Iowa radon leukaemia study: a hierarchical population risk model for spatially correlated exposure measured with error

Domestic radon exposure and childhood cancer risk by site and sex in 727 counties in the United States, 2001-2018

BACKGROUND

Childhood cancer has few established risk factors and environmental influences are underexplored. This ecologic study investigated the association between domestic radon exposure and childhood cancer risk in a large sample of United States (U.S.) counties.

METHODS

Monthly ZIP code-level basement radon estimates from a geographic machine learning model were aggregated annually to counties, analyzed as continuous and dichotomized (cut point: 74 Bq/cubic meter (Bq/m3) or 2.0 picocuries/L (pCi/L)) versions, and lagged by one year. Annual county-level counts of sex- and site-specific (all, leukemia, brain and central nervous system [CNS], and other sites) incident cancer diagnoses among those 0-19 years from 2001 to 2018 were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program database. Sex- and site-specific counts were modeled as zero-inflated Poisson distributions in a Bayesian spatiotemporal framework and sequentially adjusted for random and fixed confounder effects.

RESULTS

In 727 counties across 14 states, the average population aged 0-19 years was 41,599 people at baseline. Results from fully adjusted spatiotemporal statistical models indicated 1.05 (95% credible interval, CrI: 1.00, 1.09) times higher relative risks (RRs) of leukemia among both sexes and a RR of 1.06 (95%CrI: 1.00, 1.12) in males from a 50 Bq/m3 (1.35 pCi/L) increase in radon concentration the year prior. For radon exposures ≥74 Bq/m3 (2.00 pCi/L) the year prior, RRs were 1.08 (95%CrI: 1.02, 1.15) for both sexes and 1.12 (95%CrI: 1.04, 1.22) for females. No associations were found with other cancer sites or sexes from prior year radon exposures.

CONCLUSIONS

County-level childhood leukemia risk in both sexes were associated with average radon levels below U.S. Environmental Protection Agency guidelines recommending mitigation (148 Bq/m3 or 4.00 pCi/L). These findings warrant further investigation using population-based and individual-level study designs.

Radon exposure and potential health effects other than lung cancer: a systematic review and meta-analysis

Context and objective

To date, lung cancer is the only well-established health effect associated with radon exposure in humans. To summarize available evidence on other potential health effects of radon exposure, we performed a comprehensive qualitative and quantitative synthesis of the available literature on radon exposure and health effects other than lung cancer, in both occupational and general populations.

Method

Eligible studies published from January 1990 to March 2023, in English and French languages, were identified in PubMed, ScienceDirect, Scopus, ScieLo and HAL. In the meta-analysis, we estimated average weighted standardized incidence ratios (metaSIR), standardized mortality ratios (metaSMR), and risk ratio (metaRR) per 100 unit (Bq/m3 or Working level Month) increase in radon exposure concentration by combining estimates from the eligible studies using the random-effect inverse variance method. DerSimonian & Laird estimator was used to estimate the between-study variance. For each health outcome, analyses were performed separately for mine workers, children, and adults in the general population.

Results

A total of 129 studies were included in the systematic review and 40 distinct studies in the meta-analysis. For most of these health outcomes, the results of the meta-analyses showed no statistically significant association, and heterogeneity was only present among occupational studies, especially between those included in the metaSIR or metaSMR analyses. However, the estimated exposure-risk associations were positive and close to the statistical significance threshold for: lymphohematological cancer incidence in children (metaRR = 1.01; 95%CI: 1.00-1.03; p = 0.08); malignant melanoma mortality among adults in the general population (metaRR = 1.10; 95%CI: 0.99-1.21; p = 0.07); liver cancer mortality among mine workers (metaRR = 1.04; 95%CI: 1.00-1.10; p = 0.06); intestine and rectal cancer mortality combined among mine workers (metaRR = 1.02; 95%CI: 1.00-1.04; p = 0.06).

Conclusion

Although none of the exposure-risk associations estimated in the meta-analyses reached statistical significance, the hypothesis that radon may have other health effects apart from lung cancer could not be ruled-out and call for additional research. Larger and well-designed studies are needed to further investigate this question.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023474542, ID: CRD42023474542.

Dynamic Bayesian networks for prediction of health status and treatment effect in patients with chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is the most common blood cancer in adults. The course of CLL and patients' response to treatment are varied. This variability makes it difficult to select the most appropriate treatment regimen and predict the progression of the disease. This work was aimed at developing and validating dynamic Bayesian networks (DBNs) to predict changes of the health status of patients with CLL and progression of the disease over time. Two DBNs were developed and implemented i.e. Health Status Network (HSN) and Treatment Effect Network (TEN). Based on the literature data and expert knowledge we identified relationships linking the most important factors influencing the health status and treatment effects in patients with CLL. The developed networks, and in particular TEN, were able to predict probability of survival in patients with CLL, which was in line with the survival data collected in large medical registries. The networks can be used to personalize the predictions, taking into account a priori knowledge concerning a particular patient with CLL. The proposed approach can serve as a basis for the development of artificial intelligence systems that facilitate the choice of treatment that maximizes the chances of survival in patients with CLL.

Imputation by feature importance (IBFI): A methodology to envelop machine learning method for imputing missing patterns in time series data

A new methodology, imputation by feature importance (IBFI), is studied that can be applied to any machine learning method to efficiently fill in any missing or irregularly sampled data. It applies to data missing completely at random (MCAR), missing not at random (MNAR), and missing at random (MAR). IBFI utilizes the feature importance and iteratively imputes missing values using any base learning algorithm. For this work, IBFI is tested on soil radon gas concentration (SRGC) data. XGBoost is used as the learning algorithm and missing data are simulated using R for different missingness scenarios. IBFI is based on the physically meaningful assumption that SRGC depends upon environmental parameters such as temperature and relative humidity. This assumption leads to a model obtained from the complete multivariate series where the controls are available by taking the attribute of interest as a response variable. IBFI is tested against other frequently used imputation methods, namely mean, median, mode, predictive mean matching (PMM), and hot-deck procedures. The performance of the different imputation methods was assessed using root mean squared error (RMSE), mean squared log error (MSLE), mean absolute percentage error (MAPE), percent bias (PB), and mean squared error (MSE) statistics. The imputation process requires more attention when multiple variables are missing in different samples, resulting in challenges to machine learning methods because some controls are missing. IBFI appears to have an advantage in such circumstances. For testing IBFI, Radon Time Series Data (RTS) has been used and data was collected from 1st March 2017 to the 11th of May 2018, including 4 seismic activities that have taken place during the data collection time.

A Novel Strategy for the Assessment of Radon Risk Based on Indicators

Among the physical pollutants affecting indoor air, the radioactive gas radon may turn out to be the most hazardous. Health effects related to radon exposure have been investigated for several decades, providing major scientific evidence to conclude that chronic exposures can cause lung cancer. Additionally, an association with other diseases, such as leukemia and cancers of the extra-thoracic airways, has been advanced. The implementation of a strategy to reduce the exposure of the population and minimize the health risk, according to the European Directive 59/2013/Euratom on ionizing radiations, is a new challenge in public health management. Starting from an understanding of the general state-of-the-art, a critical analysis of existing approaches has been conducted, identifying strengths and weaknesses. Then, a strategy for assessing the radon exposure of the general population, in a new comprehensive way, is proposed. It identifies three main areas of intervention and provides a list of hazard indicators and operative solutions to control human exposure. The strategy has been conceived to provide a supporting tool to authorities in the introduction of effective measures to assess population health risks due to radon exposure.

Radon-222: environmental behavior and impact to (human and non-human) biota

As an inert radioactive gas, ²²²Rn could be easily transported to the atmosphere via emanation, migration, or exhalation. Research measurements pointed out that ²²²Rn activity concentration changes during the winter and summer months, as well as during wet and dry season periods. Changes in radon concentration can affect the atmospheric electric field. At the boundary layer near the ground, short-lived daughters of ²²²Rn can be used as natural tracers in the atmosphere. In this work, factors controlling ²²²Rn pathways in the environment and its levels in soil gas and outdoor air are summarized. ²²²Rn has a short half-life of 3.82 days, but the dose rate due to radon and its radioactive progeny could be significant to the living beings. Epidemiological studies on humans pointed out that up to 14% of lung cancers are induced by exposure to low and moderate concentrations of radon. Animals that breed in ground holes have been exposed to the higher doses due to radiation present in soil air. During the years, different dose-effect models are developed for risk assessment on human and non-human biota. In this work are reviewed research results of ²²²Rn exposure of human and non-human biota.

Radon-The Element of Risk. The Impact of Radon Exposure on Human Health

Lung cancer is a heterogeneous group of diseases with multifactorial aetiology. Smoking has been undeniably recognized as the main aetiological factor in lung cancer, but it should be emphasized that it is not the only factor. It is worth noting that a number of nonsmokers also develop this disease. Radon exposure is the second greatest risk factor for lung cancer among smokers-after smoking-and the first one for nonsmokers. The knowledge about this element amongst specialist oncologists and pulmonologists seems to be very superficial. We discuss the impact of radon on human health, with particular emphasis on respiratory diseases, including lung cancer. A better understanding of the problem will increase the chance of reducing the impact of radon exposure on public health and may contribute to more effective prevention of a number of lung diseases.

Contextual effects and cancer outcomes in the United States: a systematic review of characteristics in multilevel analyses

PURPOSE

There is increasing call for the utilization of multilevel modeling to explore the relationship between place-based contextual effects and cancer outcomes in the United States. To gain a better understanding of how contextual factors are being considered, we performed a systematic review.

METHODS

We reviewed studies published between January 1, 2002 and December 31, 2016 and assessed the following attributes: (1) contextual considerations such as geographic scale and contextual factors used; (2) methods used to quantify contextual factors; and (3) cancer type and outcomes. We searched PubMed, Scopus, and Web of Science and initially identified 1060 studies. One hundred twenty-two studies remained after exclusions.

RESULTS

Most studies utilized a two-level structure; census tracts were the most commonly used geographic scale. Socioeconomic factors, health care access, racial/ethnic factors, and rural-urban status were the most common contextual factors addressed in multilevel models. Breast and colorectal cancers were the most common cancer types, and screening and staging were the most common outcomes assessed in these studies.

CONCLUSIONS

Opportunities for future research include deriving contextual factors using more rigorous approaches, considering cross-classified structures and cross-level interactions, and using multilevel modeling to explore understudied cancers and outcomes.

County level incidence rates of chronic lymphocytic leukemia are associated with residential radon levels

Aim:

We previously reported that incidence rates for chronic lymphocytic leukemia (CLL) among US states are significantly correlated with levels of residential radon (RR). Because these correlations could be influenced by confounding and/or misclassification among large geographic units, we reinvestigated them using smaller geographic units that better reflect exposure and disease at the individual level.

Methods:

We examined the relationships between CLL and RR per county in 478 counties with publicly-available data.

Results:

After adjustment for ultraviolet radiation, a possible risk factor for CLL, county rates for CLL and RR were significantly correlated among males and females both together and separately (p < 0.0001).

Conclusion:

CLL is significantly associated with RR at the county level.

Residential radon exposure and risk of incident hematologic malignancies in the Cancer Prevention Study-II Nutrition Cohort

Dosimetric models show that radon, an established cause of lung cancer, delivers a non-negligible dose of alpha radiation to the bone marrow, as well as to lymphocytes in the tracheobronchial epithelium, and therefore could be related to risk of hematologic cancers. Studies of radon and hematologic cancer risk, however, have produced inconsistent results. To date there is no published prospective, population-based study of residential radon exposure and hematologic malignancy incidence. We used data from the American Cancer Society Cancer Prevention Study-II Nutrition Cohort established in 1992, to examine the association between county-level residential radon exposure and risk of hematologic cancer. The analytic cohort included 140,652 participants (66,572 men, 74,080 women) among which 3019 incident hematologic cancer cases (1711 men, 1308 women) were identified during 19 years of follow-up. Cox proportional hazard regression was used to calculate multivariable-adjusted hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for radon exposure and hematologic cancer risk. Women living in counties with the highest mean radon concentrations (>148Bq/m(3)) had a statistically significant higher risk of hematologic cancer compared to those living in counties with the lowest (<74Bq/m(3)) radon levels (HR=1.63, 95% CI:1.23-2.18), and there was evidence of a dose-response relationship (HRcontinuous=1.38, 95% CI:1.15-1.65 per 100Bq/m(3); p-trend=0.001). There was no association between county-level radon and hematologic cancer risk among men. The findings of this large, prospective study suggest residential radon may be a risk factor for lymphoid malignancies among women. Further study is needed to confirm these findings.

Spatial measurement errors in the field of spatial epidemiology

Background

Spatial epidemiology has been aided by advances in geographic information systems, remote sensing, global positioning systems and the development of new statistical methodologies specifically designed for such data. Given the growing popularity of these studies, we sought to review and analyze the types of spatial measurement errors commonly encountered during spatial epidemiological analysis of spatial data.

Methods

Google Scholar, Medline, and Scopus databases were searched using a broad set of terms for papers indexed by a term indicating location (space or geography or location or position) and measurement error (measurement error or measurement inaccuracy or misclassification or uncertainty): we reviewed all papers appearing before December 20, 2014. These papers and their citations were reviewed to identify the relevance to our review.

Results

We were able to define and classify spatial measurement errors into four groups: (1) pure spatial location measurement errors, including both non-instrumental errors (multiple addresses, geocoding errors, outcome aggregations, and covariate aggregation) and instrumental errors; (2) location-based outcome measurement error (purely outcome measurement errors and missing outcome measurements); (3) location-based covariate measurement errors (address proxies); and (4) Covariate-Outcome spatial misaligned measurement errors. We propose how these four classes of errors can be unified within an integrated theoretical model and possible solutions were discussed.

Conclusion

Spatial measurement errors are ubiquitous threat to the validity of spatial epidemiological studies. We propose a systematic framework for understanding the various mechanisms which generate spatial measurement errors and present practical examples of such errors.

Incidence rates of chronic lymphocytic leukemia in US states are associated with residential radon levels

Aim: Environmental risk factors for chronic lymphocytic leukemia (CLL) have not been consistently identified. An etiologic role for ionizing radiation in CLL is controversial. Because most of the ionizing radiation to which individuals are exposed comes from radon at home, we examined CLL incidence rates in relation to residential radon levels. Methods: We used population-based rates for CLL for US states from 2007 to 2011 and measurements of residential radon made by the US Environmental Protection Agency. Results: Incidence rates for CLL were significantly correlated with residential radon levels among whites (both genders together and each gender separately; p < 0.005) and among blacks (p < 0.05). Conclusion: We speculate that radon increases CLL risk and that the mechanisms may be similar to those by which radon causes lung cancer.

Effective Dose of Radon 222 Bottled Water in Different Age Groups Humans: Bandar Abbas City, Iran

Radon 222 is a natural radioactive element with a half-life of 3.8 days. It is odorless and colorless as well as water-soluble. Consuming waters which contain high concentration of 222Rn would increase the effective dose received by different age groups. It would also be followed by an increased prevalence of cancer. In this research, 72 samples of the most commonly used bottled water in Bandar Abbas were collected in 3 consecutive months, May, June and July of 2013. Concentration 222Rn of was measured by radon-meter model RTM166-2. The effective dose received by the 4 age groups, male and female adults as well as children and infants was estimated using the equation proposed by UNSCEAR. The results revealed that the mean and range concentration of 222Rn in bottled waters were 641±9 Bq/m3 and 0-901 Bq/m3, respectively. The mean concentration of 222Rn in the well-known Marks followed this Zam Zam>Bishe>Koohrng>Dassani>Christal>Polour>Damavand>Sivan. Infants were observed to receive a higher effective dose than children. The highest and lowest effective dose received was found to belong to male adults and children, respectively.

Hierarchical modeling of indoor radon concentration: how much do geology and building factors matter?

Radon is a natural gas known to be the main contributor to natural background radiation exposure and only second to smoking as major leading cause of lung cancer. The main concern is in indoor environments where the gas tends to accumulate and can reach high concentrations. The primary contributor of this gas into the building is from the soil although architectonic characteristics, such as building materials, can largely affect concentration values. Understanding the factors affecting the concentration in dwellings and workplaces is important both in prevention, when the construction of a new building is being planned, and in mitigation when the amount of Radon detected inside a building is too high. In this paper we investigate how several factors, such as geologic typologies of the soil and a range of building characteristics, impact on indoor concentration focusing, in particular, on how concentration changes as a function of the floor level. Adopting a mixed effects model to account for the hierarchical nature of the data, we also quantify the extent to which such measurable factors manage to explain the variability of indoor radon concentration.

ESTIMATING DAILY NITROGEN DIOXIDE LEVEL: EXPLORING TRAFFIC EFFECTS

Data used to assess acute health effects from air pollution typically have good temporal but poor spatial resolution or the opposite. A modified longitudinal model was developed that sought to improve resolution in both domains by bringing together data from three sources to estimate daily levels of nitrogen dioxide (NO₂) at a geographic location. Monthly NO₂ measurements at 316 sites were made available by the Study of Traffic, Air quality and Respiratory health (STAR). Four US Environmental Protection Agency monitoring stations have hourly measurements of NO₂. Finally, the Connecticut Department of Transportation provides data on traffic density on major roadways, a primary contributor to NO₂ pollution. Inclusion of a traffic variable improved performance of the model, and it provides a method for estimating exposure at points that do not have direct measurements of the outcome. This approach can be used to estimate daily variation in levels of NO₂ over a region.

Bayesian spatial modeling of disease risk in relation to multivariate environmental risk fields

The relationship between exposure to environmental chemicals during pregnancy and early childhood development is an important issue that has a spatial risk component. In this context, we have examined mental retardation and developmental delay (MRDD) outcome measures for children in a Medicaid population in South Carolina and sampled measures of soil chemistry (e.g. As, Hg, etc.) on a network of sites that are misaligned to the outcome residential addresses during pregnancy. The true chemical concentration at the residential addresses is not observed directly and must be interpolated from soil samples. In this study, we have developed a Bayesian joint model that interpolates soil chemical fields and estimates the associated MRDD risk simultaneously. Having multiple spatial fields to interpolate, we have considered a low-rank Kriging method for the interpolation that requires less computation than the Bayesian Kriging. We performed a sensitivity analysis for a bivariate smoothing, changing the number of knots and the smoothing parameter. These analyses show that a low-rank Kriging method can be used as an alternative to a full-rank Kriging, reducing the computational burden. However, the number of knots for the low-rank Kriging model needs to be selected with caution as a bivariate surface estimation can be sensitive to the choice of the number of knots.

Bibliography. Current world literature

This bibliography is compiled by clinicians from the journals listed at the end of this publication. It is based on literature entered into our database between 1 November 2007 and 31 October 2008 (articles are generally added to the database about two and a half months after publication). In addition, the bibliography contains every paper annotated by reviewers; these references were obtained from a variety of bibliographic databases and published between the beginning of the review period and the time of going to press. The bibliography has been grouped into topics that relate to the reviews in this issue.

Health effects of radon: a review of the literature

PURPOSE

Radon is natural radioactive noble gas that can be found in soil, water, outdoor and indoor air. Exposure to radon accounts for more that 50% of the annual effective dose of natural radioactivity. The purpose of the current review is to summarize recent literature and evaluate the weight of evidence on the adverse health effects of radon.

CONCLUSIONS

Radon is an established human lung carcinogen based on human epidemiological data supported by experimental evidence of mutagenesis studies in cell culture and laboratory animals. Extrapolation from cohort studies on miners suggested that radon is the second leading cause of lung cancer death after tobacco smoke. The majority of studies on the relationship between radon and other types of cancers showed weak or no association. Low levels of radon can be found in drinking water; however, radon released during water usage adds small quantities to indoor radon concentration. Studies showed that the risk of stomach cancer and other gastrointestinal malignancies from radon in drinking water is small. Studies of the genetic and cytogenetic effects of indoor radon yielded equivocal results; while radon exposure in miners induces gene mutations and chromosomal aberrations. Numerous in vitro cytogenetic studies demonstrated that radon induces different types of genetic and cytogenetic damage that is likely to play a role in radon lung carcinogenesis.