Improving exposure assessment and defining health outcomes in the reproductive epidemiology of municipal solid waste incinerators

摘要

The last decade has seen a shift away from disposal of waste in landfills to more environmentally desirable methods of waste management, such as recycling, composting and incineration. There is ongoing public concern about health risks associated with incineration. Epidemiological studies investigating exposure to incinerator emissions and risk of adverse birth outcomes are limited by poor exposure assessment lack of information on uptake of these emissions and the small numbers of birth outcomes explored.ududThe aim of this thesis was to estimate population exposure to emissions from four municipal solid waste incinerators (MSWI) in England. Also, at an individual level, to design and undertake a study to ascertain the exposure profile to dioxins for women resident near two MSWIs. Finally, to compare the availability and quality of national birth data in England and make recommendations on their use in epidemiological studies of birth outcomes. The findings of this thesis have contributed to the ongoing national study being conducted by the Small Area Health Statistics Unit (SAHSU), investigating the association between MSWI emissions and the risk of adverse birth and neonatal outcomes in Great Britain (GB).ududAtmospheric dispersion modelling was undertaken to estimate population exposure to particulate matter as a proxy for all MSWI emissions. Model outputs presented will be used in the SAHSU study and the model developed rolled out for all MSWIs in GB. The Incinerators Biomonitoring Study achieved a study database of 97 participants, each providing breast milk samples and questionnaire information. The study showed variability in participation by demographic and lifestyle factors, alongside dietary dioxin intake estimates. The findings of this study will help to interpret the results of SAHSU’s study, providing an insight into the relationship between MSWI exposure and total body burden of dioxins. Finally, a comparison of routine national birth data revealed variation in completeness and fields of information collected by dataset. Hospital birth data compared favourability with registry data at a national scale after 2002, with considerable improvements in quality between 2001 and 2010. However, large differences between datasets were observed at small area level, reflecting the influence of hospital provider effects on this dataset.