inka milewski conservation council of new brunswick
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Identifying at-risk communities for action on cancer prevention: a case study in New Brunswick (Canada) communities
Inka MilewskiConservation Council of New Brunswick
CRDCN 2012 National Conference: Evidence-based Policy Formation and Evaluation Fredericton, New Brunswick October 23, 2012
What do we know about cancer rates in Canadian communities?
• Guernsey et al 2000▫ Sydney, Nova Scotia▫ higher rates of breast and cervical cancer than provincial rates ▫ higher rate of colon, rectum and prostate cancer among men than
provincial rates• Holowaty et al. 2010
- Ontario public health unit (Wellington-Dufferin-Guelph)- highest rate of lung cancer in urban core area of Guelph- highest rate of prostate cancer in the Orangeville area
• Colquhoun et al. 2010▫ First Nations community of Fort Chipewyan, Alberta▫ higher rates of cervical and biliary tract, other and unspecified
cancers than all First Nations in Alberta and Alberta general population
Study Design• 9 rural and 5 urban
communities • 6 primary cancers for
males (prostate, lung, colorectal, bladder, NHL, kidney)
• 4 primary cancers for females (breast, lung, colorectal, NHL)
• age-unadjusted cancer incidence rates per 100,000 population (1989-2005) with 95%Cl
• Community SES measures (education, poverty rate, income, unemployment)
Statistical Analysis•Multivariate ordination (MDS) to plot
similarities in cancer incidence among communities
•Hierarchical cluster analysis to identify possible clusters and permutation testing (SIMPROF) to test the significance of clusters
•Permutation testing (RELATE) to test the correlation of SES pattern and cancer incidence
Non-metric multidimensional scaling (MDS) plot of similarities in male and female age unadjusted cancer incidence rates among 5 urban (■) and 9 rural (▼) communities
Saint John
Fredericton
Moncton
Dalhousie MiramichiBathurst
Caraquet
Edmundston
BelleduneUpperMiramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Saint John
Fredericton
MonctonDalhousie
Miramichi
Bathurst
CaraquetEdmundston
Belledune
UpperMiramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.05Males Females
p < 0.001
p < 0.001
Saint John
MonctonFredericton
Dalhousie
Miramichi
Bathurst
Caraquet
Edmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
MDS plot of similarities in socioeconomic status (SES) among among 5 urban (■) and 9 rural (▼) communities New Brunswick communities
Saint John
MonctonFredericton
Dalhousie
Miramichi
Bathurst
Caraquet
Edmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Saint John
FrederictonMoncton
DalhousieMiramichi
Bathurst
Caraquet
Edmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Saint John
Fredericton
MonctonDalhousie Miramichi
Bathurst CaraquetEdmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.05
ρ = 0.041 females
Correlation between cancer rates and SES factors
ρ = - 0.071 males
Similarities in Male Lung Cancer Incidence lung
82
118
154
190
Saint John
FrederictonMoncton
DalhousieMiramichi
Bathurst
Caraquet
Edmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Similarities in Prostate Cancer Incidenceprostate
95
140
185
230
Saint John
FrederictonMoncton
DalhousieMiramichi
Bathurst
Caraquet
Edmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Similarities in Male Colorectal Cancer Incidencecolorectal
48.5
74
99.5
125
Saint John
FrederictonMoncton
DalhousieMiramichi
Bathurst
Caraquet
Edmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Similarities in Female Lung Cancer Incidencelung
32.5
55
77.5
100
Saint John
Fredericton
MonctonDalhousie Miramichi
Bathurst CaraquetEdmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.05
Similarities in Female Colorectal Cancer Incidencecolorectal
41.5
61
80.5
100
Saint John
Fredericton
MonctonDalhousie Miramichi
Bathurst CaraquetEdmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.05
Similarities in Breast Cancer Incidencebreast
75
105
135
165
Saint John
Fredericton
MonctonDalhousie Miramichi
Bathurst CaraquetEdmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.05
Similarities in SESUnemployment rate
9.8
18.2
26.6
35
Saint John
MonctonFredericton
Dalhousie
Miramichi
Bathurst
CaraquetEdmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Similarities in SES% low income families
6.5
11
15.5
20
Saint John
MonctonFredericton
Dalhousie
Miramichi
Bathurst
CaraquetEdmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Similarities in SESMedian family income all households
3.53E4
3.92E4
4.31E4
4.7E4
Saint John
MonctonFredericton
Dalhousie
Miramichi
Bathurst
CaraquetEdmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
Similarities in SES% with university degree
5.2
11.8
18.4
25
Saint John
MonctonFredericton
Dalhousie
Miramichi
Bathurst
CaraquetEdmundston
Belledune
Upper Miramichi
Minto
Drummond-Denmark
Gagetown
Harvey
2D Stress: 0.04
1991 1996 2001 20050
20
40
60
80
100
120
140
160
Figure 2. Male Lung Cancer Rates: Age-standardized incidence rates per 100,000 populaton for 1991, 1996, 2001 and 2005.
Saint JohnFrederictonMonctonProvincialNational
1991 1996 2001 20050
10
20
30
40
50
60
70
80
90
100
Figure 4. Female Lung Cancer Rates: Age-standardized in-cidence rates for 1991, 1996, 2001 and 2005
Saint JohnFrederictonMonctonProvincialNational
Age-standardized vs age-unadjusted Cancer Rates
Milewski and Liu 2009
1994/951996/97
1998/992000/01 2003 2005
0
5
10
15
20
25
30
35
40Figure 17. Male smoking rates for current daily or occasional smokers
(1994-2005)
New BrunswickCanadaHealth Region 1 (includes Moncton)Health Region 2 (includes Saint John)Health Region 3 (includes Frederic-ton)Saint John Census Metropolitan Area (CMA)
Data sources: Statistic Canada National Population Health Surveys and Canadian Community Health Surveys
%
0
5
10
15
20
25
30
35
Figure 18. Female smoking rates for current daily or occasional smokers (1994-2005)
New Brunswick
Canada
Health Region 1 (includes Monc-ton)
Health Region 2 (includes Saint John)
Health Region 3 (includes Freder-icton)
Saint John Census Metropolitan Area (CMA)
Data sources: Statistics Canada National Population Health Surveys and Canadian Community Health Surveys
%
Milewski and Liu 2009
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 20050
10,00020,000
30,000
40,000
50,00060,000
70,000
Figure 20. Atmospheric release of carcinogens (in kilograms per year) from industrial sources (1995-2005)
Saint JohnMoncton Fredericton
Data Source: Environment Canada's National Pollutant Release Inventory and Pol -lutionWatch
1991 1996 2001 20060
5
10
15
20
25
30
Saint JohnMoncton Fredericton
Data Sources: Statistics Canada Community Census Profiles for 1991, 1996, 2001 and 2006
%
Figure 20. Percentage of the male workforce employed in trades (welding, electrical, machining, construction) transportation sector and heavy equipment operation.
Milewski and Liu 2009
•Rates of cancer differed significantly among New Brunswick communities and were unrelated to SES
•Reporting data at the right spatial scale is key to avoiding policy mismatches
•Identifying at-risk communities can result in the development of more appropriate risk reduction and prevention programs
Conclusions
Acknowledgments
• Lilly Liu, CCNB research assistant • EJLB Foundation• Salamander Foundation• New Brunswick Cancer Network• Statistics Canada
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