduction of 0.61 (95% CI: 0.81 to -0.51) on the K10 psychological distress score among those living in the active core of cities, and with an increase of 0.07 (95% CI: 0.03-0.12) on this score among those living in the most suburban areas. CONCLUSIONS Our results indicate that the potential benefits of residential greenness on mental health vary across personal and neighbourhood-level characteristics and are sensitive to how the outcome is measured. Additional research is needed to understand which features of greenness are most relevant to different sub-groups of the population to maximize these health benefits.
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Affiliation(s)
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | | | - Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Errol M Thomson
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, ON, Canada
| | - Paul J Villeneuve
- School of Mathematics and Statistics and Department of Neuroscience, Carleton University, Ottawa, ON, Canada
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Crouse DL, Boudreau J, Leonard PSJ, Pawluk K, McDonald JT. Provider caseload volume and short-term outcomes following colorectal surgeries in New Brunswick: a provincial-level cohort study. Can J Surg 2020. [PMID: 33107818 DOI: 10.1503/cjs.012319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick. METHODS We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics. RESULTS Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes. CONCLUSION Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.
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Affiliation(s)
- Dan L Crouse
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
| | - Jonathan Boudreau
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
| | - Philip S J Leonard
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
| | - Keith Pawluk
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
| | - James T McDonald
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
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Chen H, Burnett RT, Bai L, Kwong JC, Crouse DL, Lavigne E, Goldberg MS, Copes R, Benmarhnia T, Ilango SD, van Donkelaar A, Martin RV, Hystad P. Residential Greenness and Cardiovascular Disease Incidence, Readmission, and Mortality. Environ Health Perspect 2020; 128:87005. [PMID: 32840393 PMCID: PMC7446772 DOI: 10.1289/ehp6161] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 07/21/2020] [Accepted: 07/31/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Living in greener areas of cities was linked to increased physical activity levels, improved mental well-being, and lowered harmful environmental exposures, all of which may affect human health. However, whether living in greener areas may be associated with lower risk of cardiovascular disease incidence, progression, and premature mortality is unclear. OBJECTIVES We conducted a cohort study to examine the associations between residential green spaces and the incidence of acute myocardial infarction (AMI) and heart failure (HF), post-AMI and HF hospital readmissions, and mortality. METHODS We simultaneously followed four large population-based cohorts in Ontario, Canada, including the entire adult population, adults free of AMI and HF, and survivors of AMI or HF from 2000 to 2014. We estimated residential exposure to green spaces using satellite-derived observations and ascertained health outcomes using validated disease registries. We estimated the associations using spatial random-effects Cox proportional hazards models. We conducted various sensitivity analyses, including further adjusting for property values and performing exploratory mediation analysis. RESULTS Each interquartile range increase in residential greenness was associated with a 7% [95% confidence interval (CI): 4%, 9%] decrease in incident AMI and a 6% (95% CI: 4%, 7%) decrease in incident HF. Residential greenness was linked to a ∼10% decrease in cardiovascular mortality in both adults free of AMI and HF and the entire adult population. These associations remained consistent in sensitivity analyses and were accentuated among younger adults. Additionally, we estimated that the decreases in AMI and HF incidence associated with residential greenness explained ∼53% of the protective association between residential greenness and cardiovascular mortality. Conversely, residential greenness was not associated with any delay in readmission or mortality among AMI and HF patients. CONCLUSIONS Living in urban areas with more green spaces was associated with improved cardiovascular health in people free of AMI and HF but not among individuals who have already developed these conditions. https://doi.org/10.1289/EHP6161.
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Affiliation(s)
- Hong Chen
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Richard T. Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Li Bai
- ICES, Toronto, Ontario, Canada
| | - Jeffrey C. Kwong
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dan L. Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Eric Lavigne
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark S. Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ray Copes
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California, USA
| | - Sindana D. Ilango
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V. Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Harvard-Smithsonian Centre for Astrophysics, Cambridge, Massachusetts, USA
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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Paul LA, Hystad P, Burnett RT, Kwong JC, Crouse DL, van Donkelaar A, Tu K, Lavigne E, Copes R, Martin RV, Chen H. Urban green space and the risks of dementia and stroke. Environ Res 2020; 186:109520. [PMID: 32344208 DOI: 10.1016/j.envres.2020.109520] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/16/2020] [Accepted: 04/10/2020] [Indexed: 05/11/2023]
Abstract
INTRODUCTION It is unknown whether urban green space is associated with reduced risk of major neurological conditions, especially dementia and stroke. METHODS Retrospective, population-based cohorts were created for each study outcome, including 1.7 and 4.3 million adults in Ontario, Canada for dementia and stroke, respectively. Residential green space was quantified using the satellite-derived Normalized Difference Vegetation Index. Incidence was ascertained using health administrative data with validated algorithms. Mixed-effects Cox models were used to estimate hazard ratios per interquartile range increase in green space exposure. RESULTS Between 2001 and 2013, 219,013 individuals were diagnosed with dementia and 89,958 had a stroke. The hazard ratio per interquartile range increase in green space was 0.97 (95% CI: 0.96-0.98) for dementia and 0.96 (0.95-0.98) for stroke. Estimates remained generally consistent in sensitivity analyses. DISCUSSION Increased exposure to urban green space was associated with reduced incidence of dementia and stroke. To our knowledge, this is the first population-based cohort study to assess these relationships.
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Affiliation(s)
- Lauren A Paul
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON, M5G 1V2, Canada.
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Women's Bldg, 160 SW 26th St., Corvallis, OR, 97331, USA.
| | - Richard T Burnett
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Finance Bldg, 101 Tunney's Pasture Drwy, Ottawa, ON, K1A 0K9, Canada.
| | - Jeffrey C Kwong
- Public Health Ontario Laboratories, Public Health Ontario, 661 University Ave. Suite 1701, Toronto, ON, M5G 1M1, Canada; ICES, 2075 Bayview Ave. G1 06, Toronto, ON, M4N 3M5, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave. 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Dan L Crouse
- Health Effects Institute, 75 Federal St. Suite 1400, Boston, MA, 02110-1817, USA.
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Sir James Dunn Bldg, 6310 Coburg Rd., Halifax, NS, B3H 4J5, Canada.
| | - Karen Tu
- Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada; Department of Family and Community Medicine, University of Toronto, 500 University Ave. 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Eric Lavigne
- Air Health Science Division, Health Canada, 269 Laurier Ave. W A.L. 4903B, Ottawa, ON, K1A 0K9, Canada; School of Epidemiology and Public Health, University of Ottawa, Alta Vista Campus, 600 Peter Morand Cres. Room 101, Ottawa, ON, K1G 5Z3, Canada.
| | - Ray Copes
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON, M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada.
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Sir James Dunn Bldg, 6310 Coburg Rd., Halifax, NS, B3H 4J5, Canada.
| | - Hong Chen
- Department of Environmental and Occupational Health, Public Health Ontario, 480 University Ave. Suite 300, Toronto, ON, M5G 1V2, Canada; ICES, 2075 Bayview Ave. G1 06, Toronto, ON, M4N 3M5, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada.
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Crouse DL, Erickson AC, Christidis T, Pinault L, van Donkelaar A, Li C, Meng J, Martin RV, Tjepkema M, Hystad P, Burnett R, Pappin A, Brauer M, Weichenthal S. Evaluating the Sensitivity of PM2.5–Mortality Associations to the Spatial and Temporal Scale of Exposure Assessment. Epidemiology 2020; 31:168-176. [DOI: 10.1097/ede.0000000000001136] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gupta N, Crouse DL, Balram A. Individual and community-level income and the risk of diabetes rehospitalization among women and men: a Canadian population-based cohort study. BMC Public Health 2020; 20:60. [PMID: 31937292 PMCID: PMC6961319 DOI: 10.1186/s12889-020-8159-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/06/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Marked disparities by socioeconomic status in the risk of potentially avoidable hospitalization for chronic illnesses have been observed in many contexts, including those with universal health coverage. Less well known is how gender mediates such differences. We conducted a population-based cohort study to describe associations between household and community-level income and rehospitalizations for types 1 and 2 diabetes mellitus among Canadian women and men. METHODS Our cohorts were drawn from respondents to the 2006 mandatory long-form census linked longitudinally to 3 years of nationally standardized hospital records. We included adults 30-69 years hospitalized with diabetes at least once during the study period. We used logistic regressions to estimate odds ratios for 12-month diabetes rehospitalization associated with indicators of household and community-level income, with separate models by gender, and controlling for a range of other sociodemographic characteristics. Since diabetes may not always be recognized as the main reason for hospitalization, we accounted for disease progression through consideration of admissions where diabetes was previously identified as a secondary diagnosis. RESULTS Among persons hospitalized at least once with diabetes (n = 41,290), 1.5% were readmitted within 12 months where the initial admission had diabetes as the primary diagnosis, and 1.8% were readmitted where the initial admission had diabetes as a secondary diagnosis. For men, being in the lowest household income quintile was associated with higher odds of rehospitalization in cases where the initial admission listed diabetes as either the primary diagnosis (OR = 2.21; 95% CI = 1.38-3.51) or a secondary diagnosis (OR = 1.51; 95% CI = 1.02-2.24). For women, we found no association with income and rehospitalization, but having less than university education was associated with higher odds of rehospitalization where diabetes was a secondary diagnosis of the initial admission (OR = 1.88; 95% CI = 1.21-2.92). We also found positive, but insignificant associations between community-level poverty and odds of rehospitalization. CONCLUSIONS Universal health coverage remains insufficient to eliminate socioeconomic inequalities in preventable diabetes-related hospitalizations, as illustrated in this Canadian context. Decision-makers should tread cautiously with gender-blind poverty reduction actions aiming to enhance population health that may inadequately respond to the different needs of disadvantaged women and men with chronic illness.
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Affiliation(s)
- Neeru Gupta
- Department of Sociology, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
| | - Dan L. Crouse
- Department of Sociology, University of New Brunswick, P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
| | - Adele Balram
- New Brunswick Institute for Research, Data and Training (NB-IRDT), P.O. Box 4400, Fredericton, New Brunswick E3B 5A3 Canada
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Leonard PSJ, Crouse DL, Boudreau JG, Gupta N, McDonald JT. Provider volume and maternal complications after Caesarean section: results from a population-based study. BMC Pregnancy Childbirth 2020; 20:37. [PMID: 31937285 PMCID: PMC6961277 DOI: 10.1186/s12884-019-2709-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/30/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A large literature search suggests a relationship between hospital/surgeon caseload volume and surgical complications. In this study, we describe associations between post-operative maternal complications following Caesarean section and provider caseload volume, provider years since graduation, and provider specialization, while adjusting for hospital volumes and patient characteristics. METHODS Our analysis is based on population-based discharge abstract data for the period of April 2004 to March 2014, linked to patient and physician universal coverage registry data. We consider all hospital admissions (N = 20,914) in New Brunswick, Canada, where a Caesarean Section surgery was recorded, as identified by a Canadian Classification of Health Intervention code of 5.MD.60.XX. We ran logistic regression models to identify the odds of occurrence of post-surgical complications during the hospital stay. RESULTS Roughly 2.6% of admissions had at least one of the following groups of complications: disseminated intravascular coagulation, postpartum sepsis, postpartum hemorrhage, and postpartum infection. The likelihood of complication was negatively associated with provider volume and provider years of experience, and positively associated with having a specialization other than maternal-fetal medicine or obstetrics and gynecology. CONCLUSIONS Our results suggest that measures of physician training and experience are associated with the likelihood of Caesarean Section complications. In the context of a rural province deciding on the number of rural hospitals to keep open, this suggests a trade off between the benefits of increased volume versus the increased travel time for patients.
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Affiliation(s)
- Philip S J Leonard
- Department of Economics, University of New Brunswick, Singer Hall, Room 459, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada. .,New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, New Brunswick, Canada.
| | - Dan L Crouse
- New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, New Brunswick, Canada.,Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Jonathan G Boudreau
- New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Neeru Gupta
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - James T McDonald
- Department of Economics, University of New Brunswick, Singer Hall, Room 459, P.O. Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.,New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, New Brunswick, Canada
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Brauer M, Brook JR, Christidis T, Chu Y, Crouse DL, Erickson A, Hystad P, Li C, Martin RV, Meng J, Pappin AJ, Pinault LL, Tjepkema M, van Donkelaar A, Weichenthal S, Burnett RT. Mortality-Air Pollution Associations in Low-Exposure Environments (MAPLE): Phase 1. Res Rep Health Eff Inst 2019; 2019:1-87. [PMID: 31909580 PMCID: PMC7334864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Fine particulate matter (particulate matter ≤2.5 μm in aerodynamic diameter, or PM2.5) is associated with mortality, but the lower range of relevant concentrations is unknown. Novel satellite-derived estimates of outdoor PM2.5 concentrations were applied to several large population-based cohorts, and the shape of the relationship with nonaccidental mortality was characterized, with emphasis on the low concentrations (<12 μg/m3) observed throughout Canada. METHODS Annual satellite-derived estimates of outdoor PM2.5 concentrations were developed at 1-km2 spatial resolution across Canada for 2000-2016 and backcasted to 1981 using remote sensing, chemical transport models, and ground monitoring data. Targeted ground-based measurements were conducted to measure the relationship between columnar aerosol optical depth (AOD) and ground-level PM2.5. Both existing and targeted ground-based measurements were analyzed to develop improved exposure data sets for subsequent epidemiological analyses. Residential histories derived from annual tax records were used to estimate PM2.5 exposures for subjects whose ages ranged from 25 to 90 years. About 8.5 million were from three Canadian Census Health and Environment Cohort (CanCHEC) analytic files and another 540,900 were Canadian Community Health Survey (CCHS) participants. Mortality was linked through the year 2016. Hazard ratios (HR) were estimated with Cox Proportional Hazard models using a 3-year moving average exposure with a 1-year lag, with the year of follow-up as the time axis. All models were stratified by 5-year age groups, sex, and immigrant status. Covariates were based on directed acyclical graphs (DAG), and included contextual variables (airshed, community size, neighborhood dependence, neighborhood deprivation, ethnic concentration, neighborhood instability, and urban form). A second model was examined including the DAG-based covariates as well as all subject-level risk factors (income, education, marital status, indigenous identity, employment status, occupational class, and visible minority status) available in each cohort. Additional subject-level behavioral covariates (fruit and vegetable consumption, leisure exercise frequency, alcohol consumption, smoking, and body mass index [BMI]) were included in the CCHS analysis. Sensitivity analyses evaluated adjustment for covariates and gaseous copollutants (nitrogen dioxide [NO2] and ozone [O3]), as well as exposure time windows and spatial scales. Estimates were evaluated across strata of age, sex, and immigrant status. The shape of the PM2.5-mortality association was examined by first fitting restricted cubic splines (RCS) with a large number of knots and then fitting the shape-constrained health impact function (SCHIF) to the RCS predictions and their standard errors (SE). This method provides graphical results indicating the RCS predictions, as a nonparametric means of characterizing the concentration-response relationship in detail and the resulting mean SCHIF and accompanying uncertainty as a parametric summary. Sensitivity analyses were conducted in the CCHS cohort to evaluate the potential influence of unmeasured covariates on air pollution risk estimates. Specifically, survival models with all available risk factors were fit and compared with models that omitted covariates not available in the CanCHEC cohorts. In addition, the PM2.5 risk estimate in the CanCHEC cohort was indirectly adjusted for multiple individual-level risk factors by estimating the association between PM2.5 and these covariates within the CCHS. RESULTS Satellite-derived PM2.5 estimates were low and highly correlated with ground monitors. HR estimates (per 10-μg/m3 increase in PM2.5) were similar for the 1991 (1.041, 95% confidence interval [CI]: 1.016-1.066) and 1996 (1.041, 1.024-1.059) CanCHEC cohorts with a larger estimate observed for the 2001 cohort (1.084, 1.060-1.108). The pooled cohort HR estimate was 1.053 (1.041-1.065). In the CCHS an analogous model indicated a HR of 1.13 (95% CI: 1.06-1.21), which was reduced slightly with the addition of behavioral covariates (1.11, 1.04-1.18). In each of the CanCHEC cohorts, the RCS increased rapidly over lower concentrations, slightly declining between the 25th and 75th percentiles and then increasing beyond the 75th percentile. The steepness of the increase in the RCS over lower concentrations diminished as the cohort start date increased. The SCHIFs displayed a supralinear association in each of the three CanCHEC cohorts and in the CCHS cohort. In sensitivity analyses conducted with the 2001 CanCHEC, longer moving averages (1, 3, and 8 years) and smaller spatial scales (1 km2 vs. 10 km2) of exposure assignment resulted in larger associations between PM2.5 and mortality. In both the CCHS and CanCHEC analyses, the relationship between nonaccidental mortality and PM2.5 was attenuated when O3 or a weighted measure of oxidant gases was included in models. In the CCHS analysis, but not in CanCHEC, PM2.5 HRs were also attenuated by the inclusion of NO2. Application of the indirect adjustment and comparisons within the CCHS analysis suggests that missing data on behavioral risk factors for mortality had little impact on the magnitude of PM2.5-mortality associations. While immigrants displayed improved overall survival compared with those born in Canada, their sensitivity to PM2.5 was similar to or larger than that for nonimmigrants, with differences between immigrants and nonimmigrants decreasing in the more recent cohorts. CONCLUSIONS In several large population-based cohorts exposed to low levels of air pollution, consistent associations were observed between PM2.5 and nonaccidental mortality for concentrations as low as 5 μg/m3. This relationship was supralinear with no apparent threshold or sublinear association.
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Affiliation(s)
- M Brauer
- University of British Columbia, Vancouver, British Columbia, Canada
| | - J R Brook
- University of Toronto, Toronto, Ontario, Canada
| | - T Christidis
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Y Chu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - D L Crouse
- University of New Brunswick, Fredericton, New Brunswick, Canada
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - A Erickson
- University of British Columbia, Vancouver, British Columbia, Canada
| | - P Hystad
- Oregon State University, Corvallis, Oregon, U.S.A
| | - C Li
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - R V Martin
- Dalhousie University, Halifax, Nova Scotia, Canada
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts, U.S.A
| | - J Meng
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - A J Pappin
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - L L Pinault
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - M Tjepkema
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | | | | | - R T Burnett
- Population Studies Division, Health Canada, Ottawa, Ontario, Canada
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Pappin AJ, Christidis T, Pinault LL, Crouse DL, Brook JR, Erickson A, Hystad P, Li C, Martin RV, Meng J, Weichenthal S, van Donkelaar A, Tjepkema M, Brauer M, Burnett RT. Examining the Shape of the Association between Low Levels of Fine Particulate Matter and Mortality across Three Cycles of the Canadian Census Health and Environment Cohort. Environ Health Perspect 2019; 127:107008. [PMID: 31638837 PMCID: PMC6867181 DOI: 10.1289/ehp5204] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/18/2019] [Accepted: 09/18/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Ambient fine particulate air pollution with aerodynamic diameter ≤2.5 μm (PM2.5) is an important contributor to the global burden of disease. Information on the shape of the concentration-response relationship at low concentrations is critical for estimating this burden, setting air quality standards, and in benefits assessments. OBJECTIVES We examined the concentration-response relationship between PM2.5 and nonaccidental mortality in three Canadian Census Health and Environment Cohorts (CanCHECs) based on the 1991, 1996, and 2001 census cycles linked to mobility and mortality data. METHODS Census respondents were linked with death records through 2016, resulting in 8.5 million adults, 150 million years of follow-up, and 1.5 million deaths. Using annual mailing address, we assigned time-varying contextual variables and 3-y moving-average ambient PM2.5 at a 1×1 km spatial resolution from 1988 to 2015. We ran Cox proportional hazards models for PM2.5 adjusted for eight subject-level indicators of socioeconomic status, seven contextual covariates, ozone, nitrogen dioxide, and combined oxidative potential. We used three statistical methods to examine the shape of the concentration-response relationship between PM2.5 and nonaccidental mortality. RESULTS The mean 3-y annual average estimate of PM2.5 exposure ranged from 6.7 to 8.0 μg/m3 over the three cohorts. We estimated a hazard ratio (HR) of 1.053 [95% confidence interval (CI): 1.041, 1.065] per 10-μg/m3 change in PM2.5 after pooling the three cohort-specific hazard ratios, with some variation between cohorts (1.041 for the 1991 and 1996 cohorts and 1.084 for the 2001 cohort). We observed a supralinear association in all three cohorts. The lower bound of the 95% CIs exceeded unity for all concentrations in the 1991 cohort, for concentrations above 2 μg/m3 in the 1996 cohort, and above 5 μg/m3 in the 2001 cohort. DISCUSSION In a very large population-based cohort with up to 25 y of follow-up, PM2.5 was associated with nonaccidental mortality at concentrations as low as 5 μg/m3. https://doi.org/10.1289/EHP5204.
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Affiliation(s)
- Amanda J Pappin
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Tanya Christidis
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Lauren L Pinault
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Dan L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anders Erickson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Chi Li
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts, USA
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, United States
| | - Jun Meng
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, United States
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, United States
| | - Michael Tjepkema
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Crouse DL, Pinault L, Balram A, Brauer M, Burnett RT, Martin RV, van Donkelaar A, Villeneuve PJ, Weichenthal S. Complex relationships between greenness, air pollution, and mortality in a population-based Canadian cohort. Environ Int 2019; 128:292-300. [PMID: 31075749 DOI: 10.1016/j.envint.2019.04.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/12/2019] [Accepted: 04/19/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Epidemiological studies have consistently demonstrated that exposure to fine particulate matter (PM2.5) is associated with increased risks of mortality. To a lesser extent, a series of studies suggest that living in greener areas is associated with reduced risks of mortality. Only a handful of studies have examined the interplay between PM2.5, greenness, and mortality. METHODS We investigated the role of residential greenness in modifying associations between long-term exposures to PM2.5 and non-accidental and cardiovascular mortality in a national cohort of non-immigrant Canadian adults (i.e., the 2001 Canadian Census Health and Environment Cohort). Specifically, we examined associations between satellite-derived estimates of PM2.5 exposure and mortality across quintiles of greenness measured within 500 m of individual's place of residence during 11 years of follow-up. We adjusted our survival models for many personal and contextual measures of socioeconomic position, and residential mobility data allowed us to characterize annual changes in exposures. RESULTS Our cohort included approximately 2.4 million individuals at baseline, 194,270 of whom died from non-accidental causes during follow-up. Adjustment for greenness attenuated the association between PM2.5 and mortality (e.g., hazard ratios (HRs) and 95% confidence intervals (CIs) per interquartile range increase in PM2.5 in models for non-accidental mortality decreased from 1.065 (95% CI: 1.056-1.075) to 1.041 (95% CI: 1.031-1.050)). The strength of observed associations between PM2.5 and mortality decreased as greenness increased. This pattern persisted in models restricted to urban residents, in models that considered the combined oxidant capacity of ozone and nitrogen dioxide, and within neighbourhoods characterised by high or low deprivation. We found no increased risk of mortality associated with PM2.5 among those living in the greenest areas. For example, the HR for cardiovascular mortality among individuals in the least green areas was 1.17 (95% CI: 1.12-1.23) compared to 1.01 (95% CI: 0.97-1.06) among those in the greenest areas. CONCLUSIONS Studies that do not account for greenness may overstate the air pollution impacts on mortality. Residents in deprived neighbourhoods with high greenness benefitted by having more attenuated associations between PM2.5 and mortality than those living in deprived areas with less greenness. The findings from this study extend our understanding of how living in greener areas may lead to improved health outcomes.
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Affiliation(s)
- Dan L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, NB, Canada; New Brunswick Institute for Research, Data, and Training, Fredericton, NB, Canada.
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Adele Balram
- New Brunswick Institute for Research, Data, and Training, Fredericton, NB, Canada
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | | | - Randall V Martin
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Harvard-Smithsonian Center for Astrophysics, Cambridge, MA, USA.
| | - Aaron van Donkelaar
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada.
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
| | - Scott Weichenthal
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
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16
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Buteau S, Goldberg MS, Burnett RT, Gasparrini A, Valois MF, Brophy JM, Crouse DL, Hatzopoulou M. Corrigendum to "Associations between ambient air pollution and daily mortality in a cohort of congestive heart failure: Case-crossover and nested case-control analyses using a distributed lag nonlinear model" [Environ. Int. 133 (2018) 313-324]. Environ Int 2018; 119:274. [PMID: 29982130 DOI: 10.1016/j.envint.2018.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Stephane Buteau
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada.
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of the McGill University Hospital Centre, Montreal, Canada
| | | | - Antonio Gasparrini
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marie-France Valois
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of the McGill University Hospital Centre, Montreal, Canada
| | - James M Brophy
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Dan L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada; New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Marianne Hatzopoulou
- Department of Civil Engineering, University of Toronto, Toronto, Ontario, Canada
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17
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Crouse DL, Balram A, Hystad P, Pinault L, van den Bosch M, Chen H, Rainham D, Thomson EM, Close CH, van Donkelaar A, Martin RV, Ménard R, Robichaud A, Villeneuve PJ. Associations between Living Near Water and Risk of Mortality among Urban Canadians. Environ Health Perspect 2018; 126:077008. [PMID: 30044232 PMCID: PMC6108828 DOI: 10.1289/ehp3397] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/21/2018] [Accepted: 06/03/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Increasing evidence suggests that residential exposures to natural environments, such as green spaces, are associated with many health benefits. Only a single study has examined the potential link between living near water and mortality. OBJECTIVE We sought to examine whether residential proximity to large, natural water features (e.g., lakes, rivers, coasts, "blue space") was associated with cause-specific mortality. METHODS Our study is based on a population-based cohort of nonimmigrant adults living in the 30 largest Canadian cities [i.e., the 2001 Canadian Census Health and Environment Cohort) (CanCHEC)]. Subjects were drawn from the mandatory 2001 Statistics Canada long-form census, who were linked to the Canadian mortality database and to annual income-tax filings, through 2011. We estimated associations between living within of blue space and deaths from several common causes of death. We adjusted models for many personal and contextual covariates, as well as for exposures to residential greenness and ambient air pollution. RESULTS Our cohort included approximately 1.3 million subjects at baseline, 106,180 of whom died from nonaccidental causes during follow-up. We found significant, reduced risks of mortality in the range of 12-17% associated with living within of water in comparison with living farther away, among all causes of death examined, except with external/accidental causes. Protective effects were found to be higher among women and all older adults than among other subjects, and protective effects were found to be highest against deaths from stroke and respiratory-related causes. CONCLUSIONS Our findings suggest that living near blue spaces in urban areas has important benefits to health, but further work is needed to better understand the drivers of this association. https://doi.org/10.1289/EHP3397.
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Affiliation(s)
- Dan L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Adele Balram
- New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Perry Hystad
- College of Public Health & Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Matilda van den Bosch
- Department of Forest and Conservation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hong Chen
- Public Health Ontario, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Rainham
- Healthy Populations Institute, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Errol M Thomson
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | | | - Aaron van Donkelaar
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V Martin
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts, USA
| | - Richard Ménard
- Air Quality Research Division, Environment and Climate Change Canada, Dorval, Quebec, Canada
| | - Alain Robichaud
- Air Quality Research Division, Environment and Climate Change Canada, Dorval, Quebec, Canada
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
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Buteau S, Goldberg MS, Burnett RT, Gasparrini A, Valois MF, Brophy JM, Crouse DL, Hatzopoulou M. Associations between ambient air pollution and daily mortality in a cohort of congestive heart failure: Case-crossover and nested case-control analyses using a distributed lag nonlinear model. Environ Int 2018; 113:313-324. [PMID: 29361317 DOI: 10.1016/j.envint.2018.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND Persons with congestive heart failure may be at higher risk of the acute effects related to daily fluctuations in ambient air pollution. To meet some of the limitations of previous studies using grouped-analysis, we developed a cohort study of persons with congestive heart failure to estimate whether daily non-accidental mortality were associated with spatially-resolved, daily exposures to ambient nitrogen dioxide (NO2) and ozone (O3), and whether these associations were modified according to a series of indicators potentially reflecting complications or worsening of health. METHODS We constructed the cohort from the linkage of administrative health databases. Daily exposure was assigned from different methods we developed previously to predict spatially-resolved, time-dependent concentrations of ambient NO2 (all year) and O3 (warm season) at participants' residences. We performed two distinct types of analyses: a case-crossover that contrasts the same person at different times, and a nested case-control that contrasts different persons at similar times. We modelled the effects of air pollution and weather (case-crossover only) on mortality using distributed lag nonlinear models over lags 0 to 3 days. We developed from administrative health data a series of indicators that may reflect the underlying construct of "declining health", and used interactions between these indicators and the cross-basis function for air pollutant to assess potential effect modification. RESULTS The magnitude of the cumulative as well as the lag-specific estimates of association differed in many instances according to the metric of exposure. Using the back-extrapolation method, which is our preferred exposure model, we found for the case-crossover design a cumulative mean percentage changes (MPC) in daily mortality per interquartile increment in NO2 (8.8 ppb) of 3.0% (95% CI: -0.4, 6.6%) and for O3 (16.5 ppb) 3.5% (95% CI: -4.5, 12.1). For O3 there was strong confounding by weather (unadjusted MPC = 7.1%; 95% CI: 1.7, 12.7%). For the nested case-control approach the cumulative MPC for NO2 in daily mortality was 2.9% (95% CI: -0.9, 6.9%) and for O3 7.3% (95% CI: 3.0, 11.9%). We found evidence of effect modification between daily mortality and cumulative NO2 and O3 according to the prescribed dose of furosemide in the nested case-control analysis, but not in the case-crossover analysis. CONCLUSIONS Mortality in congestive heart failure was associated with exposure to daily ambient NO2 and O3 predicted from a back-extrapolation method using a land use regression model from dense sampling surveys. The methods used to assess exposure can have considerable influence on the estimated acute health effects of the two air pollutants.
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Affiliation(s)
- Stephane Buteau
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada.
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of the McGill University Hospital Centre, Montreal, Canada
| | | | - Antonio Gasparrini
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marie-France Valois
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of the McGill University Hospital Centre, Montreal, Canada
| | - James M Brophy
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Dan L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada; New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Marianne Hatzopoulou
- Department of Civil Engineering, University of Toronto, Toronto, Ontario, Canada
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Crouse DL, Leonard PSJ, Boudreau J, McDonald JT. Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study. Can J Surg 2018; 61:88-93. [PMID: 29582743 PMCID: PMC5866142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Several international studies have reported negative associations between hospital and/or provider volume and risk of postoperative death following total hip arthroplasty (THA). The only Canadian studies to report on this have been based in Ontario and have found no such association. We describe associations between postoperative deaths following THA and provider caseload volume, also adjusted for hospital volume, in a population-based cohort in New Brunswick. METHODS Our analyses are based on hospital discharge abstract data linked to vital statistics and to patient registry data. We considered all first known admissions for THA in New Brunswick between Jan. 1, 2007, and Dec. 31, 2013. Provider volume was defined as total THAs performed over the preceding 2 years. We fit logistic regression models to identify odds of dying within 30 and 90 days according to provider caseload volume adjusted for selected personal and contextual characteristics. RESULTS About 7095 patients were admitted for THA in New Brunswick over the 7-year study period and 170 died within 30 days. We found no associations with provider volume and postoperative mortality in any of our models. Adjustment for contextual characteristics or hospital volume had no effects on this association. CONCLUSION Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province's larger or smaller hospitals.
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Affiliation(s)
- Dan L Crouse
- From the Department of Sociology, University of New Brunswick, Fredericton, NB (Crouse); the New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB (Crouse, Leonard, Boudreau, McDonald); and the Department of Economics, University of New Brunswick, Fredericton, NB (Leonard, McDonald)
| | - Philip S J Leonard
- From the Department of Sociology, University of New Brunswick, Fredericton, NB (Crouse); the New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB (Crouse, Leonard, Boudreau, McDonald); and the Department of Economics, University of New Brunswick, Fredericton, NB (Leonard, McDonald)
| | - Jonathan Boudreau
- From the Department of Sociology, University of New Brunswick, Fredericton, NB (Crouse); the New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB (Crouse, Leonard, Boudreau, McDonald); and the Department of Economics, University of New Brunswick, Fredericton, NB (Leonard, McDonald)
| | - James T McDonald
- From the Department of Sociology, University of New Brunswick, Fredericton, NB (Crouse); the New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB (Crouse, Leonard, Boudreau, McDonald); and the Department of Economics, University of New Brunswick, Fredericton, NB (Leonard, McDonald)
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20
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Crouse DL, van den Bosch M, Villeneuve PJ. Love and allergies in the city beautiful-Chandigarh, India - Authors' reply. Lancet Planet Health 2018; 2:e112. [PMID: 29615225 DOI: 10.1016/s2542-5196(18)30027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Dan L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, NB, E3B 5A3, Canada; New Brunswick Institute for Research, Data, and Training, Fredericton, NB, Canada.
| | - Matilda van den Bosch
- Department of Forest and Conservation Sciences, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
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21
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Crouse DL, Leonard PSJ, Boudreau J, McDonald JT. Associations between provider and hospital volumes and postoperative mortality following total hip arthroplasty in New Brunswick: results from a provincial-level cohort study. Can J Surg 2018; 61:6917. [PMID: 29376819 DOI: 10.1503/cjs.006917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several international studies have reported negative associations between hospital and/or provider volume and risk of postoperative death following total hip arthroplasty (THA). The only Canadian studies to report on this have been based in Ontario and have found no such association. We describe associations between postoperative deaths following THA and provider caseload volume, also adjusted for hospital volume, in a population-based cohort in New Brunswick. METHODS Our analyses are based on hospital discharge abstract data linked to vital statistics and to patient registry data. We considered all first known admissions for THA in New Brunswick between Jan. 1, 2007, and Dec. 31, 2013. Provider volume was defined as total THAs performed over the preceding 2 years. We fit logistic regression models to identify odds of dying within 30 and 90 days according to provider caseload volume adjusted for selected personal and contextual characteristics. RESULTS About 7095 patients were admitted for THA in New Brunswick over the 7-year study period and 170 died within 30 days. We found no associations with provider volume and postoperative mortality in any of our models. Adjustment for contextual characteristics or hospital volume had no effects on this association. CONCLUSION Our results suggest that patients admitted for hip replacements in New Brunswick can expect to have similar risk of death regardless of whether they are admitted to see a provider with high or low THA volumes and of whether they are admitted to the province's larger or smaller hospitals.
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Affiliation(s)
- Dan L Crouse
- From the Department of Sociology, University of New Brunswick, Fredericton, NB (Crouse); the New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB (Crouse, Leonard, Boudreau, McDonald); and the Department of Economics, University of New Brunswick, Fredericton, NB (Leonard, McDonald)
| | - Philip S J Leonard
- From the Department of Sociology, University of New Brunswick, Fredericton, NB (Crouse); the New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB (Crouse, Leonard, Boudreau, McDonald); and the Department of Economics, University of New Brunswick, Fredericton, NB (Leonard, McDonald)
| | - Jonathan Boudreau
- From the Department of Sociology, University of New Brunswick, Fredericton, NB (Crouse); the New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB (Crouse, Leonard, Boudreau, McDonald); and the Department of Economics, University of New Brunswick, Fredericton, NB (Leonard, McDonald)
| | - James T McDonald
- From the Department of Sociology, University of New Brunswick, Fredericton, NB (Crouse); the New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB (Crouse, Leonard, Boudreau, McDonald); and the Department of Economics, University of New Brunswick, Fredericton, NB (Leonard, McDonald)
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Crouse DL, Pinault L, Balram A, Hystad P, Peters PA, Chen H, van Donkelaar A, Martin RV, Ménard R, Robichaud A, Villeneuve PJ. Urban greenness and mortality in Canada's largest cities: a national cohort study. Lancet Planet Health 2017; 1:e289-e297. [PMID: 29851627 DOI: 10.1016/s2542-5196(17)30118-3] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/04/2017] [Accepted: 09/11/2017] [Indexed: 05/20/2023]
Abstract
BACKGROUND Findings from published studies suggest that exposure to and interactions with green spaces are associated with improved psychological wellbeing and have cognitive, physiological, and social benefits, but few studies have examined their potential effect on the risk of mortality. We therefore undertook a national study in Canada to examine associations between urban greenness and cause-specific mortality. METHODS We used data from a large cohort study (the 2001 Canadian Census Health and Environment Cohort [2001 CanCHEC]), which consisted of approximately 1·3 million adult (aged ≥19 years), non-immigrant, urban Canadians in 30 cities who responded to the mandatory 2001 Statistics Canada long-form census. The cohort has been linked by Statistics Canada to the Canadian mortality database and to annual income tax filings through 2011. We measured greenness with images from the moderate-resolution imaging spectroradiometer from NASA's Aqua satellite. We assigned estimates of exposure to greenness derived from remotely sensed Normalized Difference Vegetation Index (NDVI) within both 250 m and 500 m of participants' residences for each year during 11 years of follow-up (between 2001 and 2011). We used Cox proportional hazards models to estimate associations between residential greenness (as a continuous variable) and mortality. We estimated hazard ratios (HRs) and corresponding 95% CIs per IQR (0·15) increase in NDVI adjusted for personal (eg, education and income) and contextual covariates, including exposures to fine particulate matter, ozone, and nitrogen dioxide. We also considered effect modification by selected personal covariates (age, sex, household income adequacy quintiles, highest level of education, and marital status). FINDINGS Our cohort consisted of approximately 1 265 000 individuals at baseline who contributed 11 523 770 person-years. We showed significant decreased risks of mortality in the range of 8-12% from all causes of death examined with increased greenness around participants' residence. In the fully adjusted analyses, the risk was significantly decreased for all causes of death (non-accidental HR 0·915, 95% CI 0·905-0·924; cardiovascular plus diabetes 0·911, 0·895-0·928; cardiovascular 0·911, 0·894-0·928; ischaemic heart disease 0·904, 0·882-0·927; cerebrovascular 0·942, 0·902-0·983; and respiratory 0·899, 0·869-0·930). Greenness associations were more protective among men than women (HR 0·880, 95% CI 0·868-0·893 vs 0·955, 0·941-0·969), and among individuals with higher incomes (highest quintile 0·812, 0·791-0·834 vs lowest quintile 0·991, 0·972-1·011) and more education (degree or more 0·816, 0·791-0·842 vs did not complete high school 0·964, 0·950-0·978). INTERPRETATION Increased amounts of residential greenness were associated with reduced risks of dying from several common causes of death among urban Canadians. We identified evidence of inequalities, both in terms of exposures to greenness and mortality risks, by personal socioeconomic status among individuals living in generally similar environments, and with reasonably similar access to health care and other social services. The findings support the development of policies related to creating greener and healthier cities. FUNDING None.
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Affiliation(s)
- Dan L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, NB, Canada; New Brunswick Institute for Research, Data, and Training, Fredericton, NB, Canada.
| | - Lauren Pinault
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Adele Balram
- New Brunswick Institute for Research, Data, and Training, Fredericton, NB, Canada
| | - Perry Hystad
- College of Public Health & Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Paul A Peters
- New Brunswick Institute for Research, Data, and Training, Fredericton, NB, Canada; Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Hong Chen
- Public Health Ontario, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aaron van Donkelaar
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada
| | - Randall V Martin
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada; Harvard-Smithsonian Center for Astrophysics, Cambridge, MA, USA
| | - Richard Ménard
- Air Quality Research Division, Environment and Climate Change Canada, Dorval, QC, Canada
| | - Alain Robichaud
- Air Quality Research Division, Environment and Climate Change Canada, Dorval, QC, Canada
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
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Buteau S, Hatzopoulou M, Crouse DL, Smargiassi A, Burnett RT, Logan T, Cavellin LD, Goldberg MS. Comparison of spatiotemporal prediction models of daily exposure of individuals to ambient nitrogen dioxide and ozone in Montreal, Canada. Environ Res 2017; 156:201-230. [PMID: 28359040 DOI: 10.1016/j.envres.2017.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/02/2017] [Accepted: 03/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND In previous studies investigating the short-term health effects of ambient air pollution the exposure metric that is often used is the daily average across monitors, thus assuming that all individuals have the same daily exposure. Studies that incorporate space-time exposures of individuals are essential to further our understanding of the short-term health effects of ambient air pollution. OBJECTIVES As part of a longitudinal cohort study of the acute effects of air pollution that incorporated subject-specific information and medical histories of subjects throughout the follow-up, the purpose of this study was to develop and compare different prediction models using data from fixed-site monitors and other monitoring campaigns to estimate daily, spatially-resolved concentrations of ozone (O3) and nitrogen dioxide (NO2) of participants' residences in Montreal, 1991-2002. METHODS We used the following methods to predict spatially-resolved daily concentrations of O3 and NO2 for each geographic region in Montreal (defined by three-character postal code areas): (1) assigning concentrations from the nearest monitor; (2) spatial interpolation using inverse-distance weighting; (3) back-extrapolation from a land-use regression model from a dense monitoring survey, and; (4) a combination of a land-use and Bayesian maximum entropy model. We used a variety of indices of agreement to compare estimates of exposure assigned from the different methods, notably scatterplots of pairwise predictions, distribution of differences and computation of the absolute agreement intraclass correlation (ICC). For each pairwise prediction, we also produced maps of the ICCs by these regions indicating the spatial variability in the degree of agreement. RESULTS We found some substantial differences in agreement across pairs of methods in daily mean predicted concentrations of O3 and NO2. On a given day and postal code area the difference in the concentration assigned could be as high as 131ppb for O3 and 108ppb for NO2. For both pollutants, better agreement was found between predictions from the nearest monitor and the inverse-distance weighting interpolation methods, with ICCs of 0.89 (95% confidence interval (CI): 0.89, 0.89) for O3 and 0.81 (95%CI: 0.80, 0.81) for NO2, respectively. For this pair of methods the maximum difference on a given day and postal code area was 36ppb for O3 and 74ppb for NO2. The back-extrapolation method showed a higher degree of disagreement with the nearest monitor approach, inverse-distance weighting interpolation, and the Bayesian maximum entropy model, which were strongly constrained by the sparse monitoring network. The maps showed that the patterns of agreement differed across the postal code areas and the variability depended on the pair of methods compared and the pollutants. For O3, but not NO2, postal areas showing greater disagreement were mostly located near the city centre and along highways, especially in maps involving the back-extrapolation method. CONCLUSIONS In view of the substantial differences in daily concentrations of O3 and NO2 predicted by the different methods, we suggest that analyses of the health effects from air pollution should make use of multiple exposure assessment methods. Although we cannot make any recommendations as to which is the most valid method, models that make use of higher spatially resolved data, such as from dense exposure surveys or from high spatial resolution satellite data, likely provide the most valid estimates.
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Affiliation(s)
- Stephane Buteau
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada.
| | - Marianne Hatzopoulou
- Department of Civil Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Dan L Crouse
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada; New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada
| | - Audrey Smargiassi
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, Quebec, Canada; Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Quebec, Canada
| | | | | | - Laure Deville Cavellin
- Department of civil engineering and applied mechanics, McGill University, Montreal, Quebec, Canada
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
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Ashley-Martin J, Lavigne E, Arbuckle TE, Johnson M, Hystad P, Crouse DL, Marshall JS, Dodds L. Air Pollution During Pregnancy and Cord Blood Immune System Biomarkers. J Occup Environ Med 2016; 58:979-986. [PMID: 27483336 PMCID: PMC5704662 DOI: 10.1097/jom.0000000000000841] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to determine whether average and trimester-specific exposures to ambient measures of nitrogen dioxide (NO2) and particular matter (PM2.5) were associated with elevated cord blood concentrations of immunoglobulin E (IgE) and two epithelial cell produced cytokines: interleukin-33 (IL-33) and thymic stromal lymphopoietin (TSLP). METHODS This study utilized data and biospecimens from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study. There were 2001 pregnant women recruited between 2008 and 2011 from 10 Canadian cities. Maternal exposure to NO2 and PM2.5 was estimated using land use regression and satellite-derived models. RESULTS We observed statistically significant associations between maternal NO2 exposure and elevated cord blood concentrations of both IL-33 and TSLP among girls but not boys. CONCLUSIONS Maternal NO2 exposure may impact the development of the newborn immune system as measured by cord blood concentrations of two cytokines.
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Affiliation(s)
- Jillian Ashley-Martin
- Departments of Obstetrics & Gynecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia (Drs Ashley-Martin, Dodds); Air Health Science Division (Drs Lavigne, Johnson), Population Studies Division, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada (Dr Arbuckle); College of Public Health and Human Sciences, Oregon State University, Corvallis (Dr Hystad); Department of Sociology, University of New Brunswick, Fredericton, New Brunswick (Dr Crouse); and Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada (Dr Marshall)
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Cakmak S, Hebbern C, Vanos J, Crouse DL, Burnett R. Ozone exposure and cardiovascular-related mortality in the Canadian Census Health and Environment Cohort (CANCHEC) by spatial synoptic classification zone. Environ Pollut 2016; 214:589-599. [PMID: 27131819 DOI: 10.1016/j.envpol.2016.04.067] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/16/2016] [Accepted: 04/17/2016] [Indexed: 05/29/2023]
Abstract
Our objective is to analyse the association between long term ozone exposure and cardiovascular related mortality while accounting for climate, location, and socioeconomic factors. We assigned subjects with 16 years of follow-up in the Canadian Census Health and Environment Cohort (CanCHEC) to one of seven regions based on spatial synoptic classification (SSC) weather types and examined the interaction of exposure to both fine particulate matter (PM2.5) and ground level ozone and cause of death using survival analysis, while adjusting for socioeconomic characteristics and individual confounders. Correlations between ozone and PM2.5 varied across SSC zones from -0.02 to 0.7. Comparing zones using the most populated SSC zone as a reference, a 10 ppb increase in ozone exposure was associated with increases in hazard ratios (HRs) that ranged from 1.007 (95% CI 0.99, 1.015) to 1.03 (95% CI 1.02, 1.041) for cardiovascular disease, 1.013 (95% CI 0.996, 1.03) to 1.058 (95% CI 1.034, 1.082) for cerebrovascular disease, and 1.02 (95% CI 1.006, 1.034) for ischemic heart disease. HRs remained significant after adjustment for PM2.5. Long term exposure to ozone is related to an increased risk of mortality from cardiovascular and cerebrovascular diseases; the risk varies by location across Canada and is not attenuated by adjustment for PM2.5. This research shows that the SSC can be used to define geographic regions and it demonstrates the importance of accounting for that spatial variability when studying the long term health effects of air pollution.
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Affiliation(s)
- Sabit Cakmak
- Population Studies Division, Environmental Health Science & Research Bureau, Health Canada, 50 Columbine Driveway, Ottawa, ON K1A 0K9, Canada.
| | - Chris Hebbern
- Population Studies Division, Environmental Health Science & Research Bureau, Health Canada, 50 Columbine Driveway, Ottawa, ON K1A 0K9, Canada
| | - Jennifer Vanos
- Department of Geosciences, Texas Tech University, Box 41053, Lubbock, TX 79409-1053, USA
| | - Dan L Crouse
- Department of Sociology, University of New Brunswick, PO Box 4400, Fredericton, NB E3B 5A3, Canada
| | - Rick Burnett
- Population Studies Division, Environmental Health Science & Research Bureau, Health Canada, 50 Columbine Driveway, Ottawa, ON K1A 0K9, Canada
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Lavigne E, Ashley-Martin J, Dodds L, Arbuckle TE, Hystad P, Johnson M, Crouse DL, Ettinger AS, Shapiro GD, Fisher M, Morisset AS, Taback S, Bouchard MF, Sun L, Monnier P, Dallaire R, Fraser WD. Air Pollution Exposure During Pregnancy and Fetal Markers of Metabolic function: The MIREC Study. Am J Epidemiol 2016; 183:842-51. [PMID: 27026336 DOI: 10.1093/aje/kwv256] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/10/2015] [Indexed: 01/02/2023] Open
Abstract
Previous evidence suggests that exposure to outdoor air pollution during pregnancy could alter fetal metabolic function, which could increase the risk of obesity in childhood. However, to our knowledge, no epidemiologic study has investigated the association between prenatal exposure to air pollution and indicators of fetal metabolic function. We investigated the association between maternal exposure to nitrogen dioxide and fine particulate matter (aerodynamic diameter ≤2.5 µm) and umbilical cord blood leptin and adiponectin levels with mixed-effects linear regression models among 1,257 mother-infant pairs from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, conducted in Canada (2008-2011). We observed that an interquartile-range increase in average exposure to fine particulate matter (3.2 µg/m(3)) during pregnancy was associated with an 11% (95% confidence interval: 4, 17) increase in adiponectin levels. We also observed 13% (95% confidence interval: 6, 20) higher adiponectin levels per interquartile-range increase in average exposure to nitrogen dioxide (13.6 parts per billion) during pregnancy. Significant associations were seen between air pollution markers and cord blood leptin levels in models that adjusted for birth weight z score but not in models that did not adjust for birth weight z score. The roles of prenatal exposure to air pollution and fetal metabolic function in the potential development of childhood obesity should be further explored.
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Crouse DL, Philip S, van Donkelaar A, Martin RV, Jessiman B, Peters PA, Weichenthal S, Brook JR, Hubbell B, Burnett RT. A New Method to Jointly Estimate the Mortality Risk of Long-Term Exposure to Fine Particulate Matter and its Components. Sci Rep 2016; 6:18916. [PMID: 26732864 PMCID: PMC4702114 DOI: 10.1038/srep18916] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
Most studies on the association between exposure to fine particulate matter (PM2.5) and mortality have considered only total concentration of PM2.5 or individual components of PM2.5, and not the combined effects of concentration and particulate composition. We sought to develop a method to estimate the risk of death from long-term exposure to PM2.5 and the distribution of its components, namely: sulphate, nitrate, ammonium, organic mass, black carbon, and mineral dust. We decomposed PM2.5 exposure into the sum of total concentration and the proportion of each component. We estimated the risk of death due to exposure using a cohort of ~2.4 million Canadians who were followed for vital status over 16 years. Modelling the concentration of PM2.5 with the distribution of the proportions of components together was a superior predictor for mortality than either total PM2.5 concentration alone, or all component concentrations modelled together. Our new approach has the advantage of characterizing the toxicity of the atmosphere in its entirety. This is required to fully understand the health benefits associated with strategies to improve air quality that may result in complex changes not only in PM2.5 concentration, but also in the distribution of particle components.
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Affiliation(s)
- Dan L. Crouse
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Sajeev Philip
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Randall V. Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada
- Harvard-Smithsonian Center for Astrophysics, Cambridge, Massachusetts
| | - Barry Jessiman
- Air Quality Assessment Section, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Paul A. Peters
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Scott Weichenthal
- Air Health Science Division, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Jeffrey R. Brook
- Air Quality Research Division, Environment Canada, Downsview, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Bryan Hubbell
- US Environmental Protection Agency, Office of Air Quality Planning and Standards, Research Triangle Park, North Carolina
| | - Richard T. Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
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Crouse DL, Peters PA, Hystad P, Brook JR, van Donkelaar A, Martin RV, Villeneuve PJ, Jerrett M, Goldberg MS, Pope CA, Brauer M, Brook RD, Robichaud A, Menard R, Burnett RT. Ambient PM2.5, O₃, and NO₂ Exposures and Associations with Mortality over 16 Years of Follow-Up in the Canadian Census Health and Environment Cohort (CanCHEC). Environ Health Perspect 2015; 123:1180-6. [PMID: 26528712 PMCID: PMC4629747 DOI: 10.1289/ehp.1409276] [Citation(s) in RCA: 332] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 07/15/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND Few studies examining the associations between long-term exposure to ambient air pollution and mortality have considered multiple pollutants when assessing changes in exposure due to residential mobility during follow-up. OBJECTIVE We investigated associations between cause-specific mortality and ambient concentrations of fine particulate matter (≤ 2.5 μm; PM2.5), ozone (O3), and nitrogen dioxide (NO2) in a national cohort of about 2.5 million Canadians. METHODS We assigned estimates of annual concentrations of these pollutants to the residential postal codes of subjects for each year during 16 years of follow-up. Historical tax data allowed us to track subjects' residential postal code annually. We estimated hazard ratios (HRs) for each pollutant separately and adjusted for the other pollutants. We also estimated the product of the three HRs as a measure of the cumulative association with mortality for several causes of death for an increment of the mean minus the 5th percentile of each pollutant: 5.0 μg/m3 for PM2.5, 9.5 ppb for O3, and 8.1 ppb for NO2. RESULTS PM2.5, O3, and NO2 were associated with nonaccidental and cause-specific mortality in single-pollutant models. Exposure to PM2.5 alone was not sufficient to fully characterize the toxicity of the atmospheric mix or to fully explain the risk of mortality associated with exposure to ambient pollution. Assuming additive associations, the estimated HR for nonaccidental mortality corresponding to a change in exposure from the mean to the 5th percentile for all three pollutants together was 1.075 (95% CI: 1.067, 1.084). Accounting for residential mobility had only a limited impact on the association between mortality and PM2.5 and O3, but increased associations with NO2. CONCLUSIONS In this large, national-level cohort, we found positive associations between several common causes of death and exposure to PM2.5, O3, and NO2. CITATION Crouse DL, Peters PA, Hystad P, Brook JR, van Donkelaar A, Martin RV, Villeneuve PJ, Jerrett M, Goldberg MS, Pope CA III, Brauer M, Brook RD, Robichaud A, Menard R, Burnett RT. 2015. Ambient PM2.5, O3, and NO2 exposures and associations with mortality over 16 years of follow-up in the Canadian Census Health and Environment Cohort (CanCHEC). Environ Health Perspect 123:1180-1186; http://dx.doi.org/10.1289/ehp.1409276.
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Affiliation(s)
- Dan L Crouse
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
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Crouse DL, Peters PA, Villeneuve PJ, Proux MO, Shin HH, Goldberg MS, Johnson M, Wheeler AJ, Allen RW, Atari DO, Jerrett M, Brauer M, Brook JR, Cakmak S, Burnett RT. Within- and between-city contrasts in nitrogen dioxide and mortality in 10 Canadian cities; a subset of the Canadian Census Health and Environment Cohort (CanCHEC). J Expo Sci Environ Epidemiol 2015; 25:482-9. [PMID: 25605445 PMCID: PMC4542139 DOI: 10.1038/jes.2014.89] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 10/27/2014] [Accepted: 10/31/2014] [Indexed: 05/21/2023]
Abstract
The independent and joint effects of within- and between-city contrasts in air pollution on mortality have been investigated rarely. To examine the differential effects of between- versus within-city contrasts in pollution exposure, we used both ambient measurements and land use regression models to assess associations with mortality and exposure to nitrogen dioxide (NO2) among ~735,600 adults in 10 of the largest Canadian cities. We estimated exposure contrasts partitioned into within- and between-city contrasts, and the sum of these as overall exposures, for every year from 1984 to 2006. Residential histories allowed us to follow subjects annually during the study period. We calculated hazard ratios (HRs) adjusted for many personal and contextual variables. In fully-adjusted, random-effects models, we found positive associations between overall NO2 exposures and mortality from non-accidental causes (HR per 5 p.p.b.: 1.05; 95% confidence interval (CI): 1.03-1.07), cardiovascular disease (HR per 5 p.p.b.: 1.04; 95% CI: 1.01-1.06), ischaemic heart disease (HR per 5 p.p.b.: 1.05; 95% CI: 1.02-1.08) and respiratory disease (HR per 5 p.p.b.: 1.04; 95% CI: 0.99-1.08), but not from cerebrovascular disease (HR per 5 p.p.b.: 1.01; 95% CI: 0.96-1.06). We found that most of these associations were determined by within-city contrasts, as opposed to by between-city contrasts in NO2. Our results suggest that variation in NO2 concentrations within a city may represent a more toxic mixture of pollution than variation between cities.
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Affiliation(s)
- Dan L Crouse
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
- Environmental Health Science and Research Bureau, Health Canada, 50 Columbine Driveway, Tunney's Pasture, Ottawa, ON K1A 0K9, Canada. Tel.: +613 941 5161. Fax: +613 941 3883. E-mail:
| | - Paul A Peters
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
- Department of Sociology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Paul J Villeneuve
- Institute of Health Science, Technology and Policy, Carleton University, Ottawa, Ontario, Canada
| | | | - Hwashin H Shin
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada
| | - Markey Johnson
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Amanda J Wheeler
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | - Ryan W Allen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Dominic Odwa Atari
- Faculty of Arts & Science, Nipissing University, North Bay, Ontario, Canada
| | - Michael Jerrett
- School of Public Health, University of California, Berkeley, California, USA
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey R Brook
- Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sabit Cakmak
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
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Hystad P, Villeneuve PJ, Goldberg MS, Crouse DL, Johnson K. Exposure to traffic-related air pollution and the risk of developing breast cancer among women in eight Canadian provinces: a case-control study. Environ Int 2015; 74:240-8. [PMID: 25454241 DOI: 10.1016/j.envint.2014.09.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 08/11/2014] [Accepted: 09/11/2014] [Indexed: 05/20/2023]
Abstract
A few recent studies have reported positive associations between long-term exposure to traffic-related air pollution and the incidence of breast cancer. We capitalized on an existing Canadian multi-site population-based case-control study to further investigate this association. We used the National Enhanced Cancer Surveillance System, a population-based case-control study conducted in eight of 10 Canadian provinces from 1994 to 1997. A total of 1569 breast cancer cases and 1872 population controls who reported at least 90% complete self-reported addresses over the 1975-1994 exposure period were examined. Mean exposure levels to nitrogen dioxide (NO2) (an indicator of traffic-related air pollution) were estimated for this period using three different measures: (1) satellite-derived observations; (2) satellite-derived observations scaled with historical fixed-site measurements of NO2; and (3) a national land-use regression (LUR) model. Proximity to major roads was also examined. Using unconditional logistic regression, stratified by menopausal status, we estimated odds ratios (ORs) adjusted for many individual-level and contextual breast cancer risk factors. We observed positive associations between incident breast cancer and all three measures of NO2 exposure from 1975 to 1994. In fully adjusted models for premenopausal breast cancer, a 10ppb increase in NO2 exposure estimated from the satellite-derived observations, the scaled satellite-derived observations, and the national LUR model produced ORs of 1.26 (95% confidence intervals (CIs): 0.92-1.74), 1.32 (95% CI: 1.05-1.67) and 1.28 (95% CI: 0.92-1.79). For postmenopausal breast cancer, we found corresponding ORs of 1.10 (95% CI: 0.88-1.36), 1.10 (95% CI: 0.94-1.28) and 1.07 (95% CI: 0.86-1.32). Substantial heterogeneity in the ORs was observed across the eight Canadian provinces and reduced ORs were observed when models were restricted to women who had received routine mammography examinations. No associations were found for road proximity measures. This study provides some support for the hypothesis that traffic-related air pollution may be associated with the development of breast cancer, especially in premenopausal women. With the few studies available, further research is clearly needed.
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Affiliation(s)
- Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
| | - Paul J Villeneuve
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan L Crouse
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada
| | - Kenneth Johnson
- Department of Epidemiology and Community Health, University of Ottawa, Ottawa, Ontario, Canada
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Brook RD, Cakmak S, Turner MC, Brook JR, Crouse DL, Peters PA, van Donkelaar A, Villeneuve PJ, Brion O, Jerrett M, Martin RV, Rajagopalan S, Goldberg MS, Pope CA, Burnett RT. Long-term fine particulate matter exposure and mortality from diabetes in Canada. Diabetes Care 2013; 36:3313-20. [PMID: 23780947 PMCID: PMC3781571 DOI: 10.2337/dc12-2189] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Recent studies suggest that chronic exposure to air pollution can promote the development of diabetes. However, whether this relationship actually translates into an increased risk of mortality attributable to diabetes is uncertain. RESEARCH DESIGN AND METHODS We evaluated the association between long-term exposure to ambient fine particulate matter (PM2.5) and diabetes-related mortality in a prospective cohort analysis of 2.1 million adults from the 1991 Canadian census mortality follow-up study. Mortality information, including ∼5,200 deaths coded as diabetes being the underlying cause, was ascertained by linkage to the Canadian Mortality Database from 1991 to 2001. Subject-level estimates of long-term exposure to PM2.5 were derived from satellite observations. The hazard ratios (HRs) for diabetes-related mortality were related to PM2.5 and adjusted for individual-level and contextual variables using Cox proportional hazards survival models. RESULTS Mean PM2.5 exposure levels for the entire population were low (8.7 µg/m3; SD, 3.9 µg/m3; interquartile range, 6.2 µg/m3). In fully adjusted models, a 10-µg/m3 elevation in PM2.5 exposure was associated with an increase in risk for diabetes-related mortality (HR, 1.49; 95% CI, 1.37-1.62). The monotonic change in risk to the population persisted to PM2.5 concentration<5 µg/m3. CONCLUSIONS Long-term exposure to PM2.5, even at low levels, is related to an increased risk of mortality attributable to diabetes. These findings have considerable public health importance given the billions of people exposed to air pollution and the worldwide growing epidemic of diabetes.
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Parent MÉ, Goldberg MS, Crouse DL, Ross NA, Chen H, Valois MF, Liautaud A. Traffic-related air pollution and prostate cancer risk: a case-control study in Montreal, Canada. Occup Environ Med 2013; 70:511-8. [PMID: 23531743 DOI: 10.1136/oemed-2012-101211] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES There is a paucity of information on environmental risk factors for prostate cancer. We conducted a case-control study in Montreal to estimate associations with exposure to ground-level nitrogen dioxide (NO2), a marker for traffic-related air pollution. METHODS Cases were 803 men with incident prostate cancer, ≤75 years of age, and diagnosed across all French hospitals in Montreal. Concurrently, 969 controls were drawn from electoral lists of French-speaking individuals residing in the same electoral districts as the cases and frequency-matched by age. Concentrations of NO2 were measured across Montreal in 2005-2006. We developed a land use regression model to predict concentrations of NO2 across Montreal for 2006. These estimates were back-extrapolated to 1996. Estimates were linked to residential addresses at the time of diagnosis or interview. Unconditional logistic regression was used, adjusting for potential confounding variables. RESULTS For each increase of 5 parts per billion of NO2, as estimated from the original land use regression model in 2006, the OR5ppb adjusted for personal factors was 1.44 (95% CI 1.21 to 1.73). Adding in contextual factors attenuated the OR5ppb to 1.27 (95% CI 1.03 to 1.58). One method for back-extrapolating concentrations of NO2 to 1996 (about 10 years before the index date) gave the following OR5ppb: 1.41 (95% CI 1.24 to 1.62) when personal factors were included, and 1.30 (95% CI 1.11 to 1.52) when contextual factors were added. CONCLUSIONS Exposure to ambient concentrations of NO2 at the current address was associated with an increased risk of prostate cancer. This novel finding requires replication.
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Affiliation(s)
- Marie-Élise Parent
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Université du Québec, Laval, Québec, Canada.
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Crouse DL, Peters PA, van Donkelaar A, Goldberg MS, Villeneuve PJ, Brion O, Khan S, Atari DO, Jerrett M, Pope CA, Brauer M, Brook JR, Martin RV, Stieb D, Burnett RT. Risk of nonaccidental and cardiovascular mortality in relation to long-term exposure to low concentrations of fine particulate matter: a Canadian national-level cohort study. Environ Health Perspect 2012; 120:708-14. [PMID: 22313724 PMCID: PMC3346774 DOI: 10.1289/ehp.1104049] [Citation(s) in RCA: 353] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 02/07/2012] [Indexed: 05/02/2023]
Abstract
BACKGROUND Few cohort studies have evaluated the risk of mortality associated with long-term exposure to fine particulate matter [≤ 2.5 μm in aerodynamic diameter (PM(2.5))]. This is the first national-level cohort study to investigate these risks in Canada. OBJECTIVE We investigated the association between long-term exposure to ambient PM(2.5) and cardiovascular mortality in nonimmigrant Canadian adults. METHODS We assigned estimates of exposure to ambient PM(2.5) derived from satellite observations to a cohort of 2.1 million Canadian adults who in 1991 were among the 20% of the population mandated to provide detailed census data. We identified deaths occurring between 1991 and 2001 through record linkage. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for available individual-level and contextual covariates using both standard Cox proportional survival models and nested, spatial random-effects survival models. RESULTS Using standard Cox models, we calculated HRs of 1.15 (95% CI: 1.13, 1.16) from nonaccidental causes and 1.31 (95% CI: 1.27, 1.35) from ischemic heart disease for each 10-μg/m(3) increase in concentrations of PM(2.5). Using spatial random-effects models controlling for the same variables, we calculated HRs of 1.10 (95% CI: 1.05, 1.15) and 1.30 (95% CI: 1.18, 1.43), respectively. We found similar associations between nonaccidental mortality and PM2.5 based on satellite-derived estimates and ground-based measurements in a subanalysis of subjects in 11 cities. CONCLUSIONS In this large national cohort of nonimmigrant Canadians, mortality was associated with long-term exposure to PM(2.5). Associations were observed with exposures to PM(2.5) at concentrations that were predominantly lower (mean, 8.7 μg/m(3); interquartile range, 6.2 μg/m(3)) than those reported previously.
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Affiliation(s)
- Dan L Crouse
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.
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Crouse DL, Goldberg MS, Ross NA, Chen H, Labrèche F. Postmenopausal breast cancer is associated with exposure to traffic-related air pollution in Montreal, Canada: a case-control study. Environ Health Perspect 2010; 118:1578-83. [PMID: 20923746 PMCID: PMC2974696 DOI: 10.1289/ehp.1002221] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 06/04/2010] [Accepted: 08/17/2010] [Indexed: 05/04/2023]
Abstract
BACKGROUND Only about 30% of cases of breast cancer can be explained by accepted risk factors. Occupational studies have shown associations between the incidence of breast cancer and exposure to contaminants that are found in ambient air. OBJECTIVES We sought to determine whether the incidence of postmenopausal breast cancer is associated with exposure to urban air pollution. METHODS We used data from a case-control study conducted in Montreal, Quebec, in 1996-1997. Cases were 383 women with incident invasive breast cancer, and controls were 416 women with other incident, malignant cancers, excluding those potentially associated with selected occupational exposures. Concentrations of nitrogen dioxide (NO2) were measured across Montreal in 2005-2006. We developed a land-use regression model to predict concentrations of NO2 across Montreal for 2006, and developed two methods to extrapolate the estimates to 1985 and 1996. We linked these estimates to addresses of residences of subjects at time of interview. We used unconditional logistic regression to adjust for accepted and suspected risk factors and occupational exposures. RESULTS For each increase of 5 ppb NO2 estimated in 1996, the adjusted odds ratio was 1.31 (95% confidence interval, 1.00-1.71). Although the size of effect varied somewhat across periods, we found an increased risk of approximately 25% for every increase of 5 ppb in exposure. CONCLUSIONS We found evidence of an association between the incidence of postmenopausal breast cancer and exposure to ambient concentrations of NO2. Further studies are needed to confirm whether NO2 or other components of traffic-related pollution are indeed associated with increased risks.
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Affiliation(s)
- Dan L Crouse
- Department of Geography, McGill University, Montreal, Quebec, Canada.
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Crouse DL, Ross NA, Goldberg MS. Double burden of deprivation and high concentrations of ambient air pollution at the neighbourhood scale in Montreal, Canada. Soc Sci Med 2009; 69:971-81. [DOI: 10.1016/j.socscimed.2009.07.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Indexed: 11/26/2022]
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