Elsevier

The Lancet

Volume 352, Issue 9126, 8 August 1998, Pages 423-427
The Lancet

Articles
Risk of congenital anomalies near hazardous-waste landfill sites in Europe: the EUROHAZCON study

https://doi.org/10.1016/S0140-6736(98)01352-XGet rights and content

Summary

Background

Waste-disposal sites are a potential hazard to health. This study is a multicentre case-control study of the risk of congenital anomalies associated with residence near hazardous-waste landfill sites in Europe.

Methods

We used data from seven regional registers of congenital anomalies in five countries. We studied 1089 livebirths, stillbirths, and terminations of pregnancy with non-chromosomal congenital anomalies and 2366 control births without malformation, whose mothers resided within 7 km of a landfill site; 21 sites were included. A zone within 3 km radius of each site was defined as the “proximate zone” of most likely exposure to teratogens.

Findings

Residence within 3 km of a landfill site was associated with a significantly raised risk of congenital anomaly (295 cases/511 controls living 0–3 km from sites, 794/1855 living 3–7 km from sites; combined odds ratio 1·33 [95% Cl 1·11–1·59], adjusted for maternal age and socioeconomic status). There was a fairly consistent decrease in risk with distance away from the sites. A significantly raised odds ratio for residence within 3 km of a landfill site was found for neural-tube defects (odds ratio 1·86 [1·24–2·79]), malformations of the cardiac septa (1·49 [1·09–2·04]), and anomalies of great arteries and veins (1·81 [1·02–3·20]). Odds ratios of borderline significance were found for tracheo-oesophageal anomalies (2·25 [0·96–5·26]), hypospadias (1·96 [0·98–3·92]), and gastroschisis (3·19 [0·95–10·77]). There was little evidence of differences in risk between landfill sites but power to detect such differences was low.

Interpretation

This study shows a raised risk of congenital anomaly in babies whose mothers live close to landfill sites that handle hazardous chemical wastes, although there is a need for further investigation of whether the association of raised risk of congenital anomaly and residence near landfill sites is a causal one. Apparent differences between malformation subgroups should be interpreted cautiously.

Introduction

Waste disposal by landfill is a cause for environmental concern. People who live near landfill sites may be exposed to chemicals released into the air, water, or soil.1 Air contamination includes off-site migration of gases, dust, and chemicals bound to dust, especially during operation of the site. Local surface water and groundwater can become contaminated, and these may in turn contaminate potable water supplies or water for recreational use. Chemical contamination of air, water, or soil may also affect locally grown and consumed food produce. Thus, a landfill site may be a health risk for local residents and their children. Information on the potential risks to health should aid the future design, location, and operation of landfill sites.

To date, however, there is little epidemiological evidence on which to base health-risk assessments of landfill sites. Studies of pregnancy outcomes among women who live near landfill sites have been done in the USA, including the well-known contamination incident at Love Canal2, 3 and multiple-site assessments.4, 5, 6, 7, 8 Some of these studies show raised risks of congenital anomalies in babies whose mothers live near landfill sites, but no clear pattern of risk has yet emerged. The potential tera-togenicity of many of the chemicals dumped in landfill sites, such as heavy metals, pesticides, and solvents, is known, but chemical dose may have to reach a threshold level before significant teratogenic effects appear.

Communities close to waste-disposal sites are concerned about the potential health risk of the sites, and may link local “clusters” of adverse health outcomes to exposure to chemicals from nearby sites. However, even with a random spatial pattern of adverse health outcomes, localised clusters will occur, and distinction of these random clusters from those in which there is a common underlying local cause is difficult. It is desirable to move beyond post-hoc study of clusters, to study of waste-disposal sites specified a priori. We studied whether pregnant women living near landfill sites would be exposed to sufficient chemical doses for there to be any risk of congenital anomalies in their children. We present the first results of a collaborative European study of the risk of congenital anomaly among people living near hazardous-waste landfill sites. These first results concern non-chromosomal congenital anomalies.

Section snippets

Data collection

We used data from seven research centres in five European countries—Belgium, Denmark, France, Italy, and the UK. The centres maintain regional population-based registers of congenital anomalies that include data on livebirths, stillbirths, and terminations of pregnancy after prenatal diagnosis. Five of these centres are in the EUROCAT network of regional registers of congenital anomalies in Europe—register methods have been described elsewhere.9, 10, 11, 12 Three other centres participated in

Results

We studied 1089 cases of non-chromosomal congenital anomaly and 2366 controls (table 1). We assessed the potential for confounding by maternal age and socioeconomic status. Maternal age had a positive but non-significant relation with risk of congenital anomaly. There was no clear relation between risk of congenital anomaly and socioeconomic status in any of the centres except in the UK, where there was a significant (p=0·04), trend of greater risk of anomaly with increasing deprivation,

Discussion

We have shown a small, but statistically significant, excess risk of non-chromosomal congenital anomalies among people who live within 3 km of hazardous-waste landfill sites. There is no evidence that the risk of anomalies differs between sites, although our study has limited statistical power to address this issue. The fundamental question is whether the relation observed is causal. In our opinion, the results of previous epidemiological multisite studies4, 5, 6 do not greatly strengthen any

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