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.     

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.     

Respiratory organs cancer mortality in New Jersey counties and the relationship with selected demographic and environmental variables

The state of New Jersey (N.J.) has been thought to have an unusually high overall cancer mortality rate; this assumption has been based on national 1950–1969 mortality data for N.J. counties. This study presents an analysis of more recent rates of respiratory cancer mortality in 21 N.J. counties during 1968–1977, a comparison with the 1950–1969 rates, and associations between current respiratory cancer mortality rates and selected demographic and environmental variables. Age-adjusted mortality rates for cancer of respiratory organs were calculated for the N.J. counties 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 United States, 1973–1977. The county rates were also correlated with chemical toxic-waste disposal sites (CTWDS), annual per capita income, percentage of the population employed in chemical industries, the density of population, and the urbanization index of each of 21 N.J. counties. The lung, bronchus, trachea, and pleura cancer mortality rates among white and nonwhite males and females in N.J. were substantially higher than the national rates during the period 1950–1969. In more recent years, the increases in U.S. mortality rates for lung, bronchus, trachea, and pleura cancers were significantly greater (P < 0.01) than those found in most of the 21 N.J. counties. As a consequence, the national rates are now more comparable to N.J. rates. Although the gaps between N.J. and the United States in these rates have narrowed, the observed number of laryngeal and lung cancer deaths remained significantly higher (P < 0.01 to P < 0.0001) than expected cancer deaths, based on U.S. rates, among one or more subgroup populations (white and nonwhite males and females) in several N.J. counties. Among white men in Middlesex, Camden, Burlington, and Ocean counties, the observed number of deaths for lung cancer was found to be significantly (P < 0.0001) greater than the expected number of deaths. In Hudson county observed deaths from both laryngeal and lung cancer among white men were significantly greater than the expected number of deaths from these cancers (P < 0.0001). Statistically significant and positive correlations were found between laryngeal cancer mortality and CTWDS, urbanization index, and population density. Lung cancer mortality also correlated significantly with CTWDS in N.J. Both larynx and lung cancer mortality showed significant and consistent negative correlations with annual per capita-income in N.J. Some of the implications of the study findings are discussed and recommendations made for future investigations.     

Changing patterns of ischaemic heart disease mortality in New Jersey 1968-1982, and the relationship with urbanization

Geographical variations in the declining rates of ischaemic heart disease (IHD) mortality may provide clues about various environmental risk factors responsible as a mass influence on the population IHD rate. The rate of IHD decline in 18 of 21 NJ counties was 2 to 45% less than the USA national rate of decline. The overall decline of IHD mortality in New Jersey (NJ) counties lagged significantly (p less than 0.05 to p less than 0.0003) behind the national trend. Age-adjusted mortality rate (AAMR) for IHD in NJ's 21 counties were 4% to 56% higher than the US rates. The IHD mortality rate of 14 of 21 NJ, counties and the entire state were significantly (p less than 0.005 to p less than 0.000001) above the US rate. Highly urbanized, industrialized, and densely populated NJ counties had the highest IHD rates. In these highly urbanized, industrialized and overcrowded NJ counties the AAMR for IHD was significantly higher and the IHD decline was significantly lower than that in the US. There was a significant (p less than 0.02 to p less than 0.00001) inverse association between annual per capita income and IHD rates. These data suggest that a high degree of urbanization, extensive industrialization, high population density and low socioeconomic status were acting as mass influences on the NJ population IHD rate.     

Cancer mortality and environmental exposure to DDE in the United States

To explore the role of DDE, the major and most persistent DDT derivative, in cancer etiology, we examined the association of the 1968 adipose DDE levels of population samples from 22 U.S. states with age-adjusted mortality rates between 1975 and 1994 for multiple myeloma; non-Hodgkin lymphoma (NHL); and cancer of the breast, corpus uteri, liver, and pancreas. Separate analyses were conducted by gender and race. Covariates in the regression models included average per-capita income, percent metropolitan residents, and the population density. Liver cancer mortality increased significantly with adipose DDE levels in both sexes among whites, but not among African Americans. No association was observed for pancreatic cancer and multiple myeloma. Breast cancer mortality was inversely correlated with adipose DDE levels among both white and African American women. Significant inverse correlations were also observed for uterine cancer among white women, whereas no association was observed for African Americans and for NHL among whites (men and women) and African American women. The results for pancreatic cancer, multiple myeloma, NHL, breast cancer, and uterine cancer did not support the hypothesis of an association with past adipose levels of the DDT derivative DDE. The multivariate analysis confirmed most findings. The association between liver cancer and DDE observed among whites, particularly in view of the occurrence of hepatic neoplasms in laboratory animals exposed to DDT, warrants further investigation.     

Ecological Analysis of Teen Birth Rates: Association with Community Income and Income Inequality

Objectives: To examine whether per capita income and income inequality are independently associated with teen birth rate in populous U.S. counties. Methods: This study used 1990 U.S. Census data and National Center for Health Statistics birth data. Income inequality was measured with the 90:10 ratio, a ratio of percent of cumulative income held by the richest and poorest population deciles. Linear regression and analysis of variance were used to assess associations between county-level average income, income inequality, and teen birth rates among counties with population greater than 100,000. Results: Among teens aged 15–17, income inequality and per capita income were independently associated with birth rate; the mean birth rate was 54 per 1,000 in counties with low income and high income inequality, and 19 per 1,000 in counties with high income and low inequality. Among older teens (aged 18–19) only per capita income was significantly associated with birth rate. Conclusions: Although teen childbearing is the result of individual behaviors, these findings suggest that community-level factors such as income and income inequality may contribute significantly to differences in teen birth rates.     

Mortality of a residential cohort exposed to radon from industrially contaminated soil

A historical cohort mortality study was conducted in three neighborhoods of Essex County, New Jersey, to investigate the mortality patterns of persons who had inhabited 45 homes documented to be contaminated by radon gas emanating from radium processing waste. Residency history and vital status were collected for 752 persons, comprising 91% of the subjects enumerated who had resided in the index homes for at least one year during the years 1923-1983. Standardized mortality ratios (SMR) were used to compare the death rates of the study group with the death rates of the United States and New Jersey. While there were no statistically significant excesses of lung cancer for the cohort or its subgroups, an elevated mortality rate for lung cancer was found for white males in the comparison of lung cancer mortality rates in the United States (SMR = 1.5, 95% confidence interval (CI) 0.7-2.7) and New Jersey (SMR = 1.7, 95% CI 0.8-3.2). No excess of lung cancer was observed in females or nonwhites. The small size of the cohort and the inability to collect smoking histories or complete occupational data limited the study. Nevertheless, the degree of excess lung cancer among white males was in agreement with both the attributable and relative risk estimates per unit of exposure derived for radon from mining studies.     

Impact of hysterectomy and bilateral oophorectomy on race-specific rates of corpus, cervical, and ovarian cancers in the United States

PURPOSE: Population-based cancer incidence rates of the corpus uteri, cervix uteri, and ovaries are underestimated if they fail to remove women not at risk for developing the cancers from the denominator in the race calculation. This study compares incidence rates among selected racial groups for these cancers before and after correction for prevalence of hysterectomy and bilateral oophorectomy. METHODS: The study covers 1998 through 2002 and involves Surveillance, Epidemiology, and End Results Program; Behavior Risk Factor Surveillance System; and National Health Interview Survey data. Prevalence data were obtained by using survey and life-table methods. Four racial groups are considered: whites, blacks, American Indians/Alaska Natives, and Asians/Pacific Islanders. RESULTS: Risk correction significantly increased rates of corpus uterine cancer by 73.1% for whites, 93.0% for blacks, 86.3% for American Indians/Alaska Natives, and 41.0% for Asians/Pacific Islanders. Corresponding percentages among these racial groups for cervical cancer were 37.7%, 60.2%, 45.6%, and 33.0%, and for ovarian cancer, 32.5%, 31.1%, 35.0%, and 23.6%, respectively. Risk correction had large influences on the comparison of rates among racial groups. For example, for uterine corpus cancer, Asians/Pacific Islanders had 32.9% lower rates than whites before correction, but 45.3% lower rates after correction. For cervical cancer, blacks had 27.6% higher rates than whites before correction, but 48.5% higher rates after correction; and for ovarian cancer, Asians/Pacific Islanders had 31.2% lower rates than whites before correction and 35.8% lower rates after correction. CONCLUSIONS: Corrected rates of corpus uteri, cervix uteri, and ovarian cancers have a large, but differential, impact on the racial groups considered.     

Cancer mortality, ethnicity, and socioeconomic status: two New York City groups

Cancer mortality rates for 1979-81 among Puerto Ricans and non-Hispanic whites in New York City are analyzed for cancer in six sites. They include cancers of the lung, esophagus, breast, stomach, colon, ovary, and all cancers. New York City health areas were divided into four quartiles representing four levels of income. In general, Puerto Ricans in New York City have lower mortality rates from cancer than non-Hispanic white residents of the city. In comparing cancer mortality by quartile, Puerto Rican males show little variation. Puerto Rican females show their highest mortality rates from breast cancer in the wealthiest quartile, and non-Hispanic white women show highest mortality rates from breast cancer in the poorest quartile. Non-Hispanic white males show mortality rates from lung cancer in the poorest quartile that are distinctly higher than in the more affluent ones. For all groups, with the exception of Puerto Rican males, mortality rates from all cancers increased progressively with decreasing income. Factors influencing differential mortality rates by quartile appear to include tobacco use, alcohol consumption, occupational hazards, fertility, and differential use of health facilities.     

Gastric cancer in New Mexico counties with significant deposits of uranium

Several counties in northern New Mexico display high rates of mortality from gastric cancer. Significant differences in sex-specific, age-adjusted, average annual stomach cancer mortality rates among whites from 1970-1979 were found between counties with significant deposits of uranium compared to those without significant deposits. These results remained unchanged when either socioeconomic status or Hispanic ethnicity were considered. Additional research needs to consider individual characteristics and competing risk factors for individuals with gastric cancer in these counties. A working hypothesis is that residents of counties with significant deposits of uranium are exposed to higher-than-average environmental levels of radionuclides such as radon and radon daughters, or to trace elements such as arsenic, cadmium, selenium, and lead which are commonly found in areas with uranium deposits.     

Wider income gaps,wider waistbands? An ecological study of obesity and income inequality

OBJECTIVES: To see if obesity, deaths from diabetes, and daily calorie intake are associated with income inequality among developed countries. DESIGN: Ecological study of 21 developed countries.Countries: Countries were eligible for inclusion if they were among the top 50 countries with the highest gross national income per capita by purchasing power parity in 2002, had a population over 3 million, and had available data on income inequality and outcome measures. MAIN OUTCOME MEASURES: Percentage of obese (body mass index >30) adult men and women, diabetes mortality rates, and calorie consumption per capita per day. RESULTS: Adjusting for gross national per capita income, income inequality was positively correlated with the percentage of obese men (r = 0.48, p = 0.03), the percentage of obese women (r = 0.62, p = 0.003), diabetes mortality rates per 1 million people (r = 0.46, p = 0.04), and average calories per capita per day (r = 0.50, p = 0.02). Correlations were stronger if analyses were weighted for population size. The effect of income inequality on female obesity was independent of average calorie intake. CONCLUSIONS: Obesity, diabetes mortality, and calorie consumption were associated with income inequality in developed countries. Increased nutritional problems may be a consequence of the psychosocial impact of living in a more hierarchical society.     

Declines in nonwhite and white neonatal mortality in Mississippi, 1975-80

Linked birth and death records provided the population for an investigation of declines in nonwhite and white neonatal mortality rates (NMR) in Mississippi between 1975 and 1980. The effect of changes in the characteristics of women giving birth and in perinatal care on declining NMRs was analyzed. A decomposition of the difference in the 1975-76 and 1979-80 NMRs was performed to determine whether declines in NMRs were due to shifts in population characteristics or in characteristic-specific rates. Between 1975 and 1980, the NMR declined significantly by 1 death per 1,000 live births per year among nonwhites and by 0.8 per 1,000 among whites. Increases in the number of prenatal visits during the study period were associated with part of this decline, especially for nonwhites. The effect of rising use of prenatal care on NMRs was not, however, a result of shifts in the birth weight distribution. The decrease in NMRs was also associated with declining birth weight-specific rates; 75 percent of the decrease in rates was noted among low birth weight infants. Shifts in the distribution of birth weight and in maternal characteristics had little effect on declining NMRs. A strong commitment of the Mississippi State Board of Health to provide prenatal care to indigent women may be responsible for the large increases in use of prenatal care among Mississippi women. The decline in NMRs among low birth weight infants is likely linked to greater availability of specialized care for the sick neonate, although survival of these infants increased across the State, even where specialized care was not available.     

An updated mortality follow-up study of Florida phosphate industry workers

We have added 14 years of mortality follow-up to a previously studied cohort of 18,446 white and 4,546 nonwhite male workers in the Florida phosphate industry. Follow-up was performed for the years 1949–1992. Based on comparisons with national rates, lung cancer standardized mortality ratios (SMR) were slightly elevated among white (SMR = 1.19; 354 observed) and nonwhite males (SMR = 1.13; 105 observed). However, no lung cancer excesses were found relative to local county rates (SMR = 0.98 for whites, SMR = 0.94 for nonwhites). Based on internal analyses of lung cancer mortality, using Poisson regression modeling, there were no associations of lung cancer with cumulative exposures to total dust, silica, or acid mists. There were weak trends or lung cancer risk with alpha and gamma radiation among white males, but no associations with radiation in nonwhites. No relation was found between acid mist exposures and laryngeal cancer. We conclude that there have not been large excesses of lung cancer or other diseases related to workplace exposures in this cohort. © 1996 Wiley-Liss, Inc.     

Racial differences in the relation of birth weight and gestational age to neonatal mortality

Utilizing South Carolina live birth-infant death cohort files for the period 1975-80, this study examines the bivariate distribution of birth weight-gestational age (BW-GA), intrauterine growth curves, and BW-GA specific neonatal mortality rates (NMRs) by race. Comparison of BW-GA distributions revealed an appreciable shift between racial subgroups. Nonwhites, on the average, were born 1 week earlier and 270 grams lighter in weight than whites. In addition to racial differences in rates of intrauterine growth, nonwhites experienced lower BW-GA NMRs than whites in BW-GA categories less than 3,000 grams and less than 38 weeks. However, the improved mortality experience of nonwhites at more immature BW-GA categories was not consistently present when different cause-specific NMRs were considered. These persistent racial variations highlight continuing issues regarding both the use of a single norm for defining low birth weight or prematurity and the role of nonsocioeconomic factors related to racial BW-GA distribution and mortality disparities. As birth weight and gestational age represent empirical indicators of the maturity and survivability of an infant at birth, these data and previous supporting research raise further concerns regarding the ability of these indicators to accurately reflect equivalent fetal development and subsequent risk of mortality among racial groups.     

Association of lung cancer mortality with precambrian granite

Sixteen counties in New York, Pennsylvania, and New Jersey that are associated with the Reading Prong granite deposits have significantly higher age-adjusted lung cancer rates among whites of both sexes (1950-1979) than do 17 nearby control counties. Elevated radon daughter concentrations have been found in homes near the Reading Prong granites. Fraction of populations living in cities with over 5,000 persons, industrial centers, cities with populations above 20,000, and median incomes did not differ significantly for three county groups (those which include the granite, fringe area, and control areas). Weaknesses were inadequate home measurements of radon and lack of smoking information. Findings are consistent with several other studies relating radon in homes to lung cancer.     

Trends in low birth weight infants and changes in Baltimore's childbearing population, 1972–77

Linked birth and death records provided the population for a study of trends in low birth weight (LBW) rates in Baltimore between 1972 and 1977 and of the effect of changes in the characteristics of the childbearing population on these trends. The impact of shifts in the birth weight distribution on neonatal mortality rates was also investigated. Trends were analyzed for unstandardized LBW rates as well as for rates standardized on the distributions of maternal age, education, gravidity, prior pregnancy losses, and marital status.Between 1972 and 1977, the 1,500 and 2,000 gm rates rose significantly by approximately 1 infant per 1,000 live births per year among whites and 2 infants per 1,000 live births among nonwhites. Despite declines in rates for most weights, the effect of these increases was a rise in neonatal mortality rates for both races, but especially for nonwhites.The population of women delivering in Baltimore in 1977 became slightly older, slightly more educated, and of higher gravidity than in 1972, but these changes had little impact on yearly fluctuations in LBW rates. In contrast, increases in births to unmarried women and to women with at least one prior pregnancy loss were related to rising LBW rates. For both races, standardization on marital status and prior pregnancy losses diminishes the increase in the LBW rate over the study period, especially when standardization is performed simultaneously for both variables. These findings hold within maternal age, education, and gravidity groups. However, the LBW rates for nonwhite teenage mothers and for nonwhite women with 12 years of less education increased significantly over the study period, regardless of standardization.     

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.     

Factor analysis of digestive cancer mortality and food consumption in 65 Chinese counties.

Dietary factors were analyzed for the regional difference of GI tract cancer mortality rates in China. Sixty-five rural counties were selected among a total of 2,392 counties to represent a range of rates for seven most prevalent cancers. The dietary data in the selected 65 counties were obtained by three-day dietary record of households in 1983. The four digestive cancer mortality rates (annual cases per 100,000 standardized truncated rates for ages 35-64) and per capita food consumption were analyzed by the principal components factor analysis. Esophageal cancer associated with poor area, dietary pattern rich in starchy tubers, and salt, lack of consumption of meat, eggs, vegetables and rice. Stomach cancer seemed to be less associated with diet in this study because of its small model Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy, suggesting some other carcinogenic factors would play more important role in the development of this cancer in China. The colon and rectal cancer showed close relation to diet; rich in sea vegetables, eggs, soy sauce, meat and fish, while lack in consumption of milk and dairy products. Rapeseed oil was more important risk factor for colon cancer than that of rectum. Rice, processed starch and sugar were closely associated with colon cancer, supporting the insulin/colon cancer hypothesis.     

Mortality among white and nonwhite farmers in North Carolina, 1976-1978

Death certificate information identified 9,245 white and 3,508 nonwhite men who died in North Carolina during 1976-1978 and who had been farmers. The distribution of deaths from various causes among these men was compared to that of other male decedents in the state. For both white and nonwhite farmers, proportional mortality ratios (PMRs) were elevated for tuberculosis (whites, 1.6; nonwhites, 1.7), diseases of the skin and subcutaneous tissue (whites, 2.5; nonwhites, 1.5), and external causes (whites, 1.2; nonwhites, 1.1) and were decreased for cancers of the esophagus (whites and nonwhites, 0.5) and large intestine and rectum (whites and nonwhites, 0.7). White farmers had an increased relative frequency of melanoma (PMR = 1.2) and other skin cancer (PMR = 1.8), while nonwhite farmers had an increased relative frequency of melanoma (PMR = 6.3), brain cancer (PMR = 2.3), and leukemia (PMR = 1.9). In addition, among decedents under 65 years of age, both white and nonwhite farmers had an elevated proportional mortality ratio for prostate cancer (whites, 1.6; nonwhites, 1.3). Many of these results are consistent with observations from other studies. Some of these findings, particularly those for nonwhites, warrant further evaluation, including detailed investigation of possibly related farming practices.