Potential Increased Risk of Ischemic Heart Disease Mortality With Significant Dose Fractionation in the Canadian Fluoroscopy Cohort Study

• Published in: American journal of epidemiology Vol. 179; no. 1; pp. 120 - 131
• Main Authors: Zablotska, Lydia B., Little, Mark P., Cornett, R. Jack
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 01.01.2014; Oxford Publishing Limited (England)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Canada - epidemiology; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cause of Death; Child; Child, Preschool; Coronary heart disease; Dose Fractionation; Dose-Response Relationship, Radiation; Epidemiology; Female; Fluoroscopy - adverse effects; Follow-Up Studies; Fractionation; General aspects; Heart; Human exposure; Humans; Infant; Infant, Newborn; Ionizing radiation; Male; Medical sciences; Middle Aged; Miscellaneous; Mortality; Mycobacterium; Myocardial Ischemia - epidemiology; Myocardial Ischemia - etiology; Myocardial Ischemia - mortality; Occupational exposure; Occupational health; Original Contributions; Poisson distribution; Public health. Hygiene; Public health. Hygiene-occupational medicine; Radiation; Radiation Dosage; Radiation, Ionizing; Regression analysis; Risk Factors; Tuberculosis - diagnostic imaging; Tuberculosis - epidemiology; Young Adult; Canada; North America; America; ischemic heart disease; noncancer diseases; cardiovascular disease; radiation dose-response relationship; dose fractionation; ionizing radiation; Radiodiagnosis; Disease; Mortality; Radioscopy; Myocardial ischemia; Cardiovascular disease; Risk; Myocardial disease; Coronary heart disease; Epidemiology; Fractionated dose; Dose activity relation; Vascular disease; Radiation dose; Ionizing radiation; Cohort study; Risk factor; Public health
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kwt244

Risks of noncancer causes of death, particularly cardiovascular disease, associated with exposures to high-dose ionizing radiation, are well known. Recent studies have reported excess risk in workers who are occupationally exposed to low doses at a low dose rate, but the risks of moderately fractionated exposures, such as occur during diagnostic radiation procedures, remain unclear. The Canadian Fluoroscopy Cohort Study includes 63,707 tuberculosis patients exposed to multiple fluoroscopic procedures in 1930–1952 and followed-up for death from noncancer causes in 1950–1987. We used a Poisson regression to estimate excess relative risk (ERR) per Gy of cumulative radiation dose to the lung (mean dose = 0.79 Gy; range, 0–11.60). The risk of death from noncancer causes was significantly lower in these subjects compared with the Canadian general population (P < 0.001). We estimated small, nonsignificant increases in the risk of death from noncancer causes with dose. We estimated an ERR/Gy of 0.176 (95% confidence interval: 0.011, 0.393) (n = 5,818 deaths) for ischemic heart disease (IHD) after adjustment for dose fractionation. A significant (P = 0.022) inverse dose fractionation effect in dose trends of IHD was observed, with the highest estimate of ERR/Gy for those with the fewest fluoroscopic procedures per year. Radiation-related risks of IHD decreased significantly with increasing time since first exposure and age at first exposure (both P < 0.05). This is the largest study of patients exposed to moderately fractionated low-to-moderate doses of radiation, and it provides additional evidence of increased radiation-associated risks of death from IHD, in particular, significantly increased radiation risks from doses similar to those from diagnostic radiation procedures. The novel finding of a significant inverse dose-fractionation association in IHD mortality requires further investigation.