Excess risk of kidney disease mortality in a population living near industrial processes Susan...
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Excess risk of kidney disease mortality in a population living near industrial processes Susan Hodgson (MSc) 1 , Mark J Nieuwenhuijsen (PhD) 2 , Anna Hansell (Dr) 1 , Sasha Shepperd (D.Phil) 1 , Tracy Flute (BSc) 3 , Brian Staples (Dr) 4 , Paul Elliott (Prof) 1 , Lars Jarup (PhD) 1 1 Small Area Health Statistics Unit (SAHSU), Imperial College London, UK. 2 Dept Environmental Science and Technology, Imperial College London, UK. 3 Warrington Primary Care Trust & Halton Primary Care Trust 4 Cheshire and Merseyside Health Protection Team, Central Liverpool Primary Care Trust
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Transcript of Excess risk of kidney disease mortality in a population living near industrial processes Susan...
Excess risk of kidney disease mortality in a population living near industrial processes
Susan Hodgson (MSc)1, Mark J Nieuwenhuijsen (PhD)2, Anna Hansell (Dr)1,
Sasha Shepperd (D.Phil)1, Tracy Flute (BSc)3, Brian Staples (Dr)4,
Paul Elliott (Prof)1, Lars Jarup (PhD)1
1Small Area Health Statistics Unit (SAHSU), Imperial College London, UK.
2Dept Environmental Science and Technology, Imperial College London, UK.
3Warrington Primary Care Trust & Halton Primary Care Trust
4Cheshire and Merseyside Health Protection Team, Central Liverpool Primary Care Trust
Introduction
‘Runcorn is exposed to the irritating vapours cast off so freely by the large chemical works in its vicinity’ Medical Officer of Health for Runcorn, Lancet, January 1880.
Runcorn is still polluted by local industry, with substantial amounts of nephrotoxic chemicals (including lead, mercury, arsenic, chromium and solvents) being released annually.
We undertook preliminary investigations into the health of the population living in the vicinity of industrial processes.
The aim of this study was to determine if there was an excess risk of kidney mortality and morbidity in people living near the industrial processes.
Methods – mortality analysis
Mortality was investigated using routinely collected data supplied by the Office for National Statistics (ONS).
Analysis was carried out using the SAHSU Rapid Inquiry Facility (RIF).
Standardised Mortality Ratios (SMR) adjusted for socio-economic deprivation were calculated for deaths from nephritis, nephrotic syndrome and nephrosis (ICD9 580-589) over the years 1981-1999.
Distance from industrial processes was used as a proxy for exposure - populations living within 0-2km and between 2.01-7.5km of 16 installations were investigated.
Expected figures were derived from the North West region population.
Methods – morbidity analysis
Morbidity was assessed by the former North Cheshire Health Authority (NCHA).
Kidney disease was mapped at electoral ward level using routinely collected local hospital admissions data (1990 to 1999).
District age Standardised Admission Ratios (SAR) were calculated for non-malignant renal disease as well as kidney cancer (ICD9 580-583 (except 581.8, 582.8 and 583.8), 585-587, 189.0; ICD10 N00-N06, N10, N11.8, N11.9, N15.8, N18, N19, N26, C64).
The population of Warrington and Halton was used as the reference.
Results
Mortality study using RIF
Distance Sex Obs Exp SMR 95% CIUnadjusted for deprivation 0-2 km Male 32 23.87 134 92 - 189
Female 47 29.3 160 118 – 213 2.01-7.5 km Male 166 152.03 109 94 - 127
Female 206 182.47 113 98 – 129Adjusted for deprivation 0-2 km Male 32 24.41 131 90 - 185
Female 47 29.18 161 118 - 214 2.01-7.5 km Male 166 154.41 108 92 - 125 Female 206 185.92 111 97 – 127
Morbidity
Town Sex SAR 95% CI
Runcorn Male 122 110-136
Female 136 122-151
Warrington Male 91 85-97
Female 84 78-91
Discussion
•Significant excess of kidney mortality in people living nearest polluting sources
•Significant excess kidney morbidity in areas closest to the polluting sources
•Consistent pattern using two different methods and independent data sources
•Unlikely to be explained by occupation
Further work is being being carried out to establish if the excess risks are causally related to chemical pollution in the area.
Ongoing work
Exposure Assessment
Air dispersion modelling of mercury and lead using ADMS-Urban (version 1.6) developed by CERC.
This model will not provide a quantitative estimate of past exposures, but should indicate the extent of dispersion of mercury and lead, and highlight areas where exposure is significantly higher than the background levels experienced elsewhere in the UK
Modelled vs measured mercury levels at Weston County Primary School
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Measured results
Modelled results
Modelled vs measured lead levels at Elton Community Centre
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Measured results
Modelled results
Modelled versus measured ambient mercury and lead levels, 2000
Ave measured value
0.022 g Hg/m3
Ave modelled value
0.028 g Hg/m3
Ave measured value
0.014 g Pb/m3
Ave modelled value
0.008 g Pb/m3
Model Validation
• Air monitoring will be carried out by the Environment Agency based on the model output.
• Urine samples will be collected from ~200 individuals. Mercury in urine will be determined by the HSL, Sheffield, using Inductively Coupled Plasma – Mass Spectrometry (ICP-MS).
Health outcomes
• Further analysis of routine databases on mortality, cancer incidence and Hospital Episode Statistics.
• Individual level sub-study will assess the prevalence of early kidney damage using urinary biomarkers such as N-acetyl-β-glucosaminidase (NAG) and urinary β2-microglobulin.
