significantly higher blood lead. None of the known health effects of lead exposure was evaluated in this study. The results suggest that the presence of lead in combustion-chamber fly ash can increase the blood-lead concentrations of incinerator workers.

Only two morbidity or mortality studies of waste-incinerator workers have been reported. Bresnitz et al. (1992) evaluated 86 male workers among 105 active employees at a Philadelphia municipal incinerator. The workers were divided into potential high- and low-exposure groups of 45 and 41, respectively, on the basis of a worksite analysis performed by an independent industrial hygienist. Eight workers had at least one measurement in blood or urine indicating excessive exposure to heavy metals, but these elevations were unrelated to exposure category. Although 34% of the workers had evidence of hypertension, the prevalence of this condition was unrelated to exposure group. None of the biochemical measurements of blood or serum were clinically significant, and, except for hematocrit and serum creatinine, the differences between the two exposure groups were not statistically significant.

Gustavsson (1989) studied the mortality experience of 176 waste-incinerator workers in Sweden. Compared with national and local death rates standardized for age and calendar year, there was an excess of deaths from lung cancer and ischemic heart disease. Analysis of duration of exposure supported the conclusion that the excess of deaths from ischemic heart disease was attributable to occupational factors, whereas lung-cancer deaths were too few to make such an inference.

In summary, workers in the incinerator industry have not been extensively studied for morbidity and mortality risks. A Swedish study found an excess of deaths from lung cancer and ischemic heart disease among a sample of 176 incineration workers. The few available studies reviewed here yield evidence that some workers are exposed to amounts of organic compounds and metals (including dioxins, furans, and lead) that result in increased tissue concentrations. The health consequences of the exposures have not been evaluated through systematic followup of these workers.

A recent report of a retrospective mortality study of a cohort of 532 male subjects employed at two municipal-waste incineration plants in Rome, Italy (Rapiti et al. 1997) revealed an increased risk of gastric cancer. The authors concluded that these findings indicate the need to further investigate the role of cancer as a result of occupational exposure to hazardous waste.

Studies of Animal Populations

Lloyd et al. (1988) studied rates of twin births in cows (“twinning”) in an area of central Scotland surrounding two waste incinerators, one a municipal-waste incinerator and the other a chemical incinerator. The study of twin births was prompted by the anecdotal observation of a dramatic increase in twinning



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