Abstract
A key feature of cumulative risk assessment (CRA) is the ability to estimate differential health risks from environmental exposures within populations. Identifying populations at increased risk from environmental exposures is the first step toward mitigating such risks as required by the fair treatment mandate of environmental justice. CRA methods remain under development except for a limited application in pesticide regulations. The goals of this research were to advance CRA methods and to test their application in a community case study. We compared cumulative risk and health assessments for South and Southwest Philadelphia communities. The analysis found positive correlations between cumulative risk and mortality measurements for total mortality in Whites and non-Whites when we conducted the risk assessment using a multi-end point toxicological database developed for this project. Cumulative risk scores correlated positively with cause-specific mortality in non-Whites. Statistically significant increases in total and respiratory mortality rates were associated with incremental increases in the hazard ratio cumulative risk scores, with ranges of 2-6% for total and 8-23% for respiratory. Regression analyses controlled for percent non-White population and per capita income, indicating that risk scores represent an environmental effect on health independent of race and income. This case study demonstrated the successful application of CRA at the community level. CRA adds a health dimension to pollutant concentrations to produce a more comprehensive understanding of environmental inequities that can inform decision making. CRA is a viable tool to identify high-risk areas and to guide surveillance, research, or interventions.
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Selected References
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- Anderson R. N., Rosenberg H. M. Age standardization of death rates: implementation of the year 2000 standard. Natl Vital Stat Rep. 1998 Oct 7;47(3):1-16, 20. [PubMed] [Google Scholar]
- Birch S., Stoddart G., Béland F. Modelling the community as a determinant of health. Can J Public Health. 1998 Nov-Dec;89(6):402–405. doi: 10.1007/BF03404083. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Blakely T. A., Kennedy B. P., Kawachi I. Socioeconomic inequality in voting participation and self-rated health. Am J Public Health. 2001 Jan;91(1):99–104. doi: 10.2105/ajph.91.1.99. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Breeze E., Fletcher A. E., Leon D. A., Marmot M. G., Clarke R. J., Shipley M. J. Do socioeconomic disadvantages persist into old age? Self-reported morbidity in a 29-year follow-up of the Whitehall Study. Am J Public Health. 2001 Feb;91(2):277–283. doi: 10.2105/ajph.91.2.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dougherty C. P., Henricks Holtz S., Reinert J. C., Panyacosit L., Axelrad D. A., Woodruff T. J. Dietary exposures to food contaminants across the United States. Environ Res. 2000 Oct;84(2):170–185. doi: 10.1006/enrs.2000.4027. [DOI] [PubMed] [Google Scholar]
- Kelsall J. E., Samet J. M., Zeger S. L., Xu J. Air pollution and mortality in Philadelphia, 1974-1988. Am J Epidemiol. 1997 Nov 1;146(9):750–762. doi: 10.1093/oxfordjournals.aje.a009351. [DOI] [PubMed] [Google Scholar]
- Kennedy B. P., Kawachi I., Glass R., Prothrow-Stith D. Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis. BMJ. 1998 Oct 3;317(7163):917–921. doi: 10.1136/bmj.317.7163.917. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morello-Frosch R. A., Woodruff T. J., Axelrad D. A., Caldwell J. C. Air toxics and health risks in California: the public health implications of outdoor concentrations. Risk Anal. 2000 Apr;20(2):273–291. doi: 10.1111/0272-4332.202026. [DOI] [PubMed] [Google Scholar]
- Woodruff T. J., Axelrad D. A., Caldwell J., Morello-Frosch R., Rosenbaum A. Public health implications of 1990 air toxics concentrations across the United States. Environ Health Perspect. 1998 May;106(5):245–251. doi: 10.1289/ehp.98106245. [DOI] [PMC free article] [PubMed] [Google Scholar]