Abstract
Research question
The objective of this analysis is to estimate the modifiable burden of disease according to the annual number of lung cancer deaths prevented and the associated period gain in quality-adjusted life years (QALYs) for the 2012 populations in Canada from reductions in residential radon exposures.
Interventions
Two postulated interventions for residential radon mitigation in new construction are assessed, corresponding to a 50% reduction and an 85% reduction in radon nationally, in the provinces/territories, and in 17 census metropolitan areas in Canada.
Methods
Data were derived from two recent Canadian radon surveys conducted by the Radiation Protection Bureau, Health Canada, along with Canadian mortality and quality of life data. Analyses adopted a lifetime horizon and a discount rate of 1.5%. A period life-table analysis was conducted using age- and sex-specific all-cause and lung cancer mortality rates, adjusted for smoking, and the BEIR VI exposure-age-concentration model for radon-attributable risk of lung cancer mortality.
Results
A reduction in residential radon by 50% could prevent 681 lung cancer deaths, associated with a gain of 15,445 QALYs in the Canadian population at a discount rate of 1.5%; a reduction in radon by 85% could prevent 1263 lung cancer deaths, associated with a gain of 26,336 QALYs. On a per population basis, the Yukon was estimated to benefit most from radon mitigation.
Conclusion
The magnitude of QALY gains in Canada estimated under the two radon mitigation scenarios is appreciable but varies considerably across provinces due to variability in indoor radon concentrations and smoking rates.
Résumé
Objectif
Cette analyse a pour objectif d’estimer la charge modifiable des maladies en tant que le nombre évitable de décès de cancer du poumon attribué au radon et l’accroissement des années de vie ajustées sur la qualité (AVAQ, que l’anglais appelle QALY) à la suite des réductions potentielles de l’exposition au radon subie par la population du Canada en 2012.
Interventions
Les effets de deux interventions qui pourraient être intégrées dans la construction de tous nouveaux logements pour réduire l’exposition au radon domestique, qui correspondraient à des réductions de 50 % et de 85 %, sont estimés pour la population du Canada, de chaque province et territoire, et de 17 régions métropolitaines de recensement.
Méthode
Les données relevées par deux enquêtes récentes mesurant la concentration de radon domestique menées par le Bureau de la protection contre les rayonnements des produits cliniques et de consommation de Santé Canada, ainsi que les données pour le taux de mortalité et la qualité de vie selon le groupe d’âge et le sexe fournies par Statistique Canada. L’analyse adopte l’horizon temporal de la vie entière et la valeur des années futures est actualisée à un taux de 1,5 %. L’analyse des tables de survie par période repose sur les tables de mortalité toutes causes et du cancer du poumon selon le sexe et le groupe d’âge, portant sur les fumeurs, les non-fumeurs et agrégées, et le modèle âge-période-concentration proposé par le BEIR VI pour le risque de mortalité par cancer de poumon attribuable au radon.
Résultats
681 décès par cancer du poumon pourraient être évités par une réduction de radon domestique de 50 %, ce qui entraîne un accroissement de 15 445 AVAQ pour la population du Canada à un taux de 1,5 % pour la valeur des années futures; 1263 décès par cancer du poumon pourraient être évités par une réduction de radon domestique de 85 %, ce qui entraîne un accroissement de 26 336 AVAQ. La réduction de radon domestique fournit les meilleurs avantages par habitant pour le Yukon.
Conclusion
L’ampleur des gains en AVAQ à la suite des réductions potentielles de l’exposition au radon domestique pour la population du Canada est. appréciable, et montre une variation considérable parmi les provinces et les régions métropolitaines de recensement, selon la distribution de radon domestique et le taux de tabagisme.
Similar content being viewed by others
References
Al-arydah, M. (2017). Population attributable risk associated with lung cancer induced by residential radon in Canada: Sensitivity to relative risk model and radon probability density function choices: In memory of Professor Jan M. Zielinski. Sci Total Environ, 596–597, 331–341. https://doi.org/10.1016/j.scitotenv.2017.04.067.
Al-arydah, M. (2018). Estimating the burden of lung cancer and the efficiency of home radon mitigation systems in some Canadian provinces. Sci Total Environ, 626, 287–306. https://doi.org/10.1016/j.scitotenv.2018.01.028.
Andersen, C. E., Bergsøe, N. C., Brendstrup, J., Damkjær, A., Gravesen, P., & Ulbak, K. (1997). Radon-95 : En undersøgelse af metoder til reduktion af radonkoncentrationen i danske enfamiliehuse. Technical University of Denmark, Denmark. Forskningscenter Risoe. Risoe-R; Nr. 979(DA).
Angell, W. (2013). Radon control in new homes: A meta-analysis of 25 years of research. Am Assoc Radon Sci Technol 45.
Brand, K. P., Zielinski, J. M., & Krewski, D. (2005). Residential radon in Canada: An uncertainty analysis of population and individual lung cancer risk. Risk Anal, 25, 253–269. https://doi.org/10.1111/j.1539-6924.2005.00587.x.
Canadian Agency for Drugs and Technologies in Health (CADTH) (2011). CADTH Smoking Cessation Scientific Summary. Available: https://www.cadth.ca/media/pdf/CADTH_Smoking_Cessation_Scientific_Summary_e.pdf.
Canadian Agency for Drugs and Technologies in Health (CADTH) (2017). Guidelines for the Economic Evaluation of Health Technologies: Canada (4th Edition). Available: https://www.cadth.ca/sites/default/files/pdf/guidelines_for_the_economic_evaluation_of_health_technologies_canada_4th_ed.pdf.
Canadian Cancer Society, Statistics Canada, Public Health Agency of Canada, Provincial/Territorial Cancer Registries (2014). Canadian Cancer Statistics 2014. Can Cancer Stat. Available: https://www.cancer.ca/~/media/cancer.ca/CW/cancerinformation/cancer 101/Canadian cancer statistics/Canadian-Cancer-Statistics-2014%2D%2DEN.pdf.
Chen, J., Moir, D., & Whyte, J. (2012). Canadian population risk of radon induced lung cancer: A re-assessment based on the recent cross-Canada radon survey. Radiat Prot Dosim, 152, 9–13. https://doi.org/10.1093/rpd/ncs147.
Chen, J., Bergman, L., Falcomer, R., & Whyte, J. (2014). Results of simultaneous radon and Thoron measurements in 33 metropolitan areas of Canada. Radiat Prot Dosim, 163, 1–7. https://doi.org/10.1093/rpd/ncu141.
Conrath, S., & Pawel, D. (2013). Letter to the Editor: Lung cancer efforts need stronger emphasis on reducing radon. Am J Public Health, 103, e4. https://doi.org/10.2105/AJPH.2013.301436.
Coyle, D., Stieb, D., Burnett, R., Decivita, P., Krewski, D., Chen, Y., et al. (2003). Impact of particulate air pollution on quality-adjusted life expectancy in Canada. J Toxicol Environ Health A, 66, 1847–1863. https://doi.org/10.1080/15287390306447.
Dunn, B., & Cooper, K. (2014). Radon in indoor air: a review of policy and law in Canada. Toronto: Canadian Environmental Law Association. CELA Publication # 1008.
Evans, J., van Donkelaar, A., Martin, R. V., Burnett, R., Rainham, D. G., Birkett, N. J., et al. (2013). Estimates of global mortality attributable to particulate air pollution using satellite imagery. Environ Res, 120, 33–42. https://doi.org/10.1016/j.envres.2012.08.005.
Gray, A., Read, S., McGale, P., & Darby, S. (2009). Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them. BMJ, 338, a3110. https://doi.org/10.1136/bmj.a3110.
Health Canada (2012). Cross-Canada survey of radon concentrations in homes—Final report. Available: http://www.hc-sc.gc.ca/ewh-semt/radiation/radon/survey-sondage-eng.php.
Health Canada (2016). Summary report on active soil depressurization (ASD) field study. Available: https://www.canada.ca/en/health-canada/services/environmental-workplace-health/radiation/radon/summary-report-active-soil-depressurization-field-study.html.
Howlader N, Noone A, Krapcho M, Neyman N, Aminou R, Waldron W, et al. (2012). SEER Cancer statistics review 1975–2009.
IHME (2013). GBD PROFILE : CANADA 2010. Available: http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_canada.pdf.
Jaswal A. (2013). Valuing health in Canada: Who, how, and how much? Canada 2020 Analytical Commentary. Available: http://canada2020.ca/wp-content/uploads/2013/06/Canada-2020-Analytical-Commentary-No-3-Valuing-Health-in-Canada-FINAL.pdf.
Kenfield, S. A., Stampfer, M. J., Rosner, B. A., & Colditz, G. A. (2008). Smoking and smoking cessation in relation to mortality in women. JAMA, 299, 2037–2047. https://doi.org/10.1001/jama.299.17.2037.
Krewski, D., Rai, S. N., Zielinski, J. M., & Hopke, P. K. (1999). Characterization of uncertainty and variability in residential radon cancer risks. Annals of the New York Academy of Sciences, 895, 245–272.
National Research Council (1999). Health effects of exposure to radon: BEIR VI. Washington, DC: National Academies Press.
Pesch, B., Kendzia, B., Gustavsson, P., Jöckel, K., Johnen, G., Pohlabeln, H., et al. (2012). Cigarette smoking and lung cancer—Relative risk estimates for the major histological types from a pooled analysis of case-control studies. Int J Cancer, 131, 1210–1219. https://doi.org/10.1002/ijc.27339.Cigarette.
Peterson, E., Aker, A., Kim, J., Li, Y., Brand, K., & Copes, R. (2013). Lung cancer risk from radon in Ontario, Canada: How many lung cancers can we prevent? Cancer Causes Control, 24, 2013–2020. https://doi.org/10.1007/s10552-013-0278-x.
Rose, G. (2008). The population strategy of prevention. In Rose’s strategy of preventive medicine (p. 192). New York: Oxford University Press.
Simkin, J., Woods, R., & Elliott, C. (2017). Cancer mortality in Yukon 1999–2013: Elevated mortality rates and a unique cancer profile. International Journal of Circumpolar Health, 76, 9. https://doi.org/10.1080/22423982.2017.1324231.
Statistics Canada (2010). Canadian Community Health Survey (CCHS) 2009–2010: derived variables. 199 pages. Available: http://www23.statcan.gc.ca/imdb-bmdi/pub/document/3226_D71_T9_V1-eng.pdf. Accessed 10 Aug 2017.
Statistics Canada (2011a). Estimates of population by census metropolitan area, sex and age group for July 1, based on the Standard Geographical Classification (SGC) 2011. Table 051–0056. Available: http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=0510056&&pattern=&stByVal=1&p1=1&p2=37&tabMode=dataTable&csid=.
Statistics Canada (2011b). National Household Survey: Structural type of dwelling. Available: http://www12.statcan.gc.ca/nhs-enm/2011/dp-pd/dt-td/Ap-eng.cfm?LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GID=0&GK=0&GRP=0&PID=106699&PRID=0&PTYPE=105277&S=0&SHOWALL=0&SUB=0&Temporal=2013&THEME=98&VID=0&VNAMEE=&VNAMEF=.
Statistics Canada (2012a). Deaths and mortality rates, by age group and sex, Canada, provinces and territories. Table 102–0504. Available: http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=1020504.
Statistics Canada (2012b). Estimates of population, by age group and sex for July 1, Canada, provinces and territories. Table 051–0001. Available: http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=0510001&&pattern=&stByVal=1&p1=1&p2=37&tabMode=dataTable&csid [accessed 10 August 2017].
Statistics Canada (2012c). New cases of primary cancer (based on the July 2016 CCR tabulation file), by cancer type, age group and sex, Canada, provinces and territories. Table 103-0550. Available: http://www5.statcan.gc.ca/cansim/a26?lang=eng&id=1030550.
Statistics Canada (2013). Health indicator profile, two year period estimates, by age group and sex, Canada, provinces, territories, health regions (2013 boundaries) and peer groups. Table 105–0502. Available: http://www5.statcan.gc.ca/cansim/a26?lang=eng&retrLang=eng&id=1050502&pattern=&csid=.
Thun, M. J., Myers, D. G., Day-Lally, C., Namboodiri, M. M., Calle, E. E., Flanders, W. D., et al. (1997). Age and the exposure–response relationships between cigarette smoking and premature death in Cancer Prevention Study II. Smoking and Tobacco Control Monograph No 8. NIH Publication No. 97-4213. Bethesda: National Institutes of Health.
Villeneuve, P., & Mao, Y. (1994). Lifetime probability of developing lung cancer, by smoking status, Canada. Canadian Journal of Public Health, 85, 385–388.
Woolliscroft, M., Scivyer, C., & Parkins, L. (1994). Field trials on the effectiveness of radon protection measures in new dwellings. Radiation Protection Dosimetry, 56, 33–40.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gaskin, J., Coyle, D., Whyte, J. et al. Utility gains from reductions in the modifiable burden of lung cancer attributable to residential radon in Canada. Can J Public Health 109, 598–609 (2018). https://doi.org/10.17269/s41997-018-0119-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/s41997-018-0119-5