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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
ENVIRONMENTAL EPIDEMIOLOGY
Volume 1
Public Health and Hazardous Wastes
Committee on Environmental Epidemiology
Board on Environmental Studies and Toxicology
Commission on Life Sciences
NATIONAL RESEARCH COUNCIL
NATIONAL ACADEMY PRESS
Washington, D.C. 1991
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
NATIONAL ACADEMY PRESS
2101 Constitution Ave. Washington, D.C. 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
National Research Council (U.S.). Committee on Environmental Epidemiology.
Environmental epidemiology / Committee on Environmental Epidemiology, Board on Environmental Studies and Toxicology. Commission on Life Sciences, National Research Council.
p. cm.
Includes bibliographical references and index.
Contents: v. 1. Public health and hazardous waste.
ISBN 0-309-04496-0 (v. 1)
1. Environmental health. 2. Epidemiology. I. Title.
[DNLM: 1. Epidemiologic Methods. 2. Hazardous Waste—adverse effects. 3. Refuse Disposal. WA 788 N275e]
RA565.N323 1991
363.72'87—dc20
DNLM/DLC
for Library of Congress 91-28051
CIP
Cover photograph: LES MOORE/UNIPHOTO
Copyright © 1991 by the National Academy of Sciences
No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the pubisher, except for the purposes of official use by the U.S. government.
Printed in the United States of America First Printing. August 1991 Second Printing, March 1993
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
COMMITTEE ON ENVIRONMENTAL EPIDEMIOLOGY
ANTHONY B. MILLER (Chairman),
University of Toronto, Ontario, Canada
DAVID BATES,
University of British Columbia, Canada
THOMAS CHALMERS,
Department of Veterans' Affairs and Harvard School of Public Health, Boston, Massachusetts
MOLLY JOEL COYE,
California Department of Health Services
JOHN FROINES,
UCLA School of Public Health, Los Angeles
DAVID HOEL,
National Institute of Environmental Health Services, Research Triangle Park, North Carolina
JOEL SCHWARTZ,
United States Environmental Protection Agency, Washington, D.C.
Special Advisor
PAUL SCHULTE,
National Institute for Occupational Safety and Health, Cincinnati, Ohio
Staff
DEVRA LEE DAVIS, Scholar in Residence
LINDA MILLER POORE, Research Associate
PAULETTE ADAMS, Project Assistant
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
BOARD ON ENVIRONMENTAL STUDIES AND TOXICOLOGY
GILBERT S. OMENN (Chairman),
University of Washington, Seattle
FREDERICK R. ANDERSON,
Washington School of Law, American University, Washington, D.C.
JOHN C. BAILAR III,
McGill University School of Medicine, Montreal, Canada
LAWRENCE W. BARNTHOUSE,
Oak Ridge National Laboratory, Oak Ridge, Tennessee
GARY D. BREWER,
Yale University, New Haven, Connecticut
JOANNA BURGER,
Nelson Laboratory, Rutgers University, Piscataway, New Jersey
YORAM COHEN,
University of California, Los Angeles
JOHN L. EMMERSON,
Lilly Research Laboratories, Greenfield, Indiana
ROBERT L. HARNESS,
Monsanto Agricultural Company, St. Louis, Missouri
ALFRED G. KNUDSON,
Fox Chase Cancer Center, Philadelphia, Pennsylvania
GENE E. LIKENS,
The New York Botanical Garden, Millbrook, New York
PAUL J. LIOY,
UMDNJ-Robert Wood Johnson Medical School, Piscataway, New Jersey
JANE LUBCHENCO,
Oregon State University, Corvallis
DONALD MATTISON,
University of Pittsburgh, Pennsylvania
NATHAN REED,
Hobe Sound, Florida
F. SHERWOOD ROWLAND,
University of California, Irvine
MILTON RUSSELL,
University of Tennessee, Knoxville
MARGARET M. SEMINARIO,
AFL/CIO, Washington, D.C.
I. GLENN SIPES,
University of Arizona, Tucson
WALTER J. WEBER, JR.,
University of Michigan, Ann Arbor
Staff
JAMES J. REISA, Director
DAVID POLICANSKY, Program Director for Natural Resources and Applied Ecology
ROBERT B. SMYTHE, Program Director for Exposure Assessment and Risk Reduction
RICHARD D. THOMAS, Program Director for Human Toxicology and Risk Assessment
LEE R. PAULSON, Manager,
Toxicology Information Center
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
COMMISSION ON LIFE SCIENCES
BRUCE M. ALBERTS (Chairman),
University of California, San Francisco
BRUCE N. AMES,
University of California, Berkeley
FRANCISCO J. AYALA,
University of California, Irvine
J. MICHAEL BISHOP,
University of California, San Francisco
MICHAEL T. CLEGG,
University of California, Riverside
GLENN A. CROSBY,
Washington State University, Pullman
FREEMAN J. DYSON,
The Institute of Advanced Study, Princeton, New Jersey
LEROY E. HOOD,
California Institute of Technology, Pasadena
DONALD F. HORNIG,
Harvard School of Public Health, Boston, Massachusetts
MARIAN E. KOSHLAND,
University of California, Berkeley
RICHARD E. LENSKI,
University of California, Irvine
STEVEN P. PAKES,
University of Texas, Dallas
EMIL A. PFITZER,
Hoffmann-LaRoche, Inc., Nutley, New Jersey
THOMAS D. POLLARD,
The Johns Hopkins Medical School, Baltimore, Maryland
JOSEPH E. RALL,
National Institutes of Health, Bethesda, Maryland
RICHARD D. REMINGTON,
University of Iowa, Iowa City
PAUL G. RISSER,
University of New Mexico, Albuquerque
HAROLD M. SCHMECK, JR.,
Armonk, New York
RICHARD B. SETLOW,
Brookhaven National Laboratory, Upton, New York
CARLA J. SHATZ,
Stanford University School of Medicine, Palo Alto, California
TORSTEN N. WIESEL,
Rockefeller University, New York, New York
Staff
JOHN E. BURRIS, Executive Director
SOLVEIG M. PADILLA, Administrative Secretary
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
The National Academy of Sciences is a private, non-profit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Frank Press is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M. White is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Samuel O. Thier is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Frank Press and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council.
The project was supported by the Agency for Toxic Substances and Disease Registry, U.S. Public Health Service, Department of Health and Human Services.
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
Preface
In response to a request from the Agency for Toxic Substances and Disease Registry (ATSDR), the Board on Environmental Studies and Toxicology in the Commission on Life Sciences of the National Research Council (NRC) convened the Committee on Environmental Epidemiology. The Board charged the Committee to review current knowledge of the human health effects caused by exposure to hazardous-waste sites and to suggest how to improve the scientific bases for evaluating the effects of environmental pollution on public health, including specifically the conduct of health assessments at Superfund sites. This first report of the committee examines and evaluates the published scientific literature on health effects that could be linked with exposure to hazardous-waste disposal sites, and develops recommendations about major data gaps that need to be remedied in order to advance the field.
With additional support from the Environmental Protection Agency, a second report of the committee will identify research opportunities and issues in methodology for environmental epidemiology and will select and evaluate a sample of non-peer-reviewed reports on the subject of the epidemiologic study of hazardous wastes. This literature includes such sources as state health department reports and relevant technical evaluations from judicial decisions that have been subject to extensive review, but are not available in the peer-reviewed
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
literature. To the extent feasible, the second report also will assess newly available reports from Eastern Europe and Asia that may be relevant.
In light of the paucity of information readily available, the Committee struggled with its charge early on. We developed the policy of looking at peer-reviewed, published studies of persons exposed at hazardous-waste sites, and also examining those studies involving environmental exposures similar to those that might be found at such sites.
The chapters reflect the consensus of the committee. We are grateful to a number of colleagues who provided drafts and critiques of sections of the report for the Committee, including Drs. Diane Wagener, Director of Environmental Epidemiology at the National Center for Health Statistics; Claire Weinberg, National Institute of Environmental Health Sciences; Peter Infante, Health Standards Division, the Occupational Safety and Health Administration; Ken Cantor, Environmental Epidemiology Branch, National Cancer Institute; Lynn Goldman, Public Health Administrator, State of California; and Marvin Schneiderman, Senior Scientist, NRC. In preparing this report, we have met with citizen groups, industry representatives and state officials (including the National Governors ' Association Task Force on Environmental Epidemiology), all of whom provided valuable suggestions. Dr. Barry Johnson, Assistant Administrator for the Agency for Toxic Substances (ATSDR), provided helpful recommendations and guidance at the outset of the study, as did a number of members of that agency. Dr. Dorothy Canter of EPA assisted us in gathering relevant agency information and navigating through the bureaucratic maze.
Linda Miller Poore provided able research and administrative support and document supervision, and Paulette Adams managed document preparation and meeting organization. Most importantly, the committee acknowledges its enormous debt to Dr. Devra Davis, Scholar in Residence, National Research Council, who not only ably fulfilled the role of project director, but contributed substantially to the drafting and revision of all chapters in the report. Without her skills and input, the report would have lacked much, and our task could never have been completed in the timely manner it has been.
Finally, as chairman, I should like to thank all of the members of the committee for their expertise, input and support throughout our deliberations.
ANTHONY B. MILLER, Chairman
Committee on Environmental Epidemiology
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
Contents
Summary
1
SECTION ONE
Public Health and Hazardous Wastes: The Context
Introduction
25
State and Federal Context for Environmental Epidemiology of Hazardous Wastes
60
Dimensions of the Problem: Exposure Assessment
101
SECTION TWO
Hazardous Wastes in Air, Water, Soil, and Food; Biologic Markers
Air Exposures
157
Domestic Water Consumption
179
Soil and Food as Potential Sources of Exposure at Hazardous-Waste Sites
203
Biologic Markers in Studies of Hazardous-Waste Sites
219
General Conclusions
256
Index
271
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
Tables
1-1
Summary of studies of residential exposure to hazardous-waste sites
48
2-1
ATSDR public health advisories
71
2-2
Cost estimates: Preremedial assessments of hazardous-waste sites
78
2-3
Environmental epidemiology: Investigators and funding sources
87
2-4
Revised preliminary assessment: Estimated costs
95
3-1
Types of activities at hazardous-waste sites in the United States
105
3-2
Selected hazardous substances at 951 national priorities list sites: Number and percentage of sites and documented migration of substances into specific media
108
3-3
Activities contributing to groundwater contamination in the United States
112
3-4
Hierarchy of exposure data or surrogates
120
3-5
Spatial considerations: Summary of sampling designs and when they are most useful
127
3-6
Some common problems with all types of human exposure data
129
3-A
Frequency of substances reported at final and proposed NPL sites
144
3-B
Priority list of substances for toxicological profiles
146
7-1
Neuropsychological test battery
226
7-2
Steps in the development of a biomarker
240
7-3
Background levels of some human hemoglobin adducts
243
Figures
1-1
Sources of evidence for inferring whether exposures to hazardous-waste sites cause an impact on public health
31
2-1
What are the potential threats to the environment that led to listing on the NPL?
67
2-2
Wastes at NPL sites come from many sources
68
2-3
NPL sites are located in all settings and areas
69
2-4
CERCLIS inventory and NPL sites
81
3-1
Few Superfund sites completely cleaned up
104
3-2
NPL: Types of activities at 1189 final sites
106
3-3
NPL sites and population resident within 1 and 4 miles
114
3-4
Physical and biological routes of transport of hazardous substances, their release from disposal sites, and potential for human exposure
118
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
3-5
Continuum from emission of a contaminant to a health effect
122
3-6
Parameters required to calculate potential and internal dose
125
4-1
Mean daily deaths in London versus mean smoke (µg/m3), 1958-1972
159
7-1
Relationship between biomarkers of susceptibility, exposure, and effect
221
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
ENVIRONMENTAL EPIDEMIOLOGY
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ENVIRONMENTAL EPIDEMIOLOGY: Volume 1
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