title: Total and cardiovascular mortality rates in relation to discharges from Toxics Release Inventory sites in the United States.
abstract: BACKGROUND
  This study analyzed Toxics Release Inventory (TRI) discharges in association with covariate-adjusted total and cardiovascular mortality rates for males and females in US counties.
  
  
  METHODS
  Average annual county-level reported releases from TRI facilities measured in pounds per square mile which were calculated for the years 1990-1999, and tested for associations with age-adjusted mortality rates for 2006-2010. Chemicals were grouped into four categories: 1) carcinogens, 2) metals, 3) hazardous air pollutants, and 4) chemicals in the Comprehensive Environmental Response, Compensation and Liability Act. For each of these chemical groups the reported total, water, and air emissions were measured. Age-adjusted mortality rates were found separately for males and females from the Centers for Disease Control and Prevention for total and cardiovascular disease. Covariates included rates of smoking, obesity, high school and college education, race/ethnicity, poverty, unemployment, percent without health insurance, and urban-rural setting. Data were analyzed using multiple linear regression models.
  
  
  RESULTS
  Greater average annual TRI releases in 1990-1999 in all four chemical categories were significantly associated with higher mortality rates in 2006-2010 for both total and cardiovascular mortality, and for both males and females, adjusted for covariates. Associations were stronger for air releases than for water releases.
  
  
  CONCLUSIONS
  This study provides the first evidence that greater amounts of TRI releases are related to higher population mortality rates for cardiovascular disease. In addition, the study showed that adverse TRI effects were broadly present for both males and females for multiple chemical groups. Further progress is needed to reduce the use and release of harmful chemicals from TRI facilities in the United States.
authors.affiliation: Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA. Electronic address: hendryx@indiana.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Hendryx
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA. Electronic address: juhluo@indiana.edu.
authors.forename: Juhua
authors.initials: J
authors.lastname: Luo
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA. Electronic address: chenboc@umail.iu.edu.
authors.forename: Bo-Chiuan
authors.initials: BC
authors.lastname: Chen
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D055884:Chemical Hazard Release / Q000401:mortality*; D004785:Environmental Pollutants / Q000009:adverse effects*; D004787:Environmental Pollution / Q000009:adverse effects*; D005260:Female; D015386:Hazardous Substances / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D004785:Environmental Pollutants; D015386:Hazardous Substances
keywords: Cardiovascular disease; Mortality; Toxics release inventory