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Love Canal Follow-Up Health Study Love Canal Follow-up Health Study Prepared by the Division of Environmental Health Assessment Center for Environmental Health New York State Department of Health for the U.S. Department of Health and Human Services Agency for Toxic Substances and Disease Registry In memory of Charlene M. Spampinato and her longstanding dedication to the Love Canal project. October 2008 State of New York Funding Provided by Department of Health United States Agency for Toxic Substances and Disease Registry CONTENTS Page LIST OF ABBREVIATIONS………………………………………………....................iii LIST OF FIGURES.……………………………………………………………...............iv LIST OF TABLES ……………………………………………………………….............v LIST OF APPENDICES....…...…...…..…………………………………………...........vii EXECUTIVE SUMMARY………………………………………………………….........1 INTRODUCTION………………………………………………………………………..5 Love Canal History……………………………………………………….6 Environmental Sampling………………………………………………….8 Study Area………………………………………………….....................10 Review of Earlier Love Canal Health Studies…………………………...11 Community Involvement………………………………………………...15 Study Objectives…………………………………………………………17 METHODS………………………………………………………………………………19 Study Population……………………………………………………........19 Comparison Populations………………………………………………....20 Tracing Former Love Canal Residents…………………………………..20 Exposure Assessment………………………………………………........22 Outcome Assessment……………………………………………….…....25 Mortality…………………………………………………….…...25 Cancer Incidence………………………………………………....26 Reproductive Outcomes……………………………………….…28 Potential Confounders…………………………………………………....31 Statistical Analysis…………………………………………………….…31 Mortality and Cancer....................................................……….…32 Reproductive Outcomes………………………………………….34 RESULTS…………………………………………………………………………..……36 Study Population and Tracing……………………………………………36 External Comparisons……………………………………………………37 Mortality…………………………………………………………37 Cancer Incidence…………………………………………………39 Reproductive Outcomes……………………………………….…41 Internal Comparisons……………………………………………….……43 Mortality…………………………………………………………43 Cancer Incidence…………………………………………………44 Reproductive Outcomes………………………………….………46 i DISCUSSION……………………………………………………………………………48 Mortality…………………………………………………………....……49 Cancer Incidence……………………………………………...………….52 Reproductive Outcomes……………………………….………….……...54 Strengths…………………………………………………………………57 Limitations……………………………………………….………………58 Next Steps.……………………………………………………………….61 Future Steps……………………………………………………………...63 REFERENCES…………………………………………………………………………..64 AUTHORS AND ACKNOWLEDGEMENTS………………………………..………...73 FIGURES………………………………………………………………………..……….74 TABLES………………………………………………………………………....………79 APPENDICES……………………………………………………………………….....103 ii LIST OF ABBREVIATIONS AKA Also known as ATSDR Agency for Toxic Substances and Disease Registry BPA British Pediatric Association CDC Centers for Disease Control CDC-WONDER Centers for Disease Control-Wide-ranging Online Data for Epidemiologic Research CERCLA Comprehensive Environmental Response, Compensation and Liability Act CI Confidence Interval CI95 95% Confidence Interval CL12 Tiers 1 and 2 during Closed Period CL34 Tiers 3 and 4 during Closed Period CMR Congenital Malformations Registry DHHS Department of Health and Human Services DMV Department of Motor Vehicles EDA Emergency Declaration Area GEE Generalized Estimating Equations HCH Hexachlorocyclohexane HR Hazard Ratio IARC International Agency for Research on Cancer ICD-9 International Classification of Diseases-9th Revision LBW Low Birth Weight LCIC Love Canal Indicator Chemicals N Number (of observations in the category) NC Niagara County NDI National Death Index NPL National Priorities List NTP National Toxicology Program NYC New York City (the five boroughs) NYS New York State (excluding NYC) NYSCR New York State Cancer Registry NYSDCR New York State Death Certificate Registry NYSDEC New York State Department of Environmental Conservation NYSDOH New York State Department of Health NYSVR New York State Vital Records OP12 Tiers 1 and 2 during Open Period OP34 Tiers 3 and 4 during Open Period OR Odds Ratio PH Proportional Hazards PPB Parts per Billion PT Pre-Term SGA Small for Gestational Age SIR Standardized Incidence Ratio SMR Standardized Mortality Ratio SSA Social Security Administration SSDI Social Security Death Index TCDD 2,3,7,8-tetrachlorodibenzo-p-dioxin TRC Technical Review Committee USEPA United States Environmental Protection Agency VLBW Very Low Birth Weight iii LIST OF FIGURES Page Figure 1. - Emergency Declaration Area……………………………………………74 Figure 2. - β- HCH Concentrations in Surface Soil..............................………..........75 Figure 3. - 1,2,4-Trichlorobenzene in Indoor Air…………………………………...76 Figure 4. - Chlorotoluene in Shallow Soil…………………………………………..77 Figure 5 - Schematic of the Tracing of the Love Canal Cohort....…………………78 iv LIST OF TABLES Page Table 1. - The Seven Exposure Variables and Five Potential Confounding……..…79 Variables Obtained from the Original 1978 to 1981 Interviews Included in Analyses Table 2. - Demographic Characteristics of the Love Canal Cohort……………...…80 Table 3. - Tracing of the Love Canal Cohort…………………………………….…81 Table 4. - Standardized Mortality Ratio (SMR) for Females and Males………...…82 Combined Compared to NYS (exclusive of NYC) Table 5. - Standardized Mortality Ratio (SMR) for Females and Males……….......83 Separately Compared to NYS (exclusive of NYC) Table 6. - Standardized Mortality Ratio (SMR) for Females and Males……….......84 Combined Compared to Niagara County Table 7. - Standardized Mortality Ratio (SMR) for Females and Males………...…85 Separately Compared to Niagara County Table 8. - Standardized Incidence Ratio (SIR) for Cancer for Females……….……86 and Males Combined, Full and Part Time Residents, Compared to NYS (exclusive of NYC) Table 9. - Standardized Incidence Ratio (SIR) for Cancer for Females……….……87 and Males Separately, Full and Part Time Residents, Compared to NYS (exclusive of NYC) Table 10. - Standardized Incidence Ratio (SIR) for Females and Males………….....88 Combined, Full and Part Time Residents, Compared to Niagara County Table 11. - Standardized Incidence Ratio (SIR) for Females and Males……….........89 Separately, Full and Part Time Residents, Compared to Niagara County Table 12. - Standardized Incidence Ratio (SIR) for Cancer Groups Based………….90 on Literature Reports Compared to NYS (exclusive of NYC) Table 13. - Standardized Incidence Ratio (SIR) for Cancer Groups Based …………91 on Toxicological Endpoints Compared to NYS (exclusive of NYC) Table 14. - Standardized Incidence Ratio (SIR) for Cancer Groups Based……….…92 on Literature Reports Compared to Niagara County Table 15. - Standardized Incidence Ratio (SIR) for Cancer Groups Based……….…93 on Toxicological Endpoints Compared to Niagara County Table 16. - Exposure Patterns and Characteristics of Mothers and Singleton…….…94 Births, 1960-1996 Table 17. - Standardized Incidence Ratios (SIR) For Low Birth Weight (LBW),…...95 Very Low Birth Weight (VLBW), Preterm (PT), and Small-for-gestational Age (SGA), Compared to Niagara County and NYS Exclusive of NYC, Singleton Births Only Table 18. - Proportion of Births by Sex and Ratio of Female to Male Births………..96 Compared to Niagara County and NYS (exclusive of NYC) v Table 19. - Standardized Incidence Ratio (SIR) for Congenital………………..……96 Malformations Compared to Niagara County and NYS Exclusive of NYC Table 20. - Summary of Demographic Information of Persons with Known………..97 Vital Status and Dates of Residence in the EDA and Subset of Interviewees Only Table 21. - Survival Analysis Modeling for Mortality, Hazard Ratios (HR)………..98 and 95% Confidence Intervals (CI), Interviewees Only Table 22. - Survival Analysis Modeling for Cancer (Full and Part-time…………….99 Residents), Hazard Ratios (HR) and 95% Confidence Intervals (CI), Interviewees Only Table 23. - Generalized Estimating Equations Modeling for Low Birth Weight ….100 (1960-1978), Preterm Births (1968-1978) and SGA (1968-1978) Among Women with Interviews, Odds Ratios (OR) and 95% Confidence Intervals (CI) Table 24. - Generalized Estimating Equations Modeling for Female Births …..…101 (1960-1978) Among Women with Interviews, Odds Ratio (OR) and 95% Confidence Intervals (CI) Table 25. - Generalized Estimating Equations Modeling for Congenital……...…...102 Malformations (1983-1996) Among Women with Interviews, Odds Ratios (OR) And 95% Confidence Intervals (CI) vi LIST OF APPENDICES Page Appendix A - Selected Malformations for Analysis - ICD-9/BPA…………..………..103 Appendix B - Love Canal Cohort Mortality Data: Person Years of Follow-Up……...106 Appendix C - Age and Sex Adjusted Standardized Mortality Ratio (SMR)…………..107 Compared To NYS (Exclusive of NYC): Date of Interview - 1996 Appendix D - Age and Sex Adjusted Standardized Mortality Ratio (SMR)………..…111 Compared To Niagara County: Date of Interview - 1996 Appendix E - Age Adjusted Standardized Mortality Ratio (SMR) Compared to…..…115 Niagara County and NYS (Exclusive of NYC): Date Of Interview - 1996, Females Only Appendix F - Age Adjusted Standardized Mortality Ratio (SMR) Compared to……..118 Niagara County and NYS (Exclusive of NYC): Date of Interview - 1996, Males Only Appendix G - Love Canal Cohort Cancer Data: Person Years of Follow-Up................121 Appendix H - Age and Sex Adjusted Standardized Incidence Ratio (SIR) for……..…122 Cancer Compared To NYS (Exclusive of NYC): Date of Interview - 1996 Appendix I - Age and Sex Adjusted Standardized Incidence Ratio (SIR) for……..…125 Cancer Compared To Niagara County: Date of Interview - 1996 Appendix
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