Modeling joint exposures and health outcomes for cumulative risk assessment: the case of radon and smoking.
Community-based cumulative risk assessment requires characterization of exposures to multiple chemical and non-chemical stressors, with consideration of how the non-chemical stressors may influence risks from chemical stressors. Residential radon provides an interesting case example, given its large attributable risk, effect modification due to smoking, and significant variability in radon concentrations and smoking patterns. In spite of this fact, no study to date has estimated geographic and sociodemographic patterns of both radon and smoking in a manner that would allow for inclusion of radon in community-based cumulative risk assessment. In this study, we apply multi-level regression models to explain variability in radon based on housing characteristics and geological variables, and construct a regression model predicting housing characteristics using U.S. Census data. Multi-level regression models of smoking based on predictors common to the housing model allow us to link the exposures. We estimate county-average lifetime lung cancer risks from radon ranging from 0.15 to 1.8 in 100, with high-risk clusters in areas and for subpopulations with high predicted radon and smoking rates. Our findings demonstrate the viability of screening-level assessment to characterize patterns of lung cancer risk from radon, with an approach that can be generalized to multiple chemical and non-chemical stressors.
Harvard School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02215, USA. tchahine@post.harvard.edu
Teresa
T
Chahine
Bradley D
BD
Schultz
Valerie G
VG
Zartarian
Jianping
J
Xue
S V
SV
Subramanian
Jonathan I
JI
Levy
D000396:Air Pollutants, Radioactive / Q000032:analysis / Q000633:toxicity; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000009:adverse effects / Q000032:analysis / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D011886:Radon / Q000032:analysis* / Q000633:toxicity; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
D000396:Air Pollutants, Radioactive; D011886:Radon