title: Mortality study of civilian employees exposed to contaminated drinking water at USMC Base Camp Lejeune: a retrospective cohort study.
abstract: BACKGROUND
  Two drinking water systems at U.S. Marine Corps Base Camp Lejeune, North Carolina were contaminated with solvents during 1950s-1985.
  
  
  METHODS
  We conducted a retrospective cohort mortality study of 4,647 civilian, full-time workers employed at Camp Lejeune during 1973-1985 and potentially exposed to contaminated drinking water. We selected a comparison cohort of 4,690 Camp Pendleton workers employed during 1973-1985 and unexposed to contaminated drinking water. Mortality follow-up period was 1979-2008. Cause-specific standardized mortality ratios utilized U.S. age-, sex-, race-, and calendar period-specific mortality rates as reference. We used survival analysis to compare mortality rates between Camp Lejeune and Camp Pendleton workers and assess the effects of estimated cumulative contaminant exposures within the Camp Lejeune cohort. Ground water contaminant fate/transport and distribution system models provided monthly estimated contaminant levels in drinking water serving workplaces at Camp Lejeune. The confidence interval (CI) indicated precision of effect estimates.
  
  
  RESULTS
  Compared to Camp Pendleton, Camp Lejeune workers had mortality hazard ratios (HRs) >1.50 for kidney cancer (HR = 1.92, 95% CI: 0.58, 6.34), leukemias (HR = 1.59, 95% CI: 0.66, 3.84), multiple myeloma (HR = 1.84, 95% CI: 0.45, 7.58), rectal cancer (HR = 1.65, 95% CI: 0.36, 7.44), oral cavity cancers (HR = 1.93, 95% CI: 0.34, 10.81), and Parkinson's disease (HR = 3.13, 95% CI: 0.76, 12.81). Within the Camp Lejeune cohort, monotonic exposure-response relationships were observed for leukemia and vinyl chloride and PCE, with mortality HRs at the high exposure category of 1.72 (95% CI: 0.33, 8.83) and 1.82 (95% CI: 0.36, 9.32), respectively. Cumulative exposures were above the median for most deaths from cancers of the kidney, esophagus, rectum, prostate, and Parkinson's disease, but small numbers precluded evaluation of exposure-response relationships.
  
  
  CONCLUSIONS
  The study found elevated HRs in the Camp Lejeune cohort for several causes of death including cancers of the kidney, rectum, oral cavity, leukemias, multiple myeloma, and Parkinson's disease. Only 14% of the Camp Lejeune cohort died by end of follow-up, producing small numbers of cause-specific deaths and wide CIs. Additional follow-up would be necessary to comprehensively assess drinking water exposure effects at the base.
authors.affiliation: Agency for Toxic Substances and Disease Registry (ATSDR), Division of Toxicology and Human Health Sciences, 4770 Buford Highway, MS F-58, Atlanta, GA 30341, USA. fbove@cdc.gov.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Bove
authors.forename: Perri Zeitz
authors.initials: PZ
authors.lastname: Ruckart
authors.forename: Morris
authors.initials: M
authors.lastname: Maslia
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Larson
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D060766:Drinking Water / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058749:Military Facilities; D008889:Military Personnel; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D009657:North Carolina / Q000453:epidemiology; D016273:Occupational Exposure; D010300:Parkinson Disease / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D014874:Water Pollutants, Chemical / Q000032:analysis / Q000633:toxicity*; D055815:Young Adult
chemical_list: D060766:Drinking Water; D014874:Water Pollutants, Chemical