Document Type

Open Access Thesis

Embargo Period


Degree Program

Public Health

Degree Type

Master of Science (M.S.)

Year Degree Awarded


Month Degree Awarded



Lung transplants improve the quality of life for individuals with end-stage lung disease. International annual rates of bilateral lung transplants have been increasing since 1990. Forced expiratory volume (FEV1) is used to evaluate lung function and disease diagnosis pre-transplant and prognosis post-transplant. Recent studies suggest that traffic related air pollution (TRAP) decreases lung function, but few studies have evaluated this association in lung transplant patients. Therefore, we evaluated this cross-sectional relationship in bilateral lung transplant patients (N=361) in the 2002-2012 Toronto General Hospital cohort. TRAP was evaluated as length and density of major roads around patients’ residential addresses using 2013 ArcGIS. Within buffer total major road length was dichotomized at 100m, 300m and 500m. Maximum major road density categorization includes 700m. FEV1 was measured as part of routine post-transplant care within the first year; clinical information was taken from medical records. Multiple linear and logistic regressions were used to evaluate maximum FEV1 and percent predicted FEV1 (PP FEV1) against TRAP, adjusting for clinical factors. Maximum major road density within 100m from residential address was associated with 9.67% (95% Confidence Interval [CI], -15.59, -3.75) lower PP FEV1 and 0.38L (95% CI, -0.59, -0.17) lower maximum FEV1 compared with more than 700m. Each 57m increase in major road length within 100m from residence was associated with a 1.55% (95% CI, -2.75, -0.34) decrease in PP FEV1 and 0.06L (95% CI, -0.09, -0.01) decrease in maximum FEV1. Our findings show that reducing TRAP may provide better outcomes for vulnerable populations.

First Advisor

Susan Sturgeon

Second Advisor

Katherine Reeves

Third Advisor

Krystal Pollitt