Groundwater Recharge with Reclaimed Water Birth outcomes in Los Angeles County 1982-1993

by Sloss, Elizabeth M.; McCaffrey, Daniel F.; Fricker, Ronald D.; Geschwind, Sandra A.; Ritz, Beate R.

• ISBN13: 9780833027702
• ISBN10: 0833027700
• Edition: 1st
• Format: Paperback
• Copyright: 1999-11-09
• Publisher: RAND CORPORATION

Summary

This book is an assessment of the effects on human health of reclaimed water. The assessment focuses on adverse outcomes among liveborn infants, including low birth weight, preterm birth, infant mortality, and birth defects from 1982 to 1993. Outcome rates in the Montebello Forebay area, which has received some reclaimed water in its water supply since 1962, are compared with a control area that received no reclaimed water. Using a cohort study design, this epidemiologic assessment analyzes outcome data on individuals classified by a ZIP code-level percentage of reclaimed water. The results of the study do not provide evidence of an association between reclaimed water and adverse birth outcomes.

Table of Contents

Preface	iii
Figures	ix
Tables	xi
Summary	xv
Acknowledgments	xvii
Abbreviations	xix
Introduction	1	(16)
Background	2	(13)
Wastewater Reuse	3	(1)
Treatment of Reclaimed Water	4	(1)
Reclaimed Water in the Montebello Forebay	5	(1)
Regulation of Reclaimed Water Use in California	6	(2)
Health Effects Study	8	(5)
Scientific Review of Health Effects Study	13	(1)
Rationale Behind Epidemiologic Studies of Reclaimed Water	13	(1)
Results of Study of Cancer, Mortality, and Infectious Disease	14	(1)
Overview of Report	15	(2)
Literature Review	17	(10)
Possible Mechanisms for Environmental Influence on Adverse Birth Outcomes	17	(1)
Impact of Fetal Loss on Adverse Outcomes Among Live Births	18	(1)
Low Birth Weight and Preterm Birth	18	(1)
Birth Defects	19	(2)
Infant Mortality	21	(1)
Studies of Drinking Water and Adverse Birth Outcomes	21	(4)
Overview of Study Designs and Methods	21	(1)
Studies of Drinking Water Contaminants and Spontaneous Abortions	22	(1)
Studies of Drinking Water and Low Birth Weight and Preterm Delivery	23	(1)
Studies of Drinking Water and Birth Defects	24	(1)
Summary	25	(2)
Methods	27	(22)
Data Sources	27	(2)
Birth and Death Certificates	27	(1)
California Birth Defects Monitoring Program	28	(1)
1990 Census	29	(1)
Definitions of Adverse Birth Outcomes	29	(2)
Prenatal Development and Infant Mortality	29	(1)
Birth Defects	30	(1)
Exposure to Reclaimed Water	31	(5)
Estimating the Percentage of Reclaimed Water in Domestic Supplies	32	(2)
Identifying Water Purveyors in the Montebellow Forebay	34	(1)
Estimating the Percentage of Reclaimed Water in Groundwater Supplies	34	(2)
Estimating Reclaimed Water Percentages by Service Area	36	(1)
Linking Exposure Data with Other Data	36	(2)
Selection of Control Area	38	(1)
Statistical Methods	39	(10)
Logistic Regression Analysis of Birth Outcome Data	41	(1)
Parameter Estimation	42	(2)
Variability of Parameter Estimates	44	(1)
Imputation, Missing Values, and Sample Sizes in Models	45	(1)
Sensitivity Analysis	46	(1)
Power of Statistical Tests	47	(2)
Results	49	(18)
Characteristics of Study Populations	49	(1)
Study Populations in 1990	49	(1)
Characteristics of Births in Study Populations	50	(1)
Association Between Reclaimed Water and Outcomes	51	(1)
Patterns of Health Outcomes in Study Populations	52	(4)
Hypotheses Tested	52	(1)
Measures of Exposure Effect and Statistical Significance	53	(1)
Assessing Causality of Associations	54	(2)
Prenatal Development and Infant Mortality	56	(1)
Birth Defects	57	(10)
All Birth Defects, Neural Tube, Other Nervous System, and Eyes, Ears, Face, and Neck Defects	58	(2)
Major Cardiac Defects, Patent Ductus Arteriosus, Other Cardiac, and Respiratory System Defects	60	(1)
Cleft Defects, Pyloric Stenosis, Intestinal Atresias, and Other Digestive System Defects	61	(1)
Limb, Other Musculoskeletal, Integument, and All Other Defects	61	(2)
Chromosomal Syndromes and Syndromes Other Than Chromosomal	63	(1)
Sensitivity Analyses	64	(3)
Summary and Discussion	67	(68)
Summary of Results	67	(1)
Interpretation of Study Results	68	(3)
Meaning of Null Effects	68	(2)
Evaluating the Dose-Response Relationship	70	(1)
Generalizability	70	(1)
Limitations of Study Design	71	(3)
Lack of Information on Individual Exposure	71	(1)
Effect of Population Mobility	72	(1)
Inability to Control for Potentially Confounding Variables	73	(1)
Effect of Spontaneous Abortions and Elective Terminations on Adverse Birth Outcomes	73	(1)
Comparison of Results with Other Studies	74	(1)
Previous Epidemiologic Studies of the Montebello Forebay	74	(1)
Epidemiologic Studies of Drinking Water and Adverse Birth Outcomes	75	(1)
Strengths of Study Design	75	(1)
Quality of Outcome Data	75	(1)
Other Strengths	76	(1)
Conclusions	76	(1)
Future Research	77	(2)
Appendix
A. Epidemiologic Studies of Drinking Water and Adverse Birth Outcomes	79	(8)
B. Methods Used to Estimate the Percentage of Reclaimed Water in Montebello Forebay Groundwater Supplies	87	(4)
C. Percentage of Reclaimed Water in Montebello Forebay Water System Service Areas and Zip Codes by Year, 1982--1993	91	(8)
D. Minimum Detectable Odds Ratio for Each Outcome and Exposure Group	99	(4)
E. Results of Sensitivity Analyses Using Logistic Regression Models of Prenatal Development Outcomes and Infant Mortality	103	(12)
F. Results of Sensitivity Analyses Using Logistic Regression Models for Birth Defect Outcomes	115	(20)
Bibliography	135