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Graphic Risk of adverse birth outcomes in populations living near landfill sites

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7309.363 (Published 18 August 2001) Cite this as: BMJ 2001;323:363

This article has a correction. Please see:

  1. Paul Elliott, director (p.elliott{at}ic.ac.uk),
  2. David Briggs, professor of environment and health,
  3. Sara Morris, research associate,
  4. Cornelis de Hoogh, research associate,
  5. Christopher Hurt, research associate,
  6. Tina Kold Jensen, lecturer,
  7. Ian Maitland, database manager,
  8. Sylvia Richardson, professor of statistics,
  9. Jon Wakefield, reader in statistics,
  10. Lars Jarup, assistant director
  1. Small Area Health Statistics Unit (SAHSU), Department of Epidemiology and Public Health, Imperial College, St Mary's Campus, London W2 1PG
  1. Correspondence and reprint requests to: P Elliott
  • Accepted 3 August 2001

Abstract

Objective: To investigate the risk of adverse birth outcomes associated with residence near landfill sites in Great Britain.

Design: Geographical study of risks of adverse birth outcomes in populations living within 2 km of 9565 landfill sites operational at some time between 1982 and 1997 (from a total of 19 196 sites) compared with those living further away.

Setting: Great Britain.

Subjects: Over 8.2 million live births, 43 471 stillbirths, and 124 597 congenital anomalies (including terminations).

Main outcome measures: All congenital anomalies combined, some specific anomalies, and prevalence of low and very low birth weight (<2500 g and <1500 g).

Results: For all anomalies combined, relative risk of residence near landfill sites (all waste types) was 0.92 (99% confidence interval 0.907 to 0.923) unadjusted, and 1.01 (1.005 to 1.023) adjusted for confounders. Adjusted risks were 1.05 (1.01 to 1.10) for neural tube defects, 0.96 (0.93 to 0.99) for cardiovascular defects, 1.07 (1.04 to 1.10) for hypospadias and epispadias (with no excess of surgical correction), 1.08 (1.01 to 1.15) for abdominal wall defects, 1.19 (1.05 to 1.34) for surgical correction of gastroschisis and exomphalos, and 1.05 (1.047 to 1.055) and 1.04 (1.03 to 1.05) for low and very low birth weight respectively. There was no excess risk of stillbirth. Findings for special (hazardous) waste sites did not differ systematically from those for non-special sites. For some specific anomalies, higher risks were found in the period before opening compared with after opening of a landfill site, especially hospital admissions for abdominal wall defects.

Conclusions: We found small excess risks of congenital anomalies and low and very low birth weight in populations living near landfill sites. No causal mechanisms are available to explain these findings, and alternative explanations include data artefacts and residual confounding. Further studies are needed to help differentiate between the various possibilities.

What is already known on this topic

What is already known on this topic Various studies have found excess risks of certain congenital anomalies and low birth weight near landfill sites

Risks up to two to three times higher have been reported

These studies have been difficult to interpret because of problems of exposure classification, small sample size, confounding, and reporting bias

What this study adds

What this study adds Some 80% of the British population lives within 2 km of known landfill sites in Great Britain

By including all landfill sites in the country, we avoided the problem of selective reporting, and maximised statistical power

Although we found excess risks of congenital anomalies and low birth weight near landfill sites in Great Britain, they were smaller than in some other studies

Further work is needed to differentiate potential data artefacts and confounding effects from possible causal associations with landfill

Footnotes

  • Funding The Small Area Health Statistics Unit is funded by a grant from the Department of Health; Department of the Environment, Food, and Rural Affairs; Environment Agency; Health and Safety Executive; Scottish Executive; National Assembly for Wales; and Northern Ireland Assembly.

  • Competing interests None declared.

  • Accepted 3 August 2001
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