Utility gains from reductions in the modifiable burden of lung cancer attributable to residential radon in Canada

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.

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Correspondence to Janet Gaskin.

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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

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Keywords

  • Radon
  • Exposure mitigation
  • Lung cancer
  • Quality-adjusted life years
  • Life tables

Mots-clés

  • Radon
  • Exposition domestique
  • Cancer du poumon
  • Années de vie ajustées sur la qualité
  • Tables de survie