Gulf War and Health Updated Literature Review of Depleted Uranium (2008) / Chapter Skim
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8 Conclusions
8 Conclusions
Pages 193-262
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From page 193... ...
Most of the studies examined cancer mortality, but several studies of UK Gulf War veterans, Balkans veterans, and the Finnish drinking-water cohort also investigated cancer incidence. Because several cancers of interest are associated 193
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From page 194... ...
. Four of the uraniumprocessing studies reported statistically significantly increased standardized mortality ratios (SMR)
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From page 195... ...
(2004) reported a statistically nonsignificant increase in lung cancer mortality among uranium millers (SMR, 113; 95% CI, 89-141, compared to US referent rates)
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Leukemia is a relatively uncommon malignancy, so large study populations are generally needed to demonstrate any significant moderate effects. The studies reviewed by the committee generally did not have adequate sample size.
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From page 197... ...
On the basis of the available evidence, the committee concludes that there is a lack of strong and consistent evidence of an association between uranium exposure and lymphatic cancers. The finding is unchanged when one considers evidence from the studies with larger samples and stronger designs: there is no consistent evidence of effect.
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From page 198... ...
Given that bone cancer is a relatively uncommon malignancy, relatively large study populations are generally needed to demonstrate any significant moderate effects. The studies reviewed by the committee generally did not have adequate sample size.
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From page 199... ...
Bladder Cancer The committee evaluated 20 published studies of a potential association between exposure to natural or depleted uranium and bladder cancer: 14 uraniumprocessing studies, two studies of military populations, and four residential studies (see Table 8-8)
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That overall pattern is unchanged if one restricts attention to the larger or better designed studies. Only two studies had significant results: significant decreases in risk after uranium exposure.
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Male Genital Cancers Prostatic cancer is the most frequently diagnosed cancer in men in the United States, and any increase in risk could result in a large increase in the number of cases or deaths. Testicular cancer, the most common cancer among young men, is of special interest to Gulf War veterans, and some studies of veterans suggested a higher but nonsignificantly increased risk (IOM, 2006)
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From page 202... ...
Despite the inconsistent evidence, testicular cancer is of special interest to Gulf War veterans. The committee believes that further study of an association between depleted uranium and testicular cancer may be warranted but should not be assigned a high priority.
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From page 203... ...
. It did not find a statistically significant increase in cancer incidence (mortality rate ratio, 1.01; 95% CI, 0.79-1.30)
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From page 204... ...
Urinary uranium ranged from 0.01 to 30.74 µg/g of The confidence interval was calculated by the Committee on Health Effects Associated with Exposure During the Gulf War; it was not stated in the original study (IOM, 2000)
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From page 205... ...
Of the 34 veterans with depleted-uranium shrapnel, 10 had current urinary uranium concentrations that exceeded the cutpoint of 0.10 μg/g of creatinine. The same number had cumulative urinary uranium concentrations over the cutpoint of 10 μg/g of creatinine.
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From page 206... ...
found that urinary uranium concentrations were an average of 44% greater than during prior sampling. The study further examined renal toxicity due to uranium exposure through drinking water in 193 of the 325 people included in the 2002 study.
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From page 207... ...
Gulf War veterans exposed to depleted uranium in embedded shrapnel had minor changes in renal measures and increased urinary uranium concentrations over the course of a 14-year followup, but overall mean values remained within normal clinical ranges. The studies of well-water users in Finland thoroughly characterized the nature of exposure but examined renal effects in a small group and included a relatively short followup.
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From page 208... ...
Additional studies of larger numbers of exposed people with well-characterized exposure and renal outcomes will be needed before any definitive conclusions can be drawn about a nephrotoxic effect of exposure to depleted uranium in a war theater. On the basis of the available evidence, the committee would assign a high priority to further study of an association between exposure to depleted uranium and nonmalignant renal disease.
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From page 209... ...
to assess neurocognitive performance in veterans. Results of the evaluation of Gulf War veterans suggested a statistically significant relationship between increased urinary uranium concentrations and poor performance on automated neuropsychologic tests regardless of the models used (24-hour-urine uranium in depleted-uranium–exposed veterans, p = 0.01; spot-urine uranium in all veterans, p = 0.01)
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From page 210... ...
. McDiarmid and colleagues evaluated endocrinologic function in Gulf War veterans by measuring blood concentrations of follicle-stimulating hormone (FSH)
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From page 211... ...
Mean values of semen characteristics also showed no statistically significant differences; however, the percentages of progressive sperm and rapid progressive sperm were lower in the high-uranium group on the basis of the current urinaryuranium metric (McDiarmid et al., 2007)
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From page 212... ...
(6.35 ± 0.267 vs 5.52 ± 0.182; p = 0.03) in cultured peripheral-blood lymphocytes from members of the highurinary-uranium group in the 1999 medical surveillance of depleted-uranium– exposed Gulf War veterans.
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From page 213... ...
. Overall, increased urinary uranium excretion had little effect on hematologic measures.
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From page 214... ...
Most of the evidence on health outcomes of exposure to uranium comes from studies of workers in uranium-processing mills and other facilities, and the committee relied heavily on those studies in developing its conclusions. It also considered studies of Gulf War veterans who were exposed to depleted uranium and studies of residential exposure to uranium.
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From page 215... ...
• The magnitude or frequency of a health outcome may be so low that it cannot be reliably detected given the sizes of the study populations. • The available studies had limitations (for example, inadequate exposure assessment or followup that was too short)
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From page 216... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Wagoner et al., Uranium mills, Colorado 611 0 1.9 0 NS 1964 Plateau (all respiratory cancers) Archer et al., Uranium mills, Colorado 622 4 4.26 94 NS (–3 to 191, 1973 Plateau (all respiratory from Volume 1)
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Stayner et al., Phosphate-fertilizer 3,199 10 8.85 113 61-192 1985 production plant, FL Dupree et al., Uranium-processing plant, 995 21 21.7 97 60-148 1987 Buffalo, NY Brown and Uranium-enrichment plant, 5,773 48 54.6 88 65-117 Bloom, 1987 OH Cragle et al., Nuclear-fuels production 9,860 53 (hourly) 62.04 (hourly)
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p < 0.001 2000b Lancashire, UK (radiation workers) Studies of Depleted-Uranium–Exposed Persons Macfarlane et al., Gulf War veterans, UK 51,721 14 cases 18 cases (IRR, 0.76)
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0.90-1.30 2003c uranium milling and mining site, TX NOTE: FTR = Freeman-Tukey residuals, IRR = incidence rate ratio, NR = not reported, NS = not significant, OR = odds ratio, RR = relative risk, SIR = standardized incidence ratio, SMR = standardized mortality ratio, WM = white men, + = corrected for incomplete ascertainment, ++ = adjusted for smoking and alcohol consumption.
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From page 220... ...
<10 Referent <10 Referent 10-49.9 1.52 10-49.9 0.74-3.13 50-99.9 1.20 50-99.9 0.54-2.67 100+ 1.40 100+ 0.65-3.01 NOTE: CI = confidence interval, RR = rate ratio, SMR = standardized mortality ratio.
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From page 221... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Archer et al., 1973 Uranium mills, Colorado 622 1 0.79 127 NS Plateau Waxweiler et al., 1983 Uranium mills, Colorado 2,002 0 4.5 0 NS Plateau Pinkerton et al., 2004 Uranium mills, Colorado 1,485 5 7.62 66 21-153 Plateau Polednak and Frome, Y-12 uranium-processing 18,869 40 43.57 92 66-125 1981 plant, Oak Ridge, TN 102 (corrected+) 74-137 Checkoway et al., 1988 Y-12 uranium-fabrication 6,781 4 NR 50 14-128 plant, Oak Ridge, TN (comparison with US white men)
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Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Hadjimichael et al., 1983 Nuclear-fuel fabricating 2,613 2 1.8 113 13-409 plant, CT (men) Beral et al., 1988 Atomic Weapons 22,552 4 9.16 44 NS Establishment, UK (employees with radiation records)
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NOTE: CI = confidence interval, HR = hazard ratio, NA = not applicable (case-control study) , NR = not reported, NS = not significant, RR = relative risk, SIR = standardized incidence ratio, SMR = standardized mortality ratio, + = corrected for incomplete ascertainment.
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From page 224... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Waxweiler et al., 1983 Uranium mills, Colorado 2,002 3 1.3 231 48-675 Plateau Pinkerton et al., 2004 Uranium mills, Colorado 1,485 4 1.21 330 90-843 Plateau Polednak and Frome, Y-12 uranium-processing 18,869 9 16.38 55 NS 1981 plant, Oak Ridge, TN Checkoway, 1988 Y-12 uranium-fabrication 6,781 3 NR 87 18-254 plant, Oak Ridge, TN (comparison with US white men) Frome et al., 1990 Y-12, K-25 uranium- 28,008 18 23 78 NS enrichment plant, research labatory, Oak Ridge, TN Loomis and Wolf, 1996 Y-12 uranium-fabrication 10,597 3 NR 62 13-183 plant, Oak Ridge, TN Frome et al., 1997 All four plants, Oak 106,020 40 NR 77 NS Ridge, TN (white men)
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0.9-3.6 uranium milling and mining site, TX NOTE: CI = confidence interval, NR = not reported, NS = not significant, RR = relative risk, SIR = standardized incidence ratio, SMR = standardized mortality ratio.
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From page 226... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Archer et al., 1973 Uranium mills, Colorado 662 4 lymphatic, 1.02 392 p < 0.05 Plateau hematopoietic cancers Waxweiler et al., 1983 Uranium mills, Colorado 2,002 4 lymphatic cancers 4.4 91 NS Plateau Pinkerton et al., 2004 Uranium mills, Colorado 1,485 12 lymphatic cancers 9.86 122 NS Plateau Polednak and Frome, Y-12 uranium-processing 18,869 17 lymphosarcoma, 25.39 67 NS 1981 plant, Oak Ridge, TN reticulosarcoma 11 other lymphatic tissue 19.27 57 NS Checkoway et al., 1988 Y-12 uranium-fabrication 6,781 3 lymphosarcoma NR 62 13-181 plant, Oak Ridge, TN 9 other lymphatic cancers NR 186 85-353 Frome et al., 1990 Y-12, K-25 uranium- 28,008 39 lymphosarcoma, 45.80 85 NS enrichment plant, research reticulosarcoma 48.23 83 NS laboratory, Oak Ridge, TN 40 other lymphatic cancers Loomis and Wolf, 1996 Y-12 uranium-fabrication 10,597 4 lymphosarcoma, NR 50 14-129 plant, Oak Ridge, TN reticulosarcoma 22 other lymphatic NR 132 82-199 cancers
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From page 227... ...
NS Beral et al., 1988 Atomic Weapons 22,552 3 NHL 6.17 49 NS Establishment, UK (employees with radiation 2 multiple myeloma 3.55 56 NS records) Ritz, 1999 Uranium-processing plant, 4,014 8 lymphosarcoma, and 4.79 167 72-329 OH reticulosarcoma 10 lymphatic tissue 9.94 101 48-185 Dupree-Ellis et al., 2000 Uranium-processing plant, 2,514 1 lymphosarcoma NR 28 1-156 St Louis, MO 5 multiple myeloma NR 130 42-303 9 other lymphoid tissue NR 96 43-186 Ritz et al., 2000 Rocketdyne/Atomics 2,297 4 lymphatic cancers 8.98 45 NS International plant, CA Continued 227
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From page 228... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Boice et al., 2006 Rocketdyne/Atomics 5,801 19 NR 98 59-152 International plant, CA McGeoghegan and Binks, Capenhurst uranium 12,540 NHL: 2000a enrichment plant, 5 deaths (50 y) 4.58 deaths 109 NS Cheshire, UK (radiation 3 cases (20 y)
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From page 229... ...
0.8-2.3 myeloma NOTE: CI = confidence interval, NHL = non-Hodgkin lymphoma, NR = not reported, NS = not significant, RR = relative risk (computed as ratio of SMR of study population to that of control population) , SIR = standardized incidence ratio, SMR = stanardized mortality ratio.
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From page 230... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Polednak and Frome, Y-12 uranium-processing 18,869 6 6.68 90 33-196 1981 plant, Oak Ridge, TN 100 (corrected+) 40-206 Frome et al., 1990 Y-12, K-25 uranium- 28,008 11 10.35 106 NS enrichment plant, research laboratory, Oak Ridge, TN Loomis and Wolf, 1996 Y-12 uranium-fabrication 10,597 1 NR 62 1-345 plant, Oak Ridge, TN Frome et al., 1997 All four plants, Oak Ridge, 106,020 25 NR 119 NS TN (white men)
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From page 231... ...
0.7-2.8 uranium milling and mining site, TX NOTE: CI = confidence interval, NR = not reported, NS = not significant, RR = relative risk (computed as ratio of SMR in study population to that in control population) , SIR = standardized incidence ratio, SMR = standardized mortality ratio, + = corrected for incomplete ascertainment.
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From page 232... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Waxweiler et al., 1983 Uranium mills, Colorado 2,002 3 2.7 112 23-325 Plateau Pinkerton et al., 2004 Uranium mills, Colorado 1,485 4 4.96 81 22-206 Plateau Polednak and Frome, Y-12 uranium-processing 18,869 20 26.54 75 NS 1981 plant, Oak Ridge, TN Checkoway et al., 1988 Y-12 uranium-fabrication 6,781 6 NR 122 45-266 plant, Oak Ridge, TN (comparison with US white men) Frome et al., 1990 Y-12, K-25 uranium- 28,008 44 52.63 84 NS enrichment plant, research laboratory, Oak Ridge, TN Loomis and Wolf, 1996 Y-12 uranium-fabrication 10,597 16 NR 130 74-211 plant, Oak Ridge, TN Frome et al., 1997 All four plants, Oak Ridge, 106,020 109 NR 92 NS TN (white men)
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58-177 near two former nuclear material processing plants, PA Boice et al., 2003b County residents near two 443,799 784 deaths NR (RR, 1.02) 0.94-1.12 former nuclear-material processing plants, PA Boice et al., 2003c Residents near former 12,455 19 NR (RR, 0.58)
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From page 234... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Polednak and Frome, Y-12 uranium-processing 18,869 26 32.32 80 NS 1981 plant, Oak Ridge, TN Checkoway et al., 1988 Y-12 uranium-fabrication 6,781 3 NR 72 15-210 plant, Oak Ridge, TN (comparison with US white men) Frome et al., 1990 Y-12, K-25 uranium- 28,008 54 66.22 82 NS enrichment plant, research laboratory, Oak Ridge, TN Loomis and Wolf, 1996 Y-12 uranium-fabrication 10,597 8 NR 72 31-142 plant, Oak Ridge, TN Frome et al., 1997 All four plants, Oak Ridge, 106,020 105 NR 76 NS TN (white men)
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From page 235... ...
90-450 Balkans Studies of Environmental Exposures to Uranium Boice et al., 2003a Residents of municipalities 16,772 36 cases 30.2 case (SIR, 119) 83-165 near two former nuclear material processing plants, PA Boice et al., 2003b County residents near two 443,799 1,044 deaths NR (RR, 0.97)
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From page 236... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Polednak and Frome, Y-12 uranium-processing plant, Oak 18,869 32 33.83 95 NS 1981 Ridge, TN Checkoway et al., Y-12 uranium-fabrication plant, Oak 6,781 14 NR 180 98-302 1988 Ridge, TN (comparison with US white men) Frome et al., 1990 Y-12, K-25 uranium-enrichment 28,008 69 59.57 116 NS plant, research laboratory, Oak Ridge, TN Loomis and Wolf, Y-12 uranium-fabrication plant, Oak 10,597 20 NR 129 79-200 1996 Ridge, TN Frome et al., 1997 All four plants, Oak Ridge, TN 106,020 151 (brain only)
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From page 237... ...
0.88-1.04 nuclear-material processing plants, PA Boice et al., 2003c Residents near former uranium milling 12,455 24 deaths NR (RR, 0.92) 0.6-1.4 and mining site, TX NOTE: CI = confidence interval, IRR = incidence rate ratio, NR = not reported, NS = not significant, RR = relative risk, SIR = standardized incidence ratio, SMR = standardized mortality ratio, ++ = adjusted for smoking and alcohol consumption.
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From page 238... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Waxweiler et al., 1983 Uranium mills, Colorado Plateau 2,002 3 7.5 40 8-117 Polednak and Frome, Y-12 uranium-processing plant, Oak 18,869 53 72.33 73 NS 1981 Ridge, TN Checkoway et al., 1988 Y-12 uranium-fabrication plant, Oak 6,781 5 NR 57 19-133 Ridge, TN (comparison with US white men) Frome et al., 1990 Y-12, K-25 uranium-enrichment 28,008 93 119.92 78 NS plant, research laboratory, Oak Ridge, TN Loomis and Wolf, 1996 Y-12 uranium-fabrication plant, Oak 10,597 12 NR 64 33-112 Ridge, TN Frome et al., 1997 All four plants, Oak Ridge, TN 106,020 176 NR 73 NS (white men)
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From page 239... ...
cancer cases, 274 controls NOTE: CI = confidence interval, HR = hazard ratio, NA = not applicable (case-control study) , NR = not reported, NS = not significant, RR = relative risk, 239 SIR = standardized incidence ratio, SMR = standardized mortality ratio.
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From page 240... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Polednak and Frome, Uranium mills, Colorado Plateau 1,485 49 60.71 81 NS 1981 Waxweiler et al., 1983 Uranium mills, Colorado Plateau 2,002 6 8.5 71 26-154 Checkoway et al., 1988 Y-12 uranium-fabrication plant, 6,781 7 NR 92 37-190 Oak Ridge, TN (comparison with US white men) Frome et al., 1990 Y-12, K-25 uranium-enrichment 28,008 150 141.96 106 NS plant, research laboratory, Oak Ridge, TN Loomis and Wolf, 1996 Y-12 uranium-fabrication plant, 10,597 36 NR 131 91-181 Oak Ridge, TN Frome et al., 1997 All four plants, Oak Ridge, TN 106,020 319 NR 101 NS (white men)
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From page 241... ...
0.7-1.2 milling and mining site, TX NOTE: CI = confidence interval, IRR = incidence rate ratio, NR = not reported, NS = not significant, RR = relative risk, SIR = standardized incidence ratio, SMR = standardized mortality ratio, ++ = adjusted for smoking and alcohol consumption.
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From page 242... ...
Expected Study Cohort/Study Site Population Cases/Deaths Cases/Deaths SMR 95% CI Studies of Uranium Processors Dupree-Ellis et al., 2000 Uranium-processing plant, St 2,514 1 NR 93 5-408 Louis, MO Ritz, 1999 Uranium-processing plant, 4,014 1 1.46 67 1-374 OH Frome et al., 1997 All four plants, Oak Ridge, 106,020 18 NR 72 NS TN (white men) Beral et al., 1988 Atomic Weapons 22,552 1 1.72 58 NS Establishment, UK Pinkerton et al., 2004 Uranium mills, Colorado 1,485 15 19.67 76 43-126 Plateau Polednak and Frome, Y-12 uranium-processing 18,869 4 7.29 55 NS 1981 plant, Oak Ridge, TN Frome et al., 1990 Y-12, K-25 uranium- 28,008 7 9.61 73 NS enrichment plant, research laboratory, Oak Ridge, TN Loomis and Wolf, 1996 Y-12 uranium-fabrication 10,597 0 NR 0 0-159 plant, Oak Ridge, TN
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From page 243... ...
11-342 near two former nuclear material processing plants, PA NOTE: CI = confidence interval, IRR = incidence rate ratio, NR = not reported, NS = not significant, SIR = standardized incidence ratio, SMR = standardized mortality ratio, ++ = adjusted for smoking and alcohol consumption.
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From page 244... ...
Disease Classification Waxweiler et al., 1983 Uranium mills, 2,002 6 3.6 167 (60-353) ICD-7 592-594 Colorado Plateau Pinkerton et al., 2004 Uranium mills, 1,484 8 5.91 135 (58-267)
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From page 245... ...
Genitourinary diseases 2000a Capenhurst Cragle et al., 1988 Nuclear-fuels production facility, 9,860 4 10.27 39 (10-96) d ICDA-8 580-629 Savannah River Plant, SC NOTE: CI = confidence interval, ICD = International Classification of Diseases, ICDA = International Classification of Diseases, Adapted, NR = not reported, SMR = standardized mortality ratio.
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From page 246... ...
TABLE 8-14 Nonmalignant Renal Disease -- Morbidity Risk 246 Health Outcomes or Study Population Exposure Outcome Measures Results Adjustments Gulf War Veterans Depleted-Uranium Surveillance Study McDiarmid et al., 29 exposed Gulf War Exposure to DU by Serum creatinine, No statistically significant Stratification 2000 veterans exposed to friendly fire, may have beta-2-microglobulin, differences in renal at median into DU during friendly-fire inhaled or ingested retinol-binding protein, function between low- and low and high Case series incidents in February airborne DU particles, serum uric acid, urinary high-exposure groups result groups 1991, 38 unexposed experienced wound creatinine, urinary veterans; examined in contamination by DU; protein March-June 1997, 7 years assessed urinary, seminal after first exposure uranium concentration McDiarmid et al., 50 exposed Gulf War Exposure to DU by Same as in McDiarmid No statistically significant 2001 veterans divided into low- friendly fire, may have et al., 2000 differences in renal uranium, high-uranium inhaled or ingested function between low- and Case series groups; examined in airborne DU particles, high-uranium-exposure March-July 1999, 8 years experienced wound groups after first exposure contamination by DU; assessed urinary uranium Mean values in normal concentration range McDiarmid et al., 39 Gulf War veterans Same exposure as in Serum calcium, serum Renal-function measures 2004 exposed to DU during McDiarmid et al., 2001 phosphate, urinary (normal range) : friendly-fire incidents in calcium, urinary Serum creatinine (0.5-1.1 Case series February 1991; followup phosphate, measures in mg/dL)
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From page 247... ...
; low-uranium group, 54.63 ± 4.94; high-uranium group, 78.69 ± 10.52; p = 0.01 McDiarmid et al., 32 Gulf War veterans Same exposure as in Urinary IAP, NAG, Renal-function measures 2006 exposed to DU during McDiarmid et al., 2001 urinary microalbumin, (normal range) : friendly-fire incidents; measures in McDiarmid Serum PO4 (2.7-4.5 mg/ Case series examined in April-July et al., 2004 dL)
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From page 248... ...
; low first exposure contamination by DU; cumulative-uranium assessed urinary uranium group, 6.19 ± 0.26; concentration, both current high-cumulative-uranium and cumulative exposure group, 5.22 ± 0.46; measures reported p = 0.03 No statistically significant differences between high and low-urinary-uranium exposure groups for other renal measures Drinking-Water and Residential Exposure Kurttio et al., 2002 325 people in Finland Median drinking-water Urinary, serum calcium, Statistically significant Uranium who obtain drinking water uranium concentration, 28 phosphate, glucose, association between exposure Cross-sectional from drilled wells used an μg/L (interquartile albumin, creatinine, uranium exposure from adjusted for average of 13 years range, 6-135 μg/L; beta-2-microglobulin drinking water and age, sex, and maximum, 1,920 (μg/L) as biomarkers of renal tubular function: calcium body mass function fractional excretion, index Median urinary uranium p < 0.05 for all types concentration, 13 ng/ of exposure; phosphate mmol of creatinine (2-75)
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From page 249... ...
cell toxicity, renal water not statistically index, dysfunction significantly associated smoking, use Median drinking-water with indicators of cell of analgesics uranium concentration, 25 Exposure assessment: toxicity, renal proximal μg/L (interquartile uranium in drinking tubular function, range, 5-148 μg/L; water, hair, nails, urine glomerular function maximum, 1,500 μg/L) Statistically significant association between cumulative uranium intake and glucose excretion (p = 0.02)
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From page 250... ...
Other kidney trouble, NEC: SPR, 111 (99% CI, 68-172) Chronic nephritis: SPR, 203 (99% CI, 76-435)
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From page 251... ...
of 208 eligible incidents, job history, microglobulin, retinol- glomerular and tubular Cross-sectional long-term employees at assessed urinary-uranium binding protein, markers and measures of FFMPC after releases of data albumin, total protein, uranium exposure uranium oxide from dust creatinine collectors in November December 1984 Urine: uranium, beta 2-microglobulin, retinol-binding protein, NAG, gamma-glutamyl transpeptidase, alanine aminopeptidase, creatinine, total protein, albumin Shawky et al., 2002 86 processors at three sites Air uranium Renal-function Mean urinary uranium in Egypt, 13 of whom also concentration, 22.6 × 10–7 indicators: serum concentration, 17.8 μg/L; Cross-sectional participated in urinary- -11.1 × 10–5 Bq/cm3 creatinine, urea, urinary in subgroup from ore uranium analysis uranium crushing site, 29.2 μg/L Exposure, 1-80 μSv/h Uranium excretion more than 20 times occupational-exposure decision level NOTE: BDI = Beck Depression Inventory, CI = confidence interval, DU = depleted uranium, FFMPC = Fernald Feed Materials Production Center, FMMP = Fernald Medical Monitoring Program, IAP = intestinal alkaline phosphatase, NAG = urinary N-acetyl-beta-glucominidase, NEC = not elsewhere classified, NHANES = National Health and Nutrition Examination Survey, NHIS = National Health Interview Survey, NIOSH = National Institute for Occupational 251 Safety and Health, SPR = standardized prevalence ratio.
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From page 252... ...
Disease Classification Waxweiler et al., 1983 Uranium mills, 2,002 55 33.7 163 (123-212) ICD-7 470-527 Colorado Plateau Pinkerton et al., 2004 Uranium mills, 1,484 100 70.16 143 (116-173)
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From page 253... ...
e ICDA-8 460-519 Savannah River Plant, SC NOTE: CI = confidence interval, ICD = International Classification of Diseases, ICDA = International Classification of Diseases, Adapted, NR = not reported, NS = not significant, SMR = standardized mortality ratio. aConfidence interval calculated by Committee on Health Effects Associated with Exposure During the Gulf War; not stated in study (IOM, 2000)
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From page 254... ...
self-selected in January 1952- Emphysema: volunteer December 1984 SPR, 61 (99% CI, group 41-86) NOTE: CI = confidence interval, FEV1 = forced expiratory volume in 1 second, FFMPC = Fernald Feed Materials Production Center, FMMP = Fernald Medical Monitoring Program, FVC = forced vital capacity, NHANES = National Health and Nutrition Examination Survey, NHIS = National Health Interview Study, SPR = standardized prevalence ratio.
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From page 255... ...
Diseases of nervous, 2001 site sense organs Cragle et al., 1988 Nuclear-fuels production facility, 9,860 8 9.92 81 (NS) c ICDA-8 320-389 Savannah River plant, SC NOTE: CI = confidence interval, ICD = International Classification of Diseases, ICDA = International Classification of Diseases, Adapted, NR = not reported, NS = not significant, SMR = standardized mortality ratio.
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From page 256... ...
TABLE 8-18 Reproductive and Developmental Effects 256 Outcomes or Study Population Exposure Outcome Measures Results Adjustments McDiarmid et al., 29 exposed Gulf War Exposure to DU by Neuroendocrine Prolactin, 2.1-17.7 Stratification at median 2000 veterans exposed to friendly fire, may measures: FSH, LH, µg/g of creatinine; low into low-, high-result DU during friendly-fire have inhaled, ingested prolactin, testosterone; urinary uranium, 1.66; groups Case series incidents in February airborne DU particles, semen characteristics high urinary uranium, 1991, 38 unexposed experienced wound 12.47; p = 0.04 veterans, examined in contamination by March-June 1997 DU; assessed urinary and seminal uranium concentration McDiarmid et al., 50 exposed Gulf War Exposure to DU by Neuroendocrine No statistically Prescription 2001 veterans divided into friendly fire, may measures: FSH, LH, significant differences psychotropic-, low-uranium and have inhaled, ingested TSH, free thyroxine, in FSH, LH, prolactin, antidepressant-drug use Case series high-uranium groups, airborne DU particles, prolactin, testosterone; testosterone, thyroid examined in March- experienced wound semen characteristics measures between July 1999 contamination by low- and high-urinary DU; assessed urinary uranium groups uranium concentration Semen characteristics: Total sperm count [≥40 million] Low urinary uranium, 286.6 ± 44.8 million; high urinary uranium, 583.5 ± 106.1 million; p = 0.02
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From page 257... ...
Low urinary uranium, 81.3 ± 15.4 million; high urinary uranium, 155.5 ± 31.1 million; p = 0.04 McDiarmid et al., 39 Gulf War veterans Same exposure as in Neuroendocrine No statistically 2004 exposed to DU during McDiarmid et al., 2001 measures: FSH, LH, significant differences friendly-fire incidents prolactin, TSH, free in reproductive-health Case series in February 1991, thyroxine, testosterone; measures examined in April-July semen characteristics 2001, followup 1994 2001 McDiarmid et al., 32 Gulf War veterans Same exposure as in Neuroendocrine No statistically 2006 exposed to DU during McDiarmid et al., 2001 measures: FSH, LH, significant differences friendly-fire incidents, prolactin, TSH, free in reproductive-health Case series examined in April-July thyroxine, testosterone; measures 2003 semen characteristics Continued 257
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From page 258... ...
NOTE: BDI = Beck Depression Inventory, CI = confidence interval, DU = depleted uranium, FSH = follicle-stimulating hormone, LH = luteinizing hormone, TSH = thyroid-stimulating hormone, WHO = World Health Organization.
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From page 259... ...
2003a. Cancer incidence in munici palities near two former nuclear materials processing facilities in Pennsylvania.
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From page 260... ...
2001. Surveillance of depleted uranium exposed Gulf War veterans: Health effects observed in an enlarged "friendly fire" cohort.
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From page 261... ...
2002. Health effects and biological monitoring results of Gulf War veterans exposed to depleted uranium.
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From page 262... ...
2006. Depleted uranium and cancer in Danish Balkan veterans deployed 1992-2001.
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