title: Risk of adverse birth outcomes in populations living near landfill sites.
abstract: OBJECTIVE
  To investigate the risk of adverse birth outcomes associated with residence near landfill sites in Great Britain.
  
  
  METHODS
  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.
  
  
  METHODS
  Great Britain.
  
  
  METHODS
  Over 8.2 million live births, 43 471 stillbirths, and 124 597 congenital anomalies (including terminations).
  
  
  METHODS
  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.
authors.affiliation: Small Area Health Statistics Unit (SAHSU), Department of Epidemiology and Public Health, Imperial College, St Mary's Campus, London W2 1PG. p.elliott@ic.ac.uk
authors.forename: P
authors.initials: P
authors.lastname: Elliott
authors.forename: D
authors.initials: D
authors.lastname: Briggs
authors.forename: S
authors.initials: S
authors.lastname: Morris
authors.forename: C
authors.initials: C
authors.lastname: de Hoogh
authors.forename: C
authors.initials: C
authors.lastname: Hurt
authors.forename: T K
authors.initials: TK
authors.lastname: Jensen
authors.forename: I
authors.initials: I
authors.lastname: Maitland
authors.forename: S
authors.initials: S
authors.lastname: Richardson
authors.forename: J
authors.initials: J
authors.lastname: Wakefield
authors.forename: L
authors.initials: L
authors.lastname: Jarup
mesh_terms: D000013:Congenital Abnormalities / Q000209:etiology*; D004787:Environmental Pollution; D005260:Female; D005313:Fetal Death; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D018811:Maternal Exposure; D011203:Poverty; D011247:Pregnancy; D012037:Refuse Disposal; D012306:Risk; D013223:Statistics as Topic; D006113:United Kingdom / Q000453:epidemiology