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Historical cancer incidence and mortality assessment in an Illinois community proximal to a former manufactured gas plant

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Abstract

Concern has been raised that the occurrence of cancer may be increased in neighbourhoods around a former manufactured gas plant in Champaign, Illinois, USA. Thus, we compared historical rates of cancer in this area to comparison communities as well as with nationally standardised rates. Retrospective population-based community cancer assessment during 1990-2010. Champaign County, Illinois, USA, and zip codes encompassing the location of the former manufactured gas plant to counties that were similar demographically. Residents of the counties and zip codes studied between 1990 and 2010. The relative risk (RR) and 95% CI were used to compare cancer incidence and mortality in the areas near the gas compression site to the comparison counties. Standardised incidence ratios (SIRs) were calculated to compare rates in the areas near the gas compression site to expected rates based on overall US cancer rates. Total cancer mortality (RR=0.91, 95% CI 0.88 to 0.94) and incidence (RR=0.95, 95% CI 0.94 to 0.97) were reduced significantly in Champaign County versus the comparison counties. Similarly, a reduced rate of total cancer was observed in analyses by zip code (proximal to the former gas plant) when compared with either similar counties (RR=0.89, 95% CI 0.86 to 0.93) or national standardised rates of cancer (SIR=0.88, 95% CI 0.85 to 0.91). This historical cancer assessment did not find an increased risk of total cancer or specific cancer types in communities near a former manufactured gas plant site. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Historical cancer incidence and
mortality assessment in an Illinois
community proximal to a former
manufactured gas plant
Dominik D Alexander, Xiaohui Jiang, Lauren C Bylsma, David H Garabrant,
Sarah R Irvin, Jon P Fryzek
To cite: Alexander DD,
Jiang X, Bylsma LC, et al.
Historical cancer incidence
and mortality assessment in
an Illinois community
proximal to a former
manufactured gas plant. BMJ
Open 2014;4:e006713.
doi:10.1136/bmjopen-2014-
006713
Prepublication history for
this paper is available online.
To view these files please
visit the journal online
(http://dx.doi.org/10.1136/
bmjopen-2014-006713).
Received 22 September 2014
Revised 4 December 2014
Accepted 5 December 2014
EpidStat Institute, Ann Arbor,
Michigan, USA
Correspondence to
Dr Jon Fryzek;
jon@epidstat.com
ABSTRACT
Objectives: Concern has been raised that the
occurrence of cancer may be increased in
neighbourhoods around a former manufactured gas
plant in Champaign, Illinois, USA. Thus, we compared
historical rates of cancer in this area to comparison
communities as well as with nationally standardised
rates.
Design: Retrospective population-based community
cancer assessment during 19902010.
Setting: Champaign County, Illinois, USA, and zip
codes encompassing the location of the former
manufactured gas plant to counties that were similar
demographically.
Participants: Residents of the counties and zip codes
studied between 1990 and 2010.
Main outcome measures: The relative risk (RR) and
95% CI were used to compare cancer incidence and
mortality in the areas near the gas compression site to
the comparison counties. Standardised incidence ratios
(SIRs) were calculated to compare rates in the areas
near the gas compression site to expected rates based
on overall US cancer rates.
Results: Total cancer mortality (RR=0.91, 95% CI
0.88 to 0.94) and incidence (RR=0.95, 95% CI 0.94 to
0.97) were reduced significantly in Champaign County
versus the comparison counties. Similarly, a reduced
rate of total cancer was observed in analyses by zip
code (proximal to the former gas plant) when
compared with either similar counties (RR=0.89, 95%
CI 0.86 to 0.93) or national standardised rates of
cancer (SIR=0.88, 95% CI 0.85 to 0.91).
Conclusions: This historical cancer assessment did
not find an increased risk of total cancer or specific
cancer types in communities near a former
manufactured gas plant site.
INTRODUCTION
The production of manufactured gas is widely
considered one of the key developments in
our industrial history, with an extensive chron-
ology beginning in the late 1700s and
spanning into the 1960s. Manufactured gas
consisted largely of the gasication of coal
and, less frequently, the combustion of other
materials such as wood and oil. Historically,
the manufactured gas industry grew signi-
cantly in the early 1800s due to the production
of lighting for the progress and development
of cities. However, later in the 19th century,
this industry diversied into heating, refriger-
ation and cooking. During the early to
Strengths and limitations of this study
The validity of our results is enhanced by the util-
isation of three comparison populations: (1) coun-
ties very well matched demographically that had
former gas plants, (2) comparison counties without
former gas plants and (3) nationally representative
cancer data from the Surveillance, Epidemiology,
and End Results (SEER) programme.
Because of the complete, systematic and state-
wide registry in Illinois, data for persons diag-
nosed with cancer were assembled in an
unbiased fashion. Identification and reporting of
cancer cases in the Illinois State Cancer Registry
(ISCR) is mandated by state law.
A priori, we developed a systematic protocol for
identifying comparable counties. We matched
counties based on residential status (urban/rural)
and similar demographic and socioeconomic
characteristics, and our analyses were adjusted
for age, sex and race (at the county level) to
control for confounding.
Our cancer assessment is ecological in nature; thus,
aside from age, sex and race, we could not model
or adjust for factors associated with cancer such as
physical activity, family history of disease or body
mass index that may have influenced the results.
The population sizes (ie, the denominator for
estimating cancer rates) for the study periods
were based on the 1990 and 2000 census infor-
mation. If there was considerable in-migration or
out-migration of the population over time, the
estimated RRs may have been affected.
Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713 1
Open Access Research
mid-20th century, the advent of natural gas obviated the
gasication of coal, ultimately leading to the conversion or
closure of manufactured gas plants. Pipelines transported
natural gas directly from the well to gas distribution
systems, and natural gas was considered more economical,
efcient and environmentally friendly. Most manufactured
gas plants in the USA were terminated by 1966 with few
exceptions, and as a result of the manufactured gas
demise, over 1500 plant sites are suggested to remain
dormant or vacant in the USA today.
Numerous health concerns have been raised regarding
possible environmental exposures stemming from manu-
factured gas plant sites. Foremost among the concerns is
that contamination and waste products from the manufac-
turing gas process leaked into the adjacent soil and
groundwater, thus posing health risks in the nearby resi-
dential areas and communities.
1
The process of coal car-
bonisation generates coal tar, which are complex mixtures
of heterocyclic compounds, phenols and polycyclic aro-
matic hydrocarbons (PAHs). Indeed, both volatile organic
compounds (VOCs) and semi-VOCs (SVOCs) from coal
tar and petroleum products are derived from the coal gas-
ication process.
1
The VOCs contain a mixture of BTEX,
or benzene, toluene, ethylbenzene and xylene isomers
among other compounds, while the SVOCs consist of a
mixture of compounds, such as benzo(a)pyrene, benzo(e)
pyrene, naphthalene and 2-methyl naphthalene. In add-
ition, principal component analyses have identied heavy
metals at former manufactured gas plant sites.
23
As a
result of these gas process by-products, the US
Environmental Protection Agency (EPA) and other regula-
tory agencies have focused on assessing the potential for
soil and groundwater contamination at former manufac-
tured gas plant sites, as well as evaluating the potential for
health risks among residents in nearby communities. The
International Agency for Research on Cancer (IARC) lists
many of the manufactured gas plant by-product com-
pounds as known, probable or possible carcinogens for
specic cancers, but the level and extent of community
exposure to such compounds resulting from former man-
ufactured gas plants is uncertain. Furthermore, sparse epi-
demiological evidence exists on the potential public
health risks associated with residing near former manufac-
tured gas plant sites.
Concern has been raised that the occurrence of
cancer may be increased in neighbourhoods around a
former manufactured gas plant on a 3.5 acre lot in
northern Champaign, Illinois, USA. The plant, in oper-
ation from 1887 until 1953, manufactured gas by
heating coal. Coal tar and other production wastes were
suggested to remain on site until the closing of the
plant. AmerenIP has registered this site with the Illinois
EPA under their Site Remediation Program. However,
the potential long-term health effects of residents in the
nearby community are unknown. Therefore, we con-
ducted a historical cancer incidence and mortality
assessment using publicly available cancer data and
census tract information to evaluate the occurrence of
cancer in the community where the former manufac-
tured gas plant was located compared with other com-
munities with and without former gas plants that have
similar demographic and lifestyle characteristics. In add-
ition, we conducted standardised incidence analyses for
Champaign County and the study zip codes using
nationally representative cancer data.
METHODS
All data used in this study are publicly available.
Specically, the cancer incidence data were obtained
from the Illinois Department of Public Health and from
the Surveillance, Epidemiology, and End Results (SEER)
programme, while cancer mortality data were obtained
from SEER. Analyses for cancer incidence are presented
at both the county and zip code level while analyses for
cancer mortality are presented at the county level, which
is the smallest area for which cancer mortality data are
available. County and zip code demarcations were based
on information provided by the US Census Bureau.
Study areas
The analytical and comparison population areas were
characterised using census tract information. The former
manufactured gas plant of interest was located in
Champaign County, Illinois, USA, and was circumscribed
by zip codes 61820 and 61801; thus, these demarcated
areas served as the analytical group. Because our assess-
ment was community-based and ecological in nature, our
objective was to identify comparison counties in the state
of Illinois with similar demographic and socioeconomic
characteristics. Relevant characteristics included county
setting (urban vs rural), county population size, and per-
centages for black race, high school graduation, persons
over age 65, persons unemployed, families below poverty
level, urban residence and ever-smoking status. In add-
ition, the median household income was utilised as a com-
parison factor. County selection was based on methods
developed by the National Cancer Institute.
45
Illinois cancer data
In concert with the Illinois State Cancer Registry (ISCR),
the SEER programme of the National Cancer Institute is
the source of data for cancer mortality between 1986 and
2010.
6
These data are grouped by age, sex and race and
are provided at the county level (the smallest available
area for cancer mortality). The National Center for
Health Statistics (NCHS) provides information on the
underlying cause of death, coded to the International
Classication of Diseases (ICD-9)
7
for all deaths for years
1986 through 1998 and the ICD-10 for all deaths for year
1999 and later.
8
Cancer mortality rates are available by
single year for Illinois only, and deaths among non-
residents and deaths of unknown age or sex are omitted
from the database calculations. Because of NCHS policy,
rates are not calculated for stratied subgroups contain-
ing less than 10 deaths. For this analysis we used mortality
2Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713
Open Access
data from 1990 to 2010 to be consistent with the census
tract reporting periods.
Cancer incidence data for the direct community com-
parisons used in this study were collected by the ISCR
and are available as a public use data set via the Illinois
Department of Public Health for the years 19912010.
All obtainable data are provided by the ISCR as a public
service for the purpose of statistical reporting and ana-
lysis only. Case ascertainment is near complete as the
identication and reporting of cancer cases is mandated
by state law. Individual (personal) information has been
de-identied, and the data have been aggregated into
categories (eg, age, race, Hispanic ethnicity, year of diag-
nosis and type of cancer) within individual records.
9
The number of cases reported in a particular region
depends on the size of the geographic area in an effort
to protect the privacy of individuals. The Illinois data set
contains sanitised records of cancer incidence among
residents who were diagnosed between 1986 and 2011.
Cancer incidence data at the county and zip code level
are based on 5-year interval groupings, and include data
for invasive cancers only with the exception of bladder
cancer. Non-melanoma skin cancers and reported cases
with an unknown age or othersex category are omitted
by the ISCR. Cancer incidence data used for the standar-
dised incidence ratio (SIR) analyses were obtained dir-
ectly from the SEER programme.
By using these data, we agreed to comply with the
Illinois Health and Hazardous Substances Registry Act
(410 ILCS 525/12). All data used in our analyses are
publically available; thus, informed consent was not
required.
Statistical analyses
As indicated, we ascertained cancer rates from the ISCR
and the SEER programme. The rates provided by these
sources were calculated using the SEER*Stat software
package, developed by the Information Management
Services Inc for the National Cancer Institute.
10
SEER
expresses rates per 100 000 population, and rates are
age-adjusted by the direct method adjusting to the 2000
US standard million population. These data were then
used to formulate the basis of our historical cancer
assessment.
Because of the ecological nature of the community-
based analyses, we conducted analyses in an effort to
account for potential confounding at the aggregate level
while considering the potential for exposure misclassica-
tion. Thus, we conducted analyses using three different
comparison populations based on: (1) Illinois counties
that were the most closely matched demographically (irre-
spective of having former gas plants), (2) counties without
former gas plants (as part of the selection criteria) that
were relatively similar demographically and (3) nationally
representative cancer data from the SEER programme. By
utilising three different comparison populations, we were
able to enhance the validity of our analyses, examine the
consistency of cancer rates across different groups, and
facilitate the identication of potential sources of statistical
heterogeneity (if present). All types of analyses serve as
complementary comparisons to appreciate fully any
observed associations.
In the rst type of analysis, we calculated relative rate
ratios (RRs) and 95% CIs to compare cancer mortality
and incidence rates in Champaign County, Illinois, USA,
and zip codes 61820 and 61801 encompassing the loca-
tion of the former manufactured gas plant to counties
that were the most similar demographically (ie, Macon,
Winnebago and Sangamon counties). Although not part
of the selection criteria, these counties had former gas
plants but were the most demographically comparable
based on our objective matching criteria. The number of
cancer cases and deaths were ascertained for the period
1990 through 2010, and the absolute rate of cancer
occurrence was calculated based on the county and zip
code population size according to the US Census Bureau.
The relative rate of cancer occurrence was calculated by
dividing the rate of cancer in Champaign County and the
zip codes ( for cancer incidence only) by the rate of
cancer in the comparison counties. County-level analyses
were statistically adjusted for age, sex and race, and zip
code-level analyses were adjusted for age and sex (race
stratied data were not available at the zip code level, and
mortality analyses were adjusted for age only).
Although the comparison counties in the rst analyses
were very well matched demographically to Champaign
County, they had former gas plants, which raise concern
about potential bias resulting from similar chemical
exposures in the comparison counties. To address this
concern, our second analyses consisted of comparing
rates of cancer in Champaign County and the study zip
codes with areas that did not have former gas plants but
had relatively similar descriptive characteristics. To do
this, we reviewed an EPA report on manufactured gas
plant production,
11
the EPA website, and the following
website link: http://www.hatheway.net/state_site_pages/
il_epa.htm to identify additional comparison counties.
Illinois counties with relatively similar demographic
characteristics but without former gas plants (ie, Brown,
Douglas, Menard, Randolph counties) were selected.
Evaluations of cancer mortality and cancer incidence,
using the same methodology as the rst analyses, were
conducted using these counties as comparisons.
In our nal set of analyses, we calculated SIRs for
cancer sites in Champaign County and the zip codes of
interest. The numbers of observed cancers in
Champaign County and in the study zip codes were
compared with those expected on the basis of standar-
dised rates of cancer in the general population using
data obtained from SEER.
12
The number of observed
cancers was determined by sex, race and 5-year age
groups (the zip codes were standardised by age and sex
groups) for each year from 1991 to 2010. Expected
numbers of cases were calculated by multiplying the esti-
mated population for Champaign County and for the
study zip codes for each year of study by annual SEER
Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713 3
Open Access
cancer rates, stratied by 5-year age groups, race and
sex. Observed and expected counts were then generated
for Champaign County and for the study zip codes, and
SIRs were calculated by dividing the observed number
by the expected number.
Anal concern was the possibility of surveillance bias
being introduced during the analytical study period. In
the mid-2000s, a neighbourhood advocacy group formed
to increase awareness about the potential health effects
from the abandoned gas plant.
13
In order to limit poten-
tial bias associated with the formation of this group, we
conducted analyses for the years 19902000, prior to the
formation of this group.
All analyses were performed using SAS statistical software.
RESULTS
Study counties
The characteristics of the study county and the compari-
son counties (with the most similar demographic
characteristics) are reported in table 1 for the 1990 and
2000 census periods.
Champaign County was very well matched to the com-
parison counties with former gas plants on the variables
of interest. Given the relatively high proportion of coun-
ties with former manufactured gas plants in Illinois, the
availability of matching counties without former gas
plants was more limited. However, based on our county
scoring methodology and criteria, we were able to iden-
tify counties (ie, Brown, Douglas, Menard, Randolph)
without former gas plants to serve as comparison com-
munities in our second type of analyses. These counties
were not as closely matched on potential confounding
factors (ie, demographic characteristics) that may be
associated with cancer as the counties used in the rst
analyses (table 2).
Cancer mortality
The RR for total cancer mortality in Champaign County
versus the comparison counties most closely matched
demographically (Macon, Winnebago and Sangamon) was
signicantly decreased (RR=0.91, 95% CI 0.88 to 0.94)
during 19902010 (table 3). Similarly, statistically signi-
cant decits in mortality were observed for cancers of the
oesophagus (RR=0.80, 95% CI 0.65 to 0.98), colorectum
(RR=0.88, 95% CI 0.80 to 0.97), pancreas (RR=0.78, 95%
CI 0.68 to 0.89) and lung and bronchus (RR=0.85, 95% CI
0.80 to 0.89). In fact, out of all 22 cancer site groupings, 17
RRs represented reduced risks, 1 RR was 1.0, no data were
available for one site (testicular cancer) and 3 RRs were
slightly elevated. None of these elevated cancer sites was
statistically signicant, with RRs of 1.03 (melanoma), 1.06
(prostate) and 1.05 (leukaemias; table 3).
In our second set of analyses, similar results for
Champaign County were observed when compared with
counties without former manufactured gas plants. Total
cancer was associated with an RR of 0.96 (95% CI 0.92 to
1.00), and statistically signicant reduced rates of
colorectal (RR=0.85, 95% CI 0.75 to 0.97) and pancreatic
cancer (RR=0.81, 95% CI 0.67 to 0.98) mortality were
observed (data tables not shown, but available on request).
Relative risks for most cancer sites were 1.0 or lower, with
few weakly positive, albeit non-signicant associations. No
statistically signicant associations for the more common
cancerslung and bronchus (RR=0.94, 95% CI 0.87 to
1.02), breast (RR=1.00, 95% CI 0.85 to 1.18) or prostate
(RR=1.00, 95% CI 0.84 to 1.19) were observed.
Taken together, results based on analyses using com-
munities with and without former gas plants are not sup-
portive of an increased risk of cancer mortality.
Cancer incidence
A statistically signicant reduced rate of total cancer inci-
dence was observed in Champaign County versus the
comparison counties most closely matched demograph-
ically (RR=0.95, 95% CI 0.94 to 0.97) during 19912010
(table 4). Decreased incidence rates were observed for
19 of 23 cancer site groupings based on analyses during
19912010. Incidence rates for cancers of the colorec-
tum, pancreas, lung and bronchus, testis, cervix, nervous
system and othersites (list of cancers in this category
are shown in table 4) were all signicantly lower versus
the rates in the comparison counties. In contrast, statis-
tically signicant slightly elevated rates were observed for
melanoma (RR=1.12, 95% CI 1.02 to 1.24) and prostate
cancer (RR=1.20, 95% CI 1.14 to 1.25). Restricting the
analytical period to 19912000 in Champaign County in
order to reduce potential bias associated with the forma-
tion of the neighbourhood advocacy group did not
appreciably modify the results; the RR for melanoma
was 1.17 (95% CI 0.99 to 1.38) and the RR for prostate
cancer was 1.17 (95% CI 1.09 to 1.26; data not tabu-
lated). Incidence rates were signicantly reduced for
total, colorectal, pancreatic, lung and bronchus, testicu-
lar, and cervical cancers during 19912000.
Fewer cancer subgroupings were available at the zip
code level. Nevertheless, results similar to those in the
county-level analyses were observed. Total cancer inci-
dence was 11% lower in the study zip codes versus the
most closely matched comparison counties, resulting in a
statistically signicant RR of 0.89 (95% CI 0.86 to 0.93)
during 19912010 (table 5). Of the 10 cancer site group-
ings, nine incidence rates were decreased versus compari-
son counties, including statistically signicant reductions
for colorectal (RR=0.85, 95% CI 0.76 to 0.95), breast
(invasive; RR=0.86, 95% CI 0.78 to 0.95) and other
(RR=0.86, 95% CI 0.79 to 0.92) cancers. The only ele-
vated incidence rate was for prostate cancer, with a signi-
cant RR of 1.13 (95% CI 1.03 to 1.24), based on 500
diagnosed cases during 19912010. However, no signi-
cant association was found for prostate cancer (RR=1.07,
95% CI 0.95 to 1.21) in the analysis for the period 1991
2000 (data not tabulated). During this period, rates for
colorectal, breast and otherremained signicantly
decreased, while signicant decits for lung and bron-
chus (RR=0.75, 95% CI 0.66 to 0.86) and central nervous
4Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713
Open Access
Table 1 Characteristics of study county and comparison counties most closely matched demographically based on 1990 and 2000 census
Characteristic
Year of
census Champaign County
Comparison counties most closely matched demographically
Sangamon County Macon County Winnebago County
Rural-urban continuum code 1990 Counties in metropolitan
areas of <250 000
Counties in
metropolitan
areas of <250 000
Counties in
metropolitan
areas of <250 000
Counties in metropolitan
areas of 250 000100 000
2000 Counties in metropolitan
areas of <250 000
Counties in
metropolitan
areas of <250 000
Counties in
metropolitan
areas of <250 000
Counties in metropolitan
areas of 250 000100 000
Per cent black 1990 9.64 8.11 12.14 9.29
2000 11.82 10.17 14.76 11.16
Per cent did not graduate high
school
1990 12.50 18.23 23.79 23.70
2000 9.02 11.93 16.83 18.57
Per cent over age 65 years 1990 8.74 13.71 14.57 12.67
2000 9.72 13.51 15.24 12.73
Per cent unemployed 1990 4.24 4.36 6.60 5.20
2000 5.52 4.07 7.15 5.83
Per cent below poverty 1990 8.03 7.19 9.84 7.71
2000 6.92 6.49 9.28 6.92
Median household income (in tens) 1990 2654 3035 2860 3134
2000 3778 4296 3786 4389
Per cent urban 1990 81.41 78.32 81.74 87.41
2000 84.34 85.40 84.17 91.78
Per cent ever smoke 1990 Not available Not available Not available Not available
2000 44.89 52.46 52.59 52.38
Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713 5
Open Access
Table 2 Characteristics of study county and comparison counties without former gas plants on 1990 and 2000 census
Characteristic
Year of
census Champaign County
Comparison counties without former gas plants
Brown Douglas Menard Randolph
Rural-urban continuum code 1990 Counties in
metropolitan
areas of <250 000
Comp rural <2500
urban population, not
adjacent to metro area
Urban population of
2500
to 19 999, adjacent to a
metro area
Counties in
metropolitan
areas of <250 000
Urban population of
2500
to 19 999, adjacent to a
metro area
2000 Counties in
metropolitan
areas of <250 000
Urban population of
2500
to 19 999, not
adjacent to a metro
area
Urban population of
2500
to 19 999, adjacent to a
metro area
Counties in
metropolitan
areas of <250 000
Urban population of
2500
to 19 999, adjacent to a
metro area
Per cent black 1990 9.64 9.37 0.05 0.05 8.26
2000 11.82 18.29 0.43 0.46 9.56
Per cent did not graduate high
school
1990 12.50 31.14 25.97 22.69 35.78
2000 9.02 36.75 20.69 11.67 28.67
Per cent over age 65 years 1990 8.74 16.83 15.26 15.06 15.33
2000 9.72 12.69 15.96 13.17 15.61
Per cent unemployed 1990 4.24 6.03 4.4 4.35 6.46
2000 5.52 3.47 2.78 3.88 5.69
Per cent below poverty 1990 8.03 10.47 6.92 7.13 8.75
2000 6.92 4.84 4.21 6.11 7.06
Median household income (in
tens)
1990 2654 2045 2676 2933 2586
2000 3778 3545 3944 4660 3701
Per cent urban 1990 81.41 0.00 49.13 0.00 46.16
2000 84.34 58.66 36.69 24.66 57.3
Per cent ever smoke 1990 Not available Not available Not available Not available Not available
2000 44.89 49.76 48.98 50.81 55.14
6Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713
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system cancers (RR=0.55, 95% CI 0.33 to 0.93) were
observed as well.
Additional subgroup analyses for the cancer sites were
conducted by individual zip codes and by analytical
periods. The rate of prostate cancer during 19912010
was elevated with marginal signicance for zip code
61820 (RR=1.15, 95% CI 1.00 to 1.32, based on 211
cases) but not for zip code 61801 (RR=1.12, 95% CI
0.99 to 1.26; data not tabulated). No effect modication
was apparent by zip code as the CIs for prostate cancer
largely overlapped. No other statistically signicantly
cancer rates were observed during 19912010 but rates
were modied in the inverse direction for colorectal
(RR for zip code 61820=0.98, 95% CI 0.84 to 1.15; zip
code 61801=0.76, 95% CI 0.65 to 0.88) and lung and
bronchus (RR for zip code 61820=0.98, 95% CI 0.86 to
1.13; zip code 61801=0.65, 95% CI 0.57 to 0.75) cancers
(data not tabulated). Interestingly, when analyses were
conducted for the period 19912000, prostate cancer
rates were modied by zip code (RR for zip code
61820=1.23, 95% CI 1.02 to 1.48; zip code 61801=0.98,
95% CI 0.83 to 1.16).
In the second type of analysis, counties without
former manufactured gas plants were used as the com-
parison (data tables not shown, but available on
request). No difference in total cancer was found
between Champaign County and the comparison coun-
ties without former gas plants (RR=1.00, 95% CI 0.97 to
1.02). Of 22 cancer site groupings, 12 had reduced rates
in Champaign County, with statistically signicant de-
cits for colorectal (RR=0.83, 95% CI 0.76 to 0.90) and
cervical cancer (RR=0.66, 95% CI 0.49 to 0.90).
Respiratory system cancers (lung and bronchus
RR=0.95), urinary tract cancers (kidney RR=0.99;
bladder RR=1.01) and lymphohaematopoietic malignan-
cies (Hodgkins lymphomas RR=0.89; non-Hodgkins
lymphomas RR=0.96; myelomas RR=0.99; leukaemias
RR=1.03) were not elevated in Champaign County com-
pared with the counties that did not have former gas
plants. As with the rst set of analyses, prostate cancer
incidence was elevated slightly and signicantly
(RR=1.14, 95% CI 1.06 to 1.23) in Champaign County,
but it was not signicant in the study zip code analysis
(RR=1.09, 95% CI 0.98 to 1.21). The only other
Table 3 Age adjusted mortality rates, RRs and 95% CIin 19902010
Champaign County
Comparison counties most closely
matched demographically
Rate
ratio 95% CI
Number of
deaths Rate 95% CI
Number of
deaths Rate 95% CI
All cancer 5611 187.2 182.3 to 192.2 27 170 206.1 203.6 to 208.5 0.91* 0.88 to 0.94
Oral cavity and
pharynx
64 2.1 1.6 to 2.7 358 2.7 2.4 to 3.0 0.78 0.59 to 1.03
Oesophagus 118 4.0 3.3 to 4.7 650 4.9 4.5 to 5.3 0.80* 0.65 to 0.98
Stomach 94 3.1 2.5 to 3.8 494 3.7 3.4 to 4.1 0.84 0.67 to 1.05
Colorectal 551 18.4 16.9 to 20.0 2765 20.8 20.1 to 21.6 0.88* 0.80 to 0.97
Liver 87 2.9 2.3 to 3.6 420 3.2 2.9 to 3.5 0.91 0.71 to 1.15
Pancreas 267 9.0 7.9 to 10.1 1526 11.5 11 to 12.1 0.78* 0.68 to 0.89
Lung and
bronchus
1526 51.3 48.7 to 53.9 7990 60.6 59.2 to 61.9 0.85* 0.80 to 0.89
Bone and joint 12 0.3 0.2 to 0.6 43 0.3 0.2 to 0.4 0.94 0.42 to 1.89
Melanomas 81 2.7 2.1 to 3.3 339 2.6 2.3 to 2.9 1.03 0.80 to 1.31
Breast438 25.6 23.3 to 28.2 2045 27.5 26.3 to 28.7 0.93 0.84 to 1.03
Prostate§ 348 31.4 28.1 to 34.9 1427 29.7 28.1 to 31.3 1.06 0.94 to 1.19
Testis§ ––– –
Cervix39 2.3 1.6 to 3.2 177 2.6 2.2 to 3.0 0.89 0.61 to 1.27
Uterine72 4.2 3.2 to 5.2 323 4.2 3.7 to 4.6 1.00 0.76 to 1.29
Ovary159 9.3 7.9 to 10.8 716 9.5 8.8 to 10.2 0.98 0.82 to 1.17
Kidney and renal
pelvis
136 4.5 3.8 to 5.4 618 4.7 4.3 to 5.1 0.97 0.80 to 1.17
Bladder 131 4.4 3.7 to 5.3 610 4.6 4.2 to 5.0 0.97 0.79 to 1.17
Nervous system 119 3.8 3.2 to 4.6 596 4.6 4.2 to 5.0 0.83 0.68 to 1.02
Hodgkins
lymphomas
13 0.4 0.2 to 0.7 61 0.5 0.4 to 0.6 0.88 0.44 to 1.61
NHL 230 7.6 6.7 to 8.7 1096 8.3 7.8 to 8.8 0.92 0.79 to 1.06
Myelomas 110 3.7 3.0 to 4.5 510 3.8 3.5 to 4.2 0.96 0.77 to 1.18
Leukaemias 251 8.2 7.3 to 9.3 1029 7.8 7.4 to 8.3 1.05 0.91 to 1.21
*p<0.05.
Tiwari et al
13a
modification for CIs.
Female only.
§Male only.
NHL, non-Hodgkins lymphomas.
Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713 7
Open Access
statistically signicant positive association in the county
analysis was for oesophageal cancer (RR=1.46, 95% CI
1.07 to 1.99), but this nding was not substantiated in
other analyses. Total cancer was signicantly reduced in
the study zip codes versus the comparison counties
without former gas plants (RR=0.94, 95% CI 0.90 to
0.98). Moreover, 7 of 10 cancer sites were associated
with reduced rates in the study zip codes, while 3 were
slightly positive and not signicant.
SIR analyses
During the period 19912010, 13 978 total cancers were
observed in Champaign County with 14 150 expected
based on nationally standardised rates, resulting in an
SIR of 0.99 (95% CI 0.97 to 1.00; data not tabulated). Of
23 cancer site groupings, 14 had expected or lower than
expected cases of cancer, with statistically signicant de-
cits observed for stomach, liver, pancreas, bone, melan-
oma, testicular, bladder, nervous system, Hodgkins
lymphoma and non-Hodgkins lymphoma. A slightly
greater than expected number of lung and bronchus
(SIR=1.07, 95% CI 1.02 to 1.11) and kidney (SIR=1.13,
95% CI 1.03 to 1.25) cancer cases were observed in
Champaign County, but these ndings were not sup-
ported by the other analyses. In fact, a slight decit of
lung and bronchus cancer cases was observed in the
study zip codes (SIR=0.98, 95% CI 0.89 to 1.07), and
urinary system cancer (includes kidney cancer) was
reduced signicantly (SIR=0.78, 95% CI 0.67 to 0.90) in
the study zip codes (table 6). Signicantly fewer than
expected total cancer cases were observed in the study
zip codes (SIR=0.88, 95% CI 0.85 to 0.91; the SIRs for
the cancer sites in the study zip codes are summarised
in table 6).
DISCUSSION
We observed statistically signicant reductions in total
cancer mortality and incidence in Champaign County,
Table 4 Age, sex and race-adjusted incidence rate by county, RRs and 95% CI
13b
in 19912010
Champaign County
Comparison counties most closely
matched demographically
Relative
rate 95% CI
Number of
cancers Rate 95% CI
Number of
cancers Rate 95% CI
All cancer 13 978 499.55 491.17 to 507.93 61 184 524.18 520.03 to 528.34 0.95* 0.94 to 0.97
Oral cavity and
pharynx
332 11.94 10.64 to 13.23 1484 12.71 12.07 to 13.36 0.94 0.83 to 1.06
Oesophagus 141 5.21 4.35 to 6.08 696 5.96 5.52 to 6.41 0.87 0.73 to 1.05
Stomach 177 6.38 5.43 to 7.33 809 6.93 6.45 to 7.41 0.92 0.78 to 1.09
Colorectal 1442 52.87 50.11 to 55.62 7140 61.17 59.75 to 62.59 0.86* 0.82 to 0.91
Liver 112 3.94 3.20 to 4.67 486 4.16 3.79 to 4.53 0.95 0.77 to 1.16
Pancreas 291 10.69 9.45 to 11.92 1558 13.35 12.69 to 14.01 0.80* 0.71 to 0.91
Lung and bronchus 1945 71.76 68.55 to 74.96 10 063 86.21 84.53 to 87.90 0.83* 0.79 to 0.87
Bone 23 0.68 0.39 to 0.97 80 0.69 0.54 to 0.84 1.00 0.62 to 1.60
Melanomas 539 17.62 16.10 to 19.14 1834 15.71 14.99 to 16.43 1.12* 1.02 to 1.24
Breast-invasive2184 150.65 144.25 to 157.04 9158 151.54 148.43 to 154.64 0.99 0.95 to 1.04
Prostate§2254 172.52 165.38 to 179.66 8125 144.35 141.21 to 147.48 1.20* 1.14 to 1.25
Testis89 4.05 3.18 to 4.93 337 5.99 5.35 to 6.63 0.68* 0.53 to 0.86
Cervix114 6.84 5.54 to 8.14 561 9.28 8.51 to 10.05 0.74* 0.60 to 0.91
Uterus406 28.53 25.74 to 31.33 1801 29.80 28.42 to 31.18 0.96 0.86 to 1.07
Ovary228 15.52 13.48 to 17.57 1022 16.91 15.87 to 17.95 0.92 0.79 to 1.06
Kidney 425 15.10 13.64 to 16.55 1945 16.66 15.92 to 17.40 0.91 0.81 to 1.01
Bladder 363 13.56 12.16 to 14.96 1725 14.78 14.08 to 15.48 0.92 0.82 to 1.03
Nervous system 164 5.53 4.66 to 6.39 797 6.83 6.35 to 7.30 0.81* 0.68 to 0.96
Hodgkins
Lymphomas
93 2.51 1.98 to 3.04 341 2.92 2.61 to 3.23 0.86 0.68 to 1.09
NHL 556 19.64 17.98 to 21.29 2490 21.33 20.49 to 22.17 0.92 0.84 to 1.01
Myelomas 183 6.68 5.71 to 7.66 758 6.49 6.03 to 6.96 1.03 0.88 to 1.21
Leukaemias 433 15.32 13.86 to 16.79 1678 14.38 13.69 to 15.06 1.07 0.96 to 1.19
All other sites§ 1484 50.63 48.00 to 53.26 6296 53.94 52.61 to 55.27 0.94* 0.89 to 0.99
*p<0.05.
Female only.
Male only.
§Includes small intestine, anus, intrahepatic bile duct, gallbladder, other biliary, retroperitoneum, peritoneum, other digestive organs, nose,
larynx, pleura, trachea, breast-invasive male only, soft tissue including heart, other non-epithelial skin, vagina, vulva, other female genital
organs, penis, other male genital organs, ureter, other urinary organs, eye, thyroid, other endocrine including thymus, mesothelioma, Kaposi
sarcoma and miscellaneous other sites.
NHL, non-Hodgkins lymphomas.
8Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713
Open Access
Illinois, USA, and the zip code study areas compared
with counties that were similar demographically and
socioeconomically, and based on nationally standardised
rates. Furthermore, cancer occurrence was lower in the
study area for most cancer types, with several statistically
signicant reductions in cancer rates. Results were
largely consistent within and across analyses, with a few
exceptions. Indeed, the lower mortality rates for most
cancers in the study area versus the comparison counties
were in accordance with the lower cancer incidence
rates observed in Champaign County and the study zip
codes. The only noteworthy positive associations in the
primary analyses were for prostate cancer and melan-
oma. Neither prostate cancer mortality nor melanoma
mortality was signicantly elevated. However, incidence
rates for these cancers were signicantly increased in
Champaign County. It is not clear why elevated rates
were observed, although based on chance alone, it
would be expected that some cancer rates would be stat-
istically signicant in the positive and inverse directions.
As indicated, we observed several statistically signicant
inverse associations (ie, RRs below the null value of 1.0),
such as for the lung and bronchus, colorectal and breast
cancers. However, only two cancer types ( prostate
cancer and melanoma; incidence only) were associated
with statistically signicant positive associations. Thus,
signicant associations may have been observed due to
multiple comparisonsa statistical phenomenon
whereby 1 out of 20 associations is statistically signicant
due to chance.
14 15
In our analysis, we generated over
100 unique RRs.
Prostate cancer is the most common cancer among
men in the USA, and 238 590 incident cases and 29 720
deaths were estimated to occur in 2013.
16 17
The gures
Table 5 Age and sex-adjusted incidence rate by zip code, RRs and 95% CI
13b
in 19912010
Zip 61820, 61801
Comparison counties most closely
matched demographically
Relative
rate 95% CI
Number of
cancers Rate 95% CI
Number of
cancers Rate 95% CI
All cancer 3191 468.15 451.25 to 485.06 61 184 524.18 520.03 to 528.34 0.89* 0.86 to 0.93
Oral cavity and
pharynx
81 12.40 9.62 to 15.19 1484 12.71 12.07 to 13.36 0.98 0.77 to 1.23
Colorectal 349 51.93 46.32 to 57.53 7140 61.17 59.75 to 62.59 0.85* 0.76 to 0.95
Lung and bronchus 440 67.81 61.34 to 74.27 10 063 86.21 84.53 to 87.90 0.79 0.71 to 0.87
Breast-invasive464 130.16 117.79 to 142.52 9158 151.54 148.43 to 154.64 0.86* 0.78 to 0.95
Cervix38 8.22 5.33 to 11.12 561 9.28 8.51 to 10.05 0.89 0.62 to 1.27
Prostate500 163.09 148.61 to 177.57 8125 144.35 141.21 to 147.48 1.13* 1.03 to 1.24
Urinary system 186 28.87 24.61 to 33.13 3670 31.44 30.42 to 32.46 0.92 0.79 to 1.07
Central nervous
system
38 5.47 3.63 to 7.31 797 6.83 6.35 to 7.30 0.80 0.57 to 1.13
Leukaemias and
lymphomas
267 36.55 31.88 to 41.22 4509 38.63 37.50 to 39.76 0.95 0.83 to 1.08
All other cancers§ 828 114.84 106.51 to 123.17 15 677 134.31 132.21 to 136.41 0.86* 0.79 to 0.92
*p<0.05.
Female only.
Male only.
§Includes oesophagus, stomach, liver, pancreas, bone, melanomas, uterus, ovary, testis, myelomas, breast-invasive male only, small
intestine, anus, intrahepatic bile duct, gallbladder, other biliary, retroperitoneum, peritoneum, other digestive organs, nose, larynx, pleura,
trachea, soft tissue including heart, other non-epithelial skin, vagina, vulva, other female genital organs, penis, other male genital organs,
ureter, other urinary organs, eye, thyroid, other endocrine including thymus, mesothelioma, Kaposi sarcoma and miscellaneous other sites.
Table 6 Standardised incidence ratios (SIRs) and 95%
CI of zip code 61820 and 61801, 19912010
Cancer sites Obs Exp SIR 95% CI
All cancer 3191 3612 0.88 0.85 to 0.91
Oral cavity and
pharynx
81 82 0.98 0.78 to 1.22
Colorectal 349 378 0.92 0.83 to 1.03
Lung and bronchus 440 450 0.98 0.89 to 1.07
Breast-invasive* 464 511 0.91 0.83 to 0.99
Cervix* 38 36 1.04 0.74 to 1.43
Prostate500 525 0.95 0.87 to 1.04
Urinary system 186 239 0.78 0.67 to 0.90
Central nervous system 38 63 0.60 0.43 to 0.83
Leukaemias and
lymphomas
267 320 0.84 0.74 to 0.94
All other cancers828 1008 0.82 0.77 to 0.88
*Female only.
Male only.
Includes oesophagus, stomach, liver, pancreas, bone,
melanomas, uterus, ovary, testis, myelomas, breast-invasive male
only, small intestine, anus, intrahepatic bile duct, gallbladder, other
biliary, retroperitoneum, peritoneum, other digestive organs, nose,
larynx, pleura, trachea, soft tissue including heart, other
non-epithelial skin, vagina, vulva, other female genital organs,
penis, other male genital organs, ureter, other urinary organs, eye,
thyroid, other endocrine including thymus, mesothelioma, Kaposi
sarcoma and miscellaneous other sites.
Exp, expected; Obs, observed.
Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713 9
Open Access
for prostate cancer represent 14.4% of all new cancer
cases and 5.1% of all cancer deaths in the USA.
17
Increasing age, African-American race, family history of
prostate cancer, and genetic variations and mutations
are established risk factors for prostate cancer, although
the aetiology is largely unknown despite an extensive
effort to identify causes of this malignancy.
16 17
The role
of lifestyle and dietary factors are thought to play a role
in prostate cancer risk, as past research has identied
obesity, physical inactivity and smoking as signicant
modiable risk factors for this malignancy.
1821
Our
cancer assessment is ecological in nature; thus, aside
from age, sex and race, we could not model or adjust for
factors such as physical activity, family history of disease
or body mass index that may have inuenced the results.
Based on a review of the literature and statements by
prominent cancer organisations,
16 17
no manufactured
gas plant by-product compound has been clearly or con-
sistently associated with prostate cancer risk.
Perhaps the most likely reason for the elevation in
prostate cancer incidence during 19912010 is the
increased rate of prostate-specic antigen (PSA) screen-
ing in Champaign County versus the comparison coun-
ties. Indeed, based on the Behavioral Risk Factor
Surveillance System (BRFSS) survey from the Centers
for Disease Control and Prevention (CDC) and adminis-
tered by the Illinois Department of Public Health,
9
the
per cent of men who underwent PSA screening was
higher in Champaign County than Sangamon, Macon
and Winnebago counties (as a composite percentage)
during the study period. Furthermore, composite rates
of PSA screening were higher in Champaign County
than the counties without former gas plants. It is well
established and well publicised that screening for pros-
tate cancer results in an increase in incidence rates,
whereas a proportion of prostate cancers may otherwise
go undetected without screening.
2224
In a sentinel
review paper on the epidemiological impact of screening
on the incidence and mortality of prostate cancer in the
USA, it was suggested that PSA testing was the likely
cause of the dramatic increase in prostate cancer inci-
dence during the 1990s.
23
Although PSA testing is useful
for early diagnosis, its value as a screening tool has been
under scrutiny because the theoretical benet on mor-
tality is questionable.
24
According to a recent study from
the Prostate, Lung, Colorectal and Ovarian (PLCO) ran-
domised screening trial, men who underwent annual
prostate cancer screening with PSA testing and digital
rectal examination had a 12% higher incidence rate of
prostate cancer compared with men in the control
group (who did not undergo PSA testing).
25
However,
approximately the same rate of death from prostate
cancer was observed between groups, and no evidence
of a mortality benet was found in age or pretrial PSA
testing strata.
25
In our assessment, we observed a statistic-
ally signicant increase in prostate cancer incidence in
Champaign County (where a greater proportion of indi-
viduals underwent PSA testing) but no statistically
signicant difference in prostate cancer mortality versus
the comparison counties.
Melanoma was also associated with a statistically signi-
cant positive association (incidence only). Cancer inci-
dence data for melanoma were not available at the zip
code level; thus, it is uncertain if melanoma occurrence
was higher in the areas directly circumscribing the aban-
doned plant. Approximately 21.3 out of 100 000 men
and women are diagnosed annually with melanoma, and
it is about 20 times more common in Caucasians than in
African-Americans.
17
The major risk factor for melan-
oma is exposure to ultraviolet (UV) rays (sunlight is the
primary source of UV rays), particularly among persons
with fair skin. Other risk factors include having a large
number of moles, having one or more rst-degree rela-
tives who have had melanoma and being immunosup-
pressed.
16
It has been hypothesised that malignant
melanoma may occur as a result of exposure to occupa-
tional or environmental chemicals (eg, vinyl chloride,
arsenic, polychlorinated biphenyls, petrochemicals, pes-
ticides), particularly because malignancy can develop in
cutaneous areas that have not been exposed to sun-
light.
26
However, the epidemiological evidence relating
chemical exposures to melanoma risk is inconsistent.
Thus, it is unclear whether the positive incidence rate
ratio in Champaign County is the result of an artifactual
nding from multiple comparisons, or has been con-
founded by sun exposure or other factors, such as
immunosuppression. Moreover, general health concerns
that the local population may have about living next to a
former gas manufacturing site may lead to surveillance
bias due to increased screening. Furthermore, a statistic-
ally signicant decit of melanoma was observed in
Champaign County based on SIR analyses, and no statis-
tically signicant associations for melanoma were found
based on comparisons with counties that did not have a
former gas plant. Finally, oesophageal cancer incidence
was elevated when Champaign County was compared
with the non-gas plant counties in our sensitivity analysis
of cancer incidence, but this observation was not sub-
stantiated by the main analyses, the sensitivity analysis of
cancer mortality or by the SIR analysis.
Alternatively, an unknown manufactured gas product
compound may have produced the slight elevations in
prostate cancer and/or melanoma incidence in the
main analyses. This scenario is unlikely, however, given
the plausible explanations listed above and because
reduced rates were observed for cancers with known
environmental or chemical relationships. That is, no
indicatorcancer types with established environmental
or chemical aetiology were observed in excess. For
example, IARC has classied coke productionas car-
cinogenic to humans (group 1) for lung cancer because
of exposure to PAHs in the industry (although associa-
tions from the occupational studies are somewhat
tenuous).
2729
In a quantitative review of occupational
exposures to PAHs, lung cancer and bladder cancer risk
was elevated signicantly among workers in the coal
10 Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713
Open Access
gasication industry.
30
However, in our assessment, we
observed statistically signicant reduced mortality and
incidence rates of 15% and 17%, respectively, for lung
and bronchus cancers, and no associations for urinary
system and bladder cancers. Moreover, our analyses were
based on rates of cancer at the community level, not
among workers likely exposed to much higher concen-
trations of possible chemical exposures.
It is unclear as to why there was a preponderance of
inverse associations in Champaign County and the study
zip codes versus the comparison counties. A priori, we
developed a systematic protocol for identifying compar-
able counties. We identied counties based on residen-
tial status (urban/rural) and similar demographic and
socioeconomic characteristics, and our analyses were
adjusted for age, sex and race (at the county level).
Based on the 2000 census information, there were
approximately 7% fewer eversmokers in Champaign
County versus the comparison counties. This may
explain, in part, the observation of lower cancer rates,
particularly for lung and bronchus, in Champaign
County. In addition, the prevalence of other potentially
important factors, such as alcohol consumption or
obesity, in these counties may have confounded the
observed associations. However, relatively similar patterns
of associations were observed in sensitivity analyses com-
paring Champaign County and the study zip codes with
counties that did not have a former gas plant, and based
on SIR analyses using nationally representative cancer
data from the SEER programme.
Most of the literature on manufactured gas plants
focuses on the environmental and ecological impacts of
the gas process residues and waste products. As such,
considerable literature exists on the methodological,
toxicological, elemental chemistry and extracting techni-
ques involving remediation and compound evaluations
from abandoned sites.
3134
While potentially hazardous
compounds may have been produced as part of the gas
manufacturing process, the extent and level to which
compound residues persist at the sites is unclear. In
certain cases, potential hazards may be overestimated as
samples in some studies have been consistent with back-
ground levels or below the assumed level.
135
As men-
tioned previously, the literature on direct or indirect
human health risks from an epidemiological standpoint,
is sparse. DeHate et al
1
investigated soil vapour intrusion
at 10 commercial buildings and 26 single family and
multifamily residential properties overlying and/or adja-
cent to three former manufactured gas plant sites. Soil
vapour samples and indoor/outdoor air were analysed
for VOCs, and comparative risks were evaluated based
on maximum and mean concentrations for BTEX rela-
tive to background levels. All hazard indices were less
than one or were comparable to mean and maximum
background levels, and there was no evidence of manu-
factured gas plant-related soil vapour intrusion from any
of the 36 sites. Based on these ndings, the authors
reported that no increased public health risks were
associated with occupied residential or commercial prop-
erties overlying or surrounding former manufactured
gas plant facilities.
1
Occupational epidemiological
studies involving postulated gas plant exposures, such as
PAH s,
27 30
BTEX
3638
and coal tar,
30 3941
are extensive
but none have evaluated potential disease outcomes
resulting from residing in a community that includes a
former manufactured gas plant site.
Our historical cancer assessment has limitations that
are commonplace with analysing population-level data.
Prime among the limitations is that we did not have
individual-level information on lifestyle, dietary, medical
or occupational factors. In addition, we did not have per-
sonal information regarding potential exposures (eg, to
soil, groundwater or air) from the manufactured gas
process. We were, however, able to adjust cancer esti-
mates for age, sex and race. Because of the complete,
systematic and statewide registry in Illinois, data for
persons diagnosed with cancer were assembled in an
unbiased fashion. Identication and reporting of cancer
cases in the ISCR is mandated by state law. The popula-
tion sizes (ie, the denominator for estimating cancer
rates) for the study periods were based on the 1990 and
2000 census information. If there was considerable
in-migration or out-migration of the population over
time, the estimated RRs may have been affected. The
gas plant ceased operations in 1953, and although
immediate release of potential compounds may have
diminished at that time, concern about the persistence
of compounds over time in the vicinity has been raised.
Our analyses were conducted on the basis of publically
available aggregate-level data. We began our analytical
period at the earliest time point possible that enabled us
to merge cancer data and census data. Given our analyt-
ical periods, there is sufcient latency to observe a car-
cinogenic effect, if one exists. However, we were not able
to capture cases that occurred in earlier time periods,
with possible greater exposures. It may be possible that
our analyses are not sensitive enough to identify small
effects of plant exposures because of the nature of resi-
dential exposure classication. Despite these limitations,
we found no clear or consistent evidence of an increase
in cancer occurrence among residents in a community
circumscribing a former manufactured gas plant.
The validity of our results is enhanced by the utilisa-
tion of three comparison populations: (1) counties very
well matched demographically that had former gas
plants, (2) comparison counties without former gas
plants and (3) nationally representative cancer data
from the SEER programme. These three types of ana-
lyses serve as complementary comparisons to examine
the consistency of ndings across different population
metrics. We implemented an objective methodological
approach to identify counties in the state of Illinois that
were the most closely matched (demographically) to the
analytical zones. By using this approach, we were able to
account for some prominent confounding factors at the
aggregate level. However, the most closely matched
Alexander DD, et al.BMJ Open 2014;4:e006713. doi:10.1136/bmjopen-2014-006713 11
Open Access
comparison areas also had former gas plants. Therefore,
we conducted a second analysis by matching demo-
graphic factors that was restricted to counties without
former gas plants. Finally, we conducted analyses using
nationally standardised rates of cancer. Despite the vari-
ation in analytical approaches, results were consistent
between techniques.
We conducted a community cancer assessment for the
purpose of appraising the public health regarding the
occurrence of cancer among residents in a community
with a former manufactured gas plant. Although this
study did not include individual-level information, rates
of total cancer and most cancer sites in the Champaign
County area and zip codes circumscribing the abandoned
facility were lower versus similar comparison areas, and
based on nationally standardised rates of cancer. The
primary exception is for prostate cancer, although there
may be relevant explanations for the higher rates aside
from potential exposure emanating from the former
manufactured gas plant site, such as an incidence spike
due to higher PSA testing rates in Champaign County, a
statistical artifact based on multiple comparisons, or con-
founding by unmeasured factors. Furthermore, a review
of the literature did not reveal any known relation
between the potential gas plant compounds and prostate
cancer risk. Interpretation of results from our analyses
should be made in the context of the many limitations of
ecological-based study designs. However, the results from
this retrospective cancer mortality and incidence assess-
ment do not support an increase in cancer occurrence in
communities surrounding a former manufactured gas
plant in Champaign, Illinois, USA.
Contributors DDA, DHG and JPF were responsible for conception and design
of the research. Statistical analyses were carried out by XJ. DDA, XJ, LCB,
DHG, SRI and JPF were responsible for development of the manuscript,
critical revision and intellectual content.
Funding This work was supported by Ameren Corporation.
Competing interests DHG has served as an expert witness on behalf of
Ameren in litigation related to manufactured gas plants. DDA, XJ, LCB, DHG,
SRI and JPF are employed by EpidStat Institute, all of whom were contracted
by Ameren Corporation to support the study.
Ethics approval Authors agreed to comply with the Illinois Health and
Hazardous Substances Registry Act (410 ILCS 525/12). All data used in this
study are publicly available; thus, informed consent was not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The full data set is available by emailing the
corresponding author of the study.
Open Access This is an Open Access article distributed in accordance with
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Open Access
... Twelve studies showed that exposure to air pollution was associated with increased risk for kidney-related outcomes. Three studies reported that exposed populations had a lower risk of kidney cancer [31,36,37]. One study reported no significant difference in the risk for hypertension or diabetes between exposed and unexposed populations [33], while the remaining nine studies reported mixed findings. ...
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Objective: This systematic review and meta-analysis aimed at synthesising epidemiological data on the association between long-term air pollution and kidney-related outcomes in oil and natural gas (ONG) situated communities. Methods: We synthesised studies using the PRISMA 2020 guideline. We searched databases including Medline, Cochrane Library, CIHANL, CAB Abstracts, Greenlife, African Journal Online, Google Scholar and Web of Science, from inception to April 2021. Heterogeneity across studies and publication bias were assessed. Results: Twenty-five studies were systematically reviewed but only 14 were included in the meta-analysis and categorised based on the outcome studied. Residents of exposed communities have increased risk for Chronic Kidney Disease (CKD) (OR = 1.70, 95% CI 1.44–2.01), lower eGFR (OR = 0.55, 95% CI 0.48–0.67) and higher serum creatinine (OR = 1.39, 95% CI 1.06–1.82) compared to less exposed or unexposed populations. The risks for hypertension and kidney cancer between the two populations were not significantly different. Conclusion: We report an increased risk for CKD and kidney dysfunction in populations residing near petrochemical plants, although from a limited number of studies. The scientific community needs to explore this environment and non-communicable disease relationship, particularly in vulnerable populations.
... Twelve studies showed that exposure to air pollution was associated with increased risk for kidney-related outcomes. Three studies reported that exposed populations had a lower risk of kidney cancer [31,36,37]. One study reported no significant difference in the risk for hypertension or diabetes between exposed and unexposed populations [33], while the remaining nine studies reported mixed findings. ...
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Workers on coke oven plants may be exposed to potentially carcinogenic polycyclic aromatic hydrocarbons (PAHs), particularly during work on the ovens tops. Two cohorts, employees of National Smokeless Fuels (NSF) and the British Steel Corporation (BSC) totalling more than 6,600 British coke plant workers employed in 1967, had been followed up to mid-1987 for mortality. Previous analyses suggested an excess in lung cancer risk of around 25%, or less when compared with Social Class IV ('partly skilled').Analyses based on internal comparisons within the cohorts identified statistical associations with estimates of individual exposures, up to the start of follow-up, to benzene-soluble materials (BSM), widely used as a metric for mixtures of PAHs. Some associations were also found with times spent in certain coke ovens jobs with specific exposure scenarios, but results were not consistent across the two cohorts and limitations in the exposure estimates were noted. The present study was designed to reanalyse the existing data on lung cancer mortality, incorporating revised and improved exposure estimates to BSM and to benzo[a]pyrene (B[a]P), including increments during the follow-up and a lag for latency. Mean annual average concentrations of both BSM and B[a]P were estimated by analysis of variance (ANOVA) from concentration measurements at all NSF and six BSC plants, and summarised by job and plant, with a temporal trend (for the BSM only). These were combined with subjects' work histories, to produce exposure estimates in each year of follow-up, with a 10-year lag to allow for latency. Exposures to BSM and to B[a]P were sufficiently uncorrelated to permit analysis in relation to each variable separately.Lung cancer death risks during the follow-up were analysed in relation to the estimated time-dependent exposures, both continuous and grouped, using Cox regression models, with adjustment for age. Changing the exposure estimates changed the estimated relative risks compared with earlier results, but the new analyses showed no significant trends with continuous measures of exposure to either BSM or B[a]P, nor with time spent on ovens tops. Analyses with grouped exposures showed mixed results. Across all BSC plants, the relative risk coefficient for working 5 or more years on ovens tops, where the exposures were highest, was 1.81, which was statistically significant. However, results for those with 0--5 years on ovens tops did not suggest a trend; the evidence for an underlying relationship was thus suggestive but not strong. The new results are in line with previous findings; they show some signs consistent with an effect of coke ovens work on lung cancer risk, especially on ovens tops, but the preponderant absence of significant results, and the inconsistencies between results for NSF and BSC, highlight how little evidence there is in these data of any effect.
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Prostate cancer (PCa) and smoking-related morbidity disproportionately burdens African American (AA) men. Smoking is associated with high-grade PCa and incidence, but few studies have focused on AA men. This study aims to determine the effect of tobacco-use on odds of PCa and of high-grade PCa in a population of predominantly AA men. This is a cross-sectional study evaluating smoking and PCa status in men with incident PCa and screened healthy controls. Altogether, 1,085 men (527 cases and 558 controls), age ≥ 40 years were enrolled through outpatient urology clinics in two US cities from 2001 to 2012. Validated questionnaires were used to gather clinical and socioeconomic data. The cases and controls were predominantly AA (79.9% and 71.3%, respectively, P = 0.01). AA men smoked more frequently (53.4% vs. 47.9%, P < 0.001) and quit less frequently than European American (EA) men (31.5% vs. 40.4%, P = 0.01). AA heavy smokers had increased odds of PCa diagnosis (OR 2.57, 95% CI 1.09, 6.10) and high-grade cancer (OR 1.89, 95% CI 1.03, 3.48) relative to never smokers and light smokers. Among AAs, heavy smokers had lower odds of NCCN low PCa recurrence risk stratification. AA former smokers had a trend for increased odds of high-grade cancer compared to never smokers. The associations between smokings, cancer diagnosis and cancer grade did not reach statistical significance in EA men. We found ethnic differences in smoking behavior. Heavy smoking is associated with increased odds of PCa and of higher Gleason grade in AA men. Prostate © 2013 Wiley Periodicals, Inc.