Inka Milewski Conservation Council of New Brunswick

Identifying at-risk communities for action on cancer prevention: a case study in New Brunswick (Canada) communities

Inka MilewskiConservation Council of New Brunswick

CRDCN 2012 National Conference: Evidence-based Policy Formation and Evaluation Fredericton, New Brunswick October 23, 2012

What do we know about cancer rates in Canadian communities?

• Guernsey et al 2000▫ Sydney, Nova Scotia▫ higher rates of breast and cervical cancer than provincial rates ▫ higher rate of colon, rectum and prostate cancer among men than

provincial rates• Holowaty et al. 2010

- Ontario public health unit (Wellington-Dufferin-Guelph)- highest rate of lung cancer in urban core area of Guelph- highest rate of prostate cancer in the Orangeville area

• Colquhoun et al. 2010▫ First Nations community of Fort Chipewyan, Alberta▫ higher rates of cervical and biliary tract, other and unspecified

cancers than all First Nations in Alberta and Alberta general population

Study Design• 9 rural and 5 urban

communities • 6 primary cancers for

males (prostate, lung, colorectal, bladder, NHL, kidney)

• 4 primary cancers for females (breast, lung, colorectal, NHL)

• age-unadjusted cancer incidence rates per 100,000 population (1989-2005) with 95%Cl

• Community SES measures (education, poverty rate, income, unemployment)

Statistical Analysis•Multivariate ordination (MDS) to plot

similarities in cancer incidence among communities

•Hierarchical cluster analysis to identify possible clusters and permutation testing (SIMPROF) to test the significance of clusters

•Permutation testing (RELATE) to test the correlation of SES pattern and cancer incidence

Non-metric multidimensional scaling (MDS) plot of similarities in male and female age unadjusted cancer incidence rates among 5 urban (■) and 9 rural (▼) communities

Saint John

Fredericton

Moncton

Dalhousie MiramichiBathurst

Caraquet

Edmundston

BelleduneUpperMiramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Saint John

Fredericton

MonctonDalhousie

Miramichi

Bathurst

CaraquetEdmundston

Belledune

UpperMiramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.05Males Females

p < 0.001

p < 0.001

Saint John

MonctonFredericton

Dalhousie

Miramichi

Bathurst

Caraquet

Edmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

MDS plot of similarities in socioeconomic status (SES) among among 5 urban (■) and 9 rural (▼) communities New Brunswick communities

Saint John

MonctonFredericton

Dalhousie

Miramichi

Bathurst

Caraquet

Edmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Saint John

FrederictonMoncton

DalhousieMiramichi

Bathurst

Caraquet

Edmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Saint John

Fredericton

MonctonDalhousie Miramichi

Bathurst CaraquetEdmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.05

ρ = 0.041 females

Correlation between cancer rates and SES factors

ρ = - 0.071 males

Similarities in Male Lung Cancer Incidence lung

82

118

154

190

Saint John

FrederictonMoncton

DalhousieMiramichi

Bathurst

Caraquet

Edmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Similarities in Prostate Cancer Incidenceprostate

95

140

185

230

Saint John

FrederictonMoncton

DalhousieMiramichi

Bathurst

Caraquet

Edmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Similarities in Male Colorectal Cancer Incidencecolorectal

48.5

74

99.5

125

Saint John

FrederictonMoncton

DalhousieMiramichi

Bathurst

Caraquet

Edmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Similarities in Female Lung Cancer Incidencelung

32.5

55

77.5

100

Saint John

Fredericton



Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.05

Similarities in Female Colorectal Cancer Incidencecolorectal

41.5

61

80.5

100

Saint John

Fredericton



Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.05

Similarities in Breast Cancer Incidencebreast

75

105

135

165

Saint John

Fredericton



Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.05

Similarities in SESUnemployment rate

9.8

18.2

26.6

35

Saint John

MonctonFredericton

Dalhousie

Miramichi

Bathurst

CaraquetEdmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Similarities in SES% low income families

6.5

11

15.5

20

Saint John

MonctonFredericton

Dalhousie

Miramichi

Bathurst

CaraquetEdmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Similarities in SESMedian family income all households

3.53E4

3.92E4

4.31E4

4.7E4

Saint John

MonctonFredericton

Dalhousie

Miramichi

Bathurst

CaraquetEdmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

Similarities in SES% with university degree

5.2

11.8

18.4

25

Saint John

MonctonFredericton

Dalhousie

Miramichi

Bathurst

CaraquetEdmundston

Belledune

Upper Miramichi

Minto

Drummond-Denmark

Gagetown

Harvey

2D Stress: 0.04

1991 1996 2001 20050

20

40

60

80

100

120

140

160

Figure 2. Male Lung Cancer Rates: Age-standardized incidence rates per 100,000 populaton for 1991, 1996, 2001 and 2005.

Saint JohnFrederictonMonctonProvincialNational

1991 1996 2001 20050

10

20

30

40

50

60

70

80

90

100

Figure 4. Female Lung Cancer Rates: Age-standardized in-cidence rates for 1991, 1996, 2001 and 2005

Saint JohnFrederictonMonctonProvincialNational

Age-standardized vs age-unadjusted Cancer Rates

Milewski and Liu 2009

1994/951996/97

1998/992000/01 2003 2005

0

5

10

15

20

25

30

35

40Figure 17. Male smoking rates for current daily or occasional smokers

(1994-2005)

New BrunswickCanadaHealth Region 1 (includes Moncton)Health Region 2 (includes Saint John)Health Region 3 (includes Frederic-ton)Saint John Census Metropolitan Area (CMA)

Data sources: Statistic Canada National Population Health Surveys and Canadian Community Health Surveys

%

0

5

10

15

20

25

30

35

Figure 18. Female smoking rates for current daily or occasional smokers (1994-2005)

New Brunswick

Canada

Health Region 1 (includes Monc-ton)

Health Region 2 (includes Saint John)

Health Region 3 (includes Freder-icton)

Saint John Census Metropolitan Area (CMA)

Data sources: Statistics Canada National Population Health Surveys and Canadian Community Health Surveys

%


1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 20050

10,00020,000

30,000

40,000

50,00060,000

70,000

Figure 20. Atmospheric release of carcinogens (in kilograms per year) from industrial sources (1995-2005)

Saint JohnMoncton Fredericton

Data Source: Environment Canada's National Pollutant Release Inventory and Pol -lutionWatch

1991 1996 2001 20060

5

10

15

20

25

30

Saint JohnMoncton Fredericton

Data Sources: Statistics Canada Community Census Profiles for 1991, 1996, 2001 and 2006

%

Figure 20. Percentage of the male workforce employed in trades (welding, electrical, machining, construction) transportation sector and heavy equipment operation.


•Rates of cancer differed significantly among New Brunswick communities and were unrelated to SES

•Reporting data at the right spatial scale is key to avoiding policy mismatches

•Identifying at-risk communities can result in the development of more appropriate risk reduction and prevention programs

Conclusions

Acknowledgments

• Lilly Liu, CCNB research assistant • EJLB Foundation• Salamander Foundation• New Brunswick Cancer Network• Statistics Canada

Documents

Inka Milewski Conservation Council of New Brunswick