Gulf War and Health Updated Literature Review of Depleted Uranium (2008) / Chapter Skim
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7 Cohort Descriptions
7 Cohort Descriptions
Pages 117-192
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From page 117... ...
Studies of deployed populations, in contrast, had limited or no exposure data other than data on deployment itself and on the possibility of exposure to depleted uranium, but the committee chose to include these studies because of their relevance to the Gulf War and Operation Iraqi Freedom veterans. The chapter also includes studies that assessed health outcomes in people who lived near uranium-processing facilities or had high concentrations of uranium in their drinking water; these residents may have exposure conditions similar with veterans who received level III exposures (see Chapter 5)
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From page 118... ...
Inhalation of dust that contains uranium compounds was the primary route of entry of uranium in processing plants, a route analogous to that of many Gulf War veterans exposed to depleted uranium during friendly-fire incidents. This section first details the cohorts reviewed in Volume 1, including updates on the cohorts published after the release of the report in 2000.
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From page 119... ...
Vital status of 95% of the study group through December 31, 1962, was determined, and mortality was compared with that in the male population of the Colorado Plateau states. Death certificates for 317 workers known to be deceased were obtained The Colorado Plateau region includes Arizona, Colorado, New Mexico, and Utah.
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From page 120... ...
Furthermore, exposure assessment was limited by the lack of specificity of exposure because of the possibility of concomitant exposure, and the cohort was relatively small. Archer et al., 1973 In a second prospective cohort study of Colorado Plateau mill workers, Archer and colleagues extended the followup of mortality in mill workers with a group of 662 white male millers.
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From page 121... ...
Vital status was determined through SSA records and other sources for all but 2% of the cohort. Death certificates were obtained for 515 (97%)
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From page 122... ...
Moreover, death certificates in at least half of the six cases also indicated either prostatic obstruction or prostatic cancer. Pinkerton et al., 2004 Pinkerton and colleagues examined mortality in 1,484 men who worked in one of the seven uranium mills in the Colorado Plateau area.
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From page 123... ...
. Mortality from tracheal, bronchial, and lung cancer for the first time exhibited a statistically nonsignificant increase (78 observed vs 68.93 expected; SMR, 113; 95% CI, 89-141)
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From page 124... ...
Blood and urine samples were collected for a number of glomerular and tubular biomarkers. Blood and urine tests were used as dichotomous variables in evaluating renal effects. Urinary uranium concentration was also measured.
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From page 125... ...
were used to determine uranium lung burden. Urinary uranium concentrations varied up to 13 µg/L, and 109 (92%)
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From page 126... ...
. External radiation doses in excess of 100 mSv (which occurred in only 2.6% of the cohort)
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From page 127... ...
Film badges were rarely used, because exposure to external radiation was low owing to the nature of the operation; respirators were required but might not have been used with great frequency. Polednak and Frome examined whether mortality was associated with longer periods of employment and exposure to higher levels of airborne uranium.
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From page 128... ...
The mean cumulative external dose for monitored workers was 0.96 rem over a 31-year period. Internal radiation exposure was determined with urinalysis (which began in the early 1950s)
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From page 129... ...
, which allowed the ratio of death rates in the index and reference groups to change over time; and multivariate analyses with Poisson regression modeling to account for the effects of multiple factors (birth year, duration of employment, SES, employment facility, period of followup, and radiation exposure level) on cancer mortality simultaneously.
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From page 130... ...
Estimates of lung dose from both internal and external radiation during the period 1947-1985 were calculated for each year of employment for each worker in the cohort, and vital status as of 1990 was obtained from SSA records and the NDI. The study focused on lung cancer as an underlying or contributory cause on the basis of ICDA-8 162 (code 162 of the International Classification of Diseases Adapted for Use in the United States)
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From page 131... ...
External radiation had a higher correlation with lung-cancer mortality than external and internal radiation combined or internal radiation alone. This study had several strengths, including exclusion of workers who had never been monitored for internal radiation exposure to reduce bias due to misclassification of exposure and selection bias, direct measurement of both external and internal exposure at the individual level, and sound methodology and analytic approach.
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From page 132... ...
were used for this purpose. From the middle of 1945, workers were monitored for external radiation exposure with film badges.
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From page 133... ...
In general, there was little evidence of a relationship between internal radiation dose and lung-cancer mortality. The authors reported increased risk in those exposed to 25 cGy or more, with an odds ratio (OR)
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From page 134... ...
Personnel records were obtained and reviewed; however, in most cases, no detailed job-specific information was available except dates of employment and job titles. Vital status was ascertained by using data from SSA, the Florida Department of Motor Vehicles, and IRS.
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From page 135... ...
conducted a retrospective cohort study to examine mortality and cancer incidence in 4,106 nuclear-fuels fabrication plant workers in Connecticut. The plant's fuel-fabrication process included receiving enriched uranium, fabricating uranium fuel, encapsulating the fuel in a corrosionresistant metal covering, and assembling it into larger components for reactors.
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From page 136... ...
The collective radiation dose received by the radiation workers was 185.1 person-sieverts, and the mean cumulative external dose was 83.6 mSv. The mean annual dose was 8.7 mSv.
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From page 137... ...
External radiation at the site was measured with film badges. The maximum cumulative dose was 769.3 mSv, and the median was 9.3 mSv; 95% of all individual cumulative doses were found to be less than 89.4 mSv.
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From page 138... ...
External radiation at the site was measured with film badges. The personnel recorded as being at risk for radiation exposure (classified by job status)
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From page 139... ...
Cumulative doses were lagged by 0, 2, and 10 years and adjusted for external radiation exposure. Mortality for all causes of death was significantly lower than expected (SMR, 72; 95% CI, 66-80)
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From page 140... ...
All available records were reviewed to determine whether a worker was monitored for radiation exposure externally or internally. External radiation exposure was determined annually, and bioassay data on radionuclide intake were estimated for 16 organs or tissues by using the International Commission on Radiological Protection models.
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From page 141... ...
Limitations include the small sample, the low doses recorded, and the incomplete availability of workers' smoking history. Savannah River Plant Workers The Savannah River Plant in Aiken, South Carolina, has been in production since 1952 and is engaged in a variety of processes: uranium processing; nuclearfuel fabrication; nuclear-reactor operation; nuclear-reactor overhaul, modification, and maintenance; nuclear-reactor refueling; and nuclear-fuel reprocessing.
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From page 142... ...
monitored external radiation exposure at two uranium-processing sites. The study population consisted of 86 processors at milling, monazite-production, and yellow-cake production locations who handled ores and materials that had high concentrations of naturally occurring radioactive materials.
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From page 143... ...
Linear regression was used in the analysis. Mean urinary uranium concentration was 17.8 µg/L in the 13 participants who provided spot urine specimens; urinary uranium ranged from 8-29 µg/L.
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From page 144... ...
Of the 33 examined, nearly half were confirmed through skeletal examination as having uranium fragments embedded in a number of locations throughout the soft tissue. They also had much higher mean urinary uranium concentrations than those without retained fragments (4.47 vs 0.03 µg/g of creatinine)
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From page 145... ...
Results were stratified at the median to create low- and high-result groups and compared with the results in the low- and highexposure groups to determine an association between higher and lower median tendencies. In a separate analysis, neurocognitive indexes were modeled as a function of urinary uranium concentration with adjustment for intelligence (the Wide Range Achievement Test 3 Reading, WRAT-3 Reading)
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From page 146... ...
Using published estimates of mean urinary uranium concentrations in unexposed groups (11-22 ng/L) and upper dietary limits as a result of naturally occurring uranium in groundwater (up to 0.35 µg/L)
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From page 147... ...
The relationship between urinary uranium and performance on automated measures observed in the 1994 and 1997 surveillance appeared to weaken and was only marginally significant when WRAT-3 and the BDI were adjusted for high and low urinary uranium. There were no statistically significant differences in concentrations of FSH, LH, prolactin, testosterone, TSH, or thyroid hormones between low and high groups.
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From page 148... ...
As in earlier studies, the authors investigated a number of clinical outcomes as related to urinary uranium concentrations 10 years after the initial exposure to uranium. In addition to the clinical measures assessed previously (McDiarmid et al., 2000, 2001)
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From page 149... ...
They examined 32 Gulf War veterans in April-July 2003 for hematologic and blood-chemistry measures, renal function, neurocognitive function, genotoxic measures, and reproductive neuroendocrine function and semen characteristics. Urinary-uranium results obtained in the 2003 examination were used for group composition, and a concentration of 0.10 µg/g of creatinine served as the cutpoint for high- and low-exposure groups.
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From page 150... ...
Despite the persistently increased urinary uranium concentrations, no clinical abnormality or dysfunction was observed. McDiarmid et al., 2007 In the 2005 surveillance, 34 members of the depleted-uranium–exposed Gulf War veteran group were examined 14 years after first exposure.
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From page 151... ...
Personnel were linked to the NHSCR to determine cancer diagnosis and vital status, and deaths were coded according to ICD-9. After exclusion of those who had died before the end of the Gulf War, those who had emigrated from the UK during the study period, and those whose vital status could not be determined, the Gulf War–deployed group consisted of 51,721 participants, and the nondeployed group consisted of 50,755 participants.
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From page 152... ...
SIRs were calculated on the basis of cancer registries for the general Italian male population. No measurement or modeling for depleted-uranium exposure was included.
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From page 153... ...
Environmental-Exposure Studies The studies reviewed below examine health outcomes in persons who lived near uranium-processing facilities or in households in Finland where well water with high uranium content was the primary source of drinking water. The studies are summarized in Table 7-3.
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From page 154... ...
There was no evidence that the observed cases were closer to the airfield than expected; that is, there was no clustering of cancers around the airfield. Boice et al., 2003b Reports of cancer clusters around nuclear facilities have prompted a number of population-based descriptive studies to determine whether cancer mortality has increased.
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From page 155... ...
. Researchers examined cancer mortality in the general population of Karnes County.
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From page 156... ...
Residential history by location was used to develop a crude exposure metric, which divided participants according to whether they had lived within 2 miles of the facility, lived in the direction of groundwater runoff from the facility, or obtained their drinking water from a well or cistern. The authors conducted interviews with area medical practitioners, examining physicians of the FMMP, local and state health officials, and community residents to obtain information about perceived disease excess.
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From page 157... ...
That is the case in various parts of Finland, where uranium concentrations in drilled wells can reach 12,000 μg/L. The proposed global limit for uranium in drinking water is 2 μg/L.
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From page 158... ...
Kurttio et al., 2002 Researchers investigated possible renal effects by evaluating relevant biomarkers in connection with uranium exposure through drinking water in Finland. The study population (n = 325)
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From page 159... ...
Uranium exposure metrics were similar to those used in the 2002 study (daily intake, uranium in urine, uranium in drinking water, and estimated cumulative intake from drinking water) ; uranium concentration in drinking water served as the primary measure.
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From page 160... ...
Blood pressure, body weight, and height were also measured. As in the previous study, urinary uranium was measured, as were daily intake, daily intake per unit body weight, intake from drinking water, and cumulative intake.
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From page 161... ...
Urinary uranium concentrations were an average of 44% greater than in prior sampling. In general, markers of renal function were within clinical limits.
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From page 162... ...
stomach cancer cases had used drinking water from drilled wells before 1981. Well-water samples for 274 controls and 88 cases were obtained in July-November 1996.
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From page 163... ...
, allowed assessment of potential bias. Limitations of the study include the lack of data on the amount of water consumed individually, of information on other sources of drinking water (for example, in the workplace)
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From page 164... ...
Boiano et al., 1989 Cross- 146 (70%) of 208 eligible long sectional term employees at Feed Materials Production Center after releases of uranium oxide from dust collectors in November-December 1984
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From page 165... ...
, year of first detect moderately employment increased risk of some outcomes of interest, inability to estimate individual exposures to uranium, silica, vanadium Self-reported exposure Lung, renal disease Smoking Limitations in incidents; job history; exposure based partly assessed urinary- on recall; crude and uranium data imprecise exposure categories (low, medium, high) Continued
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From page 166... ...
166 updated literature review of depleted uranium TABLE 7-1 Continued Person-Years Study Design Population Observed Ritz, 1999 Cohort 4,014 white male uranium-processing 124,177 workers employed in 1951-1989; followup through January 1, 1990 Oak Ridge, TN Polednak and Frome, Cohort 18,869 white male workers at 1981 uranium conversion and enrichment plant, employed in 1943-1947; followup until 1977 Checkoway et al., Cohort 6,781 white male employees at 133,535 1988 nuclear-weapons materials fabrication plant in May 4, 1947-December 31, 1974; followup through 1979
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From page 167... ...
COHORT DESCRIPTIONS 167 Exposure Outcomes Adjustments Comments External radiation Cancer mortality Controlled for Also ran further exposure derived from Social Security exposure to analyses by radiation from film-badge Administration, trichloroethylene, dose measurements; National Death Index cutting fluids internal radiation exposure based on combination of individual urine bioassays, environmental area sampling; assessed exposure to uranium, thorium, radium compounds Uranium-dust Mortality Age, calendar year exposure defined by departments and averages where employee worked Range of average concentrations of uranium in air: 25-300 µg/m3 Radiation exposure Mortality Age, calendar year assessed with film badges, estimates of dose equivalents delivered to lungs obtained from urinalysis measurements, in vivo counting of internally deposited uranium Mean cumulative alpha-radiation dose to lung 8.21 rem, mean cumulative external whole-body penetrating dose from gamma radiation 0.96 rem Continued
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From page 168... ...
168 updated literature review of depleted uranium TABLE 7-1 Continued Person-Years Study Design Population Observed Frome et al., 1990 Cohort 28,008 World War II nuclear-plant workers, white males employed at least 30 days in 1943-December 31, 1947; followup January 1, 1950 January 1, 1979 Loomis and Wolf, Cohort 6,591 white men, 922 white women, 1996 (continuation 449 black men, 149 black women, of Checkoway 5 men and women of other racial et al., 1988) groups who had worked at plant after 1947; 1,764 white men, 562 white women, 85 black men, 69 black women, 1 man of other racial group who had worked at plant before 1947 Richardson and Wing, Cohort; nested 3,864 nuclear-materials fabrication2006 case-control plant workers employed at least 30 days in May 4, 1947-December 31, 1974; followup through 1990 Frome et al., 1997 Cohort 106,020 workers at four plants in Oak Ridge, TN, employed at least 30 days in 1943-1985; followup through 1984
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From page 169... ...
External radiation Mortality Stratified by length exposure based on of employment, SES, limited monitoring; birth year, age internal radiation exposure categorized into three levels: eligible for monitoring but not monitored, eligible for monitoring and monitored, not eligible for monitoring Continued
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From page 170... ...
Dupree-Ellis et al., Cohort 2,514 white male uranium-processing 87,757 2000 plant workers employed in 1942 1966; followup through 1993 Portsmouth Uranium Enrichment Facility, Pike County, OH Brown and Bloom, Retrospective 5,773 white male employees who 1987 cohort had worked for at least 1 week in September 1954-February 1982
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From page 171... ...
1954) used to identify limited ability departments with to assess cancer potential exposure; outcomes departments ranked by relative degree of Study included potential exposure in Gulf War and Health, Volume 1, Other data included but additional cancer continuous air outcomes included in sampling, personal current report sampling of external radiation with film badges, dosimeters, in vivo counting Continued
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From page 172... ...
Hadjimichael et al., Retrospective 4,106 employees of plant who had 1983 cohort ever worked for more than 6 months in 1956-1978 New Cohorts (Not Evaluated in Gulf War and Health, Volume 1) UK (Springfields)
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From page 173... ...
COHORT DESCRIPTIONS 173 Exposure Outcomes Adjustments Comments Mortality Age, sex, race, Lack of exposure calendar year information Study included in Gulf War and Health, Volume 1, but additional cancer outcomes included in current report Exposure groups Mortality from Age, sex, calendar Potential exposure based on film badges Social Security year, cause of death or overlap between worn by employees, Administration cancer site groups due to job classification, records, Connecticut multiple exposures; consultation with mortality records; did not quantify industrial hygiene, cancer incidence from degree of exposure safety personnel, Connecticut Tumor for individuals or supervisors, employees Registry groups who had been at plant since operation began Study included in Gulf War and Job experience Health, Volume 1, obtained from but additional cancer personnel records outcomes included in current report Radiation dosimetry Mortality, cancer Age, sex, calendar Additional analyses collected for morbidity from 1971- year, industrial by dose, lag time compliance with December 31, 1995 status (industrial statutory radiation- or nonindustrial) , protection guidelines; worker status, year of used film badges joining, time from first and recorded mSv; exposure, length of included doses service acquired from other sites for workers transferred into plant Mean individual cumulative external whole-body dose: 22.8 mSv (analysis A)
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From page 174... ...
174 updated literature review of depleted uranium TABLE 7-1 Continued Person-Years Study Design Population Observed UK (Chapelcross) McGeoghegan and Cohort 2,628 nuclear-fuels workers ever Binks, 2001 employed in 1955-1995; followup 1955-December 31, 1995 UK (Capenhurst)
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From page 175... ...
, protection guidelines; workers status, year used film badges of joining, time from and recorded mSv; first exposure, length included doses of service acquired from other sites for workers transferred into plant Mean cumulative external whole-body dose: 9.85 mSv Doses estimated Mortality Pay categories used by urine or feces as proxy for SES, bioassay, in vivo smoking status whole-body counts, lung counts Company did not collect information Estimated internal on race before 1972, cumulative dose to although 96% of lung of each employee deceased workers were was calculated white Mean lung dose: 2.1 mSv Continued
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From page 176... ...
176 updated literature review of depleted uranium TABLE 7-1 Continued Person-Years Study Design Population Observed Boice et al., 2006a Retrospective 5,801 radiation workers monitored 161,605 cohort for radiation and employed on or after January 1, 1948, for at least 6 months; person-years of followup began 6 months after date of first radiation monitoring or July 1, 1948, and stopped at date of death, December 31, 1999, age of 95 years, or date lost to followup Savannah River Plant Cragle et al., 1988 Retrospective 9,860 white male employees who 232,061 cohort worked at plant in 1952-1981 and were hired before 1975; followup through 1980 Atomic Weapons Establishment, UK Beral et al., 1988 Retrospective 22,552 employees who worked cohort at establishment in January 1, 1951-December 31, 1982; followup through 1982 Egyptian Processors Shawky et al., 2002 Cross-sectional 86 processors at two sites in Egypt working in three locations, 13 of whom also participated in urinary uranium analysis
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From page 177... ...
Exposure measured Mortality Age, sex, calendar with dosimeters worn period, social class externally Average exposures per radiation worker, 7.8 mSv (whole-body exposure) , 14.4 mSv (surface exposure)
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From page 178... ...
178 updated literature review of depleted uranium TABLE 7-2 Studies of Depleted-Uranium–Exposed Persons Study Design Population Exposure Baltimore VA Medical Center Study McDiarmid Case series 29 exposed GW veterans Exposure to DU by means of et al., 2000 exposed to DU during friendly fire; may have inhaled friendly-fire incidents in or ingested airborne DU February 1991, particles, and/or experienced 38 DU-nonexposed wound contamination by DU; veterans; examined in assessed urine and semen March-June 1997, 7 years uranium concentration after first exposure Veterans with DU fragments: 0.01-30.7 µg/g creatinine vs nonexposed: 0.01-0.05 µg/g creatinine McDiarmid Case series 50 exposed GW veterans Exposure to DU by means of et al., 2001 divided into low-uranium, friendly fire; may have inhaled high-uranium groups; or ingested airborne DU examined in March-July particles, and/or experienced 1999, 8 years after first wound contamination by exposure DU; assessed urine uranium concentration Veterans with DU fragments: 0.018-39.1 µg/g creatinine vs DU-exposed veterans without fragments: 0.002-0.231 µg/g creatinine McDiarmid Case series 29 exposed GW veterans, 38 Exposure to DU by friendly et al., 2002 nonexposed GW veterans, fire; may have inhaled 30 newly identified exposed; or ingested airborne DU examined in spring 1999 particles, experienced wound contamination by DU; assessed urinary uranium McDiarmid Case series 39 GW veterans exposed Exposure to DU by friendly et al., 2004 to DU during friendly-fire fire; may have inhaled, incidents in February 1991; ingested airborne DU examined in April-July; particles, experienced wound followup in 1994-2001 contamination by DU; assessed urinary uranium Low-uranium group, <0.1 µg/g of creatinine; high uranium group, ≥0.1 µg/g of creatinine
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From page 179... ...
, concentrations of thyroid- depression (BDI) , smoking stimulating hormone, free status, use of prescription thyroxine; reproductive psychotropic, antidepressant neuroendocrine indicators, drugs, recent X-ray exposure semen characteristics reported in McDiarmid et al., 2000 Urinary uranium determinations; Small sample clinical laboratory values; psychiatric, neurocognitive assessment Hematologic, renal function; Age, smoking, exposure to No comparison group, small immunologic measures; genetic toxicants, cloning sample genetoxicity; neurocognitive, efficiency psychiatric assessment; reproductive characteristics reported in McDiarmid et al., 2001 Continued
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From page 180... ...
180 updated literature review of depleted uranium TABLE 7-2 Continued Study Design Population Exposure McDiarmid Case series 32 GW veterans exposed Exposure to DU by friendly et al., 2006 to DU during friendly fire; fire; may have inhaled, examined in April-July 2003 ingested airborne DU particles, experienced wound contamination by DU; assessed urinary uranium Low-uranium group, <0.1 µg/g of creatinine; high-uranium group, ≥0.1 µg/g of creatinine McDiarmid Case series 34 GW veterans exposed Exposure to DU by friendly et al., 2007 to DU during friendly-fire fire; may have inhaled, incidents in 1991; examined ingested airborne DU in April-June 2005 particles, experienced wound contamination by DU; assessed urinary uranium; both current and cumulative exposure measures reported Low-uranium group, <0.1 µg/g of creatinine; high-uranium group, ≥0.1 µg/g of creatinine UK Gulf War Veterans Macfarlane Cohort 51,721 UK GW veterans, Deployment to GW; selfet al., 2003 50,755 nondeployed UK reported exposure to DU service personnel; followup April 1, 1991-July 31, 2002 Balkans Cohorts Gustavsson Cohort 9,188 Swedish military Deployment to UN missions in et al., 2004 personnel deployed to UN Balkans missions in Balkans in 1989-1999; followed up through December 31, 1999; 39,816 person-years Nuccetelli Summary of 40,000 Italian soldiers Deployment to Balkans et al., 2005 data presented deployed to Balkans at in Italian least once in 1995-2001 Defence (followup time not reported) Ministry study published in Italian in 2002
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From page 181... ...
COHORT DESCRIPTIONS 181 Outcomes Adjustments Comments Hematologic characteristics; Age, intelligence, emotional Small sample, no true renal function; neurocognitive status, smoking, exposure comparison group measures; genotoxicity; to genetic toxicants, cloning reproductive characteristics efficiency reported in McDiarmid et al., 2001 Hematologic, renal function; Age, IQ, depression, cloning Small sample, no true neurocognitive, psychiatric efficiency comparison group measures; genotoxicity measures; reproductive characteristics reported in McDiarmid et al., 2001 Cancer DU analysis adjusted Latency of many cancers is for smoking, alcohol beyond time of study consumption; matched for age, sex, rank, service, level of fitness Cancer Sex, age, period Short followup period for cancer Cancer Continued
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From page 182... ...
182 updated literature review of depleted uranium TABLE 7-2 Continued Study Design Population Exposure Storm et al., Population- Danish military deployed to Deployment to Balkans 2006 based Balkans (13,552 men, 460 retrospective women) ; followup from cohort January 2002 to December 2002 Sumanovic- Pre-post All liveborn and stillborn Living in western Herzegovina Glamuzina comparison neonates in Maternity after military activities et al., 2003 Ward of Mostar University Hospital in western Herzegovina, part of Bosnia and Herzegovina, immediately (1995)
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From page 183... ...
COHORT DESCRIPTIONS 183 Outcomes Adjustments Comments Cancer Age-, sex-, period-specific Few cases, wide CIs, young SIRs cohort Major congenital malformations Not known whether DU was used in region
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From page 184... ...
184 updated literature review of depleted uranium TABLE 7-3 Studies of Environmental Exposure to Uranium Reference Design Population Exposure Residential Studies Bithell and Modeling Those living within 6 km of Environmental uranium (for Draper, 1999 Air Force base example, in leaves) Boice et al., Cross-sectional 16,722 people living in Residential proximity to 2003a 8 municipalities in PA; Apollo, Parks nuclear cancer-mortality records facilities in PA from Pennsylvania Cancer Registry for 1993-1997; reference, PA or national SEER registry Boice et al., Ecologic Mortality data from NCI, Residential proximity to 2003c mortality Texas Department of Health uranium-processing site survey for 1950-2001 Cases, Karnes County (site of uranium mining)
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From page 185... ...
Cancer mortality Matched on demographics No adjustment for diet, smoking, other cancer risk factors; no determination of length of residence (and hence exposure) Goiter, other thyroid disease, Age, sex Study questionnaires not chronic bronchitis, asthma, directly comparable; FMMP emphysema, nephritis, other is self-selected volunteer renal disease, diabetes mellitus group Continued
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From page 186... ...
Median daily uranium intake, 39 μg (range, 7-224 μg) Kurttio et al., Cross-sectional 146 men, 142 women in Median drinking-water 2005 southern Finland who obtain uranium concentration, 27 (same drinking water from drilled μg/L (interquartile range, population as wells used an average of 6-116 μg/L)
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From page 187... ...
Exposure assessment: uranium concentration in drinking water, hair, nails, urine Association with uranium, radon, Age, sex No dose-response radium assessment; no adjustments for other risk factors Continued
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From page 188... ...
188 updated literature review of depleted uranium TABLE 7-3 Continued Reference Design Population Exposure Auvinen et al., Nested 88 stomach-cancer cases, Well-water samples 2005 case-control 274 stratified randomly collected blind sampled people from in July-November 1996 subcohort who obtained water from drilled wells Median activity before 1981 concentration for both cases and reference group, 130 Bq/L Kurttio et al., Nested Cases, 61 bladder-cancer Drilled well water outside 2006b case-control cases, 51 renal-cancer cases municipal water supply diagnosed in 1981-1995; obtained in 1967-1980 controls, 274 randomly sampled people stratified by Uranium concentrations: sex, age bladder cancer, 0.08 Bq/L; renal cancer,0.07 Bq/L; reference, 0.06 Bq/L
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From page 189... ...
COHORT DESCRIPTIONS 189 Outcomes Adjustments Comments Association with uranium, radon, Age, sex No dose-response radium assessment; no adjustments for other risk factors Association with radon, radium, Bladder cancer: age at Exposures measured only up uranium exposure followup, sex, smoking status to 10 years before diagnosis to account for cancer latency Renal cancer: age, sex, smoking, BMI
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From page 190... ...
2000. External radiation exposure and mortality in a cohort of uranium processing workers.
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From page 191... ...
2002. Health effects and biological monitoring results of Gulf War veterans exposed to depleted uranium.
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From page 192... ...
2000. The effects of internal radiation exposure on cancer mortality in nuclear workers at Rocketdyne/Atomics International.
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