Association between hospital discharge rate for female breast cancer and residence in a zip code containing hazardous waste sites.

BACKGROUND: Exposure to chemicals plays a role in risk of breast cancer. However, possible associations between risk of breast cancer and residential proximity to hazardous waste sites (HWSs) have not been reported. METHODS: We determined rates of hospital discharge with a diagnosis of female breast cancer in relation to residence in a zip code containing HWSs in New York State (NYS) after adjustment for ethnicity, age, income and urbanicity. Waste exposure was assessed by both the number of waste sites and the type of contaminants. Negative binomial regression was used to test the associations. RESULTS: After controlling for confounders, the hospital discharge rate of breast cancer for women living in zip codes having four or more HWSs or in zip codes having one HWS increased significantly (at the 0.05 level) by 9.1% and 6.4%, as compared to those living in a zip code with no HWS. The association for women living in zip codes having two or three HWSs was not significant. This indicates that the extent of exposure cannot be assessed solely by the number of waste sites. The discharge rate for women living in zip codes containing at least one volatile organic compound (VOC) waste site was significantly increased 5.6% as compared to those living in a zip code without any HWS, while the increases were not significant for women living in zip codes containing waste sites with persistent organic pollutants (POPs) or other contaminants. The significant associations were stronger for African American than Caucasian women and stronger in more urbanized than in rural areas. CONCLUSIONS: Residence within a geographic area (defined by zip codes) that includes a hazardous waste site with VOCs is significantly associated with an increased rate of hospitalization for breast cancer, and the association is stronger for African American than Caucasian women and stronger in more urbanized than in rural areas after adjustment for the confounders.

Association between residential proximity to fuel-fired power plants and hospitalization rate for respiratory diseases.

BACKGROUND: Air pollution is known to cause respiratory disease. Unlike motor vehicle sources, fuel-fired power plants are stationary. OBJECTIVE: Using hospitalization data, we examined whether living near a fuel-fired power plant increases the likelihood of hospitalization for respiratory disease. METHODS: Rates of hospitalization for asthma, acute respiratory infection (ARI), and chronic obstructive pulmonary disease (COPD) were estimated using hospitalization data for 1993-2008 from New York State in relation to data for residences near fuel-fired power plants. We also explored data for residential proximity to hazardous waste sites. RESULTS: After adjusting for age, sex, race, median household income, and rural/urban residence, there were significant 11%, 15%, and 17% increases in estimated rates of hospitalization for asthma, ARI, and COPD, respectively, among individuals > 10 years of age living in a ZIP code containing a fuel-fired power plant compared with one that had no power plant. Living in a ZIP code with a fuel-fired power plant was not significantly associated with hospitalization for asthma or ARI among children < 10 years of age. Living in a ZIP code with a hazardous waste site was associated with hospitalization for all outcomes in both age groups, and joint effect estimates were approximately additive for living in a ZIP code that contained a fuel-fired power plant and a hazardous waste site. CONCLUSIONS: Our results are consistent with the hypothesis that exposure to air pollution from fuel-fired power plants and volatile compounds coming from hazardous waste sites increases the risk of hospitalization for respiratory diseases.

The role of residence near hazardous waste sites containing benzene in the development of hematologic cancers in upstate New York.

OBJECTIVES: Epidemiologic studies suggest an association between environmental exposure to benzene and hematologic cancers, but the relationship is not firmly established. The aim of this study was to assess the potential association between residence near hazardous waste sites containing benzene and hospitalization discharge rates for persons having hematologic cancers. MATERIALS AND METHODS: We determined the number of hospital discharges of people with hematologic cancers in New York State except for New York City for the years 1993 to 2008.Descriptive statistics and negative binomial regression models were used to compare the rates of hospitalization of residents in zip codes containing hazardous waste sites containing benzene to the rates of discharges from residents in zip codes without waste sites. RESULTS: When adjusting for potential confounders we found a 15% increase in the rate of hospitalization for chronic lymphatic leukemia (CLL) [rate ratio (RR): 1.15; 95% confidence interval (CI): 1.00-1.33], a 22% increase in the rate of discharges for total leukemia (RR: 1.22; 95% CI: 1.04-1.43) and a 17% increase in the rate of discharges for total lymphoma (RR: 1.17; 95% CI: 1.02-1.35) in the benzene exposed sites. We found greater effects of exposure in African Americans compared to Caucasians, females compared to males and people with higher socioeconomic status (SES) compared to those with lower SES for several of the diseases studied. CONCLUSIONS: After controlling for major confounders we found statistically significant increases in discharge rates for several hematologic cancers in persons residing in zip codes containing benzene waste sites. These results provide additional support for a relationship between environmental exposure to benzene and risk of hematologic cancers.

Impact of BRCA mutations on female fertility and offspring sex ratio.

Positive selection for inherited mutations in breast and ovarian cancer predisposing genes, BRCA1 and BRCA2, may contribute to the high frequency of BRCA mutations among the Ashkenazi Jewish population. Impact of BRCA mutations on fertility has not been generally explored in epidemiologic studies. There are reports of distorted sex ratios in BRCA carrier families but these findings have been attributed to bias. We investigated the effect of BRCA mutations on female fertility and offspring sex ratio in a study of 260 Ashkenazi Jewish women with ovarian cancer and 331 controls, unselected for age or family history of the disease. Pregnancy success was similar for 96 mutation carrier (0.84) and 164 noncarrier cases (0.87) and controls (0.83). After adjusting for covariates, there were no significant differences between BRCA carrier and noncarrier cases and controls with regards to fertility, despite lower pregnancy rates among all cases compared to controls (P = 0.0049). Male/female sex ratios were significantly lower among offspring of carriers (0.71) than offspring of noncarriers (0.95) or those of the controls (0.99). Comparisons among the three groups yielded statistically significant distortion against males among the offspring of known and obligate BRCA carriers compared to noncarriers (OR = 0.74, 95% CI:0.55-0.99) and controls (OR = 0.71, 95% CI:0.54-0.94). In conclusion, we did not find evidence for an effect of BRCA mutations on female fertility. We found a significant excess of females among the offspring of female carriers of BRCA1 and BRCA2 mutations. Potential contribution of observed sex ratio distortions to positive selection for BRCA mutations may warrant further investigation.

Association between residential proximity to PERC dry cleaning establishments and kidney cancer in New York City.

Perchloroethylene (PERC) is commonly used as a dry cleaning solvent and is believed to be a human carcinogen, with occupational exposure resulting in elevated rates of kidney cancer. Living near a dry cleaning facility using PERC has been demonstrated to increase the risk of PERC exposure throughout the building where the dry cleaning is conducted, and in nearby buildings. We designed this study to test the hypothesis that living in an area where there are many PERC dry cleaners increases PERC exposure and the risk of kidney cancer. We matched the diagnosis of kidney cancer from hospitalization discharge data in New York City for the years 1994-2004 by zip code of patient residence to the zip code density of dry cleaners using PERC, as a surrogate for residential exposure. We controlled for age, race, gender, and median household income. We found a significant association between the density of PERC dry cleaning establishments and the rate of hospital discharges that include a diagnosis of kidney cancer among persons 45 years of age and older living in New York City. The rate ratio increased by 10 to 27% for the populations in zip codes with higher density of PERC dry cleaners. Because our exposure assessment is inexact, we are likely underestimating the real association between exposure to PERC and rates of kidney cancer. Our results support the hypothesis that living near a dry cleaning facility using PERC increases the risk of PERC exposure and of developing kidney cancer. To our knowledge, this study is the first to demonstrate an association between residential PERC exposure and cancer risk.

Asthma and infectious respiratory disease in relation to residence near hazardous waste sites.

The hypothesis that simply living near a hazardous waste site increases risk of exposure to chemicals was tested. Using data from the New York Statewide Planning and Research Cooperative System, which provides information on hospitalized patients, plus information on the location and contents of every known hazardous waste site in New York, the rates of hospitalization for asthma (ICD-9 493), infectious respiratory disease (ICD-9 460-466, 480-487, and 490-491), and Chronic obstructive pulmonary disease (COPD) (ICD-9 490-492 and 494-496) were determined among individuals who lived in (a) zip codes containing or abutting a hazardous waste site with persistent organic pollutants (POPs), (b) zip codes containing or abutting a hazardous waste site, but not one with POPs, and (c) zip codes that do not contain or abut an identified hazardous waste site. After adjustment for MHI, race, gender and urban or rural residence, there was a significantly elevated risk of asthma (rate ratio (RR) = 1.09), infectious respiratory disease (RR = 1.15), and COPD (RR = 1.19) in individuals living in a zip code with a POP waste site, and a significantly elevated risk of asthma (RR = 1.09), infectious respiratory disease (RR = 1.12), and COPD (RR = 1.13) associated with residence in a zip code containing a waste site, but not one with POPs, both relative to residence in a zip code without a waste site. These observations are consistent with the hypothesis that simply living near a hazardous waste site increases risk of exposure to substances that contribute to respiratory disease.

Asthma and infectious respiratory disease in children--correlation to residence near hazardous waste sites.

Rates of hospitalization for asthma and respiratory infectious disease in children were modeled as a function of residence: (1) in a zip code containing a hazardous waste site with persistent organic pollutants ('POPs'); (2) in a zip code with a waste site that did not contain POPs ('other'); or (3) in a zip code without any identified waste site ('clean'), as well as other demographic covariates. After adjustment, living in a zip code containing a POPs waste site significantly increased the frequency of hospitalization for asthma and infectious respiratory disease. Living in a zip code with an 'other' waste site also increased hospitalization frequencies for both diseases. The association was strongest for zip codes whose residents were in the lowest quartile of medium family income. This evidence supports the hypothesis that living near a hazardous waste site increases risk of respiratory disease in children.

Increased rate of hospitalization for diabetes and residential proximity of hazardous waste sites.

BACKGROUND: Epidemiologic studies suggest that there may be an association between environmental exposure to persistent organic pollutants (POPs) and diabetes. OBJECTIVE: The aim of this study was to test the hypothesis that residential proximity to POP-contaminated waste sites result in increased rates of hospitalization for diabetes. METHODS: We determined the number of hospitalized patients 25-74 years of age diagnosed with diabetes in New York State exclusive of New York City for the years 1993-2000. Descriptive statistics and negative binomial regression were used to compare diabetes hospitalization rates in individuals who resided in ZIP codes containing or abutting hazardous waste sites containing POPs ("POP" sites); ZIP codes containing hazardous waste sites but with wastes other than POPs ("other" sites); and ZIP codes without any identified hazardous waste sites ("clean" sites). RESULTS: Compared with the hospitalization rates for diabetes in clean sites, the rate ratios for diabetes discharges for people residing in POP sites and "other" sites, after adjustment for potential confounders were 1.23 [95% confidence interval (CI), 1.15-1.32] and 1.25 (95% CI, 1.16-1.34), respectively. In a subset of POP sites along the Hudson River, where there is higher income, less smoking, better diet, and more exercise, the rate ratio was 1.36 (95% CI, 1.26-1.47) compared to clean sites. CONCLUSIONS: After controlling for major confounders, we found a statistically significant increase in the rate of hospitalization for diabetes among the population residing in the ZIP codes containing toxic waste sites.

Exposure to persistent organic pollutants and hypertensive disease.

Previous research suggests that exposure to persistent organic pollutants (POPs) increases the risk of chronic diseases such as hypertension. We identified the zip codes of more than 800 waste sites contaminated with POPs and other pollutants, based on which we classified zip codes of upstate New York into three groups: "POPs sites", zip codes containing hazardous waste sites with POPs; "other waste sites", zip codes containing hazardous waste sites but not with POPs; and "clean sites", zip codes without any known hazardous waste sites. Age, gender, race, and zip code of residence of patients diagnosed with hypertension (ICD-9 codes 401-404) were identified using the New York Statewide Planning and Research Cooperative System (SPARCS) for the years 1993-2000. A generalized linear model, the negative binomial model, was used to assess the effect of living in a zip code with a hazardous waste site on the discharge rate of hypertension. After control for the aforementioned covariates, we found a statistically significant elevation of 19.2% (95% CI = 8.5%, 31%) in hypertension discharge rate for "POPs sites" and a 10% elevation in discharge rates for "other waste sites" as compared to "clean sites". In a subset of "POPs sites" where people have higher income, smoke less, exercise more and have healthier diets, there was still a 13.9% elevation of hypertension discharge rate as compared to "clean sites". The results support the hypothesis that living near hazardous waste sites, particularly sites containing POPs, may constitute a risk of exposure and of developing hypertension.

Hazardous waste sites and stroke in New York State.

BACKGROUND: Environmental exposure to persistent organic pollutants (POPs) may lead to elevation of serum lipids, increasing risk of atherosclerosis with thromboembolism, a recognized cause of stroke. We tested the hypothesis that exposure to contaminants from residence near hazardous waste sites in New York State influences the occurrence of stroke. METHODS: The rates of stroke hospital discharges were compared among residents of zip codes containing hazardous waste sites with POPs, other pollutants or without any waste sites using information for 1993-2000 from the New York Statewide Planning and Research Cooperative System (SPARCS) database, containing the records of all discharge diagnoses for patients admitted to state-regulated hospitals. RESULTS: After adjustment for age and race, the hospitalization rate for stroke in zip codes with POPs-contaminated sites was 15% higher than in zip codes without any documented hazardous waste sites (RR 1.15, 95% CI, 1.05, 1.26). For ischemic stroke only, the RR was 1.17 (95% CI 1.04, 1.31). Residents of zip codes containing other waste sites showed a RR of 1.13 (95% CI, 1.02, 1.24) as compared to zip codes without an identified waste site. CONCLUSION: These results suggest that living near a source of POPs contamination constitutes a risk of exposure and an increased risk of acquiring cerebrovascular disease. However further research with better control of individual risk factors and direct measurement of exposure is necessary for providing additional support for this hypothesis.