title: Adverse pregnancy outcomes around incinerators and crematoriums in Cumbria, north west England, 1956-93.
abstract: OBJECTIVE
  To investigate the risk of stillbirth, neonatal death, and lethal congenital anomaly among babies of mothers living close to incinerators and crematoriums in Cumbria, north west England, 1956-93.
  
  
  METHODS
  Retrospective cohort study. Logistic regression was used to investigate the risk of each outcome in relation to proximity at birth to incinerators and crematoriums, adjusting for social class, year of birth, birth order, and multiple births. Continuous odds ratios for trend with proximity to sites were estimated.
  
  
  METHODS
  All 3234 stillbirths, 2663 neonatal deaths, and 1569 lethal congenital anomalies among the 244 758 births to mothers living in Cumbria, 1956-1993.
  
  
  RESULTS
  After adjustment for social class, year of birth, birth order, and multiple births, there was an increased risk of lethal congenital anomaly, in particular spina bifida (odds ratio 1.17, 95% CI: 1.07 to 1.28) and heart defects (odds ratio 1.12, 95% CI: 1.03 to 1.22) around incinerators and an increased risk of stillbirth (odds ratio 1.04, 95% CI: 1.01 to 1.07) and anencephalus (odds ratio 1.05, 95% CI: 1.00 to 1.10) around crematoriums.
  
  
  CONCLUSIONS
  The authors cannot infer a causal effect from the statistical associations reported in this study. However, as there are few published studies with which to compare our results, the risk of spina bifida, heart defects, stillbirth, and anencephalus in relation to proximity to incinerators and crematoriums should be investigated further, in particular because of the increased use of incineration as a method of waste disposal.
authors.affiliation: School of Clinical Medical Sciences, Paediatric and Lifecourse Epidemiology Research Group, Department of Child Health, University of Newcastle, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: T J B
authors.initials: TJ
authors.lastname: Dummer
authors.forename: H O
authors.initials: HO
authors.lastname: Dickinson
authors.forename: L
authors.initials: L
authors.lastname: Parker
mesh_terms: D000013:Congenital Abnormalities / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006256:Hazardous Waste / Q000009:adverse effects*; D006801:Humans; D017745:Incineration; D018811:Maternal Exposure / Q000009:adverse effects*; D009027:Mortuary Practice; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012111:Residence Characteristics
chemical_list: D006256:Hazardous Waste