Utilizing residential histories to assess environmental exposure and socioeconomic status over the life course among mesothelioma patients

Our plain-English summary of Utilizing residential histories to assess environmental exposure and socioeconomic status over the life course among mesothelioma patients, by B. Liu, L. Niu, F.F. Lee (Journal of Thoracic Disease, 2023).

The study

• Authors: B. Liu, L. Niu, F.F. Lee
• Journal: Journal of Thoracic Disease
• Published: 2023;15(11):6126-6139
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Exposure misclassification based solely on the address at cancer diagnosis has been widely recognized though not commonly assessed.

Methods: We linked 1,015 mesothelioma cases diagnosed during 2011-2015 from the New York State Cancer Registry to inpatient claims and LexisNexis administrative data and constructed residential histories. Percentile ranking of exposure to ambient air toxics and socioeconomic status (SES) were based on the National Air Toxic Assessment and United States Census data, respectively. To facilitate comparisons over time, relative exposures (REs) were calculated by dividing the percentile ranking at individual census tract by the state-level average and subtracting one. We used generalized linear regression models to compare the RE in the past with that at cancer diagnosis, adjusting for patient-level characteristics.

Results: Approximately 43.7% of patients had residential information available for up to 30 years, and 96.0% up to 5 years. The median number of unique places lived was 4 [interquartile range (IQR), 2-6]. The time-weighted-average RE from all addresses available had a median of -0.11 (IQR, -0.50 to 0.30) for air toxics and -0.28 (IQR, -0.65 to 0.25) for SES. RE associated with air toxics (but not SES) was significantly higher for earlier addresses than addresses at cancer diagnosis for the 5-year [annual increase =1.24%; 95% confidence interval (CI): 0.71-1.77%; n=974] and 30-year (annual increase =0.36%; 95% CI: 0.25-0.48%; n=444) look-back windows, respectively.

Conclusions: Environmental exposure to non-asbestos air toxics among mesothelioma patients may be underestimated if based solely on the address at diagnosis. With geospatial data becoming more readily available, incorporating cancer patients' residential history would lead to reduced exposure misclassification and accurate health risk estimates.

2023 Journal of Thoracic Disease. All rights reserved.

In plain English

This retrospective case-only study looked at where 1,015 people diagnosed with mesothelioma in 2011–2015, recorded in the New York State Cancer Registry, had lived before diagnosis. The authors built residential histories from the registry, hospital claims and LexisNexis records. They then estimated each person's neighborhood exposure to non-asbestos air toxics, using the EPA's National Air Toxics Assessment, and neighborhood socioeconomic status. Both were expressed relative to the New York State average. The study did not measure asbestos exposure and had no comparison group of people without mesothelioma. Patients had lived at a median of 4 addresses. Air-toxics exposure tended to be higher at earlier addresses than at the diagnosis address. With each year further back, it was 1.24% higher (95% CI 0.71–1.77%) over a 5-year look-back (974 patients), and 0.36% higher (95% CI 0.25–0.48%) over a 30-year look-back (444 patients). The yearly trend in socioeconomic status was not statistically significant in any look-back window. The authors concluded that air-toxics exposure based only on the diagnosis address was underestimated, but that the effect size was relatively small. They noted their findings may be unique to these patients and that residential histories may be incomplete.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective observational case-only study using registry, hospital claims and commercial address data
• Who was studied: 1,015 mesothelioma cases diagnosed in 2011–2015 and recorded in the New York State Cancer Registry; 75.0% male, 91.4% White, median age at diagnosis 75
• Exposure: Neighborhood (census tract) exposure to non-asbestos air toxics, measured as modeled lifetime cancer risk from the National Air Toxics Assessment, and neighborhood socioeconomic status (Yost index). Each was expressed as a relative exposure compared with the New York State average. Asbestos exposure itself was not assessed.
• Main results:
  • Among all 1,015 patients, the median number of unique addresses lived at was 4 (IQR 2–6).
  • Residential history was available for 96.0% of patients (n=974) for 5 years before diagnosis and for 43.7% (n=444) for 30 years.
  • Across all addresses, the time-weighted average relative exposure had a median of −0.11 (IQR −0.50 to 0.30) for air toxics and −0.28 (IQR −0.65 to 0.25) for socioeconomic status.
  • Air-toxics relative exposure at the diagnosis census tract differed significantly from all six alternative measures based on residential history, but the effect size ranged from small (0.04) to moderate (0.50).
  • Air-toxics relative exposure was higher with each year further back before diagnosis: by 1.24% (95% CI 0.71–1.77%) in the 5-year look-back window (n=974) and by 0.36% (95% CI 0.25–0.48%) in the 30-year window (n=444). The authors cautioned that the two figures should not be directly compared because the sample sizes differ.
  • Yearly differences in socioeconomic relative exposure were not statistically significant in any of the five look-back windows.
  • Air-toxics exposure in years before diagnosis was no more than 15% higher than in the diagnosis year.
• The authors' conclusion: The authors concluded that assessing non-asbestos air-toxics exposure from the diagnosis address alone underestimated exposure among these mesothelioma patients, and that the misclassification grew further back in time. Overall, they found the effect size of the misclassification relatively small.
• Limitations the authors state:
  • The findings may apply only to the mesothelioma patients studied.
  • Residential histories may be incomplete because of how organizations and companies collect address data.
  • Exposure assessment was limited by the time periods and geographic detail of the available exposure data.
  • A relative rather than an absolute measure of exposure was used.
  • The Yost index may not fully capture neighborhood socioeconomic status.
  • The study had a case-only design, with no comparison group.

Topics

Medical terms in this study, explained in our Lexicon: Environmental Exposure, Mesothelioma, Cancer Registry, confidence interval.

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