Children and Digital Dumpsites

Children and digital dumpsites E-waste exposure and child health WEB ANNEX Literature review on the health effects of exposure to e-waste Children and digital dumpsites E-waste exposure and child health WEB ANNEX Literature review on the health effects of exposure to e-waste iii

Children and digital dumpsites: e-waste exposure and child health. Web Annex. Literature review on the health effects of exposure to e-waste

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Contents

Table 1. Short-term health effects, stress, injuries...... 2

Table 2. Adverse neonatal outcomes...... 3

Table 3. Short placental telomere...... 5

Table 4. Growth...... 6

Table 5. Neurodevelopment, learning and behavioural outcomes...... 7

Table 6. Immune function...... 8

Table 7. Thyroid and endocrine system function...... 10

Table 8. Lung function, respiratory function and asthma...... 12

Table 9. Airway antimicrobial activity...... 13

Table 10. Cardiovascular risk factors...... 14

Table 11. Hearing loss...... 15

Table 12. Olfactory memory...... 16

Table 13. Liver function...... 17

Table 14. Impaired blood coagulation...... 18 Acknowledgements

Table 15. Fasting blood glucose levels...... 19 This annex was compiled by Julia Gorman Table 16. Male reproductive disorders, genital diseases and sperm quality...... 20 (WHO consultant) and Marie-Noël Bruné Drisse Table 17. Kidney injury markers...... 21 (WHO). Final editing by John Dawson, Nairobi, Kenya. This publication was made possible with Table 18. DNA damage...... 22 financial support from the Swedish International Table 19. Gene expression...... 23 Development Cooperation Agency (Sida) and the Federal Ministry for the Environment, Nature Table 20. Oxidative stress...... 24 Conservation, Building and Nuclear Safety, References...... 25 Germany. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 2 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 1. Short-term health effects, stress, injuries

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Decharat S (1) Nakhon Si Thammarat Informal recycling workers Informal recycling workers Mercury Urinary and airborne mercury levels significantly correlated (r = 0.552, P < 0.001). province, Thailand versus office staff (aged 18–57 years). The prevalence of insomnia (46.8%), muscle atrophy (36.7%), weakness (24.1%) Exposed (n=54), control and headaches were all statistically higher among the exposed group (P < 0.001). (n=25) Feldt T et al. (2) Agbogbloshie, Ghana Informal recycling workers Informal recycling workers. PAHs PAHs metabolite significantly higher in exposed individuals compared to non- vs residents of control Exposed (n=72), control exposed individuals. Urine concentrations: 1-OH-phenanthrene 0.85 vs 0.55 urban area (n=40) μg/g creatinine (P < 0.001); 2-/9-OH-phenanthrene 0.55 vs 0.37 μg/g creatinine (P = 0.005); 3-OH-phenanthrene 0.99 vs 0.63 μg/g creatinine (P < 0.001); 4-OH-phenanthrene 0.22 vs 0.11 μg/g creatinine (P < 0.001); 1-OH-pyrene 1.33 vs 0.54 μg/g creatinine (P < 0.001). Higher urinary PAH levels found in individuals exposed to e-waste recycling processes. Yohannessen K et al. (3) Santiago and Temuco, Chile Informal vs formal recycling Informal recycling workers Not assessed Workers generally reported good health; prevalence of chronic diseases reported workers (n=78), formal recycling was comparable to national levels. Few health differences reported between workers (n=15) informal and formal workers.

PAH: polycyclic aromatic hydrocarbon. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 3 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 2. Adverse neonatal outcomes

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Guo Y et al. (4) Guiyu, China Ecological: exposed town vs Mother–infant pairs. Lead, chromium, Placental lead: 301.43 vs 165.82 ng/g (P = 0.01); nickel: 7.64 vs 14.30 ng/g control town Exposed (n=101), control cadmium, nickel (P = 0.00). No differences in cadmium or chromium. No differences in birth weight, (n=119) birth length or gestational age. Negative correlation between placental nickel and gestational age. Correlation between blood lead and residence in e-waste recycling area. Guo Y et al. (5) Guiyu, China Ecological: exposed town vs Mother–infant pairs. PAHs Cord blood total PAH: 108.05 vs 79.63 ppb (P = 0.003); chromium: 1.57 vs 1.05 control town Exposed (n=103), control ppb (P = 0.049); BaP: 2.14 vs 1.64 ppb (P = 0.001); DahA: 12.26 vs 11.59 ppb (n=80) (P = 0.031). Increased BaA, chrysene and BaP in neonates with adverse birth outcomes (P < 0.05). Maternal PAH exposure linked to adverse effects on neonatal health. Wu K et al. (6) Guiyu, China Ecological: exposed town vs Mother–infant pairs. PBDEs Cord blood total PBDE: 13.84 vs 5.23 ng g–1 lipid (P < 0.05). No correlation found control town Exposed (n=102), control between PBDEs and neonate length, gestational age or sex. (n=51) Wu K et al. (7) Guiyu, China Informal recycling Mother–infant pairs. PCBs Cord blood PCBs: 338.56 vs 140.16 ng/g, correlated with mothers’ recycling activity. Exposed (n=108), control Higher total PCBs with adverse birth outcomes (t = –2.26, P = 0.03). Negative (n=59) associations between individual PCB congeners and neonatal height, neonatal weight, Apgar score, gestational age and BMI (all P < 0.05). Wu K et al. (8) Guiyu, China Informal recycling Pregnant women. Exposed PFOA Serum PFOA: 16.95 vs 8.7 ng/mL (P < 0.001). Negative association between PFOA (n=108), control (n=59) and spontaneous abortion (t = –3.035, P = 0.003) and preterm birth (t = –2.209, P = 0.029). PFOA associated with 15.99 days reduction in gestational age; 267.3 g reduction in birth weight; 1.91 cm reduction in birth length; 1.37 lg-unit reduction in Apgar score. The same study population as (7). Li Y et al. (9) Guiyu, China Ecological: exposed town vs Newborn infants. Exposed Chromium Cord blood chromium 2006: 303.38 vs 19.95 mg/L; 2007: 99.9 vs 32.48 mg/L. No control town 2006 (n=100); 2007 association with birth weight or birth length. Evidence suggests that chromium (n=100). Control 2006 may cause DNA damage in neonates. (n=52); 2007 (n=50) Xu X et al. (10) Guiyu, China Informal recycling Newborn infants. Exposed Lead Cord blood lead: 10.87 vs 2.25 mg/dL (P < 0.01), correlated with recycling activity. (n=432), control (n=99) Higher rates of adverse birth outcomes: stillbirth (4.72 vs 1.03%); preterm birth (5.68 vs 5.24%); lower birth weight (3168 vs 3258 g); and lower Apgar scores (9.6 vs 9.9, all P < 0.01) linked to prenatal lead exposure. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 4 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 2. Adverse neonatal outcomes continued

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Xu L et al. (11) Guiyu, China Exposed town vs control Pregnant women and Lead, cadmium Cord blood lead: 498.80 vs 27.01; cadmium: 96.19 vs 12.65 ng/g. Cadmium town newborn infants. Exposed correlated with 205.05 g reduction in neonatal weight and 0.44 cm reduction in pregnant women (n=99), body length. No statistical significance found with lead. control (n=86) Xu L et al. (12) Guiyu, China Exposed town vs control Pregnant women and PBDEs Cord blood PBDEs: 32.25 vs 5.13 ng/g. PBDE concentration negatively correlated town. Some participants newborn infants. Exposed with head circumference (33.52 vs 34.92 cm, P < 0.05) and neonatal BMI (11.90 vs employed in e-waste pregnant women (n=69), 12.69 kg/m2, P < 0.05), and strongly negatively correlated with Apgar1 score (9.16 recycling control (n=86) vs 10.0, P < 0.001). Zhang Y et al. (13) Guiyu, China Exposed town vs control Pregnant women and Cadmium Maternal urinary cadmium with female neonates: 1.59 vs 0.92; with male town. One participant did newborn infants. Exposed neonates: 1.38 vs 0.74 μg/g creatinine (P = 0.00). Maternal urinary cadmium work related to e-waste pregnant women (n=237), level with female neonates significantly inversely associated with birth weight, during pregnancy control (n=212) length, head circumference, and Apgar 1 and 5 scores (all P < 0.05), and significant association with Apgar 1 score in male neonates (P = 0.004). Huo X et al. (14) Guiyu, China Exposed town vs control Pregnant women. Exposed OH-PAHs Maternal urine OH-PAH: 6.87 vs 3.90 μg/g creatinine (P < 0.001). PAHs linked to town (n=155), control (n=102) decrease of 234.56 g in weight, 1.72 cm in head circumference, 1.06 kg/m2 in BMI and 0.42 in Apgar 1 score (all P < 0.05). Li M et al. (15) Guiyu, China Exposed town vs control Pregnant women. Exposed PBDEs Cord blood PBDEs: 71.92 vs 15.52 ng/g lipid weight (P < 0.01). Neonatal head town (n=150), control (n=150) circumference, BMI and Apgar 1 score negatively correlated with PBDEs (all P < 0.01).

BaA: benzo[a]anthracene; BaP: benzo[a]pyrene; BMI: body mass index; DahA: dibenz[a,h]anthracene; OH-PAH: hydroxylated polycyclic aromatic hydrocarbon; PAH: polycyclic aromatic hydrocarbon; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl; PFOA: perfluorooctanoic acid. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 5 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 3. Short placental telomere

Author Exposure location Exposure setting Exposed population Primary Health outcome toxicant Lin S et al. (16) Guiyu, China Exposed town vs control Newborn infants. Exposed Cadmium, lead Cord blood cadmium: 0.0929 vs 0.0239 μg/g (P < 0.01); lead 1.2491 vs 1.3525 town (n=220), control (n=93) μg/g (P > 0.05). Cord blood cadmium negatively correlated with placental telomere length (r = −0.138, P = 0.013), no significant correlation between cord blood lead and telomere length. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 6 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 4. Growth

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Huo X et al. (17) Guiyu, China Ecological: exposed town vs Children (< 6 years). Lead Blood lead: 15.3 vs 9.94 mg/dL (P < 0.01). No differences in haemoglobin levels, control town Exposed (n=165), control height, weight, chest circumference or head circumference. (n=61) Xu X et al. (18) Guiyu, China Exposed town vs control Children (aged 3–7 years). PAHs, lead Blood total PAHs: 68.53 vs 26.92 μg/L; blood lead: 13.89 vs 8.55 μg/dL (both town Exposed (n=95), control P < 0.01). Child height and child chest circumference negatively associated with (n=72) PAHs (both P < 0.05). Correlation more obvious in boys. Xu X et al. (19) Guiyu, China Exposed town vs control Children (aged 3–7 years). Chromium Blood chromium: 94.3 vs 49.3 μg/L (P < 0.001). Correlation between blood town Exposed (n=415), control chromium in children and increased body weight and chest circumference. (n=296)

Zeng X et al. (20) Guiyu, China Exposed town vs control Preschool children. Exposed Lead, cadmium, Blood lead: 6.81 vs 4.98 μg/dL; cadmium: 0.66 vs 0.54 μg/L (both P < 0.001); PM2.5: 3 town (n=300), control (n=170) chromium, 57.73 vs 40.53 μg/m , elevated lead and cadmium in PM2.5. Blood lead negatively manganese in associated with height (r = –0.066, P < 0.05), weight (r = –0.119, P < 0.001),

PM2.5 head circumference (r = –0.123, P < 0.01) and chest circumference (r = –0.104, P < 0.05). No association between cadmium, chromium and manganese and childhood development parameters (P > 0.05).

PAH: polycyclic aromatic hydrocarbon; PM2.5: particulate matter 2.5 microns or less in diameter. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 7 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 5. Neurodevelopment, learning and behavioural outcomes

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Cai H et al. (21) Guiyu, China Exposed town vs control Children (aged 3–6 years). Lead Blood lead: 4.88 vs 3.47 μg/dL (P < 0.001); serum cortisol: 451.96 vs 593.61 ng/ town Exposed (n=358), control mL (P < 0.001). SPM-HKC scores: touch 19.00 vs 18.00; body awareness 16.00 vs (n=216) 14.00; balance and motion 18.00 vs 16.00; total sensory systems 90.00 vs 86.00. Blood lead correlated with decreased serum cortisol and an increase in child sensory integration difficulties. Li Y et al. (22) Guiyu, China Ecological: exposed town vs Newborn babies. Lead Cord blood lead: 113.28 vs 60.43 mg/dL (P < 0.001); meconium lead: 2.5 vs 1.2 control town Exposed (n=100), control mg/g (P < 0.001). NBNA scores: total 38.45 vs 38.92 (P = 0.043); behaviour cluster (n=52) 10.91 vs 11.29 (P = 0.012). Negative associations between meconium lead and total NBNA activity and behavioural scores. Liu J et al. (23) Guiyu, China Ecological: exposed town vs Children (aged 3–7 years). Lead Blood lead: 13.2 vs 8.2 μg/dL (P < 0.01). Temperament scores: mean activity level: control town Exposed (n=153), control 4.53 vs 4.18; adaptability: 4.96 vs 4.67; approach withdrawal: 4.62 vs 4.3 (all (n=150) P < 0.01). Higher blood lead associated with higher approach–withdrawal scores. Liu L et al. (24) Guiyu, China Exposed town vs control Children (aged 3 years). Lead Blood lead: 11.30 vs 5.77 μg/dL (P < 0.001). Blood lead negatively correlated with town Exposed (n=135), control cognitive scale scores (100 vs 120) and language scale scores (99.87 vs 111.39, both (n=149) P < 0.001). Liu L et al. (25) Guiyu, China Exposed town vs control Children (aged 3 years). Lead, cadmium Blood lead: 11.30 vs 5.77 μg/dL; cadmium: 1.22 vs 0.72 μg/L (both P < 0.001); town Exposed (n=135), control FT4: 16.65 vs 16.06 pmol/L (P = 0.007); TSH: 2.79 vs 2.21 mIU/L (P = 0.001). Lead (n=149) negatively correlated with cognitive score (100 vs 120) and language score (99.87 vs 111.39, both P < 0.001). No significant relationship found between lead and FT4 and TSH levels and cognitive development. No correlation between cadmium and cognitive development. The same study population as (24). Liu W et al. (26) Guiyu, China Exposed town Children (aged 3–7 years). Lead, cadmium, Blood lead: 7.33 μg/dL; cadmium: 0.69 μg/dL; manganese: 17.98 μg/dL; serum Exposed (n=240) manganese S100β: 0.12 μg/L. ADHD symptoms prevalence: 18.6%. Serum S100β levels positively correlated with blood lead levels. Child blood levels of lead, cadmium and manganese correlated with some behavioural abnormalities. Wang X et al. (27) Zhejiang province, China Exposed town vs tinfoil Children (aged 11–12 Lead Blood lead: 8.11 vs 6.97 vs 2.78 μg/dL (P < 0.001). No significant differences of IQ manufacturing area vs years). Exposed (n= 108), observed between study populations. control town tinfoil manufacturing town (n=151), control (n=70) Zhang R et al. (28) Guiyu, China Exposed town Children (aged 3–7 years). Lead, cadmium Blood lead: 7.9 μg/dL; cadmium: 0.95 μg/L. ADHD symptoms prevalence: 12.8%. (n=243) Children with high blood lead level had 2.4 times higher risk of ADHD than those with low blood lead levels. No correlation between cadmium and ADHD behaviours.

ADHD: attention deficit/hyperactivity disorder; FT4: free thyroxine; IQ: intelligence quotient; NBNA: neonatal behavioural neurological assessment; S100β: S100 calcium-binding protein B; SPM-HKC: sensory processing measure-Hong Kong Chinese version; TSH: thyroid-stimulating hormone. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 8 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 6. Immune function

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Cao J et al. (29) Guiyu, China Exposed town vs control Preschool children. Exposed Lead Blood lead: 5.06 vs 3.60 μg/dL (P = 0.00); CD4+ central memory T cells: 25.79 vs town (n=62), control (n=56) 21.43; CD8+ central memory T cells: 0.89 vs 0.62 (both P < 0.001). Blood lead level positively correlated with percentage of peripheral CD4+ and marginal changes to CD8+ central memory T cells. Dai Y et al. (30) Guiyu, China Exposed town vs control Preschool children (aged Lead Blood lead: 6.5 vs 4.5 μg/dL; erythrocyte lead: 17.0 vs 11.9 μg/dL; erythrocyte CR1 town 2–6 years). Exposed expression: 6257.515 vs 8162.840 (all P < 0.01). High blood lead (> 7.00) and high (n=332), control (n=152) erythrocyte lead (> 18.6) levels associated with lower erythrocyte CR1 expression. Huo X et al. (31) Guiyu, China Exposed town vs control Preschool children (aged Lead Blood lead: 6.51 vs 4.41 μg/dL; erythrocyte lead: 16.60 vs 11.77 μg/dL (both town 2–7 years). Exposed P < 0.001); CD44: 68.08 vs 76.15%; CD58: 40.77 vs 46.32% (both P < 0.01). High (n=132), control (n=135) erythrocyte lead concentrations significantly related to lower erythrocyte CD44 and CD58 expression. Li R et al. (32) Northern China Exposed town vs control Population. Exposed Lead, PCBs, PBDEs, Blood lead: 77.1 vs 66.7 μg L–1; plasma PCBs: 60.4 vs 28.4 ng g–1; DP: 9.0 vs 2.8 ng town (n=23), control (n=28) PBBs, DP, HCB, g–1; PBB-153: 0.55 vs 0.25 ng g–1; PBDEs: 29.3 vs 23.0 ng g–1 (all P < 0.01); βHCH, p,p’DDE reactive oxygen species in immune cells: 8.3 vs 28.4 (P < 0.001). Plasma PCBs total 2 times higher than control group. Suggested link between plasma PCB levels and increased reactive oxygen species levels. Lin X et al. (33) Guiyu, China Exposed town vs control Preschool children (aged Lead, arsenic, Blood lead: 9.43 vs 6.79 μg/dL (P < 0.001); arsenic: 5.53 vs 6.56 μg/L (P = 0.002); town 2–7 years). Exposed mercury, mercury: 1.92 vs 2.25 μg/L (P = 0.051); cadmium: 0.12 vs 0.27 μg/L (P = 0.005); (n=157), control (n=127) chromium, chromium: 14.38 vs 10.64 μg/L (P = 0.005); manganese: 16.31 vs 15.08 cadmium, μg/L (P = 0.030); nickel: 4.41 vs 3.44 μg/L (P = 0.059); copper: 919.10 vs 842.45 manganese, μg/L (P < 0.001); zinc: 4746.39 vs 4313.0 μg/L (P = 0.039); selenium: 135.77 vs nickel, copper, 149.06 μg/L (P = 0.027). Significant association between elevated lead, copper and zinc, selenium zinc and decreased antibody titres after vaccination. Lin Y et al. (34) Guiyu, China Exposed town vs control Children (aged 2–7 years). Lead Blood lead: 5.61 vs 3.57 μg/dL (P < 0.001). Antibody titres against measles: 669.64 town Exposed (n=263), control vs 1046.79 mIU/mL; mumps: 272.24 vs 491.78 U/mL; rubella: 37.08 vs 66.50 IU/ (n=115) mL. Lead associated with reduction in anti-mumps and anti-rubella antibody titres after vaccination. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 9 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 6. Immune function continued

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Xu P et al. (35) Zhejiang province, China Exposed town vs control Population (aged 15–65 PCBs, PBDEs PCBs: 964.39 vs 67.98 ng g–1 (P < 0.0001); PBDEs: 139.32 vs 75.74 ng g–1 town years). Exposed (n=40), (P > 0.05); FT3: 4.72 vs 5.64 pmol L–1; FT4: 14.98 vs 18.67 pmol L–1 (both control (n=15) P < 0.001); TSH: 2.51 vs 1.80 µIU mL–1 (P > 0.05); white blood cells: 6.43 vs 6.24 L–1 (P = 0.7); haemoglobin: 152.4 vs 135.33 g L–1 (P < 0.01); platelets: 244.15 vs 201.4 *109 L− 1 (P < 0.05). PCBs negatively correlated with FT3 and FT4. PBDEs positively correlated with levels of white blood cells, haemoglobin and platelets. No correlation between PBDEs and thyroid hormones (P > 0.05). Xu X et al. (36) Guiyu, China Exposed town vs control Children (aged 3–7 years). Lead Blood lead: 6.76 vs 6.05 μg/dL (P < 0.05); HBsAb titre: 1.04 vs 4.06 s/co town Exposed (n=301), control (P < 0.001). Lead associated with reduced HBsAb response. (n=289) Zhang Y et al. (37) Guiyu, China Exposed town vs control Children. Exposed (n=285), Lead Blood lead: 6.00 vs 3.92 mg/dL (P < 0.01). Lead correlated with levels of platelets

town control (n=126) (Rs = 0.112), neutrophils (Rs = 0.139), monocytes (Rs = 0.120) (all P < 0.05). IL-1β (Rs = 0.162) levels positively and IL-27 (Rs = −0.306) levels negatively associated with lead (both P < 0.05). Zhang Y et al. (38) Guiyu, China Exposed town vs control Preschool children (aged Lead, cadmium Blood lead: 10.34 vs 8.30 μg/dL (P < 0.05); cadmium: 2.39 vs 1.79 μg/L (P < 0.05). town 3–7 years). Exposed Lead linked to increase in count of monocytes (β = 0.083), eosinophils (β = 0.078), (n=153), control (n=141) basophils (β = 0.013), monocyte percentage (β = 0.766) and decline in neutrophils percentage (β = −4.153). Cadmium linked to increase in neutrophils percentage (β = 3.919) and count (β = 0.665) (all P < 0.05).

β-HCH: β-hexachlorocyclohexane; DP: dechlorane plus; FT3: free triiodothyronine; FT4: free thyroxine; HBsAb: hepatitis B surface antibody; HCB: hexachlorobenzene; IL-1β: interleukin-1β; IL-27: interleukin-27; PBB: polybrominated biphenyl; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl; p,p’DDE: p,p’dichlorodiphenyldichloroethylene; TSH: thyroid-stimulating hormone. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 10 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 7. Thyroid and endocrine system function

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Eguchi A et al. (39) Hung Yen province, Viet Exposed town vs control Informal workers. Exposed PCBs, OH-PCBs, Serum PCBs: 420 vs 290 pg g–1; OH-PCBs: 160 vs 82 pg g–1; PBDEs: 290 vs 230 pg Nam town (n=77), control (n=34) PBDEs, MeO- g–1; BPhs: 300 vs 200 pg g–1 (all P < 0.05). FT3: 3.3 vs 3.5 pg g–1; TT3: 1.2 vs 1.3 pg PBDEs, OH-PBDEs, g–1; TT4: 78 vs 85 pg g–1 (all P < 0.05); FT4: 1.3 vs 1.2 pg g–1; TSH: 1.4 vs 1.5 pg g–1 BPhs (both P > 0.05). Positive correlation found in females between PCBs and OH-PCB and levels of FT4, FT3, TT3, TT4 (P < 0.05), but negative correlation with TSH concentrations. Eguchi A et al. (40) Northern Viet Nam Exposed town vs control Population. Exposed Perchlorate, Serum perchlorate: 0.116 vs 0.086 ng mL–1 (P < 0.05); TT3: 1.2 vs 1.3 ng mL–1; town (n=83), control (n=48) thiocyanate FT3: 3.3 vs 3.4 pg mL–1 (P < 0.05). No significant difference in thiocyanate. No correlation between thyroid hormone and perchlorate or thiocyanate (P > 0.05). Han G et al. (41) Luqiao, China Ecological: exposed town vs Population. Exposed PCBs, PBDEs, Serum PCBs: 484 vs 255.38 ng g–1; PBDE: 664.28 vs 375.81 ng g–1; dioxin: 26 vs control town (n=195), control (n=174) dioxin 39.64 ng g–1; TSH: 1.88 vs 3.31 ng g–1. No P value reported. Suggests that TSH levels in children are affected by POPs. Ju Y et al. (42) China Ecological: exposed town vs Mothers and newborn Not assessed Maternal TSH: 2.63 vs 2.10 mIU/L; FT4: 16.47 vs 160.76 pmol/L (both P < 0.05). control town babies. Exposed (n=48), Cord blood TSH: 6.35 vs 5.47 mIU/L; FT4: 8.45 vs 9.52 pmol/L (both P < 0.05). control (n=45) mRNA levels statistically significant compared to control group. Lv QX et al. (43) Wenling, China Exposed town vs control Pregnant women. Exposed PCBs, PBDEs Serum PCBs: 26.2 vs 14.0 ng g–1 lipid weight (P < 0.05); PBDEs: 9.77 vs town for over 5 years (n=64), 4.80 ng g–1 lipid weight (P < 0.001). Increased body burden of PCBs and specific exposed for under 2 years PDBE congeners. PCBs negatively correlated with TSH levels during pregnancy and not employed in (P < 0.001). e-waste recycling (n=10) Yuan J et al. (44) China Formal recycling Formal and informal PBDEs Serum PBDEs: 382 vs 158 ng/g lipid weight (P = 0.045); serum TSH: 1.79 vs 1.15 workers vs not exposed. microIU/mL (P < 0.01). No association between PBDEs and oxidative DNA damage. Exposed (n=23), control (n=26) Wang H et al. (45) Taizhou, China Ecological: workers in Population. Exposed PBDEs Serum TSH: 1.26 vs 1.57 μIU/mL; T3: 1632.4 vs 1817.2 pmol/L; FT3: 4188.8 vs exposed town vs those in (n=236), control (n=89) 4404.4 pmol/L (all P < 0.001). No difference in serum T4. PBDEs may contribute to control town changes in TSH and T4 levels. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 11 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 7. Thyroid and endocrine system function continued

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Xu P et al. (35) Zhejiang province, China Exposed town vs control Population. Exposed PCBs Serum PCBs: 964.39 vs 67.98 ng g–1 (P < 0.0001); PBDEs: 139.32 vs 75.74 ng g–1 town (n=40), control (n=15) (P > 0.05); TSH: 2.51 vs 2.78 μIU mL− 1 (P = 0.609); FT3: 4.72 vs 5.64 pmol L−1 (P < 0.001); FT4: 14.98 vs 18.67 pmol L− 1 (P < 0.001). PCBs negatively correlated with levels of FT3, FT4, monocytes and lymphocytes. PCBs positively correlated

with levels of neutrophils, haemoglobin, serum creatinine and β2-MG. PBDEs positively correlated with levels of white blood cells, haemoglobin and platelets (all P < 0.05). This study is also quoted in Table 6. Xu P et al. (46) Zhejiang province, China Exposed town vs control Children (aged 8 years). PCBs, PBDEs, Serum PCBs: 40.56 vs 20.69 ng g− 1 lipid (P < 0.01); PBDEs: 32.09 vs 8.43 town Exposed (n=21), control PCDD/Fs ng g− 1 lipid (P < 0.01). No difference in TSH between groups. Serum PCDD/Fs not (n=24) significant. PBDEs positively correlated with ACTH level (r = 0.61, P < 0.05). Zhang J et al. (47) China Ecological: exposed town vs Pregnant women. Exposed PCCD/Fs, PCBs, Cord blood PCDD/Fs: 0.041 vs 0.014 pg; PCBs 0.022 vs 0.0041 pg; PBDEs 23.4 control town (n=25), control (n=25) PDBEs vs 16.15 pg/g (all P < 0.05). Serum TSH: 1.15 vs 2.65 nmol/L; FT4: 112.5 vs 139.0 nmol/L (both P = 0.015). Negative correlation between PCDD/Fs and PCBs and levels of TT4. No correlation with PBDEs.

ACTH: adrenocorticotropic hormone; β2-MG: beta-2 microglobulin; BPh: bromophenol; FT3: free triiodothyronine; FT4: free thyroxine; MeO-PBDE: methoxylated polybrominated diphenyl ether; mRNA: messenger ribonucleic acid; OH-PBDE: hydroxylated polybrominated diphenyl ether; OH-PCB: hydroxylated polychlorinated biphenyl; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl; PCDD/F: polychlorinated dibenzodioxin/dibenzofuran; POP: persistent organic pollutant; T3: triiodothyronine; T4: thyroxine; TSH: thyroid-stimulating hormone; TT3: total triiodothyronine; TT4: total thyroxine. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 12 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 8. Lung function, respiratory function and asthma

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Zheng G et al. (48) Guiyu, China Ecological: exposed town vs School children (aged 8–13 Chromium, Blood manganese: 374.92 nmol/L vs 271.18 nmol/L; nickel: 5.3 vs 3.0 mg/L (both control town years). Exposed (n=71), manganese and P < 0.01). FVC in boys aged 8–9 years: 1859 vs 2121 mL (P = 0.03). Decrease in FVC control (n=73) nickel with increased chromium level (11-year-olds: β = –14.02, P = 0.018; 13-year-olds: β = –43.23, P = 0.027); decreased FVC with increased nickel level (10-year-olds: β = –18.47, P = 0.035).

Zeng X et al. (49) Guiyu, China Exposed town vs control School children (aged 5–7 Lead Blood lead: 5.53 vs 3.57 μg/dL (P < 0.05). FVC: 1.23 vs 1.33 L (P = 0.004); FEV1: towns years). Exposed (n=100), 1.16 vs 1.24 L (P = 0.005). Birth weight: 3.07 vs 3.25 kg; height: 111.03 vs 112.56 control (n=106) cm; chest circumference: 52.63 vs 53.42 cm (all P < 0.05). Lung function associated with birth weight and chest circumference. Same study group as (50). Zeng X et al. (50) Guiyu, China Exposed town vs control School children (aged 5–7 Lead, cadmium Blood lead: 5.53 vs 3.57 μg/dL (P < 0.001); cadmium: 0.58 vs 0.57 μg/L (P > 0.05). towns years). Exposed (n=100), Lower haemoglobin and haematocrit levels, but higher platelet and thrombocytosis

control (n=106) levels in exposed group (all P < 0.05). FVC: 1.23 vs 1.33; FEV1: 1.16 vs 1.24 (both P < 0.01); FVC/FEV1: 0.95 vs 0.96% (P = 0.20). No association between blood lead and cadmium with platelet level, FVC or FEV1 (P > 0.05). 1 g/L haemoglobin decline associated with 5 mL and 4 mL decrease in FVC and FEV1 respectively (P < 0.05). The same study population as (49).

Zeng X et al. (51) Guiyu, China Exposed town vs control Children (aged 3–8 years). Lead, cadmium, Blood lead: 6.24 vs 4.75 µg/dL; cadmium: 0.576 vs 0.500 µg/L; lead in PM2.5: 152.96 3 3 town Exposed (n=300), control chromium, vs 80.28 ng/m ; cadmium in PM2.5: 5.58 vs 3.48 ng/m (all P < 0.05); no difference (n=170) manganese in in blood chromium or manganese (both P < 0.05). Increased cough, dyspnoea,

PM2.5 and in blood phlegm, wheeze in exposed group (P < 0.05). Blood chromium associated with cough (AOR = 1.91); blood manganese associated with wheeze (AOR = 2.91); elevated blood lead (> 5 µg/dL) associated with asthma (AOR = 9.50) (all P < 0.05).

AOR: adjusted odds ratio; FEV1: forced expiratory volume; FVC: forced vital capacity; PM2.5: particulate matter 2.5 microns or less in diameter. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 13 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 9. Airway antimicrobial activity

Author Exposure location Exposure setting Exposed population Primary toxicant Health outcome 3 –1 –1 Zhang S et al. (52) Guiyu, China Exposed town vs control town Children (aged 2–7 years). Exposed PM2.5 PM2.5: 39.06 vs 26.6 μg/m ; PM2.5 CDI: 1.40 vs 0.88 ng kg day (P < 0.001). (n=110), control (n=112) Saliva: SAG: 5.05 vs 8.68 ng/mL (P = 0.027). Higher white blood cell count, neutrophils, monocytes, IL-8 and TNF-α in exposed group (all P < 0·001) associated with CDI. CDI negatively correlated with SAG level. Higher monocyte count associated with lower SAG level (P < 0.05).

CDI: chronic daily intake; IL-8: interleukin-8; PM2.5: particulate matter 2.5 microns or less in diameter; SAG: salivary agglutinin; TNF-α: tumour necrosis factor alpha. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 14 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 10. Cardiovascular risk factors

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Lu X et al. (53) Guiyu, China Exposed town vs control Children (aged 3–7 years). Lead Blood lead: 7.14 vs 3.91 μg/dL (P < 0.001). Elevated blood lead associated with town Exposed (n=337), control higher Lp-PLA2, IL-6, TG and lower HDL and PP (all P < 0.05). Lp-PLA2 negatively (n=253) associated with PP and HDL. Zheng X et al. (54) Guiyu, China Exposed town vs control Children (aged 3–7 years). Lead, PAHs Blood lead: 7.232 vs 3.912 μg/dL (P < 0.001) and elevated PAHs in exposed group town Exposed (n=105), control (both P < 0.05). Elevated blood lead linked to higher counts of IL-6, IL-12p70, IP-10, (n=98) CD4+ T cell percentage, neutrophil and monocyte counts (all P < 0.05).

Cong X et al. (55) Guiyu, China Exposed town vs control Preschool children. Exposed PM2.5, PM10, SO2, Higher concentrations of PM2.5, PM10, SO2, NO2, CO among exposed group (data town (n=228), children native NO2, CO not given, all P < 0.001). Median heart rate: 106 vs 102 vs 100 bpm; plasma to reference area (n=104), norepinephrine: 4.425 vs 3.885 vs 3.444 nmol/L (both P < 0.01). Positive

non-native children living association between concentrations of PM2.5, PM10, SO2, NO2 and plasma in reference area for > 1 norepinephrine; PM2.5, PM10, SO2, NO2 and CO levels linked to increase in heart rate year (n=91) (P < 0.05).

CO: carbon monoxide; HDL: high-density lipoprotein; IL-6: interleukin-6; IL-12p70: interleukin-12p70; IP-10: gamma interferon-inducible protein 10; Lp-PLA2: lipoprotein-associated phospholipase A2; NO2: nitrogen dioxide; PAH: polycyclic aromatic hydrocarbon; PM2.5: particulate matter 2.5 microns or less in diameter; PM10: particulate matter 10 microns or less in diameter; PP: pulse pressure; SO2: sulfur dioxide; TG: triglyceride. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 15 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 11. Hearing loss

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Liu Y et al. (56) Guiyu, China Exposed town vs control Children (aged 3–7 years). Lead, cadmium Blood lead: 4.94 vs 3.85 μg/dL (P < 0.001); urinary cadmium: 2.49 vs 1.80 μg/g town Exposed (n=146), control cre (P = 0.134). Hearing loss: 28.8 vs 13.6% (P < 0.001). Hearing loss for lead (n=88) exposure: AOR = 1.24. Lead may be an important factor for hearing loss.

AOR: adjusted odds ratio. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 16 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 12. Olfactory memory

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Zhang B et al. (57) Guiyu, China Exposed town vs control Children (aged 6 years). Lead Blood lead: 9.40 vs 5.04 mg/dL; serum BDNF: 35.91 vs 28.10 ng/mL (both town Exposed (n=61), control P < 0.001). Serum BDNF positively correlated with blood lead. Lower item and (n=57) source olfactory memory scores (at 15 minutes, 5 and 24 hours) among exposed group (P < 0.01). Olfactory memory scores negatively correlated with blood lead and serum BDNF (both P < 0.05).

BDNF: brain-derived neurotrophic factor. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 17 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 13. Liver function

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Chen Y at al. (58) Guiyu, China Exposed town vs control Hospitalized adults. Lead, cadmium Blood lead: 8.7 vs 5.1 µg/dL (P < 0.001); cadmium: 2.1 vs 2.6 µg/L (P > 0.05). Red town Exposed (n=158), control blood cell count: 4.5 vs 4.2 x103/µL; haemoglobin: 137.0 vs 123.0 g/dL; platelets: (n=109) 234.0 vs 231.0 µL (all P > 0.05). Blood lead positively correlated with blood cadmium. Positive correlation between blood lead and red blood cell count and haemoglobin. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 18 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 14. Impaired blood coagulation

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Zeng Z et al. (59) Guiyu, China Exposed town vs control Children. Exposed (n=331), Lead Blood lead: 5.64 vs 3.68 μg/dL (P < 0.01). Higher PLT, PCT, MPV and P-LCR levels town control (n=135) among exposed group (P < 0.01). Positive correlation between blood lead and levels of PLT, PCT, MPV, P-LCR.

MPV: mean platelet volume; PCT: plateletcrit; P-LCR: platelet–large cell ratio; PLT: platelet count. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 19 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 15. Fasting blood glucose levels

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Song S et al. (60) Qingyuan, China Exposed towns vs control Population; adults (aged Bisphenols BPA in serum: 3.2 vs 2.8 ng/mL (P < 0.05); BPF: 0.062 vs 0.092 ng/mL; BPAP: town 56–93 years). Exposed 0.011 vs 0.022 ng/mL; BPAF: 0.0074 vs 0.0061 ng/mL; BPS: 0.0061 vs 0.0071 ng/ (n=119), control (n=16) mL (no P level recorded). Abnormal fasting blood glucose: 45 vs 31% (P < 0.05). Abnormal fasting blood glucose associated with BPA. BPAF linked to low fasting blood glucose.

BPA: bisphenol A; BPAF: bisphenol AF; BPAP: bisphenol AP; BPF: bisphenol F; BPS: bisphenol S. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 20 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 16. Male reproductive disorders, genital diseases and sperm quality

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Xu X et al. (61) Guiyu, China Exposed town vs control Hospital outpatients. Not assessed Male genital disease morbidity (2004–2009) 0.753 per 1000 vs 0.355 per 1000 urban area Exposed (n=473 938), (P < 0.05). Higher morbidity of male genital disease in exposed group. control (n=668 764) Yu YJ et al. (62) Guiyu, China Exposed towns vs control Males aged 18–50 years. PBDEs PBDE levels in semen: BDE-28: 5.02 vs 1.62 pg g–1; BDE-47: 6.75 vs 1.32 pg g–1; BDE- town Exposed (n=32), control 153: 7.36 vs 3.62 pg g–1 (all P < 0.05). Lower sperm count and sperm progressive (n=25) motility among exposed group. Negative correlation between BDE-47 levels and sperm concentration and sperm progressive motility. Positive correlation between BDE-28, BDE-47 and BDE-153 and paired semen samples.

BDE: brominated diphenyl ether; PBDE: polybrominated diphenyl ether. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 21 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 17. Kidney injury markers

β2-MG; beta-2 microglobulin; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 22 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 18. DNA damage

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Chen L et al. (63) China Ecological: exposed town vs Population. Exposed Not assessed Micronuclei in binucleated cells: median 4.0 vs 1.0% (P < 0.01). No statistical control town (n=58), control (n=80) evidence between genotypes and frequencies of micronuclei in population. Yuan J et al. (44) China Recycling activity Recycle workers (n=23) vs PBDEs Micronuclei in binucleated cells: 5.0 vs 0.0% (P < 0.01). No association between farmers (n=26) PBDE exposure and oxidative DNA damage. This study is also quoted in Table 7. Wang Q et al. (64) China Recycling activity Recycle workers (n=48) vs Lead, copper, Blood lead: 11.44 vs 9.104 μg/dL (P < 0.001); micronuclei in binucleated cells: 4.0 not exposed (n=56) cadmium vs 1.0% (P < 0.01). Positive correlation between blood lead and micronuclei in binucleated cells. No associations with copper or chromium. Liu Q et al. (65) Jinghai, China Recycling activity Recycle workers (n=171) vs Not assessed Micronuclei in binucleated cells: 16.99 vs 3.47%; chromosomal aberration: 5.5 vs not exposed (n=30) 1.7% (both P = 0.00). Significant difference in DNA damage between exposed and control groups (P = 0.00). Women more affected than men (P < 0.05). Li Y et al. (9) Guiyu, China Ecological: exposed town vs Newborn infants. Exposed Chromium Cord blood chromium 2006: 303.38 vs 93.89 μg/L; 2007: 99.90 vs 70.60 μg/L (both control town (2006: n=100; 2007: P < 0.01). Correlation between DNA damage and cord blood chromium levels in n=100), control (2006: n= neonates (P < 0.05). This study also quoted in Table 2. 52; 2007: n=50) Ni W et al. (66) Guiyu, China Maternal or paternal Pregnant women, newborn Lead, cadmium, Cord blood lead: 110.45 vs 57.31 ng/mL; cadmium: 2.50 vs 0.33 ng/mL (both recycling activity vs control infant pairs. Exposed chromium, nickel P < 0.001); no difference in either chromium or nickel between groups (P > 0.05). town (n=126), control (n=75) Cord blood 8-OHdG: 162.09 vs 153.69 ng/mL (P > 0.05). 8-0HdG positively associated with cadmium, chromium and nickel (all P < 0.05). He X et al. (67) China Exposed town vs control Population. Exposed PCBs, BDEs, DP, Periphery blood PCBs: 149.01 vs 35.39 ng/g lipid; DPs: 8.14 vs 1.96 ng/g lipid; BDE town (n=23), control (n=25) HCB, HCH, DDE congeners: 16.33 vs 14.28 ng/g lipid (all P < 0.05). Higher reactive oxygen species activity and micronucleus rate in exposed group (both P < 0.05). No correlation between PBDEs, DP or PCBs and micronucleus rate (P < 0.05). Expression of NEIL1/3 and RPA3 downregulated, but RNF8 upregulated in exposed group. Expression of CDC25A upregulated in males, but downregulated in females in the exposed group (all P < 0.05). Xu X et al. (68) Guiyu, China Exposed town Children (aged 3–6 years). Lead, cadmium, Blood lead: 7.43 µg/dL; blood cadmium: 0.72 µg/L; blood mercury: 11.13 µg/L; (n=118) mercury median 8-OHdG: 407.79 ng/g creatinine. Children with elevated blood lead levels had higher 8-OHdG levels than children with low blood lead levels. Children with elevated blood mercury associated with higher 8-OHdG (P < 0.05). No correlation between blood cadmium and 8-OHdG levels (P > 0.05).

8-OHdG: 8-hydroxy-2’-deoxyguanosine; BDE: brominated diphenyl ether; DDE: dichlorodiphenyldichloroethylene; DNA: deoxyribonucleic acid; DP: dechlorane plus; HCB: hexachlorobenzene; HCH: hexachlorocyclohexane; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 23 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 19. Gene expression

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Li Y et al. (69) China Ecological: exposed town vs Men (n value not given) Not assessed miRNA expression profiles in spermatozoa: differential regulation (109 control town downregulated, 72 upregulated). Li Y et al. (70) Guiyu, China Ecological: exposed town vs Mothers and neonates. Cadmium Cord blood cadmium: 3.61 vs 1.25 µg/L (P < 0.01). Metallothionein expression in control town Exposed (n=289), control placenta: 67.0 vs 3.7% (P < 0.01). Placental cadmium concentration correlated (n=134) with increased placental metallothionein expression. Zhang Q et al. (71) Guiyu, China Ecological: exposed town vs Pregnant women. Exposed Cadmium, lead Placental cadmium: 83.99 vs 51.59 ng/g (P < 0.001); placental lead: 521.01 vs control town (n=55), control (n=50) 273.24 ng/g (P = 0.299). Placental cadmium negatively correlated with S100P protein and positively correlated with metallothionein expression. No correlation with placental lead. Li K et al. (72) Jinghai, China Exposed town vs control Adults employed primarily Calcium, copper, Blood lead: 90.39 vs 68.40 µg/L; copper: 17.34 vs 15.20 μM; malondialdehyde: 1.29 town in non-e-waste sectors. iron, lead, vs 0.25 nmol/mL; PCBs: 42.59 vs 10.14 ng/g; PBDEs: 23.05 vs 14.60 ng/g; calcium: Living within 5 km of magnesium, 1.71 vs 1.82 nM; zinc: 100.66 vs 127.42 µM (all P < 0.05). Micronucleus rate: 18.27 e-waste facilities (n=30) selenium, zinc, vs 7.32% (P < 0.05). Men more affected than women. and 40 km from e-waste malondialdehyde, facilities (n=28) PCBs, PBDEs, DP, BB-153

BB-153: 2,2’,4,4’,5,5’-hexabromobiphenyl; DP: dechlorane plus; miRNA: micro-ribonucleic acid; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 24 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

Table 20. Oxidative stress

Primary Author Exposure location Exposure setting Exposed population toxicant Health outcome Zhang T et al. (73) Qingyuan, China Exposed town vs control Population (aged 0.4–87 Bisphenols Urinary BPA: 2.99 vs 0.589 vs 0.952 ng/mL (P < 0.01); BPS: 0.361 vs 0.388 vs 0.652 urban and rural areas years). Exposed (n=116), ng/mL (P > 0.05); BPF: 0.349 vs 0.0886 vs 0.556 ng/mL (P < 0.01). Urinary 8-OHdG: control urban (n=22), 8.00 vs 6.84 vs 7.31 ng/mL (P value not given). 8-OHdG significantly positively control rural (n=20) correlated with BPA and BPS in exposed group (both P < 0.001), but no correlation with BPF (P > 0.05). Lu SY et al. (74) Qingyuan, China Exposed town vs control Population (aged 0.4–87 Organophosphate Urinary BCEP: 0.81 vs 0.43 vs 0.50 ng/mL (P < 0.05); BCIPP: 0.11 vs 0.028 vs 0.069 urban and rural areas years). Exposed (n=175), flame retardants ng/mL (P < 0.01); DBP: 0.38 vs 0.10 vs 0.10 ng/mL (P < 0.05); DPHP: 0.57 vs 0.67 control urban (n=17), and plasticizers vs 0.37 ng/mL (P < 0.01). Urinary concentrations of BCEP, BCIPP, DBP and DPHP control rural (n=29) significantly correlated with increase in 8-OHdG. Lu SY et al. (75) Qingyuan, China Exposed towns vs control Population (aged 0.4–87 PAHs Urinary OH-PAHs: 25.4 vs 10.9 vs 11.7 μg/g creatinine; 8-0HdG: 16.2 vs 12.3 vs urban area years). Exposed (n=130), 11.6 ng/mL; MDA: 47.9 vs 36.1 vs 31.3 μg/g creatinine (all P < 0.05). OH-PAHs control urban (n=22), significantly associated with elevated 8-OHdG. control rural (n=24) Zhou X et al. (76) Guiyu, China E-waste recycling workers Pregnant women and Not assessed Median maternal serum estradiol: 2137.52 vs 1549.74 pg/mL; umbilical cord and residents of areas with neonates. Exposed estradiol: 2757.91 vs 2211.29 pg/mL; maternal serum progesterone: 100.10 vs e-waste recycling vs control pregnant women (n=46), 61.61 ng/mL; umbilical cord progesterone: 156.52 vs 145.87 ng/mL (all P < 0.05). town control (n=44) Levels of estradiol and progesterone significantly elevated in exposed group. Significant increase in mRNA levels of estrogen receptors and decrease in mRNA levels of progesterone receptors in exposed group (all P < 0.05). Li R et al. (32) China Exposed town vs control Adults. Exposed (n=23), PCBs, PBDEs, Plasma PCBs: 60.4 vs 28.4 ng g–1; DP: 9.0 vs 2.8 ng g–1; PBB-153: 0.55 vs 0.25 ng town control (n=28) PBBs, DP, HCB, g–1 (all P < 0.01). No difference in PBDEs, HCB, β-HCH, p,p’-DDE or lead. Increased β-HCH, p,p’-DDE, levels of white blood cells, lymphocytes and neutrocytes in exposed group (20.9%, lead 18.6%, 24% respectively). Lower reactive oxygen species in respiratory burst of neutrophil granulocytes among exposed group (data not shown, P < 0.001). Positive correlation between PCBs in plasma and reactive oxygen species levels in white blood cells and neutrophil granulocytes (both P < 0.05). This study also quoted in Table 6.

8-OHdG: 8-hydroxy-2’-deoxyguanosine; β-HCH: β-hexachlorocyclohexane; BCEP: bis(2-chloroethyl) phosphate; BCIPP: bis(2-chloro-isopropyl) phosphate; BPA: bisphenol A; BPF: bisphenol F; BPS: bisphenol S; DBP: dibutyl phosphate; DP: dechlorane plus; DPHP: diphenyl phosphate; HCB: hexachlorobenzene; MDA: malondialdehyde; mRNA: messenger ribonucleic acid; OH-PAH: hydroxylated polycyclic aromatic hydrocarbon; PAH: polycyclic aromatic hydrocarbon; PBB: polybrominated biphenyl; PBDE: polybrominated diphenyl ether; PCB: polychlorinated biphenyl; p,p’-DDE: p,p’-dichlorodiphenyldichloroethylene. CHILDREN AND DIGITAL DUMPSITES: E-WASTE EXPOSURE AND CHILD HEALTH 25 WEB ANNEX. LITERATURE REVIEW ON THE HEALTH EFFECTS OF EXPOSURE TO E-WASTE

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