and Environmental H ealth Research Howard Hu MD MPH ScD Career on a slide Boston City Hospital Internal Medicine 19821985 19852005 Full Professor with Tenure Parents immigrate from Shanghai amp Beijing 1946 ID: 783451
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Slide1
Recent Advances in Occupational and Environmental Health ResearchHoward Hu MD MPH ScD
Slide2Career on a slide…
Boston City Hospital:
Internal Medicine, 1982-1985
1985-2005: Full Professor with Tenure
Parents immigrate from Shanghai & Beijing 1946
Born in New York City
Brown University
Albert Einstein Medical SchoolShipyards & Public Health
Summers of ’73,’74: shipyards
2006-2012 Department Chair, U Michigan…
Dean
July 2012
Slide3Our heritagehttp://www.youtube.com/watch?v=AdC0efvJXRQ
The
Dalla
Lana
School of Public Health
Slide42008: Recreated
2013: Became Full Faculty
2014: Merged with Institute for Health Policy, Management & Evaluation
2014: Created
Waakabinesse-Bryce Institute for Health with $10M Dan Family gift2015: Merging with Joint Centre for Bioethics
Slide5OutlineThe micro: understanding the “true” footprint of occupational & environmental risk factors on healthAdvances in molecular epidemiology, exposure science, “big data”The macro:Built environment, mega-cities, big data Climate change, planetary health
Slide6Genes v. Environment?Studies of twinsConcordance of disease occurrence in monozygotic (MZ) v dizygotic (DZ) twinshigh in MZ/ low in DZ high heritability (genes!)
medium in MZ/ medium in DZ
low heritability; high influence by environmental factors
shared
by twinslow in MZ/ low in DZlow heritability; high influence by environmental factors specific to each twin
Slide7The unexpectedly large influence of et al., (NEJM, 2000) environment on cancers: the Scandinavian Twin Study Genetics only explains 27% of breast cancer“Shared” environment only 6%
Individual environment explains 67%
Slide8Similarly, we can examine concordance in other CDsParkinson’s: ~20-30%Alzheimer’s (Late onset, >65 yo): ~40%Essential Hypertension: <40%Osteoporosis: <40%
Schizophrenia: <40%
Gene-environment interactions ??
Slide9The 3 most difficult challenges to environmental epi researchExposureExposureExposurei.e., measuring, estimating, modeling exposures to chemical
toxicants, the relevant timing, and the dose-response relationship
What metric of exposure is biologically most important?
Current? Cumulative? Peak? At some specific
lifestage? (Timing)What is the dose-response?Monotonic linear? Threshold? U-shaped?
Slide1025 years of research on a global pollutant: leadPaint, pipes, leaded-gasoline, food cans, many other products…
Slide11The hidden problem: The impact of cumulative lead exposure (bone lead levels)
Hu et
al, 1996
Slide12BONE LEAD AND HYPERTENSION In community-exposed men.*
*Adjusted for age, body mass index, family history of hypertension, smoking, alcohol ingestion, dietary calcium, dietary sodium
Hu et
al, 1996
Slide13BONE LEAD AND MORTALITYIn community-exposed men*
Weisskopf
et
al, 2009
*Adjusted for age, body mass index,
smoking, race
Slide14*Adjusting for age, smoking
BONE LEAD AND
CATARACTS
In community-exposed men*
Schaumberg
et
al, 2004
Slide15Lead, the Hemochromatosis genes C282Y/H63D, and CognitionMore intracellular iron and leadSynergistic promotion of oxidation
HFE carrier adults had worse cognition given same lead burden
Wildtype
HFE carriers
Wang
et
al, 2006
Slide16Fetal exposure to mom’s mobilized bone lead stores independently predict poorer offspring IQ at age 2 years
Slide17Knowledge TranslationNew recommendations for adults explosed to leadNew recommendations for lead and pregnancy
Slide18New Direction: Is early life lead exposure a risk factor for Alzheimer’s ???
Slide19Post-mortem brainsAlzheimer’s v ControlEpigenome discoveryTransmembrane Protein 59 identified
responsible for post-translational glycosylation of
APP
leads
to retention of APP in the Golgi apparatusStudies on lead exposure in progress
Bakulski
et al, in press
Slide20ExposomicsProposes to use available measures of external human exposures
…combined
with advanced, high
through-put methods
…to develop a comprehensive profile of human exposures over the life course.
Wild C, 2012Example
Slide21Near term strategy: chop up the lifecourse into discrete, simultaneously observed segments
Slide22The macroBuilt environment, mega-cities, big data Climate change, planetary health
Slide23- Population-based cohort study of >230,000 Ontarians aged 18+ years - Q
uestionnaires
,
Biospecimens
Physical measurements, Clinical data- Data linkage to administrative health data (from universal health coverage system x 20+ years)
-The Institute for Clinical Evaluative Sciences
www.OntarioHealthStudy.ca
Slide24Map of Ultrafine Particles in TorontoEvans lab: Sabaliauskas
et al.
Atm
Env 2015
24
Slide25Merging of health, environment, social dataPolicy-relevant research using “Big Data” resources
Slide26Climate change: Spectacular inequities
Slide27The ultimate experiment…
Slide28Thanks!(This ppt available on request from dean.dlsph@utoronto.ca )