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Contract No. W-7405-eng-26

CONGENITAL MALFoRMATI~N AND FETAL MORTALITY TRENDS IN COUNTIES SURROUNDING OAK RIDGE

K. E. Shank Environmental Surveillance and Evaluation Section

Industrial Safety and Applied Health Physics Division

C. E. Easterly Health Studies Section

Health and Safety Research Division

T. W. Oakes Environmental Surveillance and Evaluation Section

Industrial Safety and Applied Health Physics Division

OAK RIDGE .NATIONAL LABORATORY Oak Ridge, Tennessee 37830

operated by UNION CARBIDE CORPORATION

for the DEPARTMENT OF ENERGY

- - - - - - - -

I DISCLAIMER .-1

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CONTENTS

Page

L I S T O F F I G U R E S . . . . . . . . . . . . . . . . . . . . . . . . . v

. . . . . . . . . . . . . . . . . . . . . . . . . . . L I S T O F T A B L E S v i i

. . . . . . . . . . . . . . . . . . . . . . . . . ACKNOWLEDGMENTS i x

ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 R a t i o n a l e f o r S t u d y . . . . . . . . . . . . . . . . . . . . . 2 P r i o r O a k R i d g e Invest igat ions . . . . . . . . . . . . . . . 3

M E T H O D S O F S T U D Y . . . . . . . . . . . . . . . . . . . . . . . . . 5

RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 S t i l l b i r t h s . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . . . . . . . C o n g e n i t a l M a l f o r m a t i o n s 11 . . . . . . . . . . . . . . . . . B a s e d on year of death 11 . . . . . . . . . . . . . . . . . B a s e d on year of b i r t h 1 6

D I S C U S S I O N . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . SUMMARY 23

REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

. . . . . . . . . . . . . . . . . . . APPENDIX A - S T I L L B I R T H DATA 25

APPENDIX B . CONGENITAL MALFORMATION DATA ( Y e a r - o f - D e a t h . . . . . . . . . . . . . . . . . . . . . T e c h n i q u e ) 33

APPENDIX C . CONGENITAL MALFORMATION DATA ( Y e a r - o f - B i r t h T e c h n i q u e ) . . . . . . . . . . . . . . . . . . . . . 4 1

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LIST OF FIGURES

F igu re Pa'ge

1 M a p o f T e n n e s s e e . . . . . . . . . . . . . . . . . . . . . . 6

2 S p a t i a l o r i e n t a t i o n of s t i l l b i r t h d a t a . . . . . . . . . . . 9

. . . . . . . . . . . . . . . . . . . 3 S t i l l b s r t h r a t e vs time 10

. . . . . . . . 4 D i s t r i b u t i o n of s t i l l b i r t h d a t a , 1958 t o 1971 12

5 S p a t i a l o r i e n t a t i o n of congen i t a l malformation d a t a . . . . . . . . . . . . . . . . . . (year-of-death technique) 14

6 Congenital malformation r a t e (year-of-death . . . . . . . . . . . . . . . . . . . . . technique) v s t ime 15

7 S p a t i a l o r i e n t a t i o n of congen i t a l malformation d a t a . . . . . . . . . . . . . . . . . . (year-of-bir th technique) 20

8 Congenital malformation r a t e (year-of-bir th . . . . . . . . . . . . . . . . . . . . . technique) v s t ime 21

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LIST OF TABLES

Table Page

1 S t i l l b i r t h d a t a f o r 1930 t o 1943 . . . . . . . . . . . . . . . 7

. . . . . . . . . . . . . . 2 S t i l l b i r t h d a t a f o r 1944 t o 1957 8

3 S t i l l b i r t h d a t a f o r 1958 to' 1971 . . . . . . . . . . . . . . 8

4 Congenital malformation d a t a f o r 1949 t o 1957 (based on y e a r o f d e a t h ) . . . . . . . . . . . . . . . . . . . . . . . 1 3

5 Congenital malformation d a t a f o r 1958 t o 1971 (based on . . . . . . . . . . . . . . . . . . . . . . . y e a r o f d e a t h ) 1 3

6 Age d i s t r i b u t i o n of congen i t a l malformation dea ths f o r . . . . . . . . . . . . . . . . . . t h e s t a t e of Tennessee-1970 1 7

7 congen i t a l malformation d a t a f o r 1930 t o 1943 (based on . . . . . . . . . . . . . . . . . . . . . . . y e a r o f b i r t h ) 18

8 Congenital malformation d a t a f o r 1944 t o 1957 (based on . . . . . . . . . . . . . . . . . . . . . . . year of b i r t h ) 18

9 Congenital malformation d a t a f o r 1958 t o 1971 (based on . . . . . . . . . . . . . . . . . . . . . . . year of b i r t h ) 19

. . . . . . . . . . . . . . . . . . . APPENDIX A . S t i l l b i r t h Data 25

APPENDIX B . Congenital Malformation Data (Year-of-Death Technique) . . . . . . . . . . . . . . . . . . . . . 33

APPENDIX C . Congenital Malformation Data (Year-of-Birth Technique) . . . . . . . . . . . . . . . . . . . . . 41

v i i

. .

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ACKNOWLEDGMENTS

The authors wish to recognize Ms. Paula Taylor of the Tennessee

Public Health Department for her assistance in providing the authors

with the appropriate documents. A. S. Loebl and R. L. Stephenson are

also acknowledged for their data management and computer programming

assistance. '

4 \,, ABSTRACT

S t i l l b i r t h and congen i t a l malformation dea th d a t a have been eva lua ted f o r , c o u n t i e s surrounding t h e Oak Ridge nuc lea r f a c i l i t i e s . The observed va lues were compared wi th expected va lues , based on s t a t e of Tennessee and Eas t Tennessee r a t e s , f o r t h r e e t ime pe r iods : p r i o r t o t h e e x i s t e n c e of t h e nuc lea r f a c i l i t i e s ; t h e . e a r l y yea r s of ope ra t ion ; and t h e l a t e r y e a r s of opera t ion . Oak Ridge, which is t h e c l o s e s t c i t y t o t h e nuc lea r f a c i l i t i e s , had s i g n i f i c a n t l y fewer s t i l l b i r t h s and no d i f f e r e n c e i n congen i t a l malforma- t i o n s a s compared w i t h t h e s t a t e o r Eas t Tennessee. No t ime t r end was observed i n . t h e 8-county d a t a which could be a s s o c i a t e d w i t h t h e h igher l e v e l s of r a d i o a c t i v e r e l e a s e s dur ing t h e 1944z1957 per iod followed by a per iod , of l e s s e r ' r e l e a s e s i n t h e 1958-1971 period. However, a c l u s t e r i n g of s t i l l b i r t h s was found f o r t h e las t time per iod . I n t h e s tudy , no s i g n i f i c a n t r e l a t i o n s h i p w a s found between t h e occurrence of s t i l l b i r t h s and congen i t a l malformation dea ths .

INTRODUCTION

Rat ionale f o r Study

Since t h e beginning of t h e "atomic era," the re has been specula t ion

concerning t h e h e a l t h of t h e res iden t s surrounding nuclear f a c i l i t i e s .

I n p a r t i c u l a r , increased r a t e s of cancer, congenital malformations, and

s t i l l b i r t h s a r e o f t e n mentioned a s s e n s i t i v e ind ica to r s of t h e e f f e c t s

from r a d i a t i o n exposure. This r epor t analyzes the incidence of deaths

a t t r i b u t a b l e t o congeni ta l malformations and f e t a l deaths f o r counties

surrounding the Oak Ridge nuclear f a c i l i t i e s .

Oak Ridge i s t h e s i t e of one of t h e e a r l i e s t es tabl ished nuclear

f a c i l i t i e s ; therefore , t h e population surrounding t h i s f a c i l i t y has been

exposed to'manmade rad ioac t ive e f f l u e n t s f o r a s long a period a s any.

o t h e r population near nuclear a c t i v i t i e s . I n addi t ion , the Oak Ridge

f a c i l i t i e s have operated i n . a war-time and a peace-time capacity.

During t h e f i r s t period, t h e most pressing need was t o produce weapons-

grade mate r i a l t o end World War 11, and up u n t i l t h e mid 1950s, s imi la r

work continued during t h e Cold War and arms build-up. A s a consequence

of t h e urgency of t h i s work, less than present ly accepted a t t e n t i o n was

paid t o environmental r e l e a s e s .

Since the mid 1950s comparatively minor a i rborne re leases have

occurred, i n c o n t r a s t t o t h e e a r l i e r time period. The h i s t o r i c a l

s i t u a t i o n , the re fo re , a f f o r d s the p o s s i b i l i t y of studying a population:

(1) p r i o r t o t h e exis tence of a nuclear f a c i l i t y , (2) during i t s

highes t environmental r e l e a s e period, and (3) during a lower re lease period.

. I n t h e present s tudy, two ind ica to r s a r e used which a r e thought t o

be among t h e more d i r e c t l y s e n s i t i v e t o changing l e v e l s of b io log ica l

i n s u l t : f e t a l death and congenital malformations, which i n t h i s study

a r e i d e n t i f i e d by deaths due t o congenital malformations. Further,

t h e p resen t study is pr imar i ly a desc r ip t ive "ecological study" and

is not appropr ia te f o r substant ive tes ' t ing of hypotheses; i t s primary

u t i l i t y i s t o provide a b a s i s .for hypothesis generation. Previously,

four heal th-re la ted s t u d i e s of Oak Ridge populations have been reported,

and these a r e summarized below.

P r i o r Oak Ridge I n v e s t i g a t i o n s

The f i r s t paper t o ana lyze t h e h e a l t h of t h e Oak Ridge r e s i d e n t s .

w a s by Moshman and Holland.' They s tud ied t h e occurrence of cancer i n

Oak Ridge r e s i d e n t s f o r t h e s i n g l e year 1949 us ing cancer morbidi ty

s t a t i s t i c s . Cancer was def ined t o inc lude a l l malignant neoplasms,

i nc lud ing leukemias and lymphomas; t h i s tended t o maximize t h e inc idence .

Thei r s tudy showed t h e age-standardized inc idence of cancer among t h e

Oak Ridge r e s i d e n t popula t ion t o be 123 cases annual ly per 100,000. This

was s i g n i f i c a n t l y lower than t h e accepted n a t i o n a l annual r a t e a t t h a t

t ime of 230 pe r 100,000. The low cancer r a t e was found t o be i n '

harmony wi th t h e low dea th r a t e i n Oak Ridge from most d i s e a s e s . Among

whi te males, a s i g n i f i c a n t l y h igher propor t ion of cancer of t h e r e sp i r a -

t o r y system was found than might be expected by chance from t h e 1938

n a t i o n a l averages; however, an explana t ion on t h e b a s i s of a long

e s t a b l i s h e d upward t r end i n cancer of t h e r e s p i r a t o r y system, due t o

smoking, among males was suggested . l Larson e t a l . ,conducted t h e second s tudy of Oak Ridge employees.

They s tud ied t h e t o t a l number of dea ths experienced by employees i n

t h e t h r e e Oak Ridge nuc lea r f a c i l i t i e s over a 16-year pe r iod , 1950

through 1965, and compared t h e t o t a l number of Oak Ridge dea ths t o t h e

dea ths .which would be expected by applying t h e 1962 U.S. Bureau of

V i t a l S t a t i s t i c s m o r t a l i t y r a t e s t o t h e employee popula t ion over t h i s

per iod of time. Based on 207,204 man-years of employment, 692 dea ths

occurred compared t o t h e 992 expected. Thus, t h e r e s u l t s showed t h a t

t h e workers were l e s s l i k e l y t o d i e a t any given age than t h e n a t i o n a l

popula t ion , which con ta ins v a r i o u s segments of people who have low i n d i c e s

of h e a l t h . It was specula ted2 t h a t t h i s phenomenon was d u e ' i n p a r t t o t h e

"hea l thy worker" e f f e c t , i n t h a t on ly t h e hea l thy popula t ion i s included

i n t h e work fo rce .

The t h i r d Oak Ridge s tudy was conducted by S c o t t e t a1.3 I n t h i s

s tudy , t h e employee popula t ion was d iv ided i n t o two groups, uranium

workers and nonuranium workers, and t h e time per iod of 1951 through 1969

was covered. Uranium workers considered were those who r e g u l a r l y worked

i n uranium process ing a r e a s and submit ted r o u t i n e samples f o r uranium

a n a l y s i s . This group consis ted of 4553 employees with a t o t a l of about

14,230 man-years of a s s o c i a t i o n with uranium processing. The "non-

uranium" group w a s made up of a broad spectrum of employee c l a s s i f i c a -

t i o n s , such a s t echn ic ians , adminis t ra tors , profess ionals , s e c r e t a r i e s ,

and craftsmen, and t h i s group had 9821 employees f o r a t o t a l of

39,240 man-years. A d i r e c t comparison between uranium and nonuranium

workers was no t appropr ia t e , because the groups d i f f e r e d i n proportion-

a l i t y by sex , age, and race . Ins tead , a d i r e c t comparison was made of

t h e r a t i o of t h e number of a c t u a l deaths t o an expected number of deaths

f o r each group, which was ca lcu la ted by using the 1962 U.S. Bureau of

V i t a l S t a t i s t i c s m o r t a l i t y r a t e s . The r a t i o of a c t u a l t o expected

dea ths f o r t h e uranium workers was 0.59; t h e r a t i o of a c t u a l t o expected

dea ths f o r t h e nonuranium workers was 0.76.

The f i n a l Oak Ridge study, p r i o r t o t h e present inves t iga t ion , was

conducted by p a t r i c k . H e . s tudied s t i l l b i r t h s , in£ a n t deaths , congenital

malformation deaths , and cancer deaths f o r 1929 through 1971 i n Anderson

and Roane count ies and t h e c i t y of Oak Ridge. He p lo t t ed t o t a l death

t r ends f o r t h e above-mentioned causes and found no evidence which would

suggest t h a t t h e Oak Ridge a r e a has been o r is becoming a r e l a t i v e l y

hazardous l o c a l e . . He a l s o performed chi-square t e s t s f o r var ious cancers

i n Anderson and Roane count ies f o r 1950-1969 and found that the number

of a c t u a l deaths when compared t o n a t i o n a l averages was s t a t i s t i c a l l y no

d i f f e r e n t from t h e number expected f o r males and females of both white

and nonwhite populat ions.

METHODS OF STUDY

The d a t a used i n t h i s s tudy were obta ined from magnetic t apes and'

annual b u l l e t i n s on v i t a l s t a t i s t i c s . p r o v i d e d by t h e Tennessee Department

of Pub l i c Heal th. The a n a l y s i s was r e s t r i c t e d t o t h e wh i t e popula t ion a s

s t i l l b i r t h and congen i t a l e f f e c t s due t o r a d i a t i o n exposures should show

up equa l ly among r a c i a l groups, and t h e nonwhite popula t ion i s s u b j e c t

t o much l a r g e r r e p o r t i n g e r r o r s , e s p e c i a l l y p r i o r t o t h e 1950s than is

t h e wh i t e popula t ion . S t i l l b i r t h and congen i t a l malformation d a t a were

obta ined from 1930 through.1971. To ana lyze t h e t rend of dea ths be fo re

and a f t e r t h e s t a r t - u p of ope ra t ions a t Oak Ridge, t h e t ime per iod was

d iv ided i n t o t h r e e equal segments: 1930 t o 1943, 1944 t o 1957, and 1958

t o 1971 f o r t h e reasons s p e c i f i e d i n t h e In t roduc t ion . For each cause

of dea th , e i g h t c o u n t i e s were analyzed i n r e l a t i o n t o t h e s t a t e and t o

Eas t Tennessee t o o b t a i n expected dea ths . The coun t i e s examined f o r

increased l e v e l s of h e a l t h e f f e c t s were Anderson and i t s cont iguous

coun t i e s : Campbell, Knox, Loudon, Morgan, Roane, S c o t t , and Union.

Anderson and Roane coun t i e s a r e o f t e n c i t e d i n t h e s t u d y , a s t he nuc lea r

f a c i l i t i e s a r e l o c a t e d i n t h e s e two coun t i e s . The coun t i e s shown i n

Fig. 1 f o r t h e e a s t e r n t h i r d of Tennessee minus t h e above-mentioned.

e i g h t coun t i e s were summed toge the r t o form a c o n t r o l f o r t h e e a s t e r n

p a r t of t h e s t a t e . The only c i t y analyzed was Oak Ridge.

S t i l l b i r t h t r e n d s i n t h i s r e p o r t a r e r e f e r r e d t o i n terms of r a t e s . '

The methodology of c a l c u l a t i o n - s t i l l b i r t h s pe r 1000 l i v e b i r t h s - is ,

however, often referred t o as r a t i o . Conventional r a t e s , t h a t i s , number

of s t i l 1 , b i r t h s d iv ided by t h e sum of l i v e b i r t h s and s t i l l b i r t h s can be

c a l c u l a t e d from Appendix A.

KENTUCKY

TH CAROLINA '

MISSISSI>PI ALCLBAMA GEORGIA

CITIES OF 100.003 OR MORE POPLLATCOII IN 1960 CITIES OF 10,000 TO 35,000 POFULATION IN I860

Pig. 1. Map of Tennessee. (Source: ~ennessee Vital Statistics Bulletin, 1960.)

RESULTS

S t i l l b i r t h s

The s t i l l b i r t h d a t a are presented i n t h e i r e n t i r e t y i n Appendix A.

A l l of t h e county and c i t y d a t a are compared t o expected va lues , which

were computed f i r s t us ing s t a t e rates, and then us ing East Tennessee

r a t e s . The d a t a f o r t h e t h r e e t ime pe r iods a r e given i n Tables 1 through

3, w i th t h e chi-square va lue f o r each p a r t i c u l a r i n t e r v a l . The r e s u l t s

a r e g raph ica l ly presented f o r t h e eight-county a r e a i n Fig. 2.

Table 1. S t i l l b i r t h d a t a f o r 1930 t o 1943

Expected us ing x2 Expected us ing County Observed state rates Eas t Tennessee r a t e s x2

Anderson

Campbell

Knox

Loudon

Morgan

Roane

S c o t t

Union

* Observed s i g n i f i c a n t 1 y . g r e a t e r than expected.

'0bserved s i g n i f i c a n t l y less than expected. 2 d f = l , a=0.05 ( two- ta i l ) = 3.84.

From t h e d a t a presented (Appendix A), ,it can be noted t h a t , f o r t h e

s t a t e as a whole, a continuous decrease i s ev iden t i n t h e s t i l l b i r t h

r a t e over t h e per iod 1930-1971. This is i n d i c a t i v e of t h e b e t t e r h e a l t h

c a r e t h a t has become a v a i l a b l e t o expec tan t mothers over t h e years . The

s t i l l b i r t h r a t e over time f o r va r ious groups i s shown i n .Fig. 3. The

observed s t i l l b i r t h s i n Anderson County were a l s o compared t o t h e expected

va lues p red ic t ed from t h e combined r a t e s i n Knox and Blount coun t i e s .

These t h r e e coun t i e s a r e l i s t e d i n t h e same s t a t e economic a r e a (SEA),

Table 2. Stillbirth data for 1944 to 1957

. County Observed Expected using x Expected using state rates East Tennessee rates x

Anderson

Campbell

Knox

Loudon

Morgan

Roane

Scott

Union

City

Oak Ridge (1949-1957)

* Observed significantly greater than expected.

'observed significantly less than expected. 2 df=l, a=0.05 (two-tail) = 3.84.

Table 3. Stillbirth.data for 1958 to 1971

County Observed Expected using x Expected using state rates East Tennessee races x2

Anderson 209 219 0.46 237

Campbell 144 112 9.14" 120 4.80"

Knox 931 870 4.28* 939 0.07

Morgan 5 7 50 0.98 5 4 0.17

Roane 179 140 10.9" 151 5.19"

Scott 93 70 ' 7.56" 7 5 4.. 32*

Union 4 4 3 2 4.50" 3 5 2.31

City

Oak Ridge 6 5 91 7.43+ 9 8 11. lt

* Observed signfffcantly greater than expected. - t~bserved significantly less than expected.

2 df=l, a=0.05 (two-tail) = 3.84.

ORNL-DWG 79-14851R

CHI-SQUARED COMPARISONS USING STATE EXPECTED RATES

CHI-SQUARED COMPARISONS USING EAST-TENNESSEE EXPECTED RATES

GEORGIA

1930-1 943

GEORGIA

1 930-1 943

GEORGIA

1944-1957

GEORGIA

1944-1 957

GEORGIA

1958-1971 . 1968-1971 %%=gmfi

Fig. 2. Spatial orientation of stillbirth data.

100 1 ORNk DWG. 79- 44294 I

/ EAST TENNESSEE

ANDERSON CO. .

TIME

Fig. 3. S t i l l b i r t h rate vs time.

indicat ing some degree of s imi la r i ty i n the socioeconomic mix of people.

When the expected f o r Anderson County is calculated using the combined

rates from Knox and Blount counties, Anderson has more s t i l l b i r t h s than

expected f o r 1930-1943, s ign i f ican t ly l e s s than expected fo r 1944-1957,

and l e s s than expected fo r 1958-1971.

Further, the c i t y of Oak Ridge has had a s ign i f ican t ly lower

number of s t i l l b i r t h s than expected ever since the c i t y f i r e t recorded

v i t a l s t a t i s t i c s i n 1949. Final ly , it can be seen tha t , f o r the time

period 1958-1971, more of the e ight contiguous counties were s ign i f i -

cantly worse than the eastern par t of the s t a t e or the s t a t e a s a whole

than f o r the other time periods. However, a s seen i n Fig. 4 , even though

the e ight counties a r e skewed toward the higher end of the d i s t r ibu t ion

p lo t , a l l of the counties a r e within the normal d i s t r ibu t ion with none

greater than the 95th percenti le.

Congenital Malformations

The congenital malformation data, l i k e the s t i l l b i r t h data, a r e

grouped in to aggregated t i m e periods. For these time periods, observed

values f o r Anderson County and the surrounding counties a r e compared with

expected values, using the s t a t e and East Tennessee a s controls.

Based on year of death

The da ta a r e presented i n Tables 4 and 5, with Appendix B showing

the data i n its en t i re ty . Spa t ia l or ientat ion of the data is shown i n

Fig. 5. The data is only from 1949, a s it was recorded separately from

other in fan t deaths from that date i n the v i t a l s t a t i s t i c s bu l l e t i n s , and

the data tapes containing death records a r e only avai lable back to 1949.

The overa l l trend, f o r the s t a t e a s a whole, has been downward f o r the

congenital malformation r a t e , although it does not display a temporal

re la t ionship a s strongly a s the s t i l l b i r t h data. The congenital malforma-

t i on death r a t e over time is shown i n Fig. 6. The only county t h a t was

shown t o be s ign i f ican t ly grea te r than expected f o r both time in t e rva l s

is Campbell County when compared t o East Tennessee. Anderson County a l so

had s ign i f ican t ly more congenital deaths based on East Tennessee r a t e s i n

Fig. counties

- i,>;I,;-, R,P ; JJ ' -

, : ,-' 8 - ' c-, ORNL DWG 79-14662

TENNESSEE COUNT1 ES

STILLBIRTH RATE 1958 - 1971

4. Distribution of stillbirth data, 1958 to 1971. under study are indicated by vertical markers.)

98 - 08 -

05 -

90 -

80 -

80 -

40 -

20-

10 -

5 -

2 -

I -

7

(The

ST1 LI,H I K'L'H KA'I'E

I 1 I 1 1 1 1 1 1 1 1 1 I

96 Sarnplecl 4

#

4

I x X

Qg 1 fxx

f /" %

X

1 I 1 I I I 1 I 1 I I 1 1

8 9 10 11 l t 1.3 14 15 16 l7 18 19 20 21

.

Table 4. Congenital malformation data for 1949 to 1957

(based on year of death)

County Observed Expected using x 2 Expected using sta~e ratee East Tennessee rates x

Anderson 72 7 1

Campbell 6 4 43

Knox 254 265

Loudon 29 33

Morgan 14 19

Roane 4 7 39

Scott 22 2 2

Union 7 11

City

Oak Ridge 32 36

* Observed significantly greater than expected. 2 df=1, a=0.05 (two-tail) = 3.84.

Table 5. Congenital malformation data for 1958 to 1971

(based on year of death)

Expected using x2 Expected using County Observed rates East Tennessee rates X2

Anderson

Campbell

Knox

Loudon

Morgan

Roane

Scott

Union

City

Oak Ridge 4 7 4 8 0.02 46 0.02 - -- - - - *

Observed significantly greater than expected.

'. observed significantly less than expected.

~ ~ d f = l , a=0. 05 (two-tail) = 3.84.

CHI-SQUAB ED COMPARISONS USING STATE EXPECTED RATES

ORNL-DWG 7414850R

CHldQUAF ED COMPARISONS USING EAST-TENFDESSEE EXPECTED RATES

GEORGIA

1968-1971

GEORGIk SlOHFlCJLNTLY GREATER m THAN D(PF*m

6-1971

Fig. 5. Spatial orientation of congenital malformation data (year-of-death technique).

q El? T - .. "m- ,-., g&i

-. , e. :: -, . u

ORNL-DWG. 79-14292

-

/ ANDERSON CO.

TENNESSEE

- - -

- 8- COUNTY GROUP

ROANE CO.

1950 1956 1962 1968 TIME

Fig. 6. Congenital malformation rate (year-of-death technique) vs time.

t h e p e r i o d 1958-1971. When Anderson County is compared t o Blount and

Knox County combined (same SEA), t h e r e is no s i g n i f i c a n t d i f f e r e n c e f o r

'. 1949-1957 and s i g n i f i c a n t l y g r e a t e r than expected f o r 1958-1971.

For t h e preceding d a t a , t h e congen i t a l malformation dea ths a r e

compared t o t h e popula t ion t o o b t a i n r a t e s ; t h i s i s t h e convent ional

technique . F u r t h e r , they are compiled f o r t h e v i t a l s t a t i s t i c s publ ica-

t i o n s accord ing t o t h e yea r of dea th r e g a r d l e s s of age. While t h e use

of t h i s kind of d a t a might be accep tab le f o r s t u d i e s of a popula t ion i n

e q u i l i b r i u m w i t h c u l t u r a l and environmental e f f e c t s , i t is ques t ionab le

f o r t h e r e g i o n surrounding t h e c i t y of Oak Ridge between 1930 and 1971.

During t h i s t i m e , s i g n i f i c a n t changes occurred i n both socioeconomic and

p h y s i c a l environments. Therefore , i n t h i s i n v e s t i g a t i o n , congen i t a l

malformation d e a t h s are p re sen ted i n t h e above-mentioned convent ional

manner (based on y e a r of d e a t h and r a t e s c a l c u l a t e d on popula t ion numbers)

and u s i n g a d i f f e r e n t technique descr ibed below.

Based on y e a r of b i r t h

Congeni ta l malformation dea ths a r e a l s o t abu la t ed on t h e b a s i s of

y e a r of b i r t h r e g a r d l e s s of age a t dea th . This b i r t h cohor t i rocedure

a l l o w s changes i n s e r i o u s c o n g e n i t a l e f f e c t s t o be a s s o c i a t e d wi th time.

T h i s i s done as i n s u l t s t o a developing f e t u s may be g e n e t i c ( i n h e r i t e d )

o r acqu i r ed (environmental) , and, depending on t h e i n s u l t , f i n a l express ion

i n d e a t h may occur over a t ime span inc luding pre implanta t ion t o o ld

age. The i n i t i a l i n s u l t and app l i ed t h e r a p e u t i c procedures w i l l be t h e

c o n t r o l l i n g f a c t o r s i n t h e u l t i m a t e t ime of f i n a l expression. Using

t h i s technique , r a t e s a r e determined per 1000 l i v e b i r t h s f o r each year .

The r a t e s determined a r e n o t t r u e r a t e s i n t h a t f o r a l l yea r s

s t u d i e d , a l l dea ths are e i t h e r n o t on our d a t a t apes ( f o r e a r l i e r

yea r s ) o r have no t y e t occurred. Thus, t h e t o t a l number of dea ths from

a g iven b i r t h year might n o t have occurred w i t h i n t h e s tudy per iod .

However, t h i s procedure does provide f o r d i r e c t comparison of r a t e s f o r

d i f f e r e n t popu la t ion groups and does a l low f o r a " f i n e r tuning" of

a t t e m p t s t o c o r r e l a t e changes i n h e a l t h w i th changes i n e x t e r n a l condi t ions .

Table 6 showsithe age distribution for the number of deaths attributed

to congenital malformations in the state of Tennessee for 1970. Within the

age bracket of 0 to 1 year, 71% of these deaths occur; however, a

significant contribution to the total occurs for ages significantly

greater than infancy.

Table 6. Age distribution of congenital malformation deaths for the state of Tennessee - 1970

Age % of deaths

The congenital malformation death data based on year of birth is

presented in Tables 7 through 9 with the observed values compared to the

expected values using both the state and East Tennessee as controls; the

spatial orientation of this data is presented in Fig. 7. The entire

data used in the year-of-birth technique is given in Appendix C, and '

the congenital rate over rime is shown in Fig.' 8.

Table 7. Congenita1,malformafion data for 1930 to 1943

(based on year of birth)

Expected using County Observed x2 Expected using state rates East Tennessee rates x2

Anderson

Campbell

Knox

Loudon

Morgan

Roane

Scott

Union

* Observed significantly greater than expected.

2 (two-tail) = 3.84. df =1, a=0.05

Table 8. Congenital malformation data for 1944 to 1957

(based on year of birth)

Expected. using x2 Expected using County Observed state rates East Tennessee rates x2

Anderson 84 9 4 1.06 8 5 0.01

Campbell 65 50 4.50~ .. 45 8.89*

Knox 251 271 1.48 244 0.20

Loudon 29 3 2 0.28 2 8 0.04

Mo r gsn 11 2 0 4.05* 18 2. / 2

Rnane 51 4 9 0.08 ' 44 1.11

Scott 21 26 0.96 2 3 0.17

Union 6 10 1.60 ' 9 1.00

City

Oak Ridge 3 1 31 0.00. 28 0.32

* Observed significantly greater than expected.. 2 (two-tail) = 3.84. df=l, a-0.05

Table 9. Congenital malformation data f o r 1958 t o 1971

(based on year of b i r t h )

Expected using x2 Expected using County Observed state rates East Tennessee r a t e s x2

Anderson

Campbell

Knox

Loudon

Morgan

Roane

Scott

Union

City

Oak Ridge 3 9 3 3 1.09 31 1.64 -- - *

Observed s ign i f ican t ly greater than expected.

observed s ign i f ican t ly less than expected.

~ ~ d i = l , a=O. 05 (two-tail) = 3.84.

CHI-SQUARED COMPARISONS USING STATE EXPECTED RATES

CHI-SQUARED COMPARISONS USING - ' ' ' . ?; : ' - ' EAST-TENNESSEE EXPECTED RATES . ' ?! - t*

' : ~ i g . 7 . Spatial orientation of congenital malformation data (year- of -bir th technique) .

10 1 ORNL-DWG. 79-14293 I

L--J +ROANE CO.

I I I I I I 1 I I I 1949 1955 1961 1967

TIME

Fig. 8. Congenital malformation rate (year-of-birth technique) vs the.

2 2

DISCUSSION

I n any r e t r o s p e c t i v e study involving a population response, one

must choose a s u i t a b l e span of time over which t o aggregate events . The

b a s i c d a t a used i n t h i s s tudy a r e deaths per year i n a c i t y o r a county

where t h e numbers range from no events t o severa l hundred, with many

y e a r s having l e s s than 10 events per county. A s a r e s u l t of t h i s

s i t u a t i o n , the observable " s i g n i f i c a n t d i f ference" was found t o vary

cons iderably depending on t h e time i n t e r v a l over which events were

aggregated. For example, i n the s t i l l b i r t h da ta using s t a t e ~ x p p c t e d

r a t e s , f o r comparison wi th t h e e i g h t county a rea , i f t he time i n t e r v a l

chosen I s 1933 t o 1946, only Loudon county i s ca lcula ted t o have s ig-

n i f i c a n t l y more deaths than t h e s t a t e a s a whole. Using 1930 through

1943, Loudon county is again ca lcu la ted t o have s i g n i f i c a n t l y more

deaths wi th Roane County ca lcu la ted t o be s i g n i f i c a n t l y l e s s . For 1955

t o 1968, Campbell, S c o t t , and Union count ies a r e computed t o be s i g n i f i c a n t l y

worse than the s t a t e ; however, when using the time period 1957 t o 1971,

Campbell, Knox, Loudon, Roane, Sco t t , and Union a r e a l l computed t o be

c i g n i f i c a n t l y worse.

Changes i n s i g n i f i c a n t d i f f e rences a l s o occurred i n t h e congeni ta l

malformation d a t a when t h e time period t h a t was studied was changed

slightly. Thus, che "signif icance" o r "nonsignificance" of t h e count ies

wi th a smal l number of events and l a r g e year-to-year v a r i a t i o n should be

viewed wi th a measure of caution. O f t h e philosophies 1e.ading to the

s e l e c t i o n of t i m e i n t e r v a l s , t he one chosen (as described i n t h e In t ro-

duct ion) appears t o be t h e most re levant f o r the presenf s tudy; however,

t h e b a s i c d a t a a r e presented i n the appendices f o r a l t e r n a t e analyses.

I n comparing t h e count ies , no cons i s t en t c o r r e l a t i o n was found

between t h e two i n d i c a t o r s f o r count ies wi th observations higher o r lower

than expected. Fur ther , no s i g n i f i c a n t c o r r e l a t i o n using s i n g l e c o r r e l a t i o n

techniques, was found between the two chosen i n d i c a t o r s and average income,

educarion, o r o the r t y p i c a l socioeconomic c o r r e l a t e s .

2 3

SUMMARY

The s t i l l b i r t h and congen i t a l malformation dea th d a t a have been

presented f o r c o u n t i e s surrounding t h e Oak Ridge nuc lea r f a c i l i t i e s ; t h e

v a r i a b l e s analyzed were chosen a s they a r e taken t o be s e n s i t i v e i n d i c a t o r s

of t h e e f f e c t s from r a d i a t i o n exposure. Oak Ridge, which is t h e c l o s e s t

c i t y t o t h e nuc lea r f a c i l i t i e s , had s i g n i f i c a n t l y fewer s t i l l b i r t h s and

no d i f f e r e n c e i n congen i t a l malformations a s compared w i t h t h e s t a t e or

Eas t Tennessee. Fu r the r , no t ime t r end w a s observed i n t h e 8-county

d a t a which could be a s s o c i a t e d wi th t h e h igher l e v e l s of r a d i o a c t i v e

r e l e a s e s dur ing t h e 1944-1957 period followed by a per iod of l e s s e r

r e l e a s e s i n t h e 1958-1971 per iod . A c l u s t e r i n g of s t i l l b i r t h s was found

f o r t h e l a s t t ime per iod; however, s i n c e t h e p re sen t s tudy is p r imar i ly

d e s c r i p t i v e , no d e t a i l e d examination of t h e p o t e n t i a l causes has been

made. The s i g n i f i c a n c e of choosing d i f f e r e n t t i m e i n t e r v a l s f o r ana lyses

w a s d i scussed . The choice of us ing e i t h e r Eas t Tennessee o r t h e s t a t e

a s a c o n t r o l group a l s o w a s found t o change t h e s i g n i f i c a n c e of t h e chi-

square t e s t . Finally. , no s i g n i f i c a n t r e l a t i o n s h i p w a s found between t h e

occurrence of s t i l l b i r t h s and congen i t a l malformation dea ths , and no

r e l a t i o n s h i p was found between t h e s t i l l b i r t h and congen i t a l malformation

d a t a and average income, educa t ion , o r o t h e r socioeconomic c o r r e l a t e s .

REFERENCES

1. J. Moshman and A. H. .Holland, "On .the Incidence 'of Cancer in Oak

Ridge, Tennessee," Cancer - 2 ( 4 ) , 567-575 (1949).

2. C. E. Larson, T. A. Lincoln, and K.. W. Bahler, Comparison of

Mortality of Union Carbide Employees i n Oak Ridge Atomic Lhergy

~ a c i Zities .with. U. S. Bureau of Vital Sta.tistics Mortality, K-A-708,

1966.

3. L. M. Scott, K. W. Bahler, A. de la Garza, and T. A. Lincoln,

"Mortality Experience of Uranium and Nonuranium Workers," Health

Phys. - 23 , 555-557 (1.972).

4. C. H. Patrick, "Trends in Public Health in the 'Population Near

Nuclear Facilities: A Critical Assessment ," ~ u c l . Saf. - 18 (5),

647-662 (1977).

5. . East Tennessee(, Health Improvement Council, Health Systems Plan for

East Tennessee, 1977.

APPENDIX A

STILLBIRTH DATA

State of Tennessee

(Source: Annual Bulletins of Vital Statistics)

THIS PAGE 4

LEFT BLANK

STATE EAST TENNESSEE

Year Live births

Stillbirths Live births Stillbirths

ANDERSON COUNTY CAMPBELL COUNTY

Year Live b i r t h s S t i l l b i r t h s Live b i r th s S t i l l b i r t h s

2 9

KNOX COUNTY LOUDON COUNTY

Year Live b i r t h s S t i l l b i r t h s Live b i r t h s S t i l l b i r t h s

416 15 410 2 0 448 1 8 438 19 453 21 438 24 396 2 4 416, 1 8 386 22 40 3 12 40 7 12 410 8 519 11 552 14 524 7 538 1 3 657 9 715 12 593 7 599 1 8 507 10 544 11 481 7 565 10 565 11 545 7 520 , 11 5 38 9 523 1 3 518 1 463 4 484 10 474 11 450 9 443 10 441 6 370 ' 4 373 5 362 10 395 6 356 10 370 8

3 0

MORGAN COUNTY ROANE COUNTY -

Year Live b i r t h s S t i l l b i r t h s L i v e b i r t h s S t i l l b i r t h s

SCOTT COUNTY UNION COUNTY

Year Live b i r t h s S t i l l b i r t h s

~

Live b i r t h s S t i l l b i r t h s

? ?

BLOUNT 6 KNOX COUNTIES OAK RIDGE

Year Live b i r t h s S t i l l b i r t h s Live b i r ths S t i l l b i r t h s

APPENDIX B

CONGENITAL MALFORMATION DATA

(Year-of-Death Technique)

(Source: State of Tennessee Annual Bulletins of Vital Statistics)

THIS PAGE

WAS I N T E N T H O N A L L Y LEFT BLANK

35

STATE EAST TENNESSEE

Year Populat ion C. M. s Populat ion C.M, s

a Populat ion numbers a r e i n t e r p o l a t e d va lues .

3 6

ANDERSON COUNTY CAMPBELL COUNTY

Year Population C.M.8 Population C.M.s

a Population numbers are interpolated values.

KNOX COUNTY LOUDON C O U N ~

Year Population C . M . s Population C . M . s

a ~ o p u l a t i o n numbers are interpolated values.

. .

38

MORGAN COUNTY ROANE COUNTY

Year Population C . M . s Population C . M . s

"population numbers are interpolated values.

SCOTT COUNTY UNION COUNTY

Year Population C.M.s .Population C.M. s

a~opulation numbers are interpolated values.

BL0UN.T & KNOX COUNTIES OAK RIDGE

Year Population C . M . s Population C . M . s

a Population numbers are interpolated values.

APPENDIX C

CONGENITAL MALFORMATION DATA

(Year-of -Birth Technique)

(Source: State of. Tennessee, Department of Health)

THIS PAGE

LEFT BLANK

STATE EAST TENNESSEE ANDERSON COUNTY

Year C.M. s C.M. s C.M. s

CAMPBELL COUNTY KNOX COUNTY LOUDON COUNTY

Year C.M.s C.M.s C.M.s

MORGAN COUNTY ROANE COUNTY S C O T T COUNTY

Y e a r C.M. s C . M . s C . M . s

.4 6

UNION COUNTY BLOUNT & KNOX COUNTIES OAK RIDGE

Year C.M. s C.M. s C.M. s

INTERNAL DISTRIBUTION

1. J. A. Auxier 2. D. M. Davis

3-22. C. E. Easterly 23. A. S. Garrett 24. T. D. Jones 25. S. V. Kaye

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V. E. Archer, NIOSH, U.S. Post Office and Courthouse Bldg., Salt Lake City, Utah 84101 R. P. Blaunstein, Division of Biomedical and Environmental Research, DOE, Washington, D.C. 20545 F. Bowman, TVA Medical Service Division, 319 Edney Building, Chattanooga, Tennessee 37401 A. Brodsky, U.S. Nuclear Regulatory Commission, Washington, D.C. 20555 R. L. Butenhoff, Division of Biomedical and Environmental Research, DOE, Washington, D.C. 20545 R. Clusen, Asst. Secretary for Environment, DOE, Washington, D.C. 20545 B. L. Cohen, Department of Physics, University of Pittsburg, Pittsburg, PA 15260 '

D. Grahn, Argonne National Laboratory, 9700 S. Cass Avenue, Argonne, Illinois 60439 E. B. Huuk, NYS Birth Defects Institute, Albany Medical College, Albany, NY 12208 C. J. Johnson, Jefferson County Health Department, Lakewood, Colorado 80226 C. C. Lushbaugh, Medical and Health Sciences Division, ORAU, Oak Ridge, Tennessee 37830 T. F. Mancuso, University of Pittsburg, Pittsburg, Pennsylvania 15260 S. Marks, Battelle Pacific Northwest Laboratory, P.O. Box 999, Richland, Washington 99352 G. M. Matanoski, Epidemiology Department, John Hopkins University 615 N. Wolfe Street, Baltimore, Maryland 21205 J. McCarroll, Electric Power Research Institute, 3412 Hillview Ave., P. 0. Box 10412, Palo Alto, California 94304 D. McFarland, East Tennessee Health Improvement Council, 10903 Lake Ridge Road, Knoxville, Tennessee 37922

S. Milham, Washington S t a t e Department of Social and Health Services, Olympia, Washing ton 98504 V. A. Newill, Medical Department, Exxon Corporation, P. 0. Box 45, Linden, New Jersey 07036 C. H. Pa t r i ck , National I n s t i t u t e on Aging, Bethesda, Maryland 20014 A. P. Polednak, Medical and Health Sciences Division, ORAU, Oak Ridge, Tennessee 37830 L. A. Sagen, E l e c t r i c Power Research I n s t i t u t e , 3412 Hillview Ave., P. 0. ,Box 10412, Palo Alto, California 94304 C. M. Shy, UnAversity of North Carolina, Chapel H i l l , North Carolina 27514 J. H. Stebbings, Health Research Division, Los Alamos Sc i en t i f i c Laboratory, Los Alamos, New.Mexico 87545 P. Taylor, Tennessee Department of Public Health, Nashville, Tennessee 37219 G. K. Tokuhata, Bureau of Health Research, Pennsylvania Department of Health, P. 0. Box 90,' Harrisburg, Pennsylvania 17120. W. D. ~ r a v e r s , U. S. Nuclear ~ e ~ u l a t o r ~ ~ o m k s s i o n , Washington, D.C. 20555 W. H. Travis, Safety and Environmental Control Division, DOE, ORO, CIak Ridge H. M. Wallace, School of Public Health, University of Cal i fornia , Berkeley, Ca l i fo rn ia 94720 A. M. Weinburg, I n s t i t u t e fo r Energy Analysis, ORAU, Oak Ridge, Tennessee, 37830 W. H. Weyzen, Division of Biomedical and Environmental Research, '

DOE, Washington, D.C. 20545 R. W. Wood, Division of Biomedical and Environmental Research, DOE, Washington, D.C. 20545 Assistant Manager, Energy Research and ~evelopment, Department of Energy - Oak Ridge Operations, Oak Ridge, Tennessee 37830 Technical ' Information Center, Oak Ridge, TN 37830