Document OEo88kQG53gVqBnroGNRq7nN1

STATE OF NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SI DIVISION OF PUBLIC HEALTH SERVICES BUREAU OF VITAL STATISTICS 6 HAZEN DRIVE, CONCORD, NH 03301-6527 TDD Access: Relay NH 1-800-735-2964 Agency Phone: 603-271-4651 June 13, 1995 Hasmukh C. Shah, Ph.D. D.A.B.T. Manager, Vinyl Chloride Panel Chemical Manufacturers Association 2501 M Street, NW Washington, DC 20037 Dear Dr. Shah: Enclosed is the necessary application that needs to be completed before any search for records filed at the Bureau can be performed. Please have this application filled out by AEI. This application needs to be completed before your request dated March 1, 1995 can be responded to. To avoid any delay in the processing of your request, please make certain that all items have been completed and the form signed and returned to: Bureau of Vital Records and Health Statistics Health and Welfare Building 6 Hazen Drive Concord, NH 03301 If you have any questions in this regard, please feel free to contact me at (603) 271-4651. Sincerely, KG/mjcei26 Karen Grady Acting State Registrar and Chief Bureau of Vital Records and Health Statistics R&S146558 PUBLIC HEALTH OUR BEST RESOURCE STATE OF NEW HAMPSHIRE Department of Health and Human Services Division of Public Health Services Bureau of Vital Records and Health Statistics - REQUEST FOR VITAL EVENTS RECORD DATA - A. INDIVIDUAL AND ORGANIZATION REQUESTING RECORD DATA t. Project Director: Linda D. Dell,M.S. Epidemiologist Title: 2. Office. Division. Department, etc.:___________ 3. Oganfeatton: APP'ied EPidemi'gy. 4. Street Address or P.O. Box:, P.O. Box 2424 Amherst, MA 01004-2424 5. City. State. Zlpcode:______ 6. Telephone Number (Include Area Code): (413) 256-3556 7. Other contact person If more Information Is needed: Kenneth A. Mundt, Ph.D. 8. Date of Request:__________ June 26, 1995_________ __ B. REQUESTED DATA 1. Type of record data requested: | | Birth lx] Death | | Marriage | | Divorce 2. Form of requested data: ^Copies of Documents 3. Time Period of requested data:. 1942-1993 I I Magnetic Tape I | Diskette 4. If copies of documents are requested, please complete attached payment Information form. 5. If record data on magnetic tape/diskette are requested, see attachment listing data Items and check Items requested. C. TITLE OF STUDY OR PROJECT: An Update of the Epidemiologic Mortality Study of Vinyl Chloride Workers FOR OFFICE USE ONLY Date request received:______________________________________________________ Request: I__I Approved I__I Disapproved Date of Approval/Disapproval: State Registrar's Signature: -1- <trJ*) cO In answering the following questions, please be brief but as complete as possible and attach a copy of your research/study/project protocol. If you require additional space for answers please attach a separate page(s) and number each answer. D. SUMMARY OF RESEARCH/STUDY PROTOCOL OR PROJECT ACTIVITIES i. Describe the health or medical problem(s) addressed by your research/study. What are the primary objectives? State hypotheses to be tested. See Attachment. 2. Summarize the research/study/project activities. Indicate specifically each way in which the Informa tion on the records you have requested will be used. See Attachment. 3. Will the activities involve any type of followback tocontact any of the persons who are the subjects of the records or who are named In the records? [3, No {_] Yes If yes. can you modify your research to exclude followback? no Yes If no. please explain why followback cannot be excluded: R&S 146560 New Hampshire - REQUESTOR ASSURANCES - The undersigned agrees to the following terms and conditions related to this request for vital record data. A. The record data shall not be used for any purpose other than that specified In this request. 6. No data, statistics or Information derived from the record data which Identifies Individuals shall be published or released In any form and no derived tabular data or statistics prepared for publication or public presentation or distribution of research/study results, shall display cells with frequencies of fewer than three, or Information that aQows the derivation of cells with frequencies of fewer than three, when a single town Is the unit of analysis. C. No record data or copies of the record data shall be further released to any other party without the written consent of the N w Hampshire Bureau of Vital Records and Health Statistics. D. A copy of any report using data or statistics derived from the record data wNch has been prepared for publication, or public presentation or distribution shall be provided to the New Hampshire State Registrar of Vital Statistics prior to release. for the review of any statements describing the technical aspects of the data or statistics. E. Any report using data or statistics derived from the record data which has been prepared for publication, or public presentation or distribution shall: 1. acknowledge the Bureau of Vital Records and Health Statistics of the New Hampshire Division of Public H alth Services as the data source along with a disclaimer on behalf of the Bureau and the Division with respect to any conclusions, estimates or Interpretations which the authors have made from the data. 2. state any relevant qualifications in Interpretations of the data or statistics as for example, when data observa tions do not satisfy conditions required for statistical tests of significance. The r cord data provided to the requestor shall remain the property of the Bureau of Vital Records and Health Statistics of th New Hampshire Division of Public Health Services. 6. All r cord data provided to the requestor shall be destroyed within one year of the conclusion of the research/study project or. at a later date Ifthe State Registrar has approved a written request for an extension of the time. In either case, when the records have been destroyed the requestorshallso notifythe State Registrarbymeans ofanotarized statement. H. I hav reviewed the request form. All statements made In the request form are true, complete and correct to the best of my knowledge and belief. Nam of principal Investigator or project officer Linda D. Dell, M.S. Title Project Director Organization Applied Epidemiology, Inc. L Signature. 9 , V. CJtlf Date Name of official authorized to execute agreements Kenneth A. Mundt, Ph.D. Title President Organization Applied Epidemiology, Inc. Signature , Date <>(&(?$- R&S146561 New Hampshire -REQUESTOR ASSURANCES - Th undersigned agrees to the following terms and conditions related to this request for vital record data. A. Th record data shall not be used for any purpose other than that specified in this request. B. No data, statistics or information derived from the record data which identifies individuals shall be published or r I ased In any form and no derived tabular data or statistics prepared for publication or public presentation or distribution of res arch/study results, shall display cells with frequencies of fewer than three, or information that allows the derivation of cells with frequencies of fewer than three, when a single town is the unit of analysis. C. No record data or copies of the record data shall be further released to any other party without the written cons nt of the N w Hampshire Bureau of Vital Records and Health Statistics. D. A copy of any report using data or statistics derived from the record data which has been prepared for publication, or public presentation or distribution shall be provided to the New Hampshire State Registrar ofVital Statistics prior to r lease, for th r view of any statements describing the technical aspects of the data or statistics. E. Any report using data or statistics derived from the record data which has been prepared for publication, or public pres ntation or distribution shall: 1. acknowledge the Bureau of Vital Records and Health Statistics of the New Hampshire Division of Public Health Services as the data source along with a disclaimer on behalf of the Bureau and the Division with respect to any conclusions, estimates or interpretations which the authors have made from the data. 2. state any relevant qualifications in Interpretations of the data or statistics as for example, when data observa tions do not satisfy conditions required for statistical tests of significance. ^^Th r cord data provided to the requestor shall remain the property of the Bureau of Vital Records and Health Statistics ^H>fth N w Hampshire Division of Public Health Services. G. All r cord data provided to the requestor shall be destroyed within one year of the conclusion of the research/study project or, at a later date if the State Registrar has approved a written request for an extension of the time, in eith r case, wh nth recordshavebeendestroyedtherequestorshallsonotifytheStateRegisfrarbymeansofanotarizedstatem nt. H. I hav reviewed the request form. All statements made in the request form are true, complete and correct to th best of my knowledge and belief. Nam of principal investigator or project officer Hasmukh Shah Title Manager, Vinyl Chloride Panel Name of official authorized to execute agreements Langley A. Spurlock Title Vice President Organization Chemical Manufacturers Association Signature Date ------- . 7/3/95 Organization Chemical Manufacturers Association Signature / // / Date -3- 3/6/91 - REQUEST FOR COPIES OF DOCUMENTS: PAYMENT INFORMATION - l. Project Director Linda D. Dell,M.S. Epidemiologist Title: Applied Epidemiology, Inc. 2. Organization: ------------------------------------------------------------------------------------------------------------------------------------ 3. Type of organization requesting copies of documents: (check all that apply) | | Non-profit f~~| State Funded | | Federally Funded f^] Privately Funded 4. How often will copies be required? | | Weekly Q Monthly I' 3 rbirV\S D'/tf 4 Q Annually * [^J Other, Specify ______________________ __ -5. How do you proforte-bo-blllod for tho coplos-?- PerBoteh----------- Monthly R&S146563 Project Director's Signature: Date: L QdP it Li, Mr______ -4- ATTACHMENT D. SUMMARY OF RESEARCH/STUDY PROTOCOL OR PROJECT ACTIVITIES 1. Mortality in the industry-wide cohort of vinyl chloride workers has previously been updated through 1982. Since that date, it is anticipated that a substantial number of additional deaths has occurred among the cohort. Updating the study through 1992 will allow a number of important scientific questions regarding human exposure to vinyl chloride to be addressed: 1) How does the overall mortality experience of this cohort compare with a) that of the general U.S. male population and b) regional mortality patterns in those parts ofthe U.S. in which the majority of study plants were located? 2) Does the previously observed excess of mortality due to angiosarcoma ofthe liver (ASL) continue to appear as the cohort ages? Does the magnitude ofthe excess increase, decrease, or remain the same as the cohort ages? 3) Is there evidence of an association between vinyl chloride exposure and cancer at any anatomical site other than the liver? If so, how does this association(s) compare with that of ASL in terms ofthe influence of age at first exposure, duration of employment, period(s) of exposure, estimated latency, etc.? 2. Deaths that have occurred in the cohort since 1982 will be identified using the National Death Index and any other relevant sources of information (e.g., company records). Death certificates will be requested from the appropriate state vital records offices. All death certificates will be reviewed by a professional nosologist who will identify and code all underlying and contributing causes of death according to the ICD revision in effect at the time of death. These data will then be combined with data collected in previous updates for this cohort. ICD codes will be computerized and translated into a common code for uniform analysis and reporting. Overall and cause-specific Standardized Mortality Ratios (SMRs) will be calculated using the observed numbers of deaths in the cohort and expected numbers derived by applying age-, calendar year-, and sex-specific national and regional mortality rates to the person-year distribution of the cohort. SMRs and 95% confidence intervals will be calculated and reported for total deaths and for cause-specific deaths. Additional statistical analysis will be conducted as deemed appropriate. A technical report and a manuscript suitable for publication in the peerreviewed literature will be prepared when the analyses are completed. No death record followback investigation will be performed as part of this study. R&S146564