Objectives-To examine the incidence of lymphohaematopoietic malignancy around industrial complexes that include major oil refineries in Great Britain after recent public and scientific concern of possible carcinogenic hazards of emissions from the petrochemical industry. Methods-Small area study of the incidence of lymphohaematopoietic malignancies, 1974-91, within 7.5 km of all 11 oil refineries (grouped into seven sites) in Great Britain that were operational by the early 1970s and processed more than two million tonnes of crude oil in 1993.Results-Combined analysis of data from all seven sites showed no significant (p<0.05) increase in risk of these malignancies within 2 km or 7.5 km. Hodgkin's lymphoma, but no other malignancy, showed evidence (p=0.02) of a decline in risk with distance from refineries, but there was an apparent deficit of cases of multiple myeloma near the refineries (p=0.04). Conclusion-There was no evidence of association between residence near oil refineries and leukaemias, or nonHodgkin's lymphoma. A weak positive association was found between risk of Hodgkin's disease and proximity to major petrochemical industry, and a negative association with multiple myeloma, which may be chance findings within the context of multiple statistical testing. (Occup Environ Med 1999;56:577-580)
Objectives-To examine the incidence and mortality of cancer near the Pan Britannica Industries factory, Waltham Abbey, after reports of a possible cluster of all cancers and brain cancer in the vicinity. Method-Small area study of cancer incidence 1977-89, and mortality 1981-92, within a 7-5 km radius of the factory site. Postcoded cancer registrations and deaths in the study area were extracted from national data sets held by the Small Area Health Statistics Unit and compared with expected numbers computed by applying national rates stratified for age, sex, and deprivation to the local population (1981 and 1991 censuses). Observed/ expected (0(E) ratios were examined from 0-1 km and 0-7-5 km of the plant, and tests applied for a decline in relative risk with distance up to 7 5 km. Results-There were 12 859 incident cancers (1977-89) from 0-7-5 km (OlE ratio 1-04; 95% confidence interval (95% CI) 1*02 to 1-06) and 385 from 0-1 km (OlE 1*10; 1-00 to 1-22). There was an excess of skin melanoma from 0-1 km based on 11 cases (OIE 2-13; 1-06 to 3.80), and an excess from 0-7 5 km of cancer of the lung, stomach and pancreas combined, and prostate (O/Es ranged from 1-09 to 1.13). Only the findings from lung cancer were suggestive of a decline in risk with distance, especially in the later period . There were 9196 cancer deaths (1981-92) from 0-7 5 km (OlE 1-04; 95% CI 1-02 to 1.06) and 308 from 0-1 km (OlE 1-24; 1.11 to 1.39); and 25 507 non-cancer deaths (OIE 1-02; 1-01 to 1.04) from 0-7-5 km and 745 (OLE 1*14; 1-06 to 1-22) from 0-1 km. There was evidence of a decline in mortality with distance for all cancers combined, lung cancer (P = 0-001 for each), and colorectal cancer (P < 0.05), and also for non-cancers (P = 0*001).Proportional mortality analyses suggested a decline in risk with distance for lung cancer (P = 0.003) but not for all cancers or the site specific cancers examined. There was no evidence of an excess in the incidence or mortality from brain cancer. For cancer mortality in the innermost wards, the findings were, for the most part, well within the range of variation across the region as a whole. Conclusions-The study provides limited and inconsistent evidence for a localised excess of cancer in the vicinity of the PBI plant. At present, further investigation does not seem warranted other than continued surveillance of mortality and cancer incidence in the locality.
Objectives-To investigate whether residents near cokeworks have a higher standardised mortality than those further away, particularly from cardiovascular and respiratory causes, which may be associated with pollution from cokeworks. Method-Cross sectional small area study with routinely collected postcoded mortality data and small area census statistics. Populations within 7.5 km of 22 cokeworks in Great Britain, 1981-92. Expected numbers of deaths within 2 and 7.5 km of cokeworks, and in eight distance bands up to 7.5 km of cokeworks, were calculated by indirect standardisation from national rates stratified for age and sex and a small area deprivation index, and adjusted for region. Age groups examined were all ages, 1-14, 15-64, 65-74, >75. Only the 1-14 and 15-44 age groups were examined for asthma mortality. Results-There was a 3% (95% confidence interval (95% CI) 1% to 4%) excess of all deaths within 2 km of cokeworks, and a significant decline in mortality with distance from cokeworks. The excess of deaths within 2 km was slightly higher for females and elderly people, but excesses within 2 km and declines in risk with distance were significant for all adult age groups and both sexes. The size of the excess within 2 km was 5% (95%CI 3% to 7%) for cardiovascular causes, 6% (95%CI 3% to 9%) for ischaemic heart disease, and 2% (95% CI -2% to 6%) for respiratory deaths, with significant declines in risk with distance for all these causes. There was a non-significant 15% (95%CI −1% to 101%) excess in asthma mortality in the 15-44 age group. There were no significant excesses in mortality among children but 95% CIs were wide. Within 2 km of cokeworks, the estimated additional excess all cause mortality for all ages combined related to region and mainly to the greater deprivation of the population over national levels was 12%. Conclusions-A small excess mortality near cokeworks as found in this study is plausible in the light of current evidence about the health impact of air pollution. However, in this study the eVects of pollution from cokeworks, if any, are outweighed by the eVects of deprivation on mortality near cokeworks. It is not possible to confidently exclude socioeconomic confounding or biases resulting from inexact population estimation as explanations for the excess found. (Occup Environ Med 1999;56:34-40)
SUMMARY: The paper describes health differentials between small areas within three boroughs (local government areas) in London -including the incidence of TB, asthma and respiratory diseases -and their associations with deprivation, unemployment and poor housing conditions. It also discusses the value of measuring such intra-urban health differentials for policy-making and illustrates how addressing social inequalities and economic disadvantages may be among the most effective interventions to improve health.
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