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Peters & Tjepkema (2011) Proceedings of Statistics Canada Symposium 2010 Social Statistics: The Interplay among Censuses, Surveys and Administrative Data 1991-2011 Canadian Census Mortality and Cancer Follow-Up Study Paul A. Peters and Michael Tjepkema1 Abstract Census mortality linkages are proven to be powerful tools for analysing the mortality differences for numerous population groups. In an recently approved record linkage, the 1991 Census of Population, Canadian Mortality Database, and Canadian Cancer Database will be linked in order to examine cancer incidence and causes of death in conjunction with socio-demographic and neighbourhood characteristics. The linkage of the 1991 Census cohort to these databases will allow for the analysis of mortality using the CMDB in conjunction with the extensive information from the 1991 Census of Population long-forms (2B and 2D), the recording of individual mobility over time using postal codes of tax filers from the Tax Summary Files, and the inclusion of important analysis of cancer morbidity via the CCDB. This presentation overviews the previous census mortality linkage, describe the new linkage, outline the linkage process, and present some initial linkage results. Key Words: Census; Health; Mortality; Cancer; Data Linkage. 1. Introduction This paper describes the development of and preliminary results from the linkage of the 1991 Canadian Census 2B (long form) with the Canadian Mortality Database (CMDB), Canadian Cancer Database (CCDB), and annual Tax Summary Files (TSF) (record linkage number 052-2009). This linkage is an expansion and extension of the earlier 1991-2001 Canadian Census Mortality Follow-Up Study (Wilkins et. al., 2008). The linkage of the 1991 Census cohort to these three databases allows for the analysis of mortality using the CMDB in conjunction with the extensive information from the 1991 Census, the recording of individual mobility over time, and the inclusion of important analysis of cancer morbidity. The primary purpose of this expansion and extension is to assess the impact of long-term exposure to air pollution on human health, with the objective of informing the development of Canada-wide standards for key criteria air pollutants. The specific objectives of this expanded linkage are first, to determine whether mortality from all causes combined, from ischaemic heart disease, from cardiopulmonary disease, from respiratory cancer, and from all cancers combined are associated with long-term exposure to ambient air pollutants. Second, to determine whether there are air pollution risks for cancer incidence and the risks for specific types of cancer. Third, to extend the 10- year follow-up on the 1991 Census cohort in order to examine cancer incidence and causes of death in conjunction with socio-demographic, disability, and neighbourhood characteristics over an additional 10-year period. There is a recognised need for more environmental data related to human exposure, with linkages of separate sources of information identified as an important way in which Statistics Canada can meet identified data gaps (Statistics Canada, 2008). In particular, findings from a recent health-environment expert panel report noted that it is critical to investigate the health of Canadians who live, work, or are educated near sources of pollution. This linkage request addresses these key recommendations with the development of a significant baseline cohort that could be used to evaluate the risk factors of environmental exposure on human health outcomes. 1Paul A. Peters, Health Analysis Division, RHC-24M, 100 Tunney’s Pasture Driveway, Ottawa, ON, Canada, K1A 0T6 ([email protected]); Michael Tjepkema, Health Analysis Division, RHC-24Q, 100 Tunney’s Pasture Driveway, Ottawa, ON, Canada, K1A 0T6 ([email protected]) 1 2. Background and Purpose 2.1 Background The 1991-2001 Census Mortality Follow-Up Study forms the basis for the current expanded linkage. The 1991-2001 linkage created a cohort of individuals with the goal of producing indicators of mortality for monitoring health disparities across regions and among socio-economic groups, Aboriginal peoples, and immigrant groups in Canada (record linkage number 012-2001). The linkage included the 1991 Census of population (long forms), 1991 Health and Activity Limitation Survey (HALS), the 1990 and 1991 TSF, and mortality data between 1991 and 2001 from the CMDB. The 1991-2001 linkage yielded a cohort of approximately 15% of the Canadian non-institutional resident population age 25 and older in 1991. This sample of 2,735,152 Census respondents was first linked via probabilistic record linkage to the 1990 and 1991 T1 personal tax files, matching date of birth, sex, marital status and postal code on the Census and tax files to obtain a name from the TSF to use in the linkage to death registrations in the CMDB from 1991 to 2001. To preserve respondent anonymity, names were encrypted on the T1 and the CMDB prior to linkage. The Social Insurance Number (SIN) from the tax file was not used in the linkage and only tax deaths and emigration from the TSF were put into the analysis file and used to calculate person-years at risk. The intention of original linkage of the 1991 Census cohort to mortality was to create a set of baseline indicators of mortality, in order to monitor health disparities in the Canadian population. Initial work on the health effects of ambient air pollution using the existing linked analysis file is underway via a joint project of Statistics Canada and Health Canada researchers. However, there are several limitations to the 1991 Census cohort linked file. First, it does not include place of residence information for respondents on an annual basis after the 1991 Census. This information is required in studies of air pollution, to measure the residential mobility of the population, as air pollution is known to vary significantly at the local level (Jerrett et. al., 2009). Second, the analysis file is limited in scope given the number of deaths which occurred in this cohort (260,820 deaths from 1991 to 2001). A larger number of deaths are required in order to obtain sufficient statistical power to accurately measure the long-term effects of air pollution (Krewski et. al. 2009). As such, in order to examine the effect of air pollution on the risk of mortality and cancer incidence a longer follow-up period is required. Third, the existing linkage does not include the CCDB, so no information is available on cancer incidence in this cohort. Few studies have examined the risks of long-term exposure to ambient air pollution on cancer incidence and mortality. In particular, the proposed linkage to the CCDB will allow for analysis of cancer incidence rather than only deaths due to cancer. 2.2 Purpose The primary purpose for the expanded linkage is to provide a cohesive dataset for analyzing the health effects of long-term exposure to air pollution on Canadians. A secondary use of the linked data base will be to examine the relationship of socio-demographic and neighbourhood characteristics to cancer incidence and causes of death. Extension of the 1991 Census cohort follow-up linkage will allow for a substantial increase in the number of deaths over the longer time period, and the expansion of the linkage to annual tax data will result in a reduction in potential misclassification of exposure to air pollution. Since air pollution mortality risks are small, on the order of 10% increased risk over the exposure range seen in Canada, a large cohort size is required to obtain sufficient statistical power to detect such effects. The mortality follow-up on the 1991 Census cohort to 2011 is expected to more than double the number of deaths included in the estimates of years of life lost. This additional power will allow for the identification and analysis of susceptible population sub-groups who may have different levels of risk. Regional risk estimates can also be calculated and potential factors identified that correspond to different levels of risk between geographic regions. 2 In addition, there has been a considerable improvement in the monitoring of air pollution since 2000. New techniques of measuring exposure using satellite imagery or land-use regression modelling allow for significantly- improved estimates of exposure. The combination of these methods with the large cohort included in the linked database allows for a wider geographic coverage for exposure estimates and the ability to link information on a greater number of individuals to air pollution estimates. A key component of this linkage is the inclusion of place of residence from the Tax Summary Files, permitting the recording of Census respondents’ post-censal mobility. This is important because exposure to ambient air pollution is assigned based on the respondent’s place of residence. Research in Canada has shown that air pollution risks vary at the local level (Burnett et. al. 1998). Thus, detailed place of residence information is required to accurately attribute exposure values to individuals. Research in the US has shown that air pollution-related mortality risks vary widely across that country (Krewski et. al. 2009). Thus, estimates of regional risk in Canada are also expected to have substantial variation. The TSF provide a means of obtaining the six-digit postal code of Census respondents on an annual basis after 1991. 2.3 Benefits / Public Good It is now widely recognized that exposure to outdoor air pollution generated from combustion sources poses a public health risk to Canadians (Koranteng et. al., 2007; Samoli et. al., 2008). However, much of the scientific evidence is focussed on linking short-term or acute exposure to the exacerbation of health problems. For example, exposure to elevated daily outdoor concentrations of combustion-related pollution, such as ground level ozone and fine particulate matter, have been linked to increased asthma symptoms (Burra et. al., 2009), visits to emergency departments for heart, lung, and circulatory problems (Szyszkowskz, 2008; Szyszkowskz et.
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