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UC 149-2 INTERNAL CORRESP NDENCE ------------ ----------------------- ------------------ --------------------------------- CHEMICALS AND PLASTICS cisouth To (Name) Division Location Copy to Mr. J. B. Hollingsworth Dr. T. T. Szabo Mr. H. R. Guest Mr. J. L. Carvajal Dr. E. Q. Hull Subject MCA Vinyl Chloride Technical Panel Meeting April 28. 1976 2=30 The MCA Vinyl Chloride Technical Panel met April 28 to review the statue of the various research programs. Some brief notes on each program are as follows: 1. Teratology was discussed by Dr. B. A. Schwetz. The study involved exposure of rats, mice and rabbits to 50 ppm, 500 ppm and 2, 500 ppm vinyl chloride concentrations in die early days of pregnancy. Excess maternal deaths were observed at the 2,500 ppm exposure. This was enhanced by ethanol in the drinking water. There appeared to be a slight teratogenic effect in mice though results were not statistically significant. Dr. Schwetz stated that based on presenfc"day exposures and the results of the study that teratogenesis should be of no concern to pregnant women and women of child bearing age. He noted that since die first 15 to 35 days of human pregnancy were most critical with regard t teratogenesis, it would not be possible to identify pregnant women and control their exposure. 2. Metabolism was discussed by Dr. P. G. Watanabe. The study confirmed the existence of detoxification in the liver of exposed animals. Vinyl chloride is not a carcinogen but its metabolite chloroacetaldehyde is carcinogenic. During detoxification it reacts with glutalhione in the liver and is excreted as thiodiglycolic acid, or one of two conjugated cysteines. Based on the work to date. Dr. Watanabe believes the fate of ingested vinyl chloride is dose dependent. High vinyl chloride cone ntrations overcome the body's detoxification mechanism resulting in tissue damage (neoplasms). The Dow work integrated with the inhalation studies shows that 50 ppm is a threshold concentration in rats. UCC 001438 3. Animal studies were discussed by Dr. M. L. Keplinger. There have been no basic changes in the conclusions from the Industrial Biotest work. Vinyl chloride is clearly carcinogenetic to three rodent species and ia dose related. 4. Mutagenetic work was reviewed by Dr. R. V. Johnston. The cytogenetic study of rats taken from Industrial Biotest showed no significant changes in cell structure as a result of vinyl chloride exposure. Literature on mutagenesis was listed showing vinyl chloride to be a mutagen to bacteria. Three small population studies of humans showed mutagenesis from vinyl chloride. An extensive study by ICI on humans showed no mutagenesis. 5. Epidemiology was discussed by Dr. W. R. Gaffey. The "TabershawCooper Associates" (now Equitable Health Sciences) study has been ex panded to a population of 10, 173 workers with 707 deaths (95% followup) covering the period 1942 to 1972. In the long exposure, high concentration group excess deaths were noted from digestive, respiratory and "other" cancers. The "other" category was distorted by brain cancers. A draft of the final report will be available in two to three weeks. The Infante birth defects studies generated much discussion but no practical results. The Painesville, Ohio study is discredited by C.D. C. The Pottstown, Pennsylvania study via questionnaires is poorly regarded though there appears to be no way to counter it The Kanawha Valley study protocol is attached. The proposed research program at Dow and the University of Louisville was discussed and endorsed. (This is shown in a separate letter. ) RNWJr. /pm Attachments ucc 001439 CENTER FOR DISEASE CONTROL g Vol. 25, No. 8 1 WEEKLY i report IK For S Week Ending S February 28,1976 U S. DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE * PUBLIC HEAJH SERVICE DATE OF RELEASE: MARCH S. 197* - ATLANTA, GEORGIA 30333 EPIDEMIOLOGIC NOTES AND REPORTS ANGIOSARCOMA OF THE LIVER - Wisconsin In the period June 1973-November 1975, 4 cases of angiosarcoma of the liver (ASL) were diagnosed at the Marsh field Clinic, Marshfield. Wisconsin. One was based on hepatic arteriography and 3 on tissue findings later confirmed by pathologic review at the National Cancer Institute (NCI). An additional 6 cases, confirmed on pathologic review at NCI and identified through a national ASL ease surveil lance project initiated at CDC in 1974, have been diagnosed since 1964 jn Wisconsin residents. This total of 10 cases is roughly twict as large as might be expected (5.5 cases), based on CDC surveillance estimates or crude ASL incidence for the entire United Stales. (Five additional cases had been re CONTENTS Epidemiologic Notes and Reporti Angiosarcoma of the Liver - NNeonstn.............................67 Possible Lasse Fever - WeihiiRpon, D.C, ......................*4 Current Trends Influents - Worldwide ......................................................63 Internet ionel Notes SthnontH* typhitnurtvm - Cate,v Itlends. Finlend, end the Federel Republic of Germeny .... *4 ported for Wisconsin; 4 were not confirmed, and I was in a resident of another state.) In view of this relative frequency of cases, together with the recent succession or cases a* the Marshfield Clinic, epi demiologic information concerning each of these 10 cases TABLE 1. CASES OF SPECIFIED NOTIFIABLE DISEASES: UNITED STATES (Cumulative totals include revised and delayed reporti through previous weeks) DISEASE WEEK ENDING February 28 1976 February 22 1975 MEDIAN 1971-1975 CUMULATIVE. FIRST 8 February 28 1976 Fthniaiy 11 I97S WEEKS MEDIAN 1971-1976 Encephalitis Hepatitis, VW Typr A........................................ Typhus, tick-borne (Rky. Ml. spoiled fever) .. . Venereal Dnensts: (ronormea \ Militwry............................................. Syphilis, primary and secondary j '' Rahics in animals..................................................... 28 7 5*766 6 13 6 242 726 133 3 805 53 53 1*366 22 449 2 570 l 3 18.313 St 2 528 a 39 35 2 4*911 14 17 7 10 707 150 6 578 61 61 1*425 24 265 505 1 2 33 2 6 13 5 172 ) 890 6 622 41 40 i 1,892 645 __ 1 6 1 7,2 73' - *19 531 3 45 -- 56 307 38 39*288 tz 129 32 1*935 5*409 1,3tS 43 A ,318 284 281 3 9,368 194 1 *870 6 4 *572 21 58 3 151*748 4 *708 *.132 66 2*9 292 21 29*693 66 96 33 1 *568 5*428 1.123 42 2,668 270 263 7 11,136 201 1 *637 9 4 *105 8 29 10 1*1,258 A,776 3 ,938 52 Z8A 292 15 23 120 33 1,316 } 7,619 42 4*767 270 263 9 1A, 2A6 3* 534 8 13 37 9 448 TABLE II. NOTIFIABLE DISEASES OF LOW FREQUENCY Cum. Cum. Anthrax:.......................................... Botulism:.......................................... Congenital rubella syndrome: ... Leprosy: Fa. I.Calil.l..................... Lcpiospirosis:.................................. Hague: ............................................ TiiriwTliipSrHWwriBjSiT/nfi* 2 Poliomyelitis, total: ... 4 Paralytic: N Y.CI. . . 5 Psittacosis: Ohio I.CaHf.3 20 Rabies in man:............. 7 Trichinosis: NJ. I . . . . - Typhus, murine: Tax. 1. Z Z w z mak a o Ktca ucc 001440 ANGIOSARCOMA - Continued hit been assembled through medial record review tnd fimily interview (Tible 1). Particular attention hat been given to potential occupational or environmental exposure to chemi cals known to induce ASL (vinyl chloride, arsenic, and thorium dioxide). Most ases (7 of 10) were diagnosed since 1970, prob ably reflecting better case ascertainment in recent years. Apes ranged from 36-71 (mean age S8 years). All but ) pa tient were male, and all but I were white. Placet of usual residence for all cases were widely tattered across the state, roughly corresponding with the statt's population (Figure 1). One patient had a history of prior thorium dioxide ex posure. For none of the remaining cases was tumor etiology obvious. Occupations and histories of exposure to potential environmental toxins differed widely, with no more than 1 ca^c associated with any particular industry or mode of exposure. In several instances, however, individual patient occupations or exposures were suggestive of possible onco genicity (Table 1). Patient 10 had had exposure to a vinyl compound; he had worked in paper and plywood producti with potential contact with various chemicals, including poly vinyl acetate. Two other patients gave histories of possible exposure to arsenic; patient 9, who had exposure to insecti cides while farming, and patient 8, who worked with wood probably treated with arsenic preservatives in the manu facture of bleachers. All but 3 of the 10 patients were known 1o have lived on farms during their lifetimes, 2 for ail of their lives (Table 1), (Reported by J Fiechtner, MD, C Reyes. MD. Marshfield Clinic; K Renlmesster, MPH, HC Skinner, MD, State Epi demiologist. Wisconsin Stare Dept of Health and Social Serv ices; Office of Extramural Coordination and Special Protects. National Institute of Safety and Health; and the Cancer and Birth Defects Dlv, Bur of Epidemiology, CDC.) Editorial Note These data indicate no obvious common-source origins among recent ases of ASL in Wisconsin. The marked male preponderance among ases, however, suggests occupational GEOGRAPHIC DISTRIBUTION OF CONFIRMED CASES OF ANGIOSARCOMA OF THE LIVER IN WISCONSIN RESIDENTS. 1964.1975, BY PUCE OF USUAL RESIDENCE exposure aa the potentiel origin for at least some of the ases. Anecdotal histories of occupational and environmental exposures in Kveral of the ases may warrant further investi gation, particularly in relation to contact with arsenic. Al though at present only vinyl chloride monomer (I), thorium dioxide (2), and arsenic (3.4) are clearly impliated as auset of ASL, investigations such as the one described here may well provide useful leads in defining further causes. References 1. Creech JL, Johnson MN: Angiosarcoma of lives in the manufacture of polyvinyl chloride. 1 Oecup Med 16:150.151,1974 2. MacMahon HE, Murphy AS, Batea Ml; Endothelial-ceU sarcoma of liver following Thorotreit injection. Am J Pathol 23:585-595, 1947 3. Lender JJ, Stanly RJ, Sumner HW, et el; Angiosarcoma of the liver associated with Fowler's solution (potassium arsenite). Gistroenterokigy 68:1582-1586,1975 4. Roth F: The sequela of chronic arsenic poisoning in MoseDe vinters. Gar Med Mon 2:172-175,1957 Table I Cases of ASL In Wisconsin Residents 1964-1975 fast Month an 1 Year Usual Town Number Diagnosis Death or Residence i 4/64 2/65 Sheybogan 2 1161 2/67 Oshkosh 3 6/67 6/67 Ncccdah 4 7/71 7/71 Milwaukee 5 4/72 4/72 Milwaukee 6 4/74 6/74 Brown Deer 7 7/74 7/74 Wausau 8 9/74 9/74 Wiuptm 9 8/74 8/74 Stratford 10 11/75 li/75 Marshfield Age at Diagnosis 71 61 36 68 64 46 57 46 66 65 Race w W w B W W W W W W Sex Occupation Comments Farm Residence M University Teacher Lived near a chemical company Youth which made plastics and resin M Foundry Welder Exposure to welding materials None and resins F Secretary Infectious hepatitis in childhood, Youth M Hog Scalder mother and sister had liver disease None M Unknown Exposure to thorium dioxide Unknown M Lutheran Pastor Lived near a paper mill, 1955-1959 Youth M Rock Crusher; Glue- Exposure to lilici dust, rubber Youth Liner for rubber cement raincoats, 1940s M FostalMail Carrier Contact with lumber, paints, wood Lifetime formerly'employed preservatives, (ammoniacai-copper- by company that arsenate wood preservative) (7) made bleachers M Retired Farmer No tissue diagnosis; ASL diagnosed Lifetime by hepatic arteriography M Press operator for Contact with wood, plywood, Youth paper and plywood glues, polyvinyl acetate, others company (23 yean) UCC 001441 109* -'V' t Tilt I ANCKT, NltVt Still It 29, 1975 MtitcrriMi.i't and um iiiun m iihhi stats amis in rAiarsvii.i.s MIAMTAt., IN1HI An*ncfN*ivt Year 1*70 1*71 1*71 lf7J 1*74 197IN 1*74 IWinllt Mot* Pntmnlly Ntate No.rf Na.oJ N*.*T No nf cm Rate* C*M9 R*< cases Rote cm Rate 0 00 2* 5* 3 31 2 3 hi 1 10-9 SI 7 J 3 30* 44 M J 15* Jl 4 1 * 0 0 47 4 2 34 0 27 3 4 2 24 * 4* 0 0 00 22 4 1 13-1 -20 *- 4 14-1 144 yy * 21 2 224 It Ptr 10 000 ratal -Art* births. iIm diterimination of vector of meant can be tested for sigmfi- cance. A high ditcrimination between the malformation group and in matched control* appeared within the first 10 of the 24 variables (iee accompanying figure). Even with I variables a significant discrimination of both groups at 151 level was found. The ditcrimination of both groups was alto possible without the two factors "shortwnsAiiJIbmh* in mothers family" and "hour* of daily work". So, even in a sample with factors each not discriminating significantly between both groups, the linear dncnminancc analysis make* it possible to discriminate between the malfor mation group end the matched controls. This might mean that the malformations in our sample can be explained as caused by the combination of many minor factors (extrinsic and intrin sic). O&Uktal am? Z!inaT.j;{r.CtJ&4 KUmkunt 0*f Johann VoKftoftgs Goethe* Ufftvtftdit. Frankfurt am Main. . rffibai kepuMc ofGemny. J. KleinF-tRFCHT K.-H. Dsgf.hhardt CONGENITAL MALFORMATIONS AND VINYL CHLORIDE Sir,--In March, 1975, a significantly increased rate of certtral-nervous-system (c.n.s.) malformations was reponed in 3 Ohio communities where polyvinyl chloride (r.v.e.) polymeris ation plants are located;1 2the increase was nor uniform and appeared more prominent in the Paincsville area. There are two r.vx. plants in Paincsville, one of which began operation n lao nod the other in 1967. The birth-defect rate* were computed from birth-certificate data for 1970-73 and were compared with similar data for the entire State of Ohio. This study suggested a relationship between the higher rates of c.n.s. malformations and the increased risk of exposure to vinyl chloride in these communities. By analysing data collected through the Center for Disease Control's hospital-bated birth defect* monitoring programme (*.o.M.r.),' we examined this relationship. Two hospitals parti cipating in the r.o.m.p. are located in cities with polymerisa tion plants; one is in Pennsylvania, the other in I'amesville. Ohio. c.N.s.-malformation rates for white inlants born in these two hospitals in 1970-74 were compared with the rates Inr white infants in each State. No increase was seen in the Penn sylvania hospital, but an increase, primarily m anencephaly and spin* bifida, was noted in the Paincsville hospital Inr the total time 1970-74 (see table). The a.o.M.r. hospital data for Paincsville were compared ivith birth-certificate data from the Ohio department of health, and 1 additional case not included in the a.n.M.r. report was added, bringing the total to 15. 30 controls, the first normal white infant bom before and after each cate, were selected from the hospital birth registry. Medial records for cases and commit were reviewed to confirm the diagnosis and to obtain, among other data, the parents' occupation and residence at the time of the infant's birth. In addition, parents of 14 of the affected children were interviewed about previous occupations and residences. The study revealed that none of the interviewed parents of affected infants had ever worked at either of the two p.v.c.-polyniens*tion plants in Paincsville (1 set of parents could not be located, but records show that they did not work at these plants at the time of their infant's birth); 2 of the fathers of comrots had worked at one of the plants at the time of their infants' births. None of the parents in either group lived within 2 miles of the two plants. The chi-square test of significance was used in comparing the distances from residence and work-place of mothers and fathers to the r.v.e. plants for cases and controls. Companions were made at distances of I to 10 miles, in 1-mik increments. A significantly larger proportion of control mothers than case mothers worked (including housewives) within a 10-mile radius of the r.v.e. plant, at the 95% confidence level. This it probably a chance occurrence among multiple comparisons. Vinyl chloride is a known carcinogen,* and concern has arisen over its possible teratogenic effects. This concern stems from recent studies which have shown (a) an increase in muta genicity in bacterial assay systems* and (b) increased brttktgt in chromosomes of p.v.c.-poiymerisation workers.* The Ohio Department of Health study' it the only report that has sug gested that vinyl chloride cause* birth defects in man. Although the lollow-up study reported here confirmed a moderate increase in c.n.s. malformations in Paincsville, Ohio, no association was found with vuiyl-ehtonde exposure. Caacar and Mnh Utfan Umnon, Rwv*h of Epiatnnfl<og*> OAtutoternr*f,o(rftDoirtftiot *}0C)o}JnatroLl.,SA Lasbv D. Edmonds, Hrnrv Fata Jacr E. Nissim LATE COMPLICATIONS OF TUBAL LIGATION Sta,--Unlike Mr Darwish and Dr Saafan (Nov. 15, p. 975'. wc art uncertein as to the etiology of the late tcqurl* nf female sterilisation, which they refer to is menstrual irregu larity, but in our study it will be tinted we looked specifically at menorrhagia and dysmenotrhtxa. It seems unlikclv that a psy chosomatic cause could be present when two different tccl 1. Infante, P. tit Prsmedint* of the Cufitiimi m ltouf*iim*M.*rc>*nfnww t ill* New York Aeaikmy of ton, 23 Merck. 1*7* New Vnrk >hi tKr pros). 2. Center for On* Control CanpiMtH MaffarmaOwi toowRaact Anna*I Ummttf 1*74. Alton*. 1*7). ). Center for Ifewtie Control. Morfadnr an* Manilev lidh Reprint let*. *. 1*74. pee 4. R--noR, L',, Jett.......... A-, RmioL Cm Wkmuter. C A. Awt*. I*4, 1* 1*4. hmHte UnttoHe l* Umtociit J. to*, 1*73, i. 41*. ucc 001442 V DEPARTMENT Or HEALTH. EDUCATION, AND WELFARE PUBLIC HEALTH 5CRVICC crNtfp fob mscAte contool March 25, 1976 V Mr. Milton Freifeld Manufacturer's Chemist Association 1825 Connecticut Avenue Washington, D. C. 20009 Dear Mr. Freifeld: Enclosed is a copy of the protocol for the study presently underway in Charleston, West Virginia. I have made a few marginal notes where changes were made. The main change was the decision from the outset to interview cases and controls (regardless of exposures among the case group). We had at one time considered searching occupational records at the plant for names of cases and controls, but discarded the idea in favor of the interviews. ~ If you have questions about this, do not hesitate to contact me. I would like to emphasize our desire to maintain the confidentiality of hospitals that participate in the BDMP. This includes, according to our agreement with the Commission on Professional and Hospital Activities, no mention of the number of hospitals in a community which participate in BDMP. We would appreciate your cooperation in this respect. Also note that the data contained in this protocol are preliminary and were compiled only as background for planning of the study. Final data will be part of the finished report. Sincerely yours. Enclosure cc: Dr. John Finklea Mr. Larry Edmonds JWF:crs J. William Flynt, Jr., M.D. Chief, Birth Defects Branch Bureau of Epidemiology ucc 001443 Proposed Study of Increased Rates of Central Nervous System Defects In Kanawha Co. West Virginia Introduction A recent report noted higher rates of CNS defects in Painesvllle, Ohio, a city with a vinyl chloride polymerization (VCP) plant. This report suggested a causal association between the PVC plant and the higher CNS rate. We conducted a follow-up investigation, including Interviews of parents of cases, and found no current or past occupational exposures to vinyl chloride among parents of cases. Comparison of cases with controls suggested no differences in distances of family residence from the vinyl chloride plant. The latter finding has been questioned because cases and controls were based on hospital births rather than resident births in the community. The continuing concern about a causal association prompted a review of all 36 counties with VCP plants to determine those with BDMP hospitals. A similar determination had been done previously selecting for analysis those communities with a VCP plant and most likely served by a*single hospital also in the BDMP (and having a VCP plant). Painesvllle, Ohio, and Pottstown, Pennsylvania, were identified in this manner. Pottstown had no excess f malformations while Painesvllle was noticed to have a twofold increase in CNS defects. On the second review, a total of 17 counties with VCP plants also have at least 1 BDMP hospital. Pour of the 17 counties have a significantly higher number of CNS defects than expected, based on a total U.S. rate 1970-73. /* * In two counties BDMP monitors less than .50 percent of this total reported births (Table 1). The 2 remaining counties are Lake Co., Ohio (Painesvllle), VJCC 00AAAA the site of previous Investigation, and Kanawha County (Charleston), Vest Virginia. There are 4 hospitals in Kanawha County reporting 4,476 births in 1973 (Table 2). The 2 largest hospitals are enrolled in the BDMP; 1 is located in Charleston and the other in South Charleston, the site of the VCP plant. The current BDMP data show for Kanawha County a signifi cantly higher number of CNS defects than expected (59 observed vs. 37. expected). The expected number of cases are based on the total U.S. rates for 1970-74 (Table 3). In light of' continuing concern regarding the possible teratogenicity of VC monomer; the Kanawha County setting was selected for a second inves tigation concerning the possible association of increased rates of CNS defects with parentsl occupation or residential exposure to the S. Charleston VCP plant. Additional background data on Kanawha County vital statistics are pro vided in the appendix. Objectives The objective of this study will be to further investigate the possible relationship of parental exposure to vinyl chloride and the increased e Incidence of central nervous system defects. The ease-control study method will be used to compare the frequency of maternal and paternal occupational exposure to VCP. Similarly, residential exposure will be examined by comparing distances of parental residences at birth from the VCP plant in South Charleston. ucc r 001445 3 Method* .. A. Case Ascertainment All eases of Central Nervous System (1CDA NO. 740.0-743.9) defects that occurred among resident live births end fetal deaths in Kanawha County between January 1, 1970 and December 31, 1974 will be Identified. Two sources of case identifications will be employed: 1. Birth and fetal death certificates will be reviewed in the West - Virginia Department of Vital Statistics. 2. Records at all Kanawha County hospitals will be reviewed. This will Include cases reported through the Birth Defects Monitoring Program. A consolidated list of unduplicated cases will be compiled and diag nosis verified according to hospital records. Non-resldential and unverified eases will be retained for further comparative analysis, but not matched with controls. B. Selection of Controls Controls will be selected from Kanawha County resident birth certificates after all cases have been identified. Two controls will be selected for each case of CNS defects. The controls selected will be the next matched normal live birth preceding and following. The cases and controls will i a. be matched for taatemal age (15-19, 20-24, etc.), .paternal education (0-8, 9-12, 13 over), and race. A maximum of twenty-five birth certificates will be reviewed preceding and following the case to find the two matching controls. If a preceding (following) age-education-race matched control is not found, then the first preceding (following) birth matched on race ucc 001446 and either education or age will be chosen, education being the first choice. If there is still no-match, then the first preceding (following) birth matched only on race will be selected. Data Collection A. Birth Certificates and Fetal Death Certificates The information to be collected on case and controls from the birth certificates is contained on page 1 of the work sheet. B. Hospital Record The information to be collected on cases from hospital charts is listed on page 2 of the work sheet. Hospital records will be reviewed for controls only in cases where birth certificates information is incomplete. C. Interview Parents of cases will be interviewed in standard fashion regarding prior residences and occupations. The Information to be obtained is listed on Worksheets 3-5. -1 Parents of controls will not be interviewed unless 1 or more parents of ,, passes are found to be employed in the vinyl chloride plant or a signifi- v* ^ * * candy greater proportion of the parents of cases live near the vinyl 1 >|' chloride plant'. In the event that 1 or more parents of cases works at vinyl chloride plant, only 1 control will be interviewed' for each , matching case. The control chosen for interview will be the closest , i match. '- ucc 001-W7 s Data AnalyBla f''"' * An analysis of matched triples will b made using the method of Mantel and Haenszel. The possible relationship between'parents' occupational exposure and CNS defects in their children will be analyzed 3 ways by dichotomizing cases and controls on employment of mother, father, and either parent in a vinyl chloride plant. Only current employment will be used for controls unless significance is attained. Then past employment data will be otained from the controls in the same manner as for acses and the resulting data re analyzed . The effect of distance of residence from the vinyl chloride plant will be analyzed by dichotomizing on distance in increments of 1 mile in the range 1-10 miles. UCC 001448 Oklahoma Co., Oklahoma Hew Castle Co. Delaware Lake Co. Ohio Kanawha Co. West Virginia Table 1 Counties vith Significant Increases In CHS Defects 1970-73 and Reported Births in 1973 S CHS Defects in BDMP obs* exp. 68 44.9 '9 4 31 18 53 31 f Births In BDMP 4,096 W7: ) *ESE3n <.24S ESSSSEEl $Births In AHA* / / 8,718 (9 hospitals) 5,634 (3 hospitals) 1,851 (2 hospitals) 4,476 (4 hospitals) %' Monitored In BDMP 47.0 6.5 98.4 94.8 American Hospital Association Guide to the health care field (1974 edition) o Table II Reported Hospital Births In Kanawha County* W. Virginia from AHA Guide i Charleston, " --- " SouthCharleston Total birth Kanawha County * 3488 148 93 757 4476 *BDMP Hospital 9>JZ of reported hospital births are monitored by BUMP Vital Statistics Data from West Virginia Vital Statistics Reports 1974 for Kanawha County * Total Births 3348 Hospital Births 3341 White Births (male) 1616 (female) 1471 Hon-white Births (male) 126 (female) 135 UCC 001450 Table III Total Central Nervous System Defects 1970-1974 Kanawha County Total U.S. Relative risk - 1.58 0BS. 43 16' 59 7655 EXP.** 29.2 8.2 37.4 RATE+ 31.3 41.3 33.5 21.2 Anenccphalus-Spina Bifida - 1970-1974 Charleston S. Charleston Kanawha County Total U.S. Relative risk * 1.77 OBS. 27 13 40 4604 EXP. 17.6 5.0 22.6 - RATE i9.6 33.5 22.7 12.8 BUMP Births - 1970-1974 Charleston 13,754 S. Charleston 3,877 Kanawha County 17,631 Total U.S. 3,606,848 * Expected calculated'on BDMP total white U.S. rate 1970-1974 + Rates per 10,000 total births for whites UCC 001451 APPENDIX VITAL STATISTICS, KANAWHA COUNTY, WEST VIRGINIA ' S. Charleston Charleston St. Albans County POPULATION Census Population. Kanawha Countv 1970 16,330 1971 1972 1973 71,505 14,356 229,515 230,400 230,300 226,800 Kanawha County West Virginia 1970 16.3 17.3 BIRTH RATE 1971 1972 16.5 15.0 17.8 16.7 1973 14.4 15.4 White Male White Female TOTAL 1970 1724 1726 3450 BIRTHS, KANAWHA COUNTY 1971 1972 1805 1658 1694 1535 3499 3193 1973 1624 1436 3060 1974 223,700 1974 15.0 15.4 1974 1616 1471 3087 Nonwhite Male 148 116 134 120 126 Nonwhite Female 137 162 107 147 135 TOTAL 285 278 241 267 261 ucc 001452 I City Charleston S. Charleston St. Albans 1970 NUMBER OF BIRTHS 1971 1972 1035 245 200 1973 972 240 218 1974 1031 227 198 1970 1971 1972 1973 1974 10-14 7 9 6 14 10 BIRTHS BY AGE OF MOTHER, KANAWHA COUNTY 15-19 20-24 25-34 35-44 45 711 1504 1309 201 3 761 1553 1274 180 723 1360 1186 156 3 743 1247 1186 136 1 671 1290 1252 124 1 Unk Fetal Deaths Congenital Anomaly Premature Births RESIDENT DEATHS, KANAWHA COUNTY 1970 1971 1972 59 (15.8) 60 (15.9) 53 (15.4) 25 (10.9) 25 (10.9) 20 (8.7) 12 (5.2) 3 (1.3) 8 (3.5) 1973 37 (11.1) 15 (6.5) 9 (3.9) 1974 28 (8.4) 11 (4.9) 7 (3.1) FAMILIES WITH INCOME LESS THAN POVERTY LEVEL IN 1969 BY COUNTY I Families Z Of All Families Kanawha County 8020 13.0 West Virginia 81697 18.0 UCC 001453