title: Reproductive outcomes after non-occupational exposure to hexavalent chromium, Willits California, 1983-2014.
abstract: From 1963-1995, a factory in Willits, Mendocino County, CA used toxic hexavalent chromium (Cr(VI)) without adequate measures to protect the population. We use longitudinal hospital data to compare reproductive outcomes for two generations in Willits and two generations in the Rest of County (ROC). This is the first study to quantify the reproductive impact of Cr(VI) in a non-occupational population.
  
  
  
  We searched California hospital discharge data (1983-2014) to find Mendocino County residents born 1950 or later. ZIP-code 95490 identifies Willits residents, with all others living in ROC. We used the Multi-Level Clinical Classification Software (CCS) to classify health outcomes. First, we calculated the crude birth rate using an external census denominator. The next two models used self-contained denominators to assess health of infants and two generations of pregnant women. Finally, we focused on non-pregnant females and, for comparison, males. Here we added admissions for people who moved, linked and summarized admissions to the person level, and calculated rates per census population.
  
  
  
  We found 29311 newborn records in ROC and 5036 from Willits. At start of period, Willits birth rate was low and did not recover until 12 years after Plant closure. While the Plant was open, respiratory conditions, perinatal jaundice, and birth defect rates were higher for Willits infants compared to ROC, but improved post-closure. ﻿Risk for abnormal birthweight and term was high and remained high over the study period. During the period under study, we identified 31444 admissions of pregnant ROC women and 5558 from Willits. Willits women had significantly higher risk of pregnancy loss compared to ROC, whether stratified by generation, age group, or pre- and post-closure. Regardless of when exposed, Willits women continued to have significantly higher rates of in-hospital terminations, as animal studies of Cr(VI) exposure predict. In life course models, non-pregnant Willits women have significantly higher risk of reproductive organ conditions and neoplasms compared to ROC.
  
  
  
  Adverse reproductive outcomes are elevated and consistent with animal studies. General health outcomes reflect the same broad effect reported for occupationally exposed workers. For the first time, the detrimental reproductive effects of non-occupational Cr(VI) exposure in human females and their infants is reported.
authors.affiliation: Family Health Outcomes Project, Family and Community Medicine, School of Medicine, University of California San Francisco, 500 Parnassus Ave. Room MU-337, San Francisco, CA, 94143-0900, USA. lremy@well.com.
authors.forename: Linda L
authors.identifier: 0000-0001-8706-133X
authors.initials: LL
authors.lastname: Remy
authors.affiliation: Immunology Inc, PO Box 4703, Incline Village, NV, 89450, USA.
authors.forename: Vera
authors.initials: V
authors.lastname: Byers
authors.affiliation: Family Health Outcomes Project, Family and Community Medicine, School of Medicine, University of California San Francisco, 500 Parnassus Ave. Room MU-337, San Francisco, CA, 94143-0900, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Clay
mesh_terms: D000293:Adolescent; D000328:Adult; D001723:Birth Rate; D002140:California / Q000453:epidemiology; D002857:Chromium / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects*; D004785:Environmental Pollutants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000068104:Infant Health; D007231:Infant, Newborn; D008297:Male; D000068097:Maternal Health; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D060728:Reproductive Health; D055815:Young Adult
chemical_list: D004785:Environmental Pollutants; D002857:Chromium; C074702:chromium hexavalent ion
keywords: Domestic exposure; Female; Hexavalent chromium (Cr(VI)); Infant; Longitudinal research; Non-occupational exposure; Population health; Pregnancy; Reproductive health