Publications by authors named "Robyn Hocking"

5 Publications

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Systematic review and meta-analysis of cohort studies of long term outdoor nitrogen dioxide exposure and mortality.

PLoS One 2021 4;16(2):e0246451. Epub 2021 Feb 4.

Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.

Objective: To determine whether long term exposure to outdoor nitrogen dioxide (NO2) is associated with all-cause or cause-specific mortality.

Methods: MEDLINE, Embase, CENTRAL, Global Health and Toxline databases were searched using terms developed by a librarian. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Conflicts were resolved through consensus and/or involvement of a third reviewer. Pooling of results across studies was conducted using random effects models, heterogeneity among included studies was assessed using Cochran's Q and I2 measures, and sources of heterogeneity were evaluated using meta-regression. Sensitivity of pooled estimates to individual studies was examined and publication bias was evaluated using Funnel plots, Begg's and Egger's tests, and trim and fill.

Results: Seventy-nine studies based on 47 cohorts, plus one set of pooled analyses of multiple European cohorts, met inclusion criteria. There was a consistently high degree of heterogeneity. After excluding studies with probably high or high risk of bias in the confounding domain (n = 12), pooled hazard ratios (HR) indicated that long term exposure to NO2 was significantly associated with mortality from all/ natural causes (pooled HR 1.047, 95% confidence interval (CI), 1.023-1.072 per 10 ppb), cardiovascular disease (pooled HR 1.058, 95%CI 1.026-1.091), lung cancer (pooled HR 1.083, 95%CI 1.041-1.126), respiratory disease (pooled HR 1.062, 95%CI1.035-1.089), and ischemic heart disease (pooled HR 1.111, 95%CI 1.079-1.144). Pooled estimates based on multi-pollutant models were consistently smaller than those from single pollutant models and mostly non-significant.

Conclusions: For all causes of death other than cerebrovascular disease, the overall quality of the evidence is moderate, and the strength of evidence is limited, while for cerebrovascular disease, overall quality is low and strength of evidence is inadequate. Important uncertainties remain, including potential confounding by co-pollutants or other concomitant exposures, and limited supporting mechanistic evidence. (PROSPERO registration number CRD42018084497).
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246451PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861378PMC
February 2021

Correction to: Systematic review and meta-analysis of case-crossover and time-series studies of short term outdoor nitrogen dioxide exposure and ischemic heart disease morbidity.

Environ Health 2020 Jul 24;19(1):85. Epub 2020 Jul 24.

Environmental Health Science and Research Bureau, Health Canada, 420-757 West Hastings St. - Federal Tower, Vancouver, BC, V6C 1A1, Canada.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12940-020-00636-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379805PMC
July 2020

Systematic review and meta-analysis of case-crossover and time-series studies of short term outdoor nitrogen dioxide exposure and ischemic heart disease morbidity.

Environ Health 2020 05 1;19(1):47. Epub 2020 May 1.

Environmental Health Science and Research Bureau, Health Canada, 420-757 West Hastings St. - Federal Tower, Vancouver, BC, V6C 1A1, Canada.

Background: Nitrogen dioxide (NO) is a pervasive urban pollutant originating primarily from vehicle emissions. Ischemic heart disease (IHD) is associated with a considerable public health burden worldwide, but whether NO exposure is causally related to IHD morbidity remains in question. Our objective was to determine whether short term exposure to outdoor NO is causally associated with IHD-related morbidity based on a synthesis of findings from case-crossover and time-series studies.

Methods: MEDLINE, Embase, CENTRAL, Global Health and Toxline databases were searched using terms developed by a librarian. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Conflicts between reviewers were resolved through consensus and/or involvement of a third reviewer. Pooling of results across studies was conducted using random effects models, heterogeneity among included studies was assessed using Cochran's Q and I measures, and sources of heterogeneity were evaluated using meta-regression. Sensitivity of pooled estimates to individual studies was examined using Leave One Out analysis and publication bias was evaluated using Funnel plots, Begg's and Egger's tests, and trim and fill.

Results: Thirty-eight case-crossover studies and 48 time-series studies were included in our analysis. NO was significantly associated with IHD morbidity (pooled odds ratio from case-crossover studies: 1.074 95% CI 1.052-1.097; pooled relative risk from time-series studies: 1.022 95% CI 1.016-1.029 per 10 ppb). Pooled estimates for case-crossover studies from Europe and North America were significantly lower than for studies conducted elsewhere. The high degree of heterogeneity among studies was only partially accounted for in meta-regression. There was evidence of publication bias, particularly for case-crossover studies. For both case-crossover and time-series studies, pooled estimates based on multi-pollutant models were smaller than those from single pollutant models, and those based on older populations were larger than those based on younger populations, but these differences were not statistically significant.

Conclusions: We concluded that there is a likely causal relationship between short term NO exposure and IHD-related morbidity, but important uncertainties remain, particularly related to the contribution of co-pollutants or other concomitant exposures, and the lack of supporting evidence from toxicological and controlled human studies.
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http://dx.doi.org/10.1186/s12940-020-00601-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195719PMC
May 2020

Human health effects of traffic-related air pollution (TRAP): a scoping review protocol.

Syst Rev 2019 08 29;8(1):223. Epub 2019 Aug 29.

Air Health Effects Assessment Division, Health Canada, 269 Laurier Ave W, Ottawa, ON, K1A 0K9, Canada.

Background: Traffic-related air pollution (TRAP) is one of the major sources of exposure in urban areas and has been associated with a wide range of adverse human health effects. Much of the Canadian population is regularly exposed to TRAP as a result of daily activities (e.g., commuting) and a significant portion of the population resides in close proximity to major roadways. The objective of this scoping review is to develop an evidence map of the epidemiological literature of the human health effects of exposure to TRAP, to support future reviews and assessments by Health Canada.

Methods: Literature searches will be conducted in Ovid EMBASE and Ovid MEDLINE database. DistillerSR will be used to manage the review process. Two reviewers will independently screen the studies in a two-part process (title and abstract; full text) for eligibility. Epidemiological studies and reviews will be included if they report on the human health effects of exposure to TRAP. Data collection will include study design parameters and human health outcomes evaluated in the study. A descriptive analysis will be used to provide a high-level summary of the number of studies evaluating the different types of health effects and cross-tabulations by study design parameters.

Discussion: The scoping review will be used to identify subject areas for more detailed review and evaluation of the human health effects of TRAP by the Air Health Effects Assessment Division of Health Canada.
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http://dx.doi.org/10.1186/s13643-019-1106-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714303PMC
August 2019

Using maps to communicate environmental exposures and health risks: Review and best-practice recommendations.

Environ Res 2019 09 31;176:108518. Epub 2019 May 31.

School of Mathematics and Statistics, Carleton University, Herzberg Building, Room 5413, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada. Electronic address:

Background: Graphical materials can be effective communication tools, and maps in particular are a potentially powerful means of conveying spatial information. Previous reviews have provided insights on the application of cartographic best practices, pitfalls to avoid, and considerations related to risk perception and communication, but none has reviewed primary studies of the effectiveness or utility of maps to users, nor have they addressed the issue from the perspective of health literacy, environmental health literacy, or public health ethics.

Objectives: To systematically identify and review the literature pertaining to evaluation of maps in general, or specific map features, as environmental exposure and health risk communication tools; to formulate best-practice recommendations; and to identify future research priorities.

Methods: A health science librarian searched the literature for commentaries, reviews, and primary studies. Titles, abstracts, and full-text papers were screened for inclusion, and details of methods and results were extracted from 4 reviews and commentaries and 18 primary studies. This was supplemented by one additional review and 13 additional primary studies pertaining to use of maps for communication about wildfires and floods. One additional paper was identified by reviewing reference lists of all relevant papers.

Results: and Discussion: While there are significant gaps in the evidence, we formulated best practice recommendations highlighting the perspectives of health literacy and environmental health literacy. Key recommendations include: understanding the map developer's societal role and mental model underlying map design; defining, understanding and iteratively engaging with map users; informing map design using key theoretical constructs; accounting for factors affecting risk perception; adhering to risk communication principles and cartographic best practices; and considering environmental justice and public health ethics implications. Recommendations for future research are also provided.
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http://dx.doi.org/10.1016/j.envres.2019.05.049DOI Listing
September 2019