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 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 ENVIRONMENTAL EPIDEMIOLOGY

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