environmental epidemiology - mcgill university...environmental epidemiology mark goldberg professor,...
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September 11, 2009 1
Environmental Epidemiology
Mark GoldbergProfessor, Dept. of Medicine (Division of Clinical
Epidemiology, RVH)McGill School of the Environment
Dept. of Epidemiology and BiostatisticsDept. of Oncology
September 11, 2009 2
The Most Important Epidemiological Study Ever
John Snow: The Cholera Epidemic in London in the Mid-
1880s
September 11, 2009 3
Geographical Analysis: London, September 23, 1848-August 25, 1849
7.24
3.70
2.44
1.61
1
Relative death rate
1.10375,971415North
7.96
4.07
2.46
1.77
Deaths/1,000
502,5484,001South
392,4441,597East
373,605920Central
300,711533West
Population in 1841
No. deaths (1848-
49)
District
September 11, 2009 4
Deaths from Cholera per 10,000 Homes, by Source of Water Supply, London, 1854
+259.9
-18.0
0
Difference
5.7315.41,26340,046Southwark & Vauxhall
0.737.59826,107Lambeth
155.51,422256,423Rest of London
RatioDeaths/10,000 homes
Deaths from cholera
Number of homes served
Company
Estimate of average no. of deaths per home ratio=8.4
September 11, 2009 5
Geographic Distribution of Cases Around the Broad Street Pump, Summer, 1854
Broad St. Pump
September 11, 2009 6
Public Health Actions
• No specific cause identified at that time, yet…– 1857: legislation mandating that all water
companies in London filter their water– Germ theory supported– Clean up the environment….?
• NB: it has only been 20 years since Montreal has had a sewage treatment facility
• Sydney, NS, still sends its untreated sewage directly to the Atlantic
• 1883: Vibrio cholerae identified
September 11, 2009 7
My Work
• Occupational and environmental risk factors for cancer
• Acute effects of air pollution on health• Chronic effects of air pollution on health• Climate change: Acute effects of
weather on health• Funding: CIHR, NIH, Health Effects
Institute, US EPA, Health Canada
September 11, 2009 8ISEE August 2009 8
ExamplePostmenopausal Breast Cancer
and Traffic-related Air Pollution
Students: Dan L. Crouse, Hong Chen,Collaborators: Nancy Ross, France
Labrèche, Rick Burnett, Michael Jerrett
September 11, 2009 9ISEE August 2009 9
Context
• Postmenopausal breast cancer case-control study, Montreal, 1996-7
September 11, 2009 10ISEE August 2009 10
September 11, 2009 11ISEE August 2009 11
Pictures (1)
Anjou, Boul. Metropolitain Park-Extension
September 11, 2009 12ISEE August 2009 12
Land Use Regression Map Averaged over three Seasons
September 11, 2009 13ISEE August 2009 13
Back Estimation of the LUR Map for NO2
regional spat. variation (1985: NOregional spat. variation (1985: NO22))
regional spat. variation (2006: NOregional spat. variation (2006: NO22))
SmallSmall--area surface map (2006: NOarea surface map (2006: NO22))
XX
Montreal Montreal IslandIsland
÷÷÷
September 11, 2009 14ISEE August 2009 14
Results (OR per increase of 5ppb)
Year of estimate of exposure
Age adjusted OR 95%CI
Fully adjustedOR 95%CI
2006-LUR 1.15 0.89-1.48 1.31 0.96-1.79
1996-weighted by ratio of IDWs
1.10 0.91-1.32 1.24 0.98-1.56
1985-weighted by ratio of IDWs
1.05 0.91-1.22 1.14 0.95-1.37
September 11, 2009 15ISEE August 2009 15
Comparing Worst Exposed to Least Exposed Areas
Year of estimate of exposure
Fully adjustedOR 95%CI
2006-LUR 1.86 1.09-3.18
1996-weighted by ratio of IDWs
1.90 1.14-3.16
1985-weighted by ratio of IDWs
1.65 1.00-2.72
September 11, 2009 16