reduce substantially other major sources of uncertainty that are entailed in the application of epidemiology to incinerator emissions.

RESULTS OF EPIDEMIOLOGIC STUDIES OF INCINERATOR-EXPOSED POPULATIONS

This section discusses the findings from epidemiologic studies of incinerator-exposed populations, including the few studies of human populations in the vicinity of incinerators and the more-detailed health studies of workers in these facilities. In general, information is rather sparse on the relationship between human exposure to pollutants released to the environment by incinerators and the occurrence of health effects.

Studies of Local Populations

In one of the earliest epidemiologic studies of populations in the vicinity of waste incinerators, Zmirou et al. (1984) obtained data on the use of medications for respiratory illnesses over a 2-year period among residents of a French village at distances of 0.2, 1, and 2 km from a refuse incinerator. Medication use was determined by examining prescription forms filed by the residents after each purchase. The purchase of respiratory medications (bronchodilators, expectorants, antitussants, and so on) decreased as the distance of the residences from the incinerator increased, and the relationship was statistically significant. However, the prevalence of other possible confounding risk factors for respiratory illness, such as socioeconomic and geographical situation, were not accounted for in this study, and no causal associations can be inferred.

After reports of illness and neurologic symptoms in workers employed at the Caldwell Systems, Inc. hazardous-waste incinerator in western North Carolina and health complaints of nearby residents, the Agency for Toxic Substances and Disease Registry (ATSDR) performed a cross-sectional study in the surrounding community for the prevalence of self-reported respiratory, musculo-skeletal, neurologic, irritative, and other symptoms (ATSDR 1993a). A higher prevalence of self-reported respiratory symptoms, but not of respiratory or other diseases, was found in the target population than in a nearby comparison population. Prevalence data were adjusted for age, sex, and cigarette smoking. Members of the population close to the incinerator were almost nine times more likely to report recurrent wheezing or cough, and they were almost twice as likely as those living further from the site to report respiratory symptoms (after adjustment for smoking, asthma, and environmental concern). Other symptoms—including chest pain, poor coordination, dizziness, and irritative symptoms—were also statistically significantly greater in the population close to the incinerator. However, the investigators noted that neither the prevalence of physician-diagnosed diseases (as reported by subjects) nor hospital admissions



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