Clusters of cancer mortality in New Jersey municipalities; with special reference to chemical toxic waste disposal sites and per capita income

The state of New Jersey (NJ), USA, has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for NJ counties. This study presents an analysis of mortality from major cancers for NJ municipalities during 1968-1977, and correlates cancer mortality rates with several potentially relevant variables. Age-adjusted mortality rates for 13 major cancer sites for 194 municipalities of 10 000 or more people in 21 NJ counties were compared with cancer mortality in the US. Municipality rates were correlated with: distribution of chemical toxic waste disposal sites (CTWDS); annual per capita income; the rates of low birth weight, birth defects and infant mortality of NJ municipalities. Clusters of cancer mortality were observed in 23 municipalities in 10 counties in which a total of 98 age-adjusted cancer death rates were at least 50% above the national rate, and each of these municipalities had at least two race-sex-specific cancers in which the observed number of cancer deaths was greater than the expected number of deaths at the p less than 0.0005 level. Of these 98 excessive cancer death rates, 72% involved the gastrointestinal tract. Most of the municipalities are located in the highly industrialized densely populated northeastern part of the State. Correlation analyses showed a consistent and significant (p less than 0.05) negative correlation between income and cancer mortality in 11 of 12 cancers studied. These analyses also showed a significant positive association between 8 of 12 cancers studied and CTWDS in one or more subgroup populations and lesser associations with birth defects, low birth weight and infant mortality.     

Gastrointestinal cancer mortality in New Jersey counties, and the relationship with environmental variables

The State of New Jersey (NJ) USA has been thought to have an unusually high cancer mortality rate; this assumption has been based on 1950-1969 mortality data for its 21 counties. This paper presents an analysis of gastrointestinal (GI) cancer mortality rates in New Jersey counties during 1968-1977, a comparison with the 1950-1969 rates, and associations between current GI cancer mortality rates and selected environmental variables. Age-adjusted mortality rates for GI cancers were calculated for the 21 NJ counties during the period 1968-1977, and were compared with the period 1950-1969, with the Surveillance, Epidemiology and End Results (SEER) survey and with cancer mortality in the US, 1973-1977. The county rates were also correlated with: the distribution of chemical toxic waste disposal sites; annual per capita income; the rates of low birth weight, birth defects, and infant mortality; chemical industry distribution; percentage of the population employed in chemical industries; the density of population; and the urbanization index for each of the counties. Some of the major findings are: Age-adjusted GI cancer mortality rates (all sites combined) were higher than national rates in 20 of 21 NJ counties. In comparison with national trends, NJ stomach cancer rates have declined less, oesophageal cancer rates have declined more, and pancreatic cancer mortality rates have followed similar patterns. Cancer mortality rates in NJ during the period 1968-1977 significantly (p less than 0.0001) exceeded national rates for cancer of the oesophagus (white male, non-white male), stomach (men and women), colon (white male, white female, non-white female), and rectum (whites only). In 18 of the 21 NJ counties, the observed number of cancer deaths for at least one GI cancer site was significantly greater than expected at the 0.0001 level for at least one population subgroup. Among white men, a significant (p less than 0.0001) excess of observed over expected cancer deaths was observed for three or more GI cancer sites in seven counties. The environmental variables that were most frequently associated with GI cancer mortality rates (except pancreatic cancer) were degree of urbanization, population density, and chemical toxic waste disposal sites. Some of the implications of the study findings are discussed and recommendations made for future investigations.     

Cancer mortality in U.S. counties with shipyard industries during World War II

Respiratory cancer mortality, 1950–1969, was consistently high in U.S. counties where shipyards were engaged in the construction and repair of large naval and cargo vessels during World War II. Over three-fourths of the shipyard counties had elevated rates (in comparison to rates in counties of similar population size in the same region of the country) for lung and laryngeal cancer among white males, with the excess particularly evident in the South. Mortality from lung cancer was high also among white females, and the rate of increase in both sexes was greater than recorded nationally. In addition, rates for oropharyngeal, esophageal, and gastric cancers tended to be elevated in the shipyard counties, but mortality from other tumors was roughly comparable to national levels. A causal relation to asbestos exposures in shipyards cannot be inferred from this correlational analysis, but the unusual mortality patterns underscore the need for broadly based analytic studies to evaluate the risk of cancer in persons with wartime shipyard employment.     

Bladder cancer mortality in New Jersey counties, and relationship with selected environmental variables

Age-adjusted mortality rates for bladder cancer were calculated for the 21 New Jersey (NJ) counties (USA) during the period 1968-1977, and compared with the period 1950-1969, with the Surveillance, Epidemiology and End Results (SEER) survey and with cancer mortality in the US 1973-1977. The county rates were also correlated with: the rates of low birth weight, birth defects, infant mortality; chemical waste disposal sites; annual per capital income; per cent of the population working in the chemical industries; density of population and urbanization indices of 21 NJ counties. Age-adjusted bladder cancer mortality rates in 95% of NJ counties were higher than national and SEER area rates. The overall NJ State rates for four subgroup populations were highly significantly (p less than 0.001) greater than the national rates. There was a statistically significant correlation between bladder and lung cancer mortality among females in 21 NJ counties which may suggest a common risk factor--namely cigarette smoking. There was no such correlation between bladder and lung cancer mortality among males. There was a statistically significant association between bladder cancer mortality in individual counties and the percentage of the adult population working in the chemical industries.     

Brain cancer in petrochemical workers: A case series report

Eighteen primary brain cancer deaths among male workers at one Texas petrochemical plant from 1965–1980 are reported. Federal officials from OSHA and NIOSH are performing with company cooperation an historical prospective cohort mortality study, a case-control study, and neuropathological case confirmation. Average age at death was 53 (range 30–66). Median employment was 21 years and median latency was 24 years. 15/18 tumors were glioblastoma multiforme, an unusual histologic distribution. A preliminary estimate reveals a plant-wide excess brain cancer risk twice expected among 6,800 white males at the plant since 1941. Brain cancer mortality rates in surrounding counties are in the median range for US counties from 1950–1969. Ten recognized or suspected carcinogens are present in quantities > 10⁶ lbs/yr. To date no common chemical exposures or work assignments have been identified among the cases. Data on 26 experimental brain carcinogens and relevant epidemiological studies are provided.     

Cancer and occupational exposure to arsenic: A study of pesticide workers

Mortality and morbidity experience was studied in 1,393 persons exposed to considerably high air concentrations of inorganic arsenicals for varying lengths of time during the manufacture and packaging of various pesticides in a plant in Baltimore, Maryland. Study subjects were traced for the period 1946–1977, and vital status was determined for 86.9% of 1,050 men and 66.8% of 343 women. The observed numbers of deaths from all and selected causes were compared with the expected numbers of deaths derived from population mortality rates. Among men, 23 deaths from lung cancer and 2 deaths from anemias represented statistically significant excesses over the expected numbers (P < 0.05). Lung cancer mortality was especially high in male production workers with presumed high exposure to arsenicals for a prolonged period of time. A dose-response effect was suggested for lung cancer mortality which increased with length of arsenical exposure, but no such relationship appeared for nonarsenical exposure. Workers with high arsenical exposure also had increased frequencies of such forms of arsenism as keratoses and perforation of the nasal septum. Analysis of the 23 male lung cancer deaths and 23 matched controls suggested a relationship, though not statistically significant, between lung cancer and antecedent keratoses. These findings provide strong evidence for a causal relationship between occupational exposure to inorganic arsenicals and lung cancer.     

Recent geographic patterns of lung cancer and mesothelioma mortality rates in 49 shipyard counties in the United States, 1970-94

BACKGROUND: Lung cancer mortality rates among white males in the United States were observed to be elevated during 1950-69 in counties with shipbuilding industries during World War II; risk was found to be associated with asbestos exposure. We evaluated the geographic patterns in more recent years, 1970-94, for whites and compared them with the 1950-69 patterns. METHODS: We calculated age-adjusted rates and estimated rate ratios between comparison groups. RESULTS: Rates generally were higher in shipyard counties than in all nonshipyard counties and in coastal nonshipyard counties for both sexes and time periods. Rates increased markedly from 1950-69 to 1970-94 in all groups, with the changes more pronounced in females than males. Pleural mesothelioma mortality rates were also significantly higher in shipyard counties than coastal nonshipyard counties in all regions among males but not among females. CONCLUSIONS: The more pronounced changes in lung cancer mortality rates among females in shipyard counties may be attributed to the combined effects of low asbestos exposures and changes in smoking behavior. Am. J. Ind. Med. 37:512-521, 2000. Published 2000 Wiley-Liss, Inc.     

Mortality among rubber workers: X. Reclaim workers

This study evaluated the mortality experience of 1,352 white and 438 nonwhite men who worked in the rubber-reclaiming division of a large rubber manufacturing company. In comparisons of mortality of white reclaim workers with that of nonreclaim workers rate ratios were 2.7 for esophageal cancer (six observed deaths among reclaim workers), 2.1 for bladder cancer (seven observed deaths), and 4.5 for multiple myeloma (six observed deaths). The excess of bladder cancer among white reclaim workers may be associated with their employment in other high-risk areas of the plant, whereas no such explanation was found for the excesses of esophageal cancer and multiple myeloma. Overall, the lung cancer mortality rate of white reclaim workers was similar to the rate of US white males and other white rubber workers. There was a 50% excess of lung cancer deaths among nonwhite reclaim workers compared with other nonwhite rubber workers. However, this observation is based on small numbers, and no firm conclusions can be reached about the risk of lung cancer associated with reclaim operations in this group of rubber workers.     

Maternal Mortality in Michigan: An Epidemiologic Analysis, 1950-1971

An analysis was performed of direct maternal mortality over 22 years (1950 through 1971) in the state of Michigan. The overall direct maternal mortality rate fell from 5.0/10,000 live births in 1950 to 1.5 in 1971. The rate among nonwhites was more than four times greater than among whites and the difference in relative risk did not narrow over the 22 years. Mortality rates increased with increasing maternal age but not with increasing parity. Nulliparous women had a significantly higher mortality rate than did parous women, particularly those over 25 years of age. when the white gravida of urban Wayne County were compared with the white gravida of 33 rural counties, no difference in direct maternal mortality rates could be attributed to rurality per se. Hemorrhage, infection, and toxemia were the leading causes of direct maternal death. The data suggest that hospitals with less active obstetrical services were associated with a higher risk of direct maternal mortality than were hospitals whose obstetrical services were more active. An increasing proportion of the direct maternal deaths was designated as preventable over the study period. It is believed that analyses of maternal mortality have led to improved perinatal and obstetrical care and that further advances require their continued support. (Am. J. Public Health 67:821-829, 1977)     

Cancer mortality in U.S. counties with chemical industries.

Geographic analysis of U. S. cancer mortality, 1950–1969, revealed excess rates for bladder, lung, liver, and certain other cancers among males in 139 counties where the chemical industry is most highly concentrated. The correlation could not be explained by confounding variables such as urbanization, socioeconomic class, or employment in nonchemical industries. If the excess cancer mortality in these areas is due to industrial exposures, the actual risk of cancer among certain chemical workers must be very high. The correlation was limited to counties associated with specific categories of the chemical industry; many involve known occupational hazards, while others suggest new leads to chemically induced cancer in man.     

Ultraviolet radiation and melanoma mortality in the United States

White male and female melanoma mortality rates for the period 1950–1969 for 18 U.S. counties have been examined to clarify the importance of received ultraviolet radiation as a factor in melanoma mortality. Although latitude and received ultraviolet radiation were correlated at the 0.01 significance level, no significant correlation was found between melanoma mortality in white males or females and ultraviolet radiation. This suggests that factors other than received ultraviolet radiation may play a role in melanoma mortality, particularly in the 18 counties studied.     

AIDS and changing patterns of mortality.

We compared changes in all-causes mortality rates, 1986 versus 1980, among members 25 to 44 years of age of demographically defined groups with high AIDS cumulative incidence to the changes among same-age, same-sex members of groups with low AIDS cumulative incidence. Among nonwhite men ages 25-44 residing in northeastern New Jersey (NJ) counties, AIDS cumulative incidence was 1,409 cases per 100,000; all-causes mortality was 413.8 deaths per 100,000 per year in 1980 and increased 74% to 726.6 deaths per 100,000 per year by 1986. In contrast, among white men ages 25-44 residing in other NJ counties, AIDS cumulative incidence was 75 cases per 100,000; all-causes mortality fell slightly from 192.6 deaths per 100,000 per year in 1980 to 189.2 deaths per 100,000 per year in 1986. Among nonwhite women ages 25-44 residing in northeastern NJ counties, AIDS cumulative incidence was 435 cases per 100,000; all-causes mortality was 162.07 deaths per 100,000 per year in 1980 and increased 70% to 276.3 deaths per 100,000 per year by 1986. Among white women ages 25-44 residing in other NJ counties, AIDS cumulative incidence was 9.1 cases per 100,000; all-causes mortality was 90.5 deaths per 100,000 per year in 1980 and fell slightly to 83.0 deaths per 100,000 per year in 1986. A substantial portion of the increased mortality of the groups with high AIDS cumulative incidence resulted from causes that have not been associated with HIV infection.     

Temporal trends of cancer mortality in eastern New England compared to the nation, 1950-1975

Cancer mortality trends among the white population in eastern New England are compared to National trends for the years 1950-1975 for 62 age and sex-standardized sites. The 26 years considered in the study are divided into five time periods (1950-1954, 1955-1959, 1960-1964, 1965-1969, 1970-1975) representing rates age-adjusted to the 1960 white population. The findings show that male cancer mortality in eastern New England is increasing at a rate consistently higher than and almost parallel to National male cancer mortality. Female cancer rates in eastern New England are declining, but less rapidly than National female cancer mortality. Female lung cancer in the study region has experienced a dramatic increase from 1950 to 1975; and the greatest increases occurred in areas of the lowest relative urbanization.     

Cancer and other causes of death among male and female farmers from twenty-three states

Occupation and industry codes on death certificates from 23 states for 1984–1988 were used to evaluate mortality risks among white and nonwhite, male and female farmers. Proportionate mortality and proportionate cancer mortality ratios were calculated using deaths among nonfarmers from the same states to generate expected numbers. Among farmers there were 119,648 deaths among white men, 2,400 among white women, 11,446 among nonwhite men, and 2,066 among nonwhite women. Deficits occurred in all race-sex groups for infective and parasitic diseases, all cancer combined, lung cancer, liver cancer, diseases of the nervous system, multiple sclerosis, hypertension, and emphysema. As reported in other studies, white male farmers had excesses of cancer of the lymphatic and hematopoietic system, lip, eye, brain, and prostate. Excesses of cancers of the pancreas, kidney, bone, and thyroid were new findings. Regional patterns were evident, particularly among white men. Significant excesses for accidents, vascular lesions of the central nervous system (CNS), and cancers of the prostate tended to occur in most geographic regions, while excesses for mechanical suffocation, non-Hodgkin's lymphoma, and cancers of the lip, brain, and the lymphatic and hematopoietic system were limited to the Central states. Increases among nonwhite men were similar to those in white men for some causes of death (vascular lesions of the CNS and cancers of the pancreas and prostate), but were absent for others (lymphatic and hematopoietic system, lip, eye, kidney, and brain). Women (white and nonwhite) had excesses for vascular lesions of the CNS, disease of the genitourinary system (white women only), and cancers of the stomach and cervix (nonwhite women only). Cancer of the buccal cavity and pharynx was slightly elevated among women, and white women had nonsignificant excesses of multiple myeloma and leukemia. Excesses for leukemia and non-Hodgkin's lymphoma occurred among white men and women, but not among nonwhites. Excesses for several types of accidental deaths were seen among all race-sex groups. © 1993 Wiley-Liss, Inc.     

Cancer mortality in U.S. counties with hazardous waste sites and ground water pollution

Since the late 1950s, more than 750 million tons of toxic chemical wastes have been discarded in an estimated 30,000 to 50,000 hazardous waste sites (HWSs). Uncontrolled discarding of chemical wastes creates the potential for risks to human health. Utilizing the National Priorities Listing (NPL) of hazardous waste sites developed by the United States Environmental Protection Agency (EPA), this study identified 593 waste sites in 339 U.S. counties in 49 states with analytical evidence of contaminated ground drinking water providing a sole source water supply. For each identified county, age-adjusted, site-specific cancer mortality rates for 13 major sites for the decade 1970-1979, for white males and females, were extracted from U.S. Cancer Mortality and Trends 1950-1979. Also, HWS and non-HWS counties that showed excess numbers of deaths were enumerated for each cancer selected. Significant associations (p less than .002) between excess deaths and all HWS counties were shown for cancers of the lung, bladder, esophagus, stomach, large intestine, and rectum for white males; and for cancers of the lung, breast, bladder, stomach, large intestine, and rectum for white females when compared to all non-HWS counties. There were no consistent geographical patterns that suggested a broad distribution of gastrointestinal cancers associated with HWSs throughout the United States, although we did identify a cluster of excess gastrointestinal cancers in counties within states located in EPA Region 3 (Delaware, Maryland, Pennsylvania, Virginia, West Virginia).(ABSTRACT TRUNCATED AT 250 WORDS)     

Racial differences in acute lymphocytic leukemia mortality and incidence trends

Mortality and morbidity rates for childhood leukemia are examined with reference to time trends and racial differences. Prior to 1964, white and nonwhite children had very different acute lymphocytic leukemia (ALL) mortality rates. With the advent of successful chemotherapy, the mortality rate of ALL in white children has decreased resulting in virtually no racial differences in ALL mortality. The reasons for a stable ALL mortality rate in nonwhite children despite successful chemotherapy include poor access to health care, undefined socioeconomic factors and a biologically different type of ALL occurring in nonwhite children. Recent data from two cancer surveys (1969-1971, 1973-1976) reveal that nonwhite children have a lower incidence of ALL than white children. Underreporting in the nonwhite children could partly account for the difference, but other contributing factors might include a genetic predisposition, undefined socioeconomic influences, and perhaps, a viral agent. Further studies of the factors contributing to racial differences in ALL incidence and mortality are needed.     

Morbidity and mortality in Los Alamos County,New Mexico: I. Methodological issues and preliminary results

Cancer among Los Alamos County, New Mexico, male residents, all of whom have worked in or have lived within a few kilometers of a major plutonium plant and other nuclear facilities, has been reviewed with respect to mortality between 1950 and 1969 and incidence between 1969 and 1974. A possible excess of neoplasms of the reticuloendothelial system was detected, but the incidence data suggest that this excess, if real, is no longer occurring. Several potentially causal occupational exposures have existed. Higher than expected incidence, currently, of cancers of the colon and rectum appears to be explained better by socioeconomic than occupational factors. Neither mortality nor incidence data suggest an excess of lung cancer in Los Alamos males. Healthy worker and healthy military effects, white ethnicity, and migration are discussed as intervening variables relevant to interpreting mortality data in counties dominated by a single major facility. The utility of county data bases in the study of single local area mortality rates is reviewed.     

Age dependence of cohort phenomena in breast cancer mortality in the United States

Breast cancer mortality has increased in most parts of the world, and many explanations have been postulated. In this paper, the authors examined the evolution of mortality rates for white and nonwhite females in the United States from 1950-1979. Using both graphic techniques and Poisson regression models, they found that there has been strong modification of apparent cohort effects by age. For both white and nonwhite females, they observed an increase in mortality rates limited to the postmenopausal ages.     

Selenium in forage crops and cancer mortality in U.S. counties

The potential protective effect of selenium status on the risk of developing cancer has been examined in animal and epidemiologic studies. This ecological study investigated the association between U.S. county forage selenium status and site- and sex-specific county cancer mortality rates (1950-1969) using weighted least squares regression. Consistent, significant (p less than .01) inverse associations were observed for cancers of the lung, rectum, bladder, esophagus, and cervix in a model limited to rural counties and for cancers of the lung, breast, rectum, bladder, esophagus, and corpus uteri in a model of all counties. No consistent significant positive associations were observed in the rural county models. This remarkable degree of consistency for the inverse associations strengthens the likelihood of a causal relationship between low selenium status and an increased risk of cancer mortality.     

Expected indoor 222Rn levels in counties with very high and very low lung cancer rates

Counties in the U.S. with high lung cancer rates should have higher average 222Rn levels than counties with low lung cancer rates, assuming the average 222Rn level in a county is not correlated with other factors that cause lung cancer. The magnitude of this effect was calculated, using the absolute risk model, the relative risk model, and an intermediate model, for females who died in 1950-1969. The results were similar for all three models. We concluded that, ignoring migration, the average Rn level in the highest lung cancer counties should be about three times higher than in the lowest lung cancer counties according to the theory. Preliminary data are presented indicating that the situation is quite the opposite: The average Rn level in the highest lung cancer counties was only about one-half that in the lowest lung cancer counties.