Contaminated Water Supplies at Camp Lejeune Assessing Potential Health Effects (2009) / Chapter Skim
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8 Studies of the Camp Lejeune Population
8 Studies of the Camp Lejeune Population
Pages 184-197
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From page 184... ...
is the only agency to have performed epidemiologic studies of the Camp Lejeune population exposed to water supplies contaminated with volatile organic compounds (VOCs)
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From page 185... ...
In both studies, residents of the base trailer park were excluded because housing records were incomplete, and, as noted above, a few births to mothers residing on base for a very short time or during ambiguous exposure periods were excluded. The remaining births to mothers residing on the base were considered unexposed, including births to all residents of the Marine Corps Air Station, Rifle Range, and Courthouse Bay and the remaining residents of Berkeley Manor, Midway Park, Paradise Point, and Watkins Village.
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From page 186... ...
Specific subgroups showed statistically significant effects, but no formal hypothesis test for the presence of interaction between subgroups defined by maternal age or history of fetal loss was mentioned. The authors concluded that there was no association between PCE exposure and mean birth weight or preterm birth and that there was a weak association between PCE exposure and SGA in all groups.
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From page 187... ...
after adjustment only for officers' housing. No exposure-response patterns were observed for PCE exposure and mean birth weight or SGA in women who had had fetal deaths.
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From page 188... ...
On the basis of its review of the scientific literature, ATSDR decided to focus on specific childhood cancers and birth defects: childhood leukemia, childhood nonHodgkin lymphoma, spina bifida, anencephaly, cleft lip, and cleft palate (ATSDR 2005a)
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From page 189... ...
The primary hypotheses concern the association between drinking TCE- or PCE-contaminated water during the first trimester and specific birth defects and the association between drinking TCE- or PCE-contaminated water during pregnancy and childhood cancers. The hypotheses are extended to incorporate contaminant concentration and personal exposure (taking into account the amount of water consumed by the mother or used in showering, hand-washing dishes, and so on)
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From page 190... ...
Even with the uncertainty about the total number of cases that will eventually be included in the analysis and even under the more optimistic scenario, statistical power is low. Review and Evaluation Owing to the paucity of measurements of PCE and TCE concentrations in contaminated water at Camp Lejeune during the period of interest, exposure assessment is a major limitation of the current birthdefect and childhood-cancer study.
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From page 191... ...
The three cohorts would be considered for inclusion in an allcause mortality study and a cancer-incidence study, and the Camp Pendleton cohort would serve as an external comparison group for the analysis of civilian and military personnel at Camp Lejeune. ATSDR proposed to link study participants' residence history on the base with housing records (family housing unit or barracks)
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From page 192... ...
If the Navy-Marine Corps health survey is deemed successful, it will use information from the survey participants to adjust for confounding in a two-stage approach, extrapolating the information from the health survey for application to the mortality study. If the survey does not generate an adequate response, consideration will be given to nested case-control sampling with interviews of decedents' next of kin to determine information on risk factors.
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From page 193... ...
Personal identification information on the survey participants will be matched to available data on cancer in the state, DOD, and VA cancer registries. Therefore, like the mortality study, the incidence study will use a two-stage approach in which information on exposure and cancer would be available on everyone in the study who is not lost to followup, but information on individual-level potential confounders will be available only on those who complete the health survey.
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From page 194... ...
However, the comparison between Camp Lejeune and Camp Pendleton could be affected if there are differences between the bases in the percentage of retired marines migrating to states whose cancer registries are older, and there are broader concerns about the constitution of the study populations and the multiple ways in which the Camp Lejeune cohort would be assembled. In summary, although the major issues bearing on the feasibility of the proposed studies have been considered by ATSDR and the approach has some strengths, notably inclusion of a comparable ma
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From page 195... ...
With those concerns layered on the previously noted problems regarding the accuracy of exposure assessment, it is not clear what the scientific value of additional studies would be. FINDINGS OF COMPLETED, CURRENT, AND FUTURE STUDIES The committee considered the value of completed, current, and planned studies of the Camp Lejeune population in light of the information available on assessing exposure, health end points of primary concern, and what is known about the potentially affected population from previous studies and work in progress.
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From page 196... ...
Future research needs to be both scientifically informative and credible to the multiple target audiences. CONCLUSIONS AND RECOMMENDATIONS The scope of health outcomes addressed in completed and current studies of the Camp Lejeune population is limited and driven, to a large extent, by the types of diseases that are feasible to measure with available surveillance data and a health survey.
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From page 197... ...
However, on the basis of what is known about the contamination of water supplies at Camp Lejeune; the size, age, and residential mobility of the residents; and the availability of records, the committee concludes that it would be extremely difficult to conduct direct epidemiologic studies of sufficient quality and scope to make a substantial contribution to resolving the health concerns of former Camp Lejeune residents. Conduct of research that is deficient in those respects not only would waste resources but has the potential to do harm by generating misleading results that erroneously implicate or exonerate the exposures of concern.
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