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

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 (3)

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 .

April 11, 20087

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?”

Water:Surface Ground

Toxicants

Soil:Sludge

Sediments Flooding

AIRToxicants

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

ContaminantsVerification of

Possible Disruption

Personal Biomarker

Environmental Markers

NPL Location

Monitoring System??

Project Overview

Prototype of Diagnostic and Interference Analysis

NPL Sites:Framework

Location: Geography

Contaminant: Nature

Environmental Interactions

Fetal /Infant Death Rate vs. Distance as a

Proxy

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

Fetal Deaths by Census

Tract

Ho: µ0= FD0.5 = FD1.1 =FD2.8 = FD7 = FDCounty

Ha: µ1= FD0.5 > FD1.1 >FD2.8 > FD7 > FDCounty

Distance vs. Fetal Death mortality Vs Risk/Site

Matching

Overall Site Risk Assessment

Character of Contaminants

Classification by Effects:1.Carcinogenicity2.Year of Deletion of NPL list

General Assessment Data Collection StructureHypothesis Statement

Project Overview Part 1

Classification by site:1.Geography

2.Construction Status 3.Location Characteristics

Character of Site

Character of SiteCharacter of Site

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 Latitude LongitudeFLD004145140 25.8152 -80.2559FLD020536538 25.84306 -80.2565FLD981014368 25.92319 -80.2215FLD004574190 25.83958 -80.3001

GIS Analysis

Fetal Death by Census

Tract (FDOH)

CarcinogenicityFetal Mortality In Census tracts @ 0.5, 1.1, 2.8, 7 M

Soil, Water, AirFlooding NPL Status

Toxicant Risk (IRIS, ATSDR)

Exposure Route (EPA)

Project Overview: FINAL

Step 1 Step 2 Step 3

Step 4

Procedure: Step 1Fetal 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 DeathsAcross

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 2Contaminants:

By Type, Media & Periculosity

1. By Type of Contaminant Inorganic Metals PAH VOC PCBs Base Neutral Acids Pesticides Radioactive Petroleum Hydrocarbon

1

2

3

4

2. By Toxicant Risk

Locate Contaminant 1. EPA NPL list

2. By County

3. Contaminated Media

4. 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 3Site Exposure Route

3. By Exposure Route (EPA) Contaminated Media

Air Soil Water

Groundwater Surface Water

Sludge/ Sediment/ Other

Flooding NPL Status

Site Characteristics: 1. Flooding2. Groundwater and Soil contamination3. Population within one mile: 10,001-50,000

Procedure: Step 4Site:

Toxicity Algorithm

Simulation ExampleSite Address: 3636 NW 46TH STREET

MIAMI, Florida

33142   County: MIAMI-DADE   U.S. Congressional District: 18   Population within one mile: 10,001-50,000  

D. CAS# Chemical Carcinogenic

Assigned Value

117-81-7 BIS(2-ETHYLHEXYL)PHTHALATE B2 50

127-18-4 TETRACHLOROETHYLENE D 1

156-59-2 CIS-1,2-DICHLOROETHYLENE D 1

39638-32-9 CADMIUM B1 5057-12-5 CYANIDE D 167-64-1 ACETONE D 1

67-66-3 CHLOROFORM N/A  7439-92-1 LEAD B2 507440-02-0 NICKEL B1 507440-47-3 CHROMIUM Ai/Do 17440-50-8 COPPER A 1007440-66-6 ZINC D 175-01-4 VINYL CHLORIDE D 175-35-4 1,1-DICHLOROETHYLENE C 2079-01-6 TRICHLOROETHYLENE N/A 327

Column A=B 411.11Assigned toxicity by chemicals

A.Assigned toxicity for Contaminated

mediaGroundwater 90 

Soil 50 Flooding: partial 10   150  

B.

Class Construction: complete     Total values

  50  150Control Year 9  41  41  191

C. Toxicants     Inorganics, Metals, PAH, VOC

E. Added toxicity:  Site: 191.00Toxicants 411.11

602.11

Miami Flood Oct 4 2000???SOIL AND GROUNDWATER

Data/Observations

Data/Observations:

Site Anaconda Aluminum Co./Milgo Electronics

Circlis ID FLD020536538

Air

Surface waterGroundwater 90SoilSludgeOtherFlooding: partialFlooding: total Flooding + sludgeFlooding + sedimentFlooding + surface waterTotal 90Year Exposure Controled 1994Years w/o Exposure 14Type of Contaminant

Metals

VOCsPCBs

PesticidesTotal Value 400

Conclusions

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);

3. Soil exposure (resident population, nearby population, sensitive environments);

4. Air migration (population, sensitive environments).

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

Need to get HRS SCORES!

Future Research

1. Address limitations

2. Add to the study: Mutagenicity (ATSDR) NonCA Effects (RfD, ToxFAQsTM )

3. Address Outcomes addinga. Birth defects

b. Cancer (children)

c. Adults

d. Mutagenicity

e. Non- Carcinogenic Effects (inverse RfD/10)

Butterfly Chrysalis. (Frederik Meijer Gardens & Sculpture Park,butterfly exposition March 5, 2008)

‘Life in a bud’

Most Precious Form of Life

We Do not seeDO WE CARE?

The Future

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