An Introductory Lecture to

Environmental Epidemiology
Part 1. Introductory Examples.
Mark S. Goldberg
INRS-Institut Armand-Frappier, University of
Quebec, and McGill University

July 2000
The author
Dr. Mark Goldberg obtained his MSc in 1985
and his PhD in 1991 from McGill, both
degrees in epidemiology and biostatistics.
Dr. Goldberg is an associate professor at the
INRS-Institut Armand-Frappier, University of
Québec, and is adjunct professor at McGill
University. He currently holds a health
research scientist award from Health Canada.
His main interests are in occupational and
environmental epidemiology, including
cancer in textile manufacturing workers,
health effects of exposures from municipal
solid waste landfill sites, the relationship
between ionizing radiation and cancer and
reproductive outcomes, and the connection
between tobacco smoking and back pain.
Currently, he is conducting research into the short-
and long-term effects of air pollution,
environmental case-control studies of breast
cancer, and a study of waiting times for
treatment of breast cancer in Quebec. Dr.
Goldberg has published about 40 papers in
scientific peer-review journals, is the recipient
of research funds from a number of
organizations, and sits on a number of scientific
review panels.
Objectives
This is the first in a five-part series of an
introductory lecture on environmental
epidemiology. The goal of the lecture is to
provide the student with a basic understanding
of the elements of environmental epidemiology.
Throughout the lecture, examples from the
literature are used to illustrate the basic
methods. It is assumed that the student is
familiar with basic epidemiology and with
regression techniques.
 Environmental Epidemiology
The study of the determinants of the
distributions of disease that are exogenous
to and nonessential for the normal
functioning of human beings

 Adapted from Hertz-Piccioto (in Rothman and

Greenland, 1998)
Types of Environmental
Exposures
Point sources
Pollution from factories, municipal solid
waste sites
Line sources
EMF exposures from high tension power lines
Pollutants from internal combustion engines
around motorways
Area sources
Long-range transport of combustion
products from traffic
Volatile organic compounds contaminating
underground water reservoirs
Example: Cancer Rates Near a
Solid Waste Landfill Site
Ecological Analysis (Goldberg et al., Arch
Environ Health 1995;50:417-24):
Landfill site opened in 1968
100,000 persons lived within 2 km of the
site
In 1993, it contained about 36x106 Tons of
domestic, commercial, & industrial waste
Rates for men and women living in zones
around site 1981-1988
Zones defined by 3-character
postal codes (fairly large areas)
Putative “upwind” and
“downwind” zones
Putative “unexposed” zone far
from the site
The “High” zone surrounds the landfill site to
about 1 mile.
The “High A” zone is downwind and the “High
B” zone is upwind; because of the crude
geographic identifiers, there is a region directly
surrounding the site that is in both sub-zones.
The “Medium” zone is further away from the site
and exposure was likely to be very limited.
Map of the site showing the different exposure zones
Poisson regression adjusted for age and year,
by sex
Reference zones selected from the “unexposed”
areas to ensure similarities for:
average household income
proportion of immigrants
proportion first language was French
unemployment and poverty rates
Matching was not entirely successful, as some
key factors were dissimilar (e.g., percentage
of persons with an Italian family
background)
Analytic study(Goldberg et al., Arch Environ Health
1999;54:291-6)
Multi-site cancer case-control study of
occupation, men, 1979-85
Distance from site and by geographic
zones (at time of interview)
Logistic regression for each site of cancer,
adjusted for occupational and
nonoccupational risk factors
Age, family income, cigarette
smoking, alcohol consumption,
ethnicity, place of birth, body
mass index, consumption of
vitamins, occupational “salubrity”
 Relative Risks for Cancer

Ecologic analysis Case-control

Cancer site Geographic No. of RR 95% CI OR 95% CI
region cases
1
Stomach High 190 1.2 1.1-1.4 0.8 0.5-1.3
High-A 121 1.2 0.9-1.5 0.8 0.5-1.4
High-B 94 1.1 0.8-1.4 0.6 0.3-1.2

1
Liver and High 72 1.5 1.2-2.0
Intrahepatic High 72 1.3 0.9-1.8 1.8 0.8-4.3
bile ducts High-A 53 1.8 1.2-2.6 1.5 0.5-4.4
High-B 30 1.2 0.8-2.0 1.5 0.5-4.8

Prostate High 563 1.0 0.9-1.1 1.5 1.0-2.1

High-A 259 0.8 0.7-1.0 1.2 0.7-1.9
High-B 350 1.2 1.0-1.4 2.0 1.3-3.0
 Relative Risks for Liver Cancer from the
Case-control Analysis
Adjusted 95% Confidence
Exposure Number odds interval (p-value for
metric Categories of cases ratio* linear trend test)
Geographic Unexposed 24 1
zone Low 2 0.7 0.2-3.1
Medium 6 0.9 0.4-2.4
High 9 1.8 0.8-4.3
High-A 5 1.5 0.5-4.4
High-B 4 1.5 0.5-4.8

Distance (m) > 3000 28 1

1500-2999 7 1.3 0.6-3.2
<1500 6 2.1 0.8-5.3
Continuous 1.05 0.97-1.13 (0.219)
Conclusions
1) Slightly different results obtain using
different methodologies. Populations were
somewhat different, although there was an
overlap.
2) The results are inconclusive, except perhaps
for liver cancer. Vinyl chloride monomer is
one of the constituents of the biogas, and
this is an accepted liver carcinogen.
3) Further studies are needed at other landfill
sites. Results from such studies may be
difficult to generalize if the constituents of
the biogas differs and if exposure patterns
in populations vary considerably.
Another Ecological Example
The following example is a complex
longitudinal cohort study undertaken for the
purposes of determining whether air
pollution affects pulmonary function. The
analysis presented here is for mortality and
the comparison is between six cities in the
US. As in the preceding case-control study,
this study can be viewed as an ecological
study standardized for personal risk factors.
Example: Harvard Six-cities
Study (Dockery et al, NEJM 1993;329:1753-9)
Prospective cohort study of about 8,000 subjects
selected randomly from 6 US cities with
different levels of air pollution
Subjects followed every two years and lung
function and questionnaires administered
periodically
Ambient air exposures assessed from special
fixed-site monitoring stations (particles,
sulfates, gaseous pollutants)
Mortality analyses, comparing mean annual levels in
each city for years near start of followup
Assumed that subjects did not move during followup
and that the rank ordering of cities for levels of air
pollution was invariant of followup time
Stratified Cox proportional hazards models to
estimate cause-specific relative risks
Mortality rates by level of pollution by city and by pollutant
Estimates of Relative Rates of
Mortality, Comparing Most
Exposed to Least Exposed City
This analysis is a Cox regression analysis
comparing the most polluted city
(Steubenville) to the least polluted city
(Portage). The range of exposures for fine
particles is about 18.6 µg/m3. A wide range
of key risks factors were included in the
statistical model.
Results from Harvard Six-Cities Study: All-Cause Mortality Rates
Comparing Most Exposed to Least Exposed City (Fine Particles)
Comparing Steubenville to Portage
RR 95%CI
All causes of death 1.26 1.08-1.47
Lung cancer 1.37 0.81-2.31
Cardiopulmonary disease 1.37 1.11-1.68
All other causes 1.01 0.79-1.30

Range of exposure: 11-29.6 ug/m3

Adjusted for age, sex, smoking, alcohol, body-mass index, occupational exposures to dust, gases, and fumes.

Source: Dockery et al., N Engl J Med 1993; 329:1753-1759

References
Environmental Epidemiology
Hertz-Piccioto, I. “Environmental Epidemiology”, in
Rothman and Greenland: Modern Epidemiology,
Second edition, Lippincott-Raven Publishers,
1998, Philadelphia, Chapter 28, pages 555-583.