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1.
Environ Res ; 204(Pt C): 112344, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34742713

RESUMO

BACKGROUND: Over the last decade, several studies have reported that residential proximity to vegetation, or 'greenness', is associated with improved birth outcomes, including for term birth weight (TBW), preterm birth (PTB), and small for gestational age (SGA). However, there remain several uncertainties about these possible benefits including the role of air pollution, and the extent to they are influenced socioeconomic status. METHODS: We addressed these gaps using a national population-based study of 2.2 million singleton live births in Canadian metropolitan areas between 1999 and 2008. Exposures to greenness, fine particulate matter (PM2.5), and nitrogen dioxide (NO2) were assigned to infants using the postal code of their mother's residence at the time of birth. The Normalized Difference Vegetation Index (NDVI) was used to characterize greenness, while estimates of ambient PM2.5 and NO2 were estimated using remote sensing, and a national land-use regression surface, respectively. Multivariable regression analysis was performed to describe associations between residential greenness and the birth outcomes. Stratified analyses explored whether these associations were modified by neighbourhood measures of socioeconomic status. RESULTS: Mothers who lived in greener areas had a lower risk of low TBW, PTB, and SGA babies. These associations persisted after adjustment for ambient NO2 and PM2.5. Specifically, in fully adjusted models, an interquartile range (IQR = 0.16) increase in the NDVI within a residential buffer of 250 m yielded odds ratios of 0.93 (95% confidence interval (CI): 0.92, 0.94), 0.94 (95% CI: 0.92, 0.95), and 0.94 (95% CI: 0.93, 0.95) for the outcomes of PTB, low TBW, and SGA, respectively. Similarly, an IQR increase in greenness was associated with a 16.3 g (95% CI: 15.3, 17.4) increase in TBW. We found inverse associations between greenness and the occurrence of adverse birth outcomes regardless of the socioeconomic status of the neighbourhood. INTERPRETATION: Our findings support the hypothesis that residential greenness contributes to healthier pregnancies, that these associations are independent from exposure to air pollution. , and that proximity to greenness benefits all mothers regardless of socioeconomic status.

2.
Environ Res ; 204(Pt A): 111975, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34478722

RESUMO

We used a large national cohort in Canada to assess the incidence of acute myocardial infarction (AMI) and stroke hospitalizations in association with long-term exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3). The study population comprised 2.7 million respondents from the 2006 Canadian Census Health and Environment Cohort (CanCHEC), followed for incident hospitalizations of AMI or stroke between 2006 and 2016. We estimated 10-year moving average estimates of PM2.5, NO2, and O3, annually. We used Cox proportional hazards models to examine the associations adjusting for various covariates. For AMI, each interquartile range (IQR) increase in exposure was found to be associated with a hazard ratio of 1.026 (95% CI: 1.007-1.046) for PM2.5, 1.025 (95% CI: 1.001-1.050) for NO2, and 1.062 (95% CI: 1.041-1.084) for O3, respectively. Similarly, for stroke, an IQR increase in exposure was associated with a hazard ratio of 1.078 (95% CI: 1.052-1.105) for PM2.5, 0.995 (95% CI: 0.965-1.030) for NO2, and 1.055 (95% CI: 1.028-1.082) for O3, respectively. We found consistent evidence of positive associations between long-term exposures to PM2.5, and O3, and to a lesser degree NO2, with incident AMI and stroke hospitalizations.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Infarto do Miocárdio , Ozônio , Acidente Vascular Cerebral , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Canadá/epidemiologia , Estudos de Coortes , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/epidemiologia , Dióxido de Nitrogênio/análise , Dióxido de Nitrogênio/toxicidade , Ozônio/análise , Ozônio/toxicidade , Material Particulado/análise , Material Particulado/toxicidade , Acidente Vascular Cerebral/induzido quimicamente , Acidente Vascular Cerebral/epidemiologia
3.
Environ Epidemiol ; 5(6): e180, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34909560

RESUMO

Background: Associations between mortality and exposure to ambient air pollution are usually explored using concentrations of residential outdoor fine particulate matter (PM2.5) to estimate individual exposure. Such studies all have an important limitation in that they do not capture data on individual mobility throughout the day to areas where concentrations may be substantially different, leading to possible exposure misclassification. We examine the possible role of outdoor PM2.5 concentrations at work for a large population-based mortality cohort. Methods: Using the 2001 Canadian Census Health and Environment Cohort (CanCHEC), we created a time-weighted average that incorporates employment hours worked in the past week and outdoor PM2.5 concentration at work and home. We used a Cox proportional hazard model with a 15-year follow-up (2001 to 2016) to explore whether inclusion of workplace estimates had an impact on hazard ratios for mortality for this cohort. Results: Hazard ratios relying on outdoor PM2.5 concentration at home were not significantly different from those using a time-weighted estimate, for the full cohort, nor for those who commute to a regular workplace. When exploring cohort subgroups according to neighborhood type and commute distance, there was a notable but insignificant change in risk of nonaccidental death for those living in car-oriented neighborhoods, and with commutes greater than 10 km. Conclusions: Risk analyses performed with large cohorts in low-pollution environments do not seem to be biased if relying solely on outdoor PM2.5 concentrations at home to estimate exposure.

4.
BMJ ; 375: n2368, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625469

RESUMO

OBJECTIVE: To investigate the association between changes in long term residential exposure to ambient fine particulate matter (PM2.5) and premature mortality in Canada. DESIGN: Population based quasi-experimental study. SETTING: Canada. PARTICIPANTS: 663 100 respondents to the 1996, 2001, and 2006 Canadian censuses aged 25-89 years who had consistently lived in areas with either high or low PM2.5 levels over five years preceding census day and moved during the ensuing five years. INTERVENTIONS: Changes in long term exposure to PM2.5 arising from residential mobility. MAIN OUTCOME MEASURES: The primary outcome was deaths from natural causes. Secondary outcomes were deaths from any cardiometabolic cause, any respiratory cause, and any cancer cause. All outcomes were obtained from the national vital statistics database. RESULTS: Using a propensity score matching technique with numerous personal, socioeconomic, health, and environment related covariates, each participant who moved to a different PM2.5 area was matched with up to three participants who moved within the same PM2.5 area. In the matched groups that moved from high to intermediate or low PM2.5 areas, residential mobility was associated with a decline in annual PM2.5 exposure from 10.6 µg/m3 to 7.4 and 5.0 µg/m3, respectively. Conversely, in the matched groups that moved from low to intermediate or high PM2.5 areas, annual PM2.5 increased from 4.6 µg/m3 to 6.7 and 9.2 µg/m3. Five years after moving, individuals who experienced a reduction in exposure to PM2.5 from high to intermediate levels showed a 6.8% (95% confidence interval 1.7% to 11.7%) reduction in mortality (2510 deaths in 56 025 v 4925 deaths in 101 960). A greater decline in mortality occurred among those exposed to a larger reduction in PM2.5. Increased mortality was found with exposure to PM2.5 from low to high levels, and to a lesser degree from low to intermediate levels. Furthermore, the decreases in PM2.5 exposure were most strongly associated with reductions in cardiometabolic deaths, whereas the increases in PM2.5 exposure were mostly related to respiratory deaths. No strong evidence was found for the changes in PM2.5 exposure with cancer related deaths. CONCLUSIONS: In Canada, decreases in PM2.5 were associated with lower mortality, whereas increases in PM2.5 were associated with higher mortality. These results were observed at PM2.5 levels considerably lower than many other countries, providing support for continuously improving air quality.


Assuntos
Poluição do Ar/análise , Mortalidade Prematura , Material Particulado/efeitos adversos , Adulto , Idoso , Poluição do Ar/efeitos adversos , Canadá/epidemiologia , Censos , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto
5.
Environ Int ; 157: 106817, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34385046

RESUMO

BACKGROUND: There is increasing interest in the health effects of air pollution. However, the relationships between ozone exposure and mortality attributable to neurological diseases remain unclear. OBJECTIVES: To assess associations of long-term exposure to ozone with death from Parkinson's disease, dementia, stroke, and multiple sclerosis. METHODS: Our analyses were based on the 2001 Canadian Census Health and Environment Cohort. Census participants were linked with vital statistics records through 2016, resulting in a cohort of 3.5 million adults/51,045,700 person-years, with 8,500/51,300/43,300/1,300 deaths from Parkinson's/dementia/stroke/multiple sclerosis, respectively. Ten-year average ozone concentrations estimated by chemical transport models and adjusted by ground measurements were assigned to subjects based on postal codes. Cox proportional hazards models were used to calculate hazard ratios (HRs) for deaths from the four neurological diseases, adjusting for eight common demographic and socioeconomic factors, seven environmental indexes, and six contextual covariates. RESULTS: The fully adjusted HRs for Parkinson's, dementia, stroke, and multiple sclerosis mortalities related to one interquartile range increase in ozone (10.1 ppb), were 1.09 (95% confidence interval 1.04-1.14), 1.08 (1.06-1.10), 1.06 (1.04-1.09), and 1.35 (1.20-1.51), respectively. The covariates did not influence significance of the ozone-mortality associations, except airshed (i.e., broad region of Canada). During the period of 2001-2016, 5.66%/5.01%/ 3.77%/19.11% of deaths from Parkinson's/dementia/stroke/multiple sclerosis, respectively, were attributable to ozone exposure. CONCLUSIONS: We found positive associations between ozone exposure and mortality due to Parkinson's, dementia, stroke, and multiple sclerosis.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Ozônio , Adulto , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/análise , Canadá/epidemiologia , Exposição Ambiental/análise , Humanos , Mortalidade , Ozônio/análise , Ozônio/toxicidade , Material Particulado/análise
6.
Health Rep ; 31(7): 3-11, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32761579

RESUMO

BACKGROUND: A growing number of epidemiological studies have linked air pollution exposure to psychological conditions. Laboratory studies indicate that air pollutants can activate the neuroendocrine stress axis and modulate stress hormone levels, which could contribute to the development or exacerbation of psychological distress. The present study examined the spatial associations between air pollutants (fine particulate matter [PM2.5], nitrogen dioxide [NO2] and ground-level ozone [O3]) and psychological distress among subjects in the most populous provinces in Canada. DATA AND METHODS: Subjects were sampled from the Canadian Community Health Survey in three regions (Quebec in 2005 [n=25,800], British Columbia and Alberta in 2005 [n=23,000], and Ontario in 2011 [n=36,000]), and were assigned estimates of annual exposure to three ambient air pollutants (PM2.5, NO2 and O3) for the same years. Individual psychological distress was assessed using the Kessler Psychological Distress Scale (K10), based on anxiety and depressive symptoms in the past month. Regression models (both ordinary least squares and simultaneous autoregressive models) were applied to estimate associations between K10 distress scores and each air pollutant, after adjusting for individual (demographic, socioeconomic and behavioural) and neighbourhood covariates.. RESULTS: Psychological distress was positively associated with PM2.5 and NO2 in all three regions, and with O3 in Quebec. However, after further adjusting for individual and neighbourhood covariates, the associations between distress and air pollution remained statistically significant only in Quebec. DISCUSSION: Some evidence for positive associations between psychological distress and ambient air pollution after adjusting for spatial autocorrelation was found.


Assuntos
Poluentes Atmosféricos , Poluição do Ar/efeitos adversos , Dióxido de Nitrogênio/efeitos adversos , Material Particulado/efeitos adversos , Angústia Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/efeitos adversos , Colúmbia Britânica , Estudos Transversais , Exposição Ambiental/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Quebeque , Autorrelato , Análise Espacial
7.
Environ Res ; 191: 109973, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32810502

RESUMO

BACKGROUND: Individual and neighbourhood-scale socioeconomic characteristics modify associations between exposure to air pollution and mortality. The role of stress, which may integrate effects of social and environmental exposures on health, is unknown. We examined whether an individual's perspective on their own well-being, as assessed using self-rated measures of stress and health, modifies the pollutant-mortality relationship. METHODS: The Canadian Community Health Survey (CCHS)-mortality cohort includes respondents from surveys administered between 2001 and 2012 linked to vital statistics and postal codes from 1981 until 2016. Annual fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) exposure estimates were attached to a sample of cohort members aged 30-89 years (n = 398,300 respondents/3,848,400 person-years). We examined whether self-rated stress, distress, mental health, and general health modified associations between long-term exposure to each pollutant (three-year moving average with one-year lag) and non-accidental mortality using Cox survival models, adjusted for individual- (i.e. socioeconomic and behavioural) and neighbourhood-scale covariates. RESULTS: In fully-adjusted models, the relationship between exposure to pollutants and mortality was stronger among those with poor self-rated mental health, including a significant difference for NO2 (hazard ratio (HR) = 1.15, 95% CI 1.06-1.25 per IQR) compared to those with very good/excellent mental health (HR = 1.05, 95% CI 1.01-1.08; Cochran's Q = 4.01; p < 0.05). Poor self-rated health was similarly associated with higher pollutant-associated HRs, but only in unadjusted models. Stress and distress did not modify pollutant-mortality associations. CONCLUSIONS: Poor self-rated mental and general health were associated with increased mortality attributed to exposure to ambient pollutants.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Poluentes Ambientais , Ozônio , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Canadá , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Saúde Mental , Pessoa de Meia-Idade , Dióxido de Nitrogênio/análise , Dióxido de Nitrogênio/toxicidade , Ozônio/análise , Material Particulado/análise
8.
Health Rep ; 31(3): 3-13, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32644759

RESUMO

BACKGROUND: Postal codes are often the only geographic identifier available to match subjects in a health dataset to census geography. This paper describes the characteristics of postal codes reported by the Canadian population on the census and, as an indicator of geocoding accuracy, the proportion that are linked to a single dissemination area (DA). DATA AND METHODS: Postal codes reported on the 2016 Census questionnaire were matched to a combination of the Postal Code Conversion File (PCCF) and the Postal Code Conversion File Plus (PCCF+ version 7B) (reference date November 2018) to calculate population-weighted counts and the number of matches to DAs by province or territory, delivery mode type (DMT), population centre or rural area size, and census metropolitan area. The number of single matches to census tracts (CTs), census subdivisions (CSDs) and census divisions (CDs) was also calculated. RESULTS: In Canada, 72.6% of the population reported postal codes that matched to a single DA. This proportion was higher in urban cores (87.1%) and among postal codes for an urban street address (DMT=A) (85.3%) or apartment building (DMT=B) (95.3%), and was lower in rural areas (26.2% to 38.1%) and among rural postal codes (13.9%). In comparison, 89.3% and 95.4% of the population reported postal codes matching to a single CSD or CD, respectively, while 92.1% of the population that live within CT boundaries were matched to a single CT. DISCUSSION: Matching postal codes to census geography is relatively accurate and frequently one to one in urban centres. In rural areas and for some types of postal code DMTs, alternative approaches to using the PCCF and PCCF+ for attaching census geography might be explored.


Assuntos
Censos , Mapeamento Geográfico , Geografia , Canadá , Humanos , Modelos Estatísticos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos
9.
Health Rep ; 31(3): 14-26, 2020 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-32644760

RESUMO

BACKGROUND: Immigrants make up 20% of the Canadian population; however, little is known about the mortality impacts of fine particulate matter (PM2.5) air pollution on immigrants compared with non-immigrants, or about how impacts may change with duration in Canada. DATA AND METHODS: This study used the 2001 Canadian Census Health and Environment Cohort, a longitudinal cohort of 3.5 million individuals, of which 764,000 were classified as immigrants (foreign-born). Postal codes from annual income tax files were used to account for mobility among respondents and to assign annual PM2.5 concentrations from 1998 to 2016. Exposures were estimated as a three-year moving average prior to the follow-up year. Cox survival models were used to determine hazard ratios (HRs) for cause-specific mortality, comparing the Canadian and foreign-born populations, with further stratification by year of immigration grouped into 10-year cohorts. RESULTS: Differences in urban-rural settlement patterns resulted in greater exposure to PM2.5 for immigrants compared with non-immigrants (mean = 9.3 vs. 7.5 µg/m3), with higher exposures among more recent immigrants. In fully adjusted models, immigrants had higher HRs per 10 µg/m3 increase in PM2.5 concentration compared with Canadian-born individuals for cardiovascular mortality (HR [95% confidence interval] = 1.22 [1.12 to 1.34] vs. 1.12 [1.07 to 1.18]) and cerebrovascular mortality (HR = 1.25 [1.03 to 1.52] vs. 1.03 [0.93 to 1.15]), respectively. However, tests for differences between the two groups were not significant when Cochran's Q test was used. No significant associations were found for respiratory outcomes, except for lung cancer in non-immigrants (HR = 1.10 [1.02 to 1.18]). When stratified by year of immigration, differences in HRs across varied by cause of death. DISCUSSION: In Canada, PM2.5 is an equal-opportunity risk factor, with immigrants experiencing similar if not higher mortality risks compared with non-immigrants for cardiovascular-related causes of death. Some notable differences also existed with cerebrovascular and lung cancer deaths. Continued reductions in air pollution, particularly in urban areas, will improve the health of the Canadian population as a whole.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Doenças Cardiovasculares , Censos , Emigrantes e Imigrantes , Exposição Ambiental/efeitos adversos , Material Particulado/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Canadá/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Material Particulado/análise , Fatores de Risco , População Rural , População Urbana
10.
Ann Work Expo Health ; 64(4): 387-401, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32144413

RESUMO

OBJECTIVES: Shift work with circadian disruption is a suspected human carcinogen. Additional population-representative human studies are needed and large population-based linkage cohorts have been explored as an option for surveillance shift work and cancer risk. This study uses a surveillance linkage cohort and job-exposure matrix to test relationships. METHODS: We estimated associations between shift work and breast, ovarian, and prostate cancer using the population-based Canadian Census Health and Environment Cohort (CanCHEC), linking the 1991 Canadian census to national cancer registry and mortality databases. Prevalence estimates from population labour survey data were used to estimate and assign probability of night, rotating, or evening shifts by occupation and industry. Cohort members were assigned to high (>50%), medium (>25 to 50%), low (>5 to 25%), or no (<5%) probability of exposure categories. Cox proportional hazards modelling was used to estimate associations between shift work exposure and incidence of prostate cancer in men and ovarian and breast cancer in women. RESULTS: The cohort included 1 098 935 men and 939 520 women. Hazard ratios (HRs) indicated null or inverse relationships comparing high probability to no exposure for prostate cancer: HR = 0.96, 95% confidence interval (CI) = 0.91-1.02; breast cancer: HR = 0.94, 95% CI = 0.90-0.99; and ovarian cancer: HR = 0.99, 95% CI = 0.87-1.13. CONCLUSIONS: This study showed inverse and null associations between shift work exposure and incidence of prostate, breast, or ovarian cancer. However, we explore limitations of a surveillance cohort, including a possible healthy worker survivor effect and the possibility that this relationship may require the nuanced exposure detail in primary collection studies to be measurable.

11.
Health Rep ; 31(1): 3-14, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31940148

RESUMO

BACKGROUND: Life expectancy (LE) and health expectancy have increased throughout much of the world. However, these gains have not been shared equally across all population groups. Socioeconomic disparities exist, though varied methodologies and data sources have made it difficult to ascertain changes over time in Canada. DATA AND METHODS: The 1996 and 2011 Canadian Census Health and Environment Cohorts, with a five-year mortality follow-up, were used to estimate the LE of the household population at ages 25 and 65, according to individual-level education and income. Health status was measured by the Health Utilities Index Mark 3 instrument in two national population health surveys and was used to adjust LE to estimate health-adjusted life expectancy (HALE). Disparities in LE and HALE, and differences between cohorts, were examined. RESULTS: LE, HALE and the ratio of HALE to LE were greater at higher levels of education or income. A stepwise gradient was also observed by level of education within and across income quintiles, with people in the lowest combined education and income categories at the greatest disadvantage. Disparities were wider in the 2011 cohort compared with the 1996 cohort, but not necessarily to the same extent for both sexes or at different ages. DISCUSSION: In Canada, education-related and income-related disparities in life and health expectancy persist and may be wider than they were in the past. This underscores the importance of ongoing data development for routine monitoring of trends in mortality and morbidity, which can, in turn, inform policy development and planning to advance health equity.


Assuntos
Características da Família , Saúde da População , Fatores Socioeconômicos , Adulto , Idoso , Canadá/epidemiologia , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Expectativa de Vida/tendências , Masculino , Modelos Estatísticos
12.
Epidemiology ; 31(2): 168-176, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31693516

RESUMO

BACKGROUND: The temporal and spatial scales of exposure assessment may influence observed associations between fine particulate air pollution (PM2.5) and mortality, but few studies have systematically examined this question. METHODS: We followed 2.4 million adults in the 2001 Canadian Census Health and Environment Cohort for nonaccidental and cause-specific mortality between 2001 and 2011. We assigned PM2.5 exposures to residential locations using satellite-based estimates and compared three different temporal moving averages (1, 3, and 8 years) and three spatial scales (1, 5, and 10 km) of exposure assignment. In addition, we examined different spatial scales based on age, employment status, and urban/rural location, and adjustment for O3, NO2, or their combined oxidant capacity (Ox). RESULTS: In general, longer moving averages resulted in stronger associations between PM2.5 and mortality. For nonaccidental mortality, we observed a hazard ratio of 1.11 (95% CI = 1.08, 1.13) for the 1-year moving average compared with 1.23 (95% CI = 1.20, 1.27) for the 8-year moving average. Respiratory and lung cancer mortality were most sensitive to the spatial scale of exposure assessment with stronger associations observed at smaller spatial scales. Adjustment for oxidant gases attenuated associations between PM2.5 and cardiovascular mortality and strengthened associations with lung cancer. Despite these variations, PM2.5 was associated with increased mortality in nearly all of the models examined. CONCLUSIONS: These findings support a relationship between outdoor PM2.5 and mortality at low concentrations and highlight the importance of longer-exposure windows, more spatially resolved exposure metrics, and adjustment for oxidant gases in characterizing this relationship.


Assuntos
Poluição do Ar , Exposição Ambiental , Mortalidade , Material Particulado , Adulto , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Canadá/epidemiologia , Estudos de Coortes , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Mortalidade/tendências , Material Particulado/efeitos adversos , Material Particulado/análise , Análise Espaço-Temporal
13.
Epidemiology ; 31(2): 177-183, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31714401

RESUMO

BACKGROUND: Ambient ultrafine particles (UFPs, <0.1 µm) can reach the human brain, but to our knowledge, epidemiologic studies have yet to evaluate the relation between UFPs and incident brain tumors. METHODS: We conducted a cohort study of within-city spatial variations in ambient UFPs across Montreal and Toronto, Canada, among 1.9 million adults included in multiple cycles of the Canadian Census Health and Environment Cohorts (1991, 1996, 2001, and 2006). UFP exposures (3-year moving averages) were assigned to residential locations using land-use regression models with exposures updated to account for residential mobility within and between cities. We followed cohort members for malignant brain tumors (ICD-10 codes C71.0-C71.9) between 2001 and 2016; Cox proportional hazards models (stratified by age, sex, immigration status, and census cycle) were used to estimate hazard ratios (HRs) adjusting for fine particle mass concentrations (PM2.5), nitrogen dioxide (NO2), and various sociodemographic factors. RESULTS: In total, we identified 1,400 incident brain tumors during the follow-up period. Each 10,000/cm increase in UFPs was positively associated with brain tumor incidence (HR = 1.112, 95% CI = 1.042, 1.188) after adjusting for PM2.5, NO2, and sociodemographic factors. Applying an indirect adjustment for cigarette smoking and body mass index strengthened this relation (HR = 1.133, 95% CI = 1.032, 1.245). PM2.5 and NO2 were not associated with an increased incidence of brain tumors. CONCLUSIONS: Ambient UFPs may represent a previously unrecognized risk factor for incident brain tumors in adults. Future studies should aim to replicate these results given the high prevalence of UFP exposures in urban areas.


Assuntos
Poluição do Ar , Neoplasias Encefálicas , Material Particulado , Adulto , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Neoplasias Encefálicas/epidemiologia , Canadá/epidemiologia , Cidades/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Material Particulado/efeitos adversos , Material Particulado/análise , Análise Espacial
14.
Health Rep ; 30(12): 3-10, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851367

RESUMO

BACKGROUND: The Truth and Reconciliation Commission of Canada has called upon the federal government to provide data on a number of health indicators, including life expectancy among First Nations people, Métis and Inuit. In Canada, estimating the life expectancy of Indigenous populations is methodologically challenging since death registrations do not usually collect information on whether the deceased was Indigenous. For the first time in Canada, a series of census-mortality linked datasets has been created that can be used to estimate life expectancies among Indigenous household populations enumerated by a census. DATA AND METHODS: Life expectancy is the average number of years a person at a given age would be expected to live if the mortality rates observed for a specific period persisted into the future. For this study, abridged period life tables (based on five-year age groups) were calculated for self-reported First Nations, Métis, Inuit and non-Indigenous males and females. RESULTS: Life expectancy was substantially and consistently shorter for First Nations, Métis and Inuit household populations compared with the non-Indigenous household population across all time periods. In 2011, life expectancy at age 1 for the male household population was 72.5 years for First Nations, 76.9 years for Métis, 70.0 years for Inuit and 81.4 years for non-Indigenous people. Among the female household population, life expectancy at age 1 was 77.7 years for First Nations, 82.3 years for Métis, 76.1 years for Inuit and 87.3 for non-Indigenous people. DISCUSSION: With the creation of a series of census-mortality linked datasets, it is now possible to produce national mortality and life expectancy estimates starting at age 1 for Indigenous household populations. The routine monitoring of longevity by population group can inform policy development and planning intended to advance health equity.


Assuntos
Características da Família , Índios Norte-Americanos , Inuítes , Expectativa de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Censos , Criança , Pré-Escolar , Conjuntos de Dados como Assunto , Feminino , Humanos , Lactente , Tábuas de Vida , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Adulto Jovem
15.
Health Rep ; 30(12): 11-17, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851368

RESUMO

BACKGROUND: The routine measurement of population health status indicators like mortality is important to assess progress in the reduction of inequalities. Previous studies of mortality inequalities have relied on area-based measures of socioeconomic indicators. A new series of census-mortality linked datasets has been created in Canada to quantify mortality inequalities based on individual-level data and examine whether these inequalities have changed over time. DATA AND METHODS: This study used the 1991, 1996, 2001, 2006, and 2011 Canadian Census Health and Environment Cohorts (CanCHECs) with five years of mortality follow-up. It estimated age-standardized mortality rates by sex according to income quintile and highest level of educational attainment categories for the household population aged 25 or older. Absolute and relative measures of mortality inequality were also estimated. RESULTS: Men had a greater reduction in mortality rates over time compared with women, regardless of income or education level. Absolute income-related mortality inequality decreased for men but increased for women over time, while relative income-related inequality increased for both sexes. Education-related mortality inequality for women followed the same pattern as income, though the absolute mortality difference for men remained roughly unchanged over the period. DISCUSSION: Mortality inequalities by income and education persist in Canada, and have increased for women. Further research to determine the mechanisms underlying these trends could help address the complex challenge of reducing health inequalities in Canada.


Assuntos
Escolaridade , Características da Família , Renda , Mortalidade/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Censos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos
16.
Health Rep ; 30(12): 18-26, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851369

RESUMO

The Canadian Census Health and Environment Cohorts (CanCHECs) are population-based linked datasets of the household population at the time of census collection. The CanCHECs combine data from respondents to the long-form census or the National Household Survey between 1991 and 2011 with administrative health data (e.g., mortality, cancer incidence, hospitalizations, emergency ambulatory care) and annual mailing address postal codes. The CanCHEC datasets are rich national data resources that can be used to measure and examine health inequalities across socioeconomic and ethnocultural dimensions for different periods and locations. These datasets can also be used to examine the effects of exposure to environmental factors on human health. Because of their large size, the CanCHECs are an excellent resource for examining rare health outcomes and small population groups. They are ideally suited for environmental health research because of their geographic coverage across all regions of Canada, their long follow-up periods and their linkage to annual postal code history.


Assuntos
Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Neoplasias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos , Canadá/epidemiologia , Censos , Criança , Pré-Escolar , Estudos de Coortes , Conjuntos de Dados como Assunto , Serviços Médicos de Emergência , Feminino , Hospitalização , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Neoplasias/epidemiologia , Fatores Socioeconômicos , Análise Espacial , Adulto Jovem
17.
Environ Health Perspect ; 127(10): 107008, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31638837

RESUMO

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.


Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Mortalidade/tendências , Material Particulado , Poluentes Atmosféricos , Canadá/epidemiologia , Censos , Estudos de Coortes , Humanos , Dióxido de Nitrogênio , Ozônio , Modelos de Riscos Proporcionais
18.
Environ Health ; 18(1): 84, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601202

RESUMO

BACKGROUND: Approximately 2.9 million deaths are attributed to ambient fine particle air pollution around the world each year (PM2.5). In general, cohort studies of mortality and outdoor PM2.5 concentrations have limited information on individuals exposed to low levels of PM2.5 as well as covariates such as smoking behaviours, alcohol consumption, and diet which may confound relationships with mortality. This study provides an updated and extended analysis of the Canadian Community Health Survey-Mortality cohort: a population-based cohort with detailed PM2.5 exposure data and information on a number of important individual-level behavioural risk factors. We also used this rich dataset to provide insight into the shape of the concentration-response curve for mortality at low levels of PM2.5. METHODS: Respondents to the Canadian Community Health Survey from 2000 to 2012 were linked by postal code history from 1981 to 2016 to high resolution PM2.5 exposure estimates, and mortality incidence to 2016. Cox proportional hazard models were used to estimate the relationship between non-accidental mortality and ambient PM2.5 concentrations (measured as a three-year average with a one-year lag) adjusted for socio-economic, behavioural, and time-varying contextual covariates. RESULTS: In total, 50,700 deaths from non-accidental causes occurred in the cohort over the follow-up period. Annual average ambient PM2.5 concentrations were low (i.e. 5.9 µg/m3, s.d. 2.0) and each 10 µg/m3 increase in exposure was associated with an increase in non-accidental mortality (HR = 1.11; 95% CI 1.04-1.18). Adjustment for behavioural covariates did not materially change this relationship. We estimated a supra-linear concentration-response curve extending to concentrations below 2 µg/m3 using a shape constrained health impact function. Mortality risks associated with exposure to PM2.5 were increased for males, those under age 65, and non-immigrants. Hazard ratios for PM2.5 and mortality were attenuated when gaseous pollutants were included in models. CONCLUSIONS: Outdoor PM2.5 concentrations were associated with non-accidental mortality and adjusting for individual-level behavioural covariates did not materially change this relationship. The concentration-response curve was supra-linear with increased mortality risks extending to low outdoor PM2.5 concentrations.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Doenças Cardiovasculares/mortalidade , Exposição Ambiental/efeitos adversos , Material Particulado/efeitos adversos , Doenças Respiratórias/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar/estatística & dados numéricos , Canadá/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Saúde Pública , Medição de Risco
19.
Health Rep ; 30(9): 3-13, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31532538

RESUMO

BACKGROUND: Walkability is positively associated with physical activity in adults. Walkability is more consistently associated with walking for transportation than recreational walking. The purpose of this study is to examine how the association between walkable neighbourhoods and physical activity varies by age and type of physical activity using a new Canadian walkability database. DATA AND METHODS: The 2016 Canadian Active Living Environments (Can-ALE) database was attached to two cross-sectional health surveys: the Canadian Health Measures Survey (CHMS; 2009 to 2015) and the Canadian Community Health Survey (CCHS; 2015 to 2016). Physical activity was measured in the CHMS using the Actical accelerometer (n = 10,987; ages 3 to 79). Unorganized physical activity outside of school among children aged 3 to 11 was reported by parents in the CHMS (n = 4,030), and physical activity data by type (recreational, transportation-based, school-based, and household and occupational) was self-reported by respondents in the CCHS (n = 105,876; ages 12 and older). RESULTS: Walkability was positively associated with accelerometer-measured moderate-to-vigorous physical activity in youth (p < 0.05), younger adults (p < 0.0001) and older adults (p < 0.05), while walkability was negatively associated with light physical activity in youth (ages 12 to 17) and older adults (ages 60 to 79) (p < 0.05). Walkability was positively associated with self-reported transportation-based physical activity in youth (p < 0.001) and adults of all ages (p < 0.0001). Walkability was negatively associated with parent-reported unorganized physical activity of children aged 5 to 11, and children living in the most walkable neighbourhoods accumulated 10 minutes of physical activity less-on average-than those living in the least walkable neighbourhoods. DISCUSSION: The results of this study are consistent with previous studies indicating that walkability is more strongly associated with physical activity in adults than in children and that walkability is associated with transportation-based physical activity. Walkability is one of many built environment factors that may influence physical activity. More research is needed to identify and understand the built environment factors associated with physical activity in children and with recreational or leisure-time physical activity.


Assuntos
Planejamento Ambiental , Recreação , Características de Residência , Transportes , Caminhada , Adolescente , Adulto , Fatores Etários , Idoso , Canadá , Criança , Pré-Escolar , Estudos Transversais , Exercício Físico , Feminino , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Instituições Acadêmicas , Autorrelato , Trabalho , Adulto Jovem
20.
Health Rep ; 30(9): 14-24, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31532539

RESUMO

BACKGROUND: Two-thirds of Canadian adults and one-third of Canadian children and youth are overweight or obese. There is increased interest in identifying features of the built environment-such as walkability-that facilitate lifestyle habits associated with reduced obesity and improved health. The purpose of this study is to examine how the associations between walkability and both obesity and self-rated health vary by age in Canadians using a new walkability dataset. DATA AND METHODS: The 2016 Canadian Active Living Environments (Can-ALE) database was attached to Canadian Health Measures Survey (CHMS; 2009 to 2015) data. Moderate-to-vigorous physical activity (MVPA), light physical activity (LPA) and step counts were measured in the CHMS using the Actical accelerometer (n = 10,852; ages 3 to 79). Body mass index (BMI) and waist circumference were measured in a mobile clinic. Self-rated general and mental health were assessed using a questionnaire. RESULTS: The percentage of adults aged 40 to 59 classified as overweight or obese was 28 percentage points lower in the most walkable Can-ALE category than in the least walkable category (49.1% vs. 77.5%, p < 0.0125). There was a significant downward linear trend in measured BMI and waist circumference across Can-ALE categories (from least to most walkable) for adults aged 18 to 59, but not for children and youth or older adults aged 60 to 79. MVPA was a significant mediating factor in the association between the Can-ALE index and BMI in adults aged 40 to 79 (and in the waist circumference of respondents aged 40 to 59). Young adults (aged 18 to 39) were more likely than older adults (aged 60 to 79) to report very good or excellent general health as walkability increased. DISCUSSION: Using a new and freely-available Canadian walkability index, this study observed a positive association between walkability and both measured obesity and self-rated general health in adults. Walkability is one of many built environment characteristics that should be considered when trying to understand the relative contribution of the built environment to a person's weight and overall health.


Assuntos
Planejamento Ambiental , Nível de Saúde , Obesidade/prevenção & controle , Características de Residência , Caminhada , Adolescente , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Canadá , Criança , Pré-Escolar , Autoavaliação Diagnóstica , Feminino , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Sobrepeso , Circunferência da Cintura , Adulto Jovem
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