E. J. Holowaty and P. BrownDivision of Preventive Oncology
Cancer Care OntarioDec 8, 2006.
The Ontario Health and Environment Information
System (OHEIS)P.E.I. Potato farms a hotbed of cancer debate
From The Cancer Blog, Mar 27, 2006.
Breast cancer more likely in farm workers:
From CTV News Oct 12, 2006.
From the UK Black From the UK Black Enquiry, 1984Enquiry, 1984
Small Area Health Statistics Small Area Health Statistics Unit and the Rapid Inquiry Unit and the Rapid Inquiry
Facility (RIF)Facility (RIF)
Spatial mapping and risk assessmentSpatial mapping and risk assessment Funding proposal submitted to Funding proposal submitted to
GeoConnectionsGeoConnections Modeled on EUROHEIS in European Union and Modeled on EUROHEIS in European Union and
Natl Environmental PUBLIC Health Tracking Natl Environmental PUBLIC Health Tracking Network in USANetwork in USA
Starting point for further R&D at CCOStarting point for further R&D at CCO Spatio-temporal modelsSpatio-temporal models Continuous spatial variationContinuous spatial variation Screening and mortalityScreening and mortality
Surveillance QuestionSurveillance Question
Do known population characteristics Do known population characteristics (RFs, SES, demographics) fully (RFs, SES, demographics) fully explain cancer incidence, orexplain cancer incidence, or– Is the variability between areas higher Is the variability between areas higher
than we would expect if each area had than we would expect if each area had an identical cancer risk?an identical cancer risk?
– Do neighbouring areas tend to have Do neighbouring areas tend to have similar cancer incidence rates?similar cancer incidence rates?
A Spatial ModelA Spatial Model
Maps and Exceedence ProbabilitiesMaps and Exceedence Probabilities
Aim of OHEIS ProjectAim of OHEIS Project To design, implement and test an enhanced spatial To design, implement and test an enhanced spatial
surveillance system to improve our understanding of the surveillance system to improve our understanding of the association between environmental exposures, health association between environmental exposures, health outcomes and confounding risk factors.outcomes and confounding risk factors.
Integrated information systems (GIS) for mapping and risk Integrated information systems (GIS) for mapping and risk ass’tass’t
Rapid assessment (3-6 mos. <1 week)Rapid assessment (3-6 mos. <1 week)
Scientifically sound, robust, understandable and transparentScientifically sound, robust, understandable and transparent
Easily export data to more sophisticated spatial analysis Easily export data to more sophisticated spatial analysis systems – WINBugs; SATScansystems – WINBugs; SATScan
To deploy data, software and/or results to PH partners thru To deploy data, software and/or results to PH partners thru web-based portal and/or stand-alone, secure PC application.web-based portal and/or stand-alone, secure PC application.
Environmental andgeographic data
Roads, Railways,Rivers
Road TrafficChemical Release
Radiation release or exposure
Locations of refineries, incinerators, dumps
Water supplies
Oracle/Access, GIS
CancerDeathsBirthsHospital admissionsCongenital anomaliesStillbirths and perinatal deaths
Healtheventdata
Oracle/Access
Censusdata
(1976,1981,1986,1991,1996, 2001)
DeprivationCensus geographyArea classification
Oracle/Access, GIS
PostcodeEA, CT
Link dataPostcode – EA/DAStreet Address - EACSD, CD boundaries…. etc.. ….
Vectors, polygons
Integrated Information Integrated Information SystemsSystems
airbornewaterbornefoodbornesoil
Pathway Analysisand
Exposure Modelling
Name?Street addressPostal codeMunicipality
Historic Pop’nFiles
SmokingScreening
Confounders
A Study of the Association Between A Study of the Association Between Cancer Rates and TCE Ground Water Cancer Rates and TCE Ground Water
ContaminationContaminationin Communities Surrounding Hill Air Force in Communities Surrounding Hill Air Force
Base, Utah from 1973 - 2001Base, Utah from 1973 - 2001
Exposure DataExposure Data
Graphic plume boundariesGraphic plume boundaries– 5-10 ug/l TCE 5-10 ug/l TCE – 2001-2002 sampling 2001-2002 sampling
periodperiod
Limited pathway dataLimited pathway data– Indoor air intrusionIndoor air intrusion– Plant samplingPlant sampling
Exposed population : UtahExposed population : Utah
Select Shape Files, Popn Centroids Select Shape Files, Popn Centroids and Test for Homogeneityand Test for Homogeneity
Tests for Homogeneity and Linear Tests for Homogeneity and Linear TrendTrend
Routine Tabular OutputRoutine Tabular Output
Time Advantage of Utah Time Advantage of Utah testtest
Export FunctionalityExport Functionality
Next Steps Next Steps
Feasibility Phase 3 mos.Feasibility Phase 3 mos. Privacy issues; public and stakeholder Privacy issues; public and stakeholder
acceptability - Users surveys; Focus acceptability - Users surveys; Focus groups; groups; privacy impact ass’tprivacy impact ass’t
Preparation of detailed scientific protocolPreparation of detailed scientific protocol Submission to GeoConnectionsSubmission to GeoConnections External scientific reviewExternal scientific review REB ReviewREB Review
Next StepsNext Steps
Feasibility Phase 3 mos.Feasibility Phase 3 mos. DB design; software acquisitionDB design; software acquisition Creation of “test” cohort and comparison Creation of “test” cohort and comparison
cohortcohort Develop record linkage strategiesDevelop record linkage strategies Review of methods of Pathway Analysis and Review of methods of Pathway Analysis and
exposure estimation - point/line/area sourceexposure estimation - point/line/area source Statistical issues - minimizing random var.; Statistical issues - minimizing random var.;
adjusted estimates; multilevel, multivar. adjusted estimates; multilevel, multivar. ModellingModelling
Next StepsNext Steps
Implementation and Implementation and EnhancementsEnhancements
– 4 mos.4 mos.
Testing and DeploymentTesting and Deployment– 6-7 mos6-7 mos
Final ReportFinal Report– 1-2 mos1-2 mos