Danielle C Ashworth1, Paul Elliott2, Mireille B Toledano3. 1. Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, Paddington, London, W2 1PG, UK. Electronic address: danielle.ashworth09@imperial.ac.uk. 2. Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, Paddington, London, W2 1PG, UK. 3. Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, Paddington, London, W2 1PG, UK. Electronic address: m.toledano@imperial.ac.uk.
Abstract
BACKGROUND: Public concern about potential health risks associated with incineration has prompted studies to investigate the relationship between incineration and risk of cancer, and more recently, birth outcomes. We conducted a systematic review of epidemiologic studies evaluating the relationship between waste incineration and the risk of adverse birth and neonatal outcomes. METHODS: Literature searches were performed within the MEDLINE database, through PubMed and Ovid interfaces, for the search terms; incineration, birth, reproduction, neonatal, congenital anomalies and all related terms. Here we discuss and critically evaluate the findings of these studies. RESULTS: A comprehensive literature search yielded fourteen studies, encompassing a range of outcomes (including congenital anomalies, birth weight, twinning, stillbirths, sex ratio and infant death), exposure assessment methods and study designs. For congenital anomalies most studies reported no association with proximity to or emissions from waste incinerators and "all anomalies", but weak associations for neural tube and heart defects and stronger associations with facial clefts and urinary tract defects. There is limited evidence for an association between incineration and twinning and no evidence of an association with birth weight, stillbirths or sex ratio, but this may reflect the sparsity of studies exploring these outcomes. CONCLUSIONS: The current evidence-base is inconclusive and often limited by problems of exposure assessment, possible residual confounding, lack of statistical power with variability in study design and outcomes. However, we identified a number of higher quality studies reporting significant positive relationships with broad groups of congenital anomalies, warranting further investigation. Future studies should address the identified limitations in order to help improve our understanding of any potential adverse birth outcomes associated with incineration, particularly focussing on broad groups of anomalies, to inform risk assessment and waste policy.
BACKGROUND: Public concern about potential health risks associated with incineration has prompted studies to investigate the relationship between incineration and risk of cancer, and more recently, birth outcomes. We conducted a systematic review of epidemiologic studies evaluating the relationship between waste incineration and the risk of adverse birth and neonatal outcomes. METHODS: Literature searches were performed within the MEDLINE database, through PubMed and Ovid interfaces, for the search terms; incineration, birth, reproduction, neonatal, congenital anomalies and all related terms. Here we discuss and critically evaluate the findings of these studies. RESULTS: A comprehensive literature search yielded fourteen studies, encompassing a range of outcomes (including congenital anomalies, birth weight, twinning, stillbirths, sex ratio and infant death), exposure assessment methods and study designs. For congenital anomalies most studies reported no association with proximity to or emissions from waste incinerators and "all anomalies", but weak associations for neural tube and heart defects and stronger associations with facial clefts and urinary tract defects. There is limited evidence for an association between incineration and twinning and no evidence of an association with birth weight, stillbirths or sex ratio, but this may reflect the sparsity of studies exploring these outcomes. CONCLUSIONS: The current evidence-base is inconclusive and often limited by problems of exposure assessment, possible residual confounding, lack of statistical power with variability in study design and outcomes. However, we identified a number of higher quality studies reporting significant positive relationships with broad groups of congenital anomalies, warranting further investigation. Future studies should address the identified limitations in order to help improve our understanding of any potential adverse birth outcomes associated with incineration, particularly focussing on broad groups of anomalies, to inform risk assessment and waste policy.
Authors: Antonella Bena; Manuela Orengia; Ennio Cadum; Elena Farina; Alessandro Alimonti; Beatrice Bocca; Monica Chiusolo; Elena De Felip; Martina Gandini; Anna Laura Iamiceli; Anna Pino; Enrico Procopio; Giuseppe Salamina Journal: Environ Monit Assess Date: 2016-10-06 Impact factor: 2.513
Authors: Maria Triassi; Rossella Alfano; Maddalena Illario; Antonio Nardone; Oreste Caporale; Paolo Montuori Journal: Int J Environ Res Public Health Date: 2015-01-22 Impact factor: 3.390
Authors: Alfredo Mazza; Prisco Piscitelli; Andrea Falco; Maria Lucia Santoro; Manuela Colangelo; Giovanni Imbriani; Adele Idolo; Antonella De Donno; Leopoldo Iannuzzi; Annamaria Colao Journal: Int J Environ Res Public Health Date: 2018-01-10 Impact factor: 3.390
Authors: Anna Maria Romanelli; Fabrizio Bianchi; Olivia Curzio; Fabrizio Minichilli Journal: Int J Environ Res Public Health Date: 2019-08-10 Impact factor: 3.390
Authors: Frédéric B Piel; Daniela Fecht; Susan Hodgson; Marta Blangiardo; M Toledano; A L Hansell; Paul Elliott Journal: Int J Epidemiol Date: 2020-04-01 Impact factor: 7.196
Authors: Philippa Douglas; Anna Freni-Sterrantino; Maria Leal Sanchez; Danielle C Ashworth; Rebecca E Ghosh; Daniela Fecht; Anna Font; Marta Blangiardo; John Gulliver; Mireille B Toledano; Paul Elliott; Kees de Hoogh; Gary W Fuller; Anna L Hansell Journal: Environ Sci Technol Date: 2017-06-16 Impact factor: 9.028