Download Fetal Deaths

Fetal Deaths
NPL Sites and Fetal Deaths: A Simple Correlation
Issue of Census Tracts and NPL Sites.
The Purpose
The purpose of this study is to attempt to assess
correlation of Infant and Fetal Mortality with
hazardous waste sites, specifically Florida’s
National Priority List (NPL) sites with distance
and carcinogenicity of toxicants present as a
proxy for exposure.
Outline
1. Statement of the Problem
2. Definitions
3. Introduction/Statement of the Problem
4. Project Overview
5. Procedure
6. Data/ Observations
7. Conclusion/Future Studies
Definitions (1)
 "Stillbirth" means the death of a fetus of more than 20 weeks gestation." (s. 467.003 Florida
Statutes, Definitions)
 "Fetal death" means death prior to the complete expulsion or extraction of a product of
human conception from its mother if the 20th week of gestation has been reached and the
death is indicated by the fact that after such expulsion or extraction the fetus does not breathe
or show any other evidence of life such as beating of the heart, pulsation of the umbilical
cord, or definite movement of voluntary muscles."
 "Live birth" means the complete expulsion or extraction of a product of human conception
from its mother, irrespective of the duration of pregnancy, which, after such expulsion,
breathes or shows any other evidence of life such as beating of the heart, pulsation of the
umbilical cord, and definite movement of the voluntary muscles, whether or not the
umbilical cord has been cut or the placenta is attached." (Emphasis added, s. 382.002 Florida
Statutes, Definitions)
http://www.volusia.org/medicalexaminer/stillbirth.htm
Definitions (2)
 Fetal death:
"Stillbirth" means an unintended, intrauterine fetal death after a gestational age of not less
than 20 completed weeks.
 Fetal mortality rate:
The ratio of fetal deaths divided by the sum of the births (the live births + the fetal deaths) in
that year.
Fetal Deaths (Stillbirths) = Average Number of Fetal Deaths/ Average Number of
Live and Still Births
http://www.medterms.com/script/main/art.asp?articlekey=3420
Definitions (3)
 Infant Mortality:
 The death of a live born infant which occurs within the first year of life.

Infant Mortality Rate = Number of Infant Deaths /Number of Live Births
“The Fetal mortality rate is considered a good
measure of the quality of health care (and
environment) in a country or a medical
facility.” (Florida DOH: 2010 aims)
Definitions (4)
 “National Priorities List (NPL) site”
EPA's list of the most serious uncontrolled or abandoned hazardous waste sites
identified for possible long-term remedial action under Comprehensive
Environmental Response, Compensation, and Liability Act (CERCLA): Superfund .
The list is based primarily on the score a site receives from the Hazard Ranking
System. EPA is required to update the NPL at least once a year (National Safety
Council).
 “Carcinogenicity "
The ability or tendency to produce cancer .
7
April 11, 2008
Statement of the Problem (1)
The assumption is that toxicity affects the embryo, as there
is evidence in animal and human research that endorses
individual Chemicals as ‘toxic’.
However, the mixture of chemicals and especially its
exposure from the environment are scarce and riddled
limitations.
Research
 Washington State (Mueller, 2007)
 NO
 England (Morgan, 2004); EUROHAZCON,
Vrijheid)
 Maybe, however: ½ of the population live within ‘kilometers’ of hazardous waste
sites
 Middle East: Israel (Bentov, 2006):
 Yes, but only in the Bedouin population (intermarriage as a confounder?)
 History:
 Dwarfs, Gnomes, one eyed monsters, two headed beasts…
 Beowulf: steps in ‘lighted underground lake’, and begets a monster
Introduction
Statement of the Problem (2)
“Is there a correlation between National Priority List (NPL) Sites
and infant/fetal deaths in the surrounding population?”
Toxicants
Soil:
Sludge
Sediments
AIR
Toxicants
Water:
Surface
Ground
Flooding
Fetal Deaths?
Facts
• NPL sites:
• 1641 sites in the USA
• Region 4
• Florida: 72 sites
• 2 proposed (Hillsborough and Broward)
 Fetal Deaths: Health Indicator 8
 2010 objective 4.1 (Target 16-1a, Florida’s objective for reducing fetal deaths)
 2000 Baseline 8.2 (Fetal deaths at 20 or more weeks of gestation)
National Priorities List Sites in Florida
From: EPA, Superfund
Adverse Health Effects in Population
Prototype for Diagnosis
Contaminants
Verification of
Possible
Disruption
Monitoring
System
Personal
Biomarker
?
Environment
al Markers
NPL
Location
Project Overview
Prototype of Diagnostic and Interference Analysis
NPL Sites:
Framework
Fetal /Infant
Death Rate vs.
Distance as a
Proxy
Location:
Geography
Contaminant:
Nature
Environmental
Interactions
Variables
 Average Fetal/ Infant Mortality Rates
 Census Tracts (CHARTS): Years 1997-2001, 2002-2006
 Contaminant Toxicity
 Types of Media Contaminated (Surface water, Groundwater, Soil, Sludge, Other)
 Flooding: partial, total; + sludge, + sediment, + surface water
 Grade Contaminant Risk Assessment (EPA list of Carcinogen Classification: A, B1,
B2, C, D, N/A)
 Distance from Exposure Site
 0.5, 1.1, 2.8, 7 miles with the County averages of the same year as reference
population
Project Overview
Part 1
General Assessment
Data Collection Structure
Hypothesis Statement
Character of Site
Character of
Contaminants
Classification by
Effects:
1. Carcinogenicity
2. Year of Deletion of
NPL list
Classification by site:
1. Geography
2. Construction Status
3. Location
Characteristics
Character of Site
Fetal Deaths
by Census
Tract
Overall Site Risk Assessment
Distance vs. Fetal Death
mortality Vs Risk/Site
Matching
Ho: µ0= FD0.5 = FD1.1 =FD2.8
= FD7 = FDCounty
Ha: µ = FD0.5 > FD1.1 >FD2.8 >
1
FD7 > FDCounty
Limitations:
 Location: Centroid Coordinates
 NPL site & Census tract fetal death rate
 Toxicants: Site Contaminant Algorithm
 Carcinogenic Potential Classification
 Exposure: Dyad fetus-mother
 Personalized risk assessment of environmental factors: behavior/addictions, genetics
 Exposure interval
 Others:
 Missing Information _X_ sites
Research Component
The detailed analytical work on the characterization of ALL
contaminants and identification of risk factors.
The next step will involve the analysis of the correlation with
fetal deaths by distance from the NPL site
These then will be further analyzed by GIS through
superimposition of the sites for added strength of correlation
Proceedure
 Contaminants
 Categorized (=n)
 Assigned a risk value these will be added by computerized risk factor for
contaminated media, identified for flooding characteristics
 Risk factors
 Added Toxicity Algorithm: compared with the results of the estimates of Fetal
Deaths/ Infant Deaths per thousand according to census tracts and distance
(categorical variables) of the sites (0.5, 1.1, 2.8 and 7 miles).
 GIS
 Superimposition of similar sites in magnitude of carcinogenicity for added strength
of correlation
Tools
 U.S. Census Bureau American FactFinder. Reference Maps:
2000 Census Tracts and Blocks
 EPA
 National Priority List (NPL). National Priority List Sites in
Florida: NPL Sites in Florida by County
 Integrated Risk Information System (IRIS)
 Florida Charts: Community Health Assessment Resource Tool
Set. Fetal and Infant Death Indicators
 Computer analysis software
 Geographical positioning: ArcGIS
 Excel (2007)
 IRB: Public Data
IRB & HIPPA
Geographical
Coordinates:
Plotted on Graph
instead of Map
EPA ID
FLD004145140
FLD020536538
FLD981014368
FLD004574190
Latitude Longitude
25.8152 -80.2559
25.84306 -80.2565
25.92319 -80.2215
25.83958 -80.3001
Project Overview: FINAL
Fetal Death
by Census
Tract (FDOH)
Toxicant
Risk (IRIS,
ATSDR)
Exposure
Route
(EPA)
Fetal Mortality In
Census tracts @
0.5, 1.1, 2.8, 7 M
Carcinogenicity
Soil, Water, Air
Flooding
NPL Status
Step 1
Step 2
Step 3
GIS
Analysis
Step 4
Procedure: Step 1
Fetal Deaths:
Distance as a Proxy
Fetal Death by Census Tract
Fetal Mortality In Census tracts
@ 0.5, 1.1, 2.8, 7 M and County
Tracts found by entering the geographical
Coordinates from the sites
Fetal Deaths by Census Tracts
# of Fetal Mortality/Tract =
(Deaths/ Mile radius)/1000 live births (?)
AIRCO PLATING CO.
FLD004145140
Average Fetal Deaths
Across
Fetal Deaths/1,000 live births
0.5 miles
10.65
1.1 miles
8.33
2.8 miles
7.85
7 miles
5.23
County
0.18
Miami Flood Oct 4 2000???
SOIL AND GROUNDWATER
Procedure: Step 2
Contaminants:
By Type, Media & Periculosity
1. By Type of Contaminant









Inorganic
Metals
PAH
VOC
PCBs
Base Neutral Acids
Pesticides
Radioactive
Petroleum Hydrocarbon
2. By Toxicant Risk
Locate Contaminant
1.
2.
3.
4.
1
2
3
4
EPA NPL list
By County
Contaminated Media
Classify for
Carcinogenicity (IRIS)
Contaminants of Concern found in the Soil
CAS #
Contaminant Name
Contaminated Media Area of Site Found
(OU)
127-18-4
TETRACHLOROETHYLENE Groundwater/Soil
RI/FS (01)
39638-32-9
CADMIUM
Groundwater/Soil
RI/FS (01)
57-12-5
CYANIDE
Groundwater/Soil
RI/FS (01)
7439-92-1
LEAD
Groundwater/Soil
RI/FS (01)
7440-02-0
NICKEL
Groundwater/Soil
RI/FS (01)
7440-47-3
CHROMIUM
Groundwater/Soil
RI/FS (01)
7440-50-8
COPPER
Groundwater/Soil
RI/FS (01)
7440-66-6
ZINC
Groundwater/Soil
RI/FS (01)
Procedure: Step 3
Site Exposure Route
3. By Exposure Route (EPA)
 Contaminated Media
 Air
 Soil
 Water
Site Characteristics:
1. Flooding
2. Groundwater and Soil contamination
3. Population within one mile: 10,001-50,000
 Groundwater
 Surface Water
 Sludge/ Sediment/ Other
 Flooding
 NPL Status
Procedure: Step 4
Site:
Toxicity Algorithm
Simulation Example
Site Address: 3636 NW 46TH STREET
MIAMI, Florida
33142 County: MIAMI-DADE U.S. Congressional District: 18 Population within one mile: 10,001-50,000
A.
Assigned toxicity for Contaminated
media
Groundwa
ter
90
Soil
Flooding:
partial
D.
50
10
150
B.
Class
Constructi
on:
complete
Control
Year
Total values
50
150
9
41
41
191
C.
Toxicants
Inorganics, Metals, PAH, VOC
E.
Added toxicity:
Site:
191.00
Toxicants
411.11
602.11
CAS#
Chemical
BIS(2117-81-7 ETHYLHEXYL)PHTHALATE
127-18-4 TETRACHLOROETHYLENE
CIS-1,2156-59-2 DICHLOROETHYLENE
39638-329
CADMIUM
57-12-5 CYANIDE
67-64-1 ACETONE
67-66-3 CHLOROFORM
7439-92-1 LEAD
7440-02-0 NICKEL
7440-47-3 CHROMIUM
7440-50-8 COPPER
7440-66-6 ZINC
75-01-4 VINYL CHLORIDE
75-35-4 1,1-DICHLOROETHYLENE
79-01-6 TRICHLOROETHYLENE
Column A=B
Carcinoge Assigned
nic
Value
B2
D
50
1
D
1
B1
D
D
50
1
1
N/A
B2
B1
Ai/Do
A
D
D
C
N/A
50
50
1
100
1
1
20
327
Assigned toxicity by
411.11chemicals
Miami Flood Oct 4 2000???
SOIL AND GROUNDWATER
Data/Observations
Fetal Deaths/1,000 live
births
12.00
10.00
8.00
6.00
4.00
2.00
0.00
0.5
miles
1.1
miles
2.8
miles
7 miles
County
Site
Anaconda Aluminum Co./Milgo Electronics
Circlis ID
FLD020536538
Air
Surface water
Groundwater
Soil
Sludge
Other
Flooding: partial
Flooding: total
Flooding + sludge
Flooding + sediment
Flooding + surface water
Total
Year Exposure Controled
Years w/o Exposure
Type of Contaminant
90
90
1994
14
Metals
VOCs
PCBs
Pesticides
Total Value 400
Data/Observations:
Conclusions
Need to get HRS SCORES!
The HRS uses a structured analysis approach to scoring sites. This approach
assigns numerical values to factors that relate to risk based on conditions at the site. The
factors are grouped into three categories:
likelihood that a site has released or has the
potential to release hazardous substances into the environment; characteristics of the waste
(e.g. toxicity and waste quantity); and people or sensitive environments (targets) affected by
the release.
Four pathways can be scored under the HRS:
1.
Ground water migration (drinking water)
2.
Surface water migration (drinking water, human food chain, sensitive
environments);
Soil exposure (resident population, nearby population, sensitive environments);
Air migration (population, sensitive environments).
3.
4.
After scores are calculated for one or more pathways, they are combined
using a root-mean-square equation to determine the overall site score.
Superfund Hazard Ranking System(HRS): Quickscore
Future Research
1. Address limitations
2. Add to the study:
 Mutagenicity (ATSDR)
 NonCA Effects (RfD, ToxFAQsTM )
3. Address Outcomes adding
a.
b.
c.
d.
e.
Birth defects
Cancer (children)
Adults
Mutagenicity
Non- Carcinogenic Effects (inverse RfD/10)
The Future
‘Life in a bud’
Most Precious Form
of Life
We Do not see
DO WE CARE?
Butterfly Chrysalis. (Frederik Meijer Gardens & Sculpture Park,
butterfly exposition March 5, 2008)
References







Integrated Risk Information System (IRIS): Carcinogenicity Assessment for Lifetime Exposure.
http://www.epa.gov/iris/links.htm
EPA. National Priorities List (NPL): National Priorities List Sites in Florida.
http://www.epa.gov/superfund/sites/npl/fl.htm
U.S. Census Bureau: American Fact Finder. Reference Maps: 2000 Census Tracts and Blocks.
State:
Florida.
http://factfinder.census.gov/jsp/saff/SAFFInfo.jsp?_pageId=referencemaps&_submenuId=maps_
2
Florida Charts: Community Health Assessment Resource Tool Set. Fetal and Infant Death
Indicators. http://www.floridacharts.com/charts/CensusTractMap.aspx?DataType=3&Rate=Y
Mueller, B. A., Kuehn, C. M., Shapiro-Mendoza, C. K., & Tomashek, K. M. (2007). Fetal
Deaths and Proximity to Hazardous Waste Sites in Washington State. Environmental Health
Perspectives, 115(5), 776-780.
Bentov, Y., Kordysh, E., Hershkovitz, R., Belmaker, I., Polyakov, M., Bilenko, N. & Sarov, B.
(2006). Major congenital malformations and residential proximity to a regional industrial park
including a national toxic waste site: An ecological study. Environmental Health: A Global
Access Science Source, 5, 1-9
Morgan, O. W., Vrijheid, M., Dolk, H. (2004). Risk of low birth weight near EUROHAZCON
hazardous waste landfill sites in England. Archives of Environmental Health, 59(3),149-51.
Thanks










Dr. Ribeiro
Dr. Harris
Dr. Kearney
Dr. Camerom
Dr. Groetsch
Dr. Merchant
Dr. Van Horn
Ms. Rebecca Shultz
Ms. Larrieux
Mr. DeSousa