Appendix B Description of Studies on Health Effects of Landfills

Appendix B– Description of studies on health effects of landfills

Outcome / Author, Year / Study design / Population / Design (methods) / Exposure evaluation / Results: effect estimation / Study quality
Country / Individuals
Bladder cancer / Gouveia et al. 2010 / Ecological study / Brazil, SaoPaolo / Residents at various distances from the site / Mortality rates / 15 sites in the area of Sao Paolo active in the period 1980-1990. Distances from sites (Lower limit 2 km). / Bladder cancer SMR: 0.98 (0.79-1.22). No significant risk increase. / Exposure - -
Outcome +
Confounding +
Williams et al. 1998 / Ecological study / Australia, Sydney metropolitan region / Residents in the geographic area near the site / Mortality and incidence ratesfrom cancer registry / Exposure defined through residence according to the distance from the site. Rates compared withNew South Wales population / SIR 0.58 (0.07-2.09) / Exposure - -
Outcome
Confounding +
Jarup et al. 2002 / Ecological study / UK / 341.856.640 person-years, for adults cancer:89.786cases of bladder cancer were observed / Data used of England,Wales, Scottish come from postal code register. Disease information from cancer registry.
Adjustment for age, sex, year of diagnosis, region, deprivation / Residence within 2 Km from 9.565sites activein the period 1982- 1997 (19.196global sites) / No significant risk increase of bladder cancer for residents within 2kmfrom the landill (rate =1.01 CI 99%=1.00-1.02). rate<2km /> 2 km 1.01(99% CI =1.00-1.02) / Exposure- -Outcome +
Confounding +
Liver cancer / Gouveia et al. 2010 / Ecological study / Brazil, Sao Paolo / Residents in the areas near and far from the sites / Mortality rates / 15 landfills in the Sao Paolo area (active from 1980-1990). Distances from sites (Lower limit 2 km). / Liver cancer SMR: 1.00 (0.86-1.16)). No significant risk increase / Exposure - -
Outcome +
Confounding +
Michelozzi et al, 1998 / Mortality/ Ecological study / Malagrotta, Rome, Italy / Mortality data in the years 1987-1993.
341.389 residents (165,074 males e 176,315 females). / Standardized Mortality Rates (SMR) evaluated separately for males and females according to the distance from the site , until 10 km. SMRwere calculated also after adjustment for four categories of socioeconomicstatus / Distance from multiple sources of pollution: a big landfill, an incineratoran oil refinery. / Non significant risk increase or decrease for liver cancer in both sex according to the distance.No deaths for liver cancer at 0-3 km; for males living at 3-8km SMR= 69(CI 95% =45-101), for females SMR= 115(CI=76-168) for males living at8-10 kmSMR= 95(CI=80-113), for females SMR= 88(CI=69-110) No cases were observed within 3 km / Exposure –
Outcome +
Confounding +
Goldberg, 1999 / Case-control study / Montreal, Canada / 41 casesof liver and biliary ducts cancer (diagnosed between 1979 and 1985) and a control groupfrom 533 individuals
All individuals were males of 35- 70 years / The exact address at diagnosis was used to classifythe individuals by geographicalareas (high, medium, andno exposure) and distance from the site. The covariates are: age, family income, ethnic group, cigarette smoking and alcohol consumption. / Residence near landfill of urban solid waste in Miron Quarry. / In the exposure area nearest the site ,highest risks for liver cancer were found (OR= 1.8, CI =0.8-4.3).
An higher risk was found using the distance from the site at 1.5 Km (OR 1,5km=2.1 CI=0.8-5.3) / Exposure–
Outcome 0
Counfounding 0
Leukemia in adults / Gouveia et al. 2010 / Ecological study / Brazil, Sao Paolo / Residents in the areas near and far from the sites / Mortality rates / 15 landfill in the Sao Paolo area (active since 1980-1990). Distances from sites (Lower limit 2 km). / Leukemia in adults SMR: 0.92 (0.77-1.10). No risk increase. / Exposure - -
Outcome +
Confounding +
Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Males : SIR 1.76 (0.48-4.51)
Females: SIR 2.84 (0.77-7.26) / Exposure - -
Outcome
Confounding +
Leukemia in children / Gouveia et al. 2010 / Ecological study / Brazil, Sao
Paolo / Residents in the areas near and far from the sites / Mortality rates / 15 landfill in the Sao Paolo area (active since 1980-1990). Distances from sites (Lower limit 2 km). / Leukemia in children SMR: 0.84 (0.54-1.31). No risk increase / Exposure - -
Outcome +
Confounding +
Brain cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Males: SIR 3.80 (1.39-8.27)
Females: SIR 1.97 (0.24-7.11) / Exposure - -
Outcome
Confounding +
Larynx
Larynx cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Males: SIR 3.16 (0.86-8.09) / Exposure - -
Outcome
Confounding +
Michelozzi et al, 1998 / Mortality/ Ecological study / Malagrotta, Rome, Italy / See liver cancer / See liver cancer / See liver cancer / No significant risk increase for males according to the distance 0-3 km e 3-8 km (SMR = 236, CI= 27-800 and SMR = 133, CI = 80-206, respectively);for females at 3-8 km SMR = 92 (CI = 4-454), no case observed at 0-3 km.
A significant reduction of mortality for larynx cancer was found according to the distancefor males (p = 0.03), the trend hold steady after adjustment for socioeconomic status (p = 0.06)Within3 km:for males SMR=236(CI =27-800);
no case was observed for females / Exposure- -
Outcome+
Confounding +
Lung cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Males: SIR 1.59 (0.99-2.18)
Females: SIR 1.57 (0.43-4.01) / Exposure - -
Outcome
Confounding +
Michelozzi et al, 1998 / Mortality/ Ecological study / Malagrotta, Rome, Italy / See liver cancer / See liver cancer / See liver cancer / No risk increase or decrease was found for lung cancer according to the distance in both sex
For males within 0-3kmSMR= 95(CI =48-169), for females SMR= 55(CI =2-271). / Exposure - -Outcome + Confounding +
Pukkala et al, 2001 / Retrospective cohort study / Helsinki, Finland / 2014 (957 males and 1057 females) individuals residents since ever in the landfill area and a and a similar reference cohort (2028 individuals) / The cohort’s components are identified through the Finland Population Register. The cancer follow-up has beginning on the admittance in the apartment or on 1st January 1976, and ended in emigration or death on 31 December 1998, Adjustmentfor age and sex. / Residents in houses built in a former landfill area (containing domestics and industrials waste). / See colo-rectal cancer . No SIRd/SIRR for various types of cancer was statisticallysignificant different from 1.0: for lung cancer was 1.29(CI 95%=0.46-3.44).RR=1.29 (CI 95% =0.46-3.44) / Exposure–
Outcome +
Confounding +
Colo-rectal cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Colon
Males: SIR 0.70 (0.19-1.79)
Females: SIR 0.63 (0.13-1.85)
Rectum
Males: SIR 0.88 (0.18-2.56)
Females: SIR 1.47 (0.30-4.29) / Exposure - -
Outcome
Confounding +
Pukkala et al, 2001 / Retrospective cohort study / Helsinki, Finland / See lung cancer / See lung cancer / See lung cancer / The relative risk for every type of cancer from site area and residence houses is 1.50 ( CI = 1.08-2.09), similar in both sex and increased by number of years lived in the area. Between cancer type with more than 5 cases the rate is higher (3.14; CI = 0.80-14.6) for colorectal cancer , observed completely among individuals residents at least 5 years in the landfill area RR=3.14( CI =0.80-14.6) / Exposure -
Outcome +
Confonunding +
Non-Hodgkin Lymphoma / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Males: SIR 1.91 (0.70-4.16) / Exposure - -
Outcome
Confounding +
Michelozzi et al, 1998 / Mortality/ Ecological study / Malagrotta, Rome, Italy / See liver cancer / See liver cancer / See liver cancer / No excess or reduction risk was found with the distance in both sex.
For males living 0-3 km SMR = 251 (CI 95% = 29-851), for females living 3-8 km SMR = 152 (CI 95% = 89-242), whereas no case found on the 3 km range.
On the 3 km range: for malesSMR = 251 (CI 95% = 29-851);
no case found for females / Exposure - -
Outcome + Confounding +
Goldberg, 1999 / Case-control study / Montreal, Canada / (168 cancer cases identified between 1979and 1985) and control groupof 533individuals based on population. Individuals was all males , aged between 35and 70 / See liver cancer / See liver cancer / In the exposure area nearest the site OR =1.2 (CI 95% =0.8-2.0). Using the distance from the site as an other metric exposure, risks higher than expected was found for NHL(OR1 km=2.0CI 95% =1.0-4.0) Distance <1 km: OR =2.0(CI 95% =1.0-4.0) / Exposure-Partecipazione+
Kidney cancer / Michelozzi et al, 1998 / Mortality/ Ecological study / Malagrotta, Rome, Italy / See liver cancer / See liver cancer / See liver cancer / On the 3 km range,mortality for kidney cancer for males has been higher than expected , but nonstatistically significant (SMR =276, CI 95% =31-934). For females the mortality has been significantly higher in the 3-8km rangealso after adjustment for socio-economic status (SMR = 198, CI 95% =111-325); no case observed on 0-3km.range. On the 3 km range :for males SMR=276(95% CI =31-934);
no case observed for females. / Exposure- -Outcome +
Confounding +
Goldberg, 1999 / Case-control study / Montreal, Canada / (146 cancer cases identified between 1979and 1985) and control group of 533individuals based on population. Individuals was all males , aged between 35and 70 / See liver cancer / See liver cancer / In the exposureareamore closer to the site OR =0.9 (CI 95% =0.5-1.6).
Using the distance from the site like metric exposure results are higher than expected for kidney cancer OR2 km =1.4, CI 95% =0.9-2.3).Distance <2km:OR =1.4 (CI 95% =0.9-2.3) / Exposure - - Partecipazione+
Breast cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Females: SIR 1.14 (0.63-1.65) / Exposure - -
Outcome
Confounding +
Uterus cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Females: SIR 1.99 (0.54-5.10) / Exposure - -
Outcome
Confounding +
Prostate cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Males: SIR 1.05 (0.34-2.44) / Exposure - -
Outcome
Confounding +
Stomach cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Males: SIR 1.11 (0.23-3.25) / Exposure - -
Outcome
Confounding +
Skin cancer / Williams et al. 1998 / Ecological study / See bladder cancer / See bladder cancer / See bladder cancer / Definition of exposed population according to the residencein the district around the site. Mortality and incidence rates are compared with the rates of New South Wales / Males: SIR 0.47 (0.10-1.37)
Females : SIR 0.36 (0.04-1.29) / Exposure - -
Outcome
Confounding +
Children cancer / Jarup et al. 2002 / Ecological study / UK / 113.631.433person-years for children cancer : 3973cases of children leukemia. / See bladder cancer / See bladder cancer / No excess risk of children leukemia in resident populations within 2kmfrom landfill (Rate = 0.96CI 99%=0.91-1.00)Rate <2km /> 2 km 0,96( CI 99% =0.91-1.00) / Exposure- -Outcome +
Confounding +
Other cancers
Other cancers / Michelozzi et al, 1998 / Mortality/ Ecological study / Malagrotta, Rome, Italy / See liver cancer / See liver cancer / See liver cancer / No excess or reduction risk with distance for limphoematopoietic cancer (Hodgkin lymphoma, multiple myeloma, leukemia) in both sex. In the range from 0-3 km SMR for leukemia was 82 (CI 95% = 3-409) for males, e 137 (CI 95% = 5-679) for females. In the rangeof 3 km no deaths was observed for Hodgkin lymphoma and multiple myeloma, ; for males in the range of 3-8 km SMR for Hodgkin lymphoma, and multiple myeloma, was respectively 33 (CI 95% = 1-162) e 64 (CI 95% = 17-158), and for females , 50 (CI 95% = 2-250) e 115 (CI 95% = 50-223), respectively .In the range of 3 km:Leukemia: for males SMR = 82 (CI 95% = 3-409), for females SMR = 137 (CI 95% = 5-679). Hodgkin diseases : no cases for both sex
Multiple myeloma: no cases for both sex / Exposure - -Outcome +
Confounding +
Goldberg, 1999 / Case-control study / Montreal, Canada / 101cases of pancreas and 367cases of prostate cancer (identified between 1979and 1985) and control group of 533individuals based on population. Individuals was all males , aged between 35and 70 / See liver cancer / See liver cancer / In the exposure area nearest the site , highest risks for pancreas cancer were found (OR= 1.4, CI 95% =0.8-2.6) and for prostate (OR= 1.5CI 95% =1.0-2.1). Using the distance from the site like metric exposure risks higher than expected was found for pancreas cancer(OR1,25 km= 2.2, 95% CI =1.0-4.6), but non for prostate cancer (OR0,75 km= 1.5, 95 %CI =0.6-3.6).Pancreas cancer : for residents within 1.25kmOR =2.2(CI 95% =1.0-4.6);
Prostate cancer : for residents
within 0,75kmOR =1.5(95% CI =0.6-3.6) / Exposure -Partecipazione+
Pukkala et al, 2001 / Retrospective cohort study / Helsinki, Finland / See lung cancer / See lung cancer / See colo-rectal cancer / No SIRd/SIRRfor various types of cancer was statistically significant different from 1.0: for pancreas cancer 1.46 (CI 95% = 0.29-6.79) and for skin cancer (melanoma and non combined-melanoma) 2.11 (CI 95% = 0.45-10.6). Males showed an excess risk for these cancer (SIR = 5.05, CI 95% = 1.38-12.9 e SIR = 4.03, CI 95% = 1.31-9.41, respectively), whereasno cases of these cancer was found for females .
Landfill / reference range : for pancreas cancer SIRd/SIRr=1.46 (CI 95% =0.29-6.79), for skin cancer SIRd/SIRr=2.11(CI 95% =0.45-10.6), for males SIR=5.05(CI 95% =1.38-12.9) for pancreas cancer SIR=4.03 (CI 95% =1.31-9.41) for skin cancer. / Exposure–
Outcome+Confounding +
Jarup et al. 2002 / Ecological study / UK / 341.856.640person-yearsfor adults cancer : 36802cases of brain cancer was found ,21773cases of hepatobiliary cancer and 37812cases of leukemia. / See bladder cancer / See bladder cancer / No excess risk for brain cancer (rate ratio= 0.99 CI 99%=0.98-1.01), for hepatobiliary cancer (rate ratio=1.00 CI 99%=0.98-1.03) or adults leukemia (rate ratio= 0.99CI 99%=0.98-1.01)Rate <2 km /> 2 km:
0.99 (CI 99% = 0.98-1.01) for brain cancer;
1.00 (CI 99% = 0.98-1.03) for hepatobiliary cancer
0.99 (CI 99% = 0.98-1.01) for adults leukemia / Exposure - -Outcome +
Confounding +
Birth defects
Birth defects
Birth defects / Marshall EG et al. 1997 / Ecological study / New York State, USA / 473 births with centra l nervous system defects and 3305with muscoskeletal defects ; compared with 12,436 normal births randomly selected . / Adjustment for race, mother’s age, prenatal care, density population. / Residence near industrial sites with presence of landfill relate to industry / Comparing individuals with low probabilityof exposure mother resident in areas defined at medium-high risk of exposure to toxic contaminants of landfill no showed increase risk of birth defects studied . Insufficient numbers. / Exposure --
Outcome +
Confounding +
GeschwindSA et al. 1992 / Case-control study / New York State, USA / 9313 cases of congenital anomalies and 17802 control births. Born with congenital anomaliesin the areas near 590 toxic waste landfills / Overall evaluation of proximity area; proximity evaluation to sites with non-monitored and identified emission of chemical substances Adjustment for age race education address and mother’s municipality residence , pregnancy-related complications, number of children, birth weight, pregnancy duration , and unborn sex. / Industrial toxic waste landfills. / High exposure levels
OR = 1.63, 95% Cl 1.34-1.99); documentation of non-monitored emission of chimical substances (non exposed OR = 1.00; exposed to non-monitored emission: OR =
1.17, 95% Cl 1.08-1.27) / Exposure - -Outcome 0
Confounding 0
Gouveia et al. 2010 / Ecological study / Brazil, Sao Paolo / Residents in the areas near and far from the sites. / Mortality data of areas near landfills. Congenital anomalies under one year. / 15 landfills in Sao Paolo area (active since 1980-1990). Distances from landfills ( 2 km limit). / Congenital anomalies SMR 0.86 (0.72-1.03). No increase risk for congenital anomalies / Exposure - -
Outcome +
Confounding +
Fielder HMP, et al. 2001 / Ecological study / England - South Wales / Residents in three areas near the landfill and in 26 other areas not near. The 26 are divided into 18 with similar socioeconomic characteristics and 8 included in the Mertyr Unitary Authority. / Ecological study comparing mortality, hospitalization rate and reproductive health’s index in three different populations evaluating also temporary trends of contemplated outcomes . / Exposure evaluation occurred on distance’s parameter from landfill and accounting for three areas nearest and other 26 as control . / No difference between exposed and non exposed in the period 1983-1987; in the period 1989-1996 in the three exposed areas is higher than 18 control areas.
1983-1987: exposed 17.8 (x1000), non exposed 15.7 (x1000) RR 1.13 CI 95% 0.78-1.62 p=0.50;
1989-1996: exposed 16.5 (x1000) CI 95% 1.3-2.9 p<0.001, non exposed 8.5 (x1000) / Exposure - -
Outcome + Confounding +
Morris et al, 2003 / Ecological study / Scotland / Residents whitin 2km of a scottish landfill compared with individuals living at >2km distance. / Ecological study comparing rates of congenital anomalies in exposed in respect to non exposed . Adjustments for deprivation index evaluate by area. / Exposure definition depending on distance from landfill (2km) / Relative risk of congenital anomalies , adjusted for deprivation index is not statistical significant .
RR: 0.96 (0.89-1.02) / Exposure - - Outcome 0
Confounding +
Vrijheid et al 2002 / Case-control study / 5 European countries / 1270 cases of congenital anomalies and 2308 birth controls. Born with congenital anomalies in areas near 20 toxic waste landfills in 14 study areas , classified by level of danger. / Evaluation of dangerousness , diagnosed by expert groups of toxic waste landfills / Toxic waste landfills. Distance from landfill (0-3 vs. 3-7 km) / Higher risk of chromosomal anomalies in people who lived close to sites (0–3 km) than in those who lived further away (3–7 km; odds ratio 1·41, 95% CI 1·00–1·99) / Exposure - Outcome 0
Confounding +
Dummer et al. 2003 / Retrospective cohort study / Cumbria, nord-est of England / The cohort include 283.668 live births and 4.325 stillborn, born from mother’s residents in the period 1950 -1993. / Cases of congenital anomalies near landfill areas divided into 4 types. Analysis stratified in three
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statified periods: 1950-1960; 1961-1975; 1976-1993. / Exposure to 4 landfill types depending on waste 1-2 type : inactive and non hazardous ; 3 type domestic -putrescible; 4 type difficult to manage . / Except for congenital anomalies and cardiac defects in regard to type 4 landfill for what there is a non significant OR= 1.29 IC 95% (1.00-1.66).