ML20127F252

Epidemiologic Surveillance in Pennsylvania:Case of Nuclear Power Plants

ML20127F252
Person / Time
Site:	Three Mile Island
Issue date:	06/30/1984
From:	Tokuhata G PENNSYLVANIA, COMMONWEALTH OF
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ML20127C068	List: ML20127C065 ML20127F223 ML20127F239 ML20127F252 ML20127F269 ML20127F296 ML20127F310
References
FOIA-85-8 NUDOCS 8506250091
Download: ML20127F252 (10)

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EPIDtHIDLOGIC SURVE!LLANCE IN PfNNSYLVANIA:

A CASE OF NUCLEAR POWER PLANTS George X. Tokuhata, Dr.P.H., Ph.D.

Director .

Division of Epidemiology Research Pennsylvania Department of Health June, 1984 4

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EP!DEMIOLOGIC SURVEILLANCE IN PENN5YLVANIA: A CASE OF NUCLEAR POWER PLANTS I. INTRODUCTION The need for monitoring and eva'l uating the health status of populations was clearly indicated by the accident at Three Mile Island on March 28. 1979.

Had the accident been more serious in a health threatening sense, the infor- (

mational needs of involved government agencies and a concerned public could not have been adequately served in a timely manner. In A,oril,19M. the Secretary of Health' issued a memorandum to the Three Mile Island (1NI) . ,

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Advisory Panel for Health Research Studies regarding the Need for Baseline Data Around Nuclear Power Facilities." The Panel endorsed the concept of improved epidemiologic surveillance i'n general and approved the project for

. development by the Divl'sion of Epidemiology Research. /

Several important feharacteristics of the Epidemiologic surveillance System should be emphastred. First. the primary intent is to establish an

. automated method of compiling baseline health data for specific geographic l

areas which can be updated and monitored routinely. Second, the System is designed as a . screening" rather than " diagnostic" device; that is, signif.

icant changes or differences in health states based on the data analyzed will be regarded only as " potential warning signals." If and when such signals are detected in a population, further " diagnostic" study would be necessary to substantiate the magnitude of the probicm and to identify specific cause(s). Third. the Surveillance System. of itself, is not'.

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intended.to test any specific hypotheses or to determine health effects of radiation as such or any other specific health hazares, but rather to

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detect significant chances within or differences from norms in any health indicators under consideration that can be determined with the availabic da ta . Fourth, the System would provide comparative data which would be

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useful in the continuing effort to assess the potential health effects of the TMI accident. The'public demand for health information in the

<TMI area is beginning to rise again as the length of' time since the acci-

'cknt approaches the lower limits of the estimated latency periods of cer-tain cancers and many local residents believe that they had been exposed to large doses of radiation. Furthemore, the System would provide health information which would be invaluable in the event of another nuclear acci-6ent or any other health threatening event.

II. PROJECT OBJECTIVE $

In view of practical consioerations and innediate need, the objectives of this System are to:

(1) Develop and implement a baseline health information system which will insure the centinuous and systematic compilation, analysis and interpretation of available democraphic, natality, morbidity.

and mortality data for minor civil divisions (MCDs) within 20 mile radii of the six nuclea_r p1_ ants (5 geographic areas) and selected contr_o_1 areas in Pennsylvania.

(2) Establish baseline health indices for each selected area. These baseline indices established during years of normal operation of nuclear plants can. serve as "controir." against which updated indices

, can be compared in subsequent years. Health indices developed during pre-operational years (new plant sites) can also serve as

" controls" against wh.ich post-operational indices can be compared. ,

(3) Monitor and evaluate the health indices for study populations in -

the vicinity of nuclear facilities on a recular basis to detect any significant changes over time or differences from norms that may have occurred or been observed.

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(4) Determine if special studies should be initiated to establish whether significant changes or differences in health indicators, if and when observed, are related te living in proximity to ,

nuclear power plants or to other factors.

!!!. GE0 GRAPHIC AREAS The initial focus of the Epidemiologie Surveillance System will be on populations residino in minor civil divisions (MCDs) wholly or partially within 20 miles of the six nuclear power plants (comercially operational and under construction in Pennsylvania) and populations in control areas.

The nuclear power plant sites include (1) Seaver Valley 1 and 2 -

(Shippingport, Beaver County); (2) Shippingport (Shippingport, Beaver

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County; (3) Three Mile Island 1 and 2 (Goldsboro, York County); (4)

Susquehanna 1 and 2 (Berwick, Luzerne County); (5) Peach Bottom 2 and 3

'(Peach Bottom Township. York County); and (6) 1.imerick 1 and 2 (Pottstown, Montgomery County). The surveillance in these areas will cover a total of 565 minor civil divisions and about 2,970,000 people. One hundred and fifty-four MCDs with a population of 760,000 reside within 10 miles of the six power plants and an additional 411 MCDs with a population of 2,210,000 reside within a 10-20 mile ring of the plants. The comunities (MCDs) selected for this surveillance program are included in the evacua-tion plans developed by the Pennsylvania Emergency Management Agency (PEMA) and the " Plume Exposure Pathway EPZ" plans available for each nuclear plant.

site. .

The so.ntrol areas selected for comparative purpenes, collectively - -

provide' a social-industrial-geographical representation of Pennsylvania; except that there are no nuclear power plants within 20 miles of the perimeters .of any of the areas. ,

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IV. HEALTH STATUS MEASURES (INDICES)

The need for a minimum data set is recognized. It should be noted that certain health indicators or indices (e.g., cancer) have a long r latency period (interval between exposure and diaanosis), while others

. (e.g., fetal mortality) may have a short latency and effects, if any. can be shown within a year or less.

First, the short-tenn health indicators included in the minimum data set are largely derived from birth, fetal, and infant mortality data. These include:

(a) Fetal mortality (with or without abortio'ns of 16+ week gestation).

(b) Hebdomadal mortality (during first 7 days of life).

(c) Neonatal mortality (durin9 first 28 days of life).

(d) Perinatal mortality (combination of fetal and neonatal mortalities).

(e) Infant trortality (during first 365 days of life).

(f) Congenital malfonnations, including neonatal hypothyroidism.

(g) Prematurity (gestation less than 37 weeks).

(h) Low birth weight (birth weight less than 2500 grams).

(i) Low Apgar Score (less than 7 at one minute).

Second, with respect to lono-term health indicators, data on cancer

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incidence, prevalence, and mortality of the following organ sites are important.

(a) Leukemia (g) Lymphatic system b) Thyroid (h) Bladder (urinary)

Breast (i) Kidney Skin (j) Pancreas Lung and bronchus (k) Stomach (f) Bone (1) Escohacus ,

Third, th'yroid disease (other than congenital and cancer) will be

, studied as intemediate-term indicators, particularly in relation to'the

. release of radioactive iodine into the environment which can be ingested _

i or inhaled by local residents.

Fourth, in view of the possible effects on aeneral life exoectancy or longevity of a total population, abrjdned life tables will be computed l periodically using annual mortality data and base pooulations by age and i-sex.

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v. METHOD OF ANALYSIS In general, the methods of analysis to be utilized will be determined i by general surveillance needs and the requirements of particular studies. .

)ihen the baseline morbidity and mortality data are established, a variet;y of routine epidemiologic analyses will be carried out. Demographic differs ie,,

ences in the populations under consideration which could bias results will be adjusted for wherever possible in a*1 analyses.

First, cross-sectional analyses: Various health status measures will -.

be r.ompared between the nuclear power plant (NPP) and control areas for selea.ted years. Such measures will be based on area-specific mortality '-

, and/or mortidity data. -

5econd. temcoral analyses: Changes over time in health status indi- -

cators of populations residing within each of the specified NPP and control '

areas will be assessed. Specifically, when the baseline health experience .

- ' ion around a' given NPP is established, the health experience '

of snat r t

!cular population can be compared from one time period to anothe r. Such historical analyses have an advantage over cross-sectional

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comparisons in that much of the basic environmental characteristics (Physicala.s r socioeconomic, cultural, etc.) tends to remain fairly stable. On the other hand, historical analyses will permit the relating of significant changes ,j in health status, if they occur. red, to recognizable socioeconomic changes. 4 . T-such as the establishment of a new industry with subsequent influx of morters ji.

in certain age groups into the area comunities. *

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Third, temocral-spatial analyses: This is a combination of ap4M ,#

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ag e comparisons with historical comparisons. For example, time trends in apr- ,1,S; z tality from specific cancers in the NPP and control areas will be evaIW8W in reference to each,other. This will Dermit assessment of sicnificant s

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changes in cancee,6 cath rates which may be limited to a particular WM ~ a f area rather than/as a reflection of the more nenerali20d chances alle N* _

served .el sewhere'.

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If justified by the results of the ruutine "screenino", special in-depth epidemiologic studies will be developed. Data available in the system will be useful in planning and carrying out such special .

studies. .

Health status indices, such as the ratto of observed and expected ,

morbidity and mortality measures will be developed for minor civil divi-

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sions individually or as a pool. Control charts and confidence limits Will be derived in order to detemine significant excesses of morbidity /

, mortality in any particular area population. Due to the spurious nature of adjusted morbidity / mortality rates sometimes obtained for small popu-lation groups by the direct method, the indirect method of standardiza-tion will be used when indicated to adjust the measures with respect to factors such as age and sex and to derive expected numbers and rates.

The various statistical analyses will involve the use of statistical tools ranging from simple univariate measures of central tendency to graphtes, including tests of significance (differences in health indices

, between populations or changes in health indices over time) as well as multivariate regression and correlation analyses.

.VI. OPERATIONAL PROCEDURES -

The Division of Epidemielogy Research and the State Health Data Center will develop the mechanism to assure the orderly consolidation and coordin-ation of routinely collected vital statistics, population and morbidity data. The surveillance data will be pomputerized and the automated data base will be updated by the State Health Data Center annually or at other -

time intervals as needed. The Division of Epidemiolocy Research will be.

I responsib1'e for data analysis and epidemiologic. interpretation. There will be no routine reporting of the results of " screening" analyses. Such findings will be used solely for tne purpose of internal management and recosndation for further action. .

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. 7 Yll. DATA COMP 0fiENTS

1. Natality and Nortal_ity_ Data Componer.t:

The vital statistics data to be utilized in the System will be -

limited to special computer files ( minimum data set") containing selected data elementh stripped from the Health Data Center's Com- '

puterized birth and death statistics files. This newly create.d computer file will cover the period 1970-present and contain only -

data for minor civil divisions within 20 miles of the five surveil-lance areas and selected control sites in Pennsylvania. Because of confidentiality and other constraining factors. the file will not contain identifying information, and direct access will be limited to specified surveillince system staff.

The " minimum dats set" will include information on live births.

fetal deaths. neonatal deaths. infant deaths, congenital anomalies, prematurity, low birth weight Apgar scores, and selected causes of death including malignant neoplasms. It will diso ind ude such basic data elements as sex,: race, date of death age at death, place of residence (MCD), place of death, cause of death (underlying to 1979, underlying and contributory. 1979-present). The data files of the system will be updated with current data by the Hea'th Data Center annually or at other time intervals as needed.

2. Morbidity Data Component:

This component will be based on routinely collected morbidity' ,

data that are readily.available by minor civil division of residence. ~  :

One of the two computerited morbidity riata systems which hold most promise at present is the Pennsylvanie conc.ar Reaist*y. the other is a hospital discharge system of the Hosuital Utilization Project (HUP).

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.l 8-u Surveillance System staff in cooperation with the Division of Chronic Diseases and the State Health Data Center Will develop the operational procedures needed to insure the availability of the most recent Cancer Registry data for survcillance purposes.

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The minimum morbidity data set would include discharge date -

and status, age, sex, race, primary diagnosis, other diagnoses,

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place of residence (MCD) and hospital of discharge. Due to 1imita-tions in quality and availability, these HUP data will be collected only for the years from 1978 onwards. This minimum data set will be incorporated after the automated surveillance system has been fully developed with ,the available data within the State Health Depa rtment. ,

3. Population Data Compone_nt:_

Baseline population data are essential for a variety of purposes, including the computing of rates. The population data to be utilized will be obtained from the Health Data Center (HDC) which is a census affiliate data center. Data for the years 1970 and 1980 will be used.

V111. INTERAGENC_Y_ C_00RDINA_TI_0N The Epidemiologic Surveillance System Around Nuclear Power Plants, which is being developed in Pennsylvania, is unique and the first of its kind in the United States and abroad, The concept and approach of the system, which evolved from the experiences of the Three Mile Island nuclear accident, have attracted some interests by nuclear industry, media and by

'other states. The $ystem is designed to serve a vital function of the State public health agency. ~

The importance of the' Epidemiologic Surveillance System being discussed here is closely related to any future nuclear accident or other environmental health hazards in ,the Commonwealth which will be monitored and regulated by both state and federal agencies, For this reason, there should be adequate coordination with at least three major agencies including Pennsylvania Emergency Management Agency, Bureau 'of Radiation Protection of DER. and the U.S. Nuclear Regul& tory Commission. Steps are being taken to accomolish this objective,

ADDITIONAL VIEWS OF C0ntISSIOMFP ASSELSTINE The Commissier shculd do more to resolve the concerns raised by Mr. and Mrt Aamodt. The Commission should request that the Pennsylvania Decartment of Pcalth review the infonnation submitted by the Aamodts as well as the various existing studies of the radiological releases from the TMI accident and their impact on the people surrounding the plant as part of the Department's ongoing epidemiological research efforts. To assist the Department in this effort, the Commission should provide tt.e funds rieeded to hire an independent consultant who is expert in the fields of epidemiology and the health effects of ionizing radiation. I can think of no more upsetting concern to the people living in the vicinity of the Three Mile Island plant than the possibility that radiation releases from the accident were higher than estimated by previous studies and that such releases are causing serious health effects. Given the obvious seriousness

,of these concerns, we should do more thar ,iust rely on what appears to be a very cursory review of the Aamodts' information by the Centers for Disease Control. At the same time, I do not find sufficient evidence in the

/.anodts' petition to justify a decision to defer further action in the TM-1 restart proceeding at this time.

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.a = % IN RESPONSE, PLEASE i 9"q UNITED STATES NUCLEAR REGULATORY COMMISSION REFER TO: M840815

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W ASHIN GTON. D.C. 20555 August 27, 1984 h *' .'.'. #'

OFFCE OF THE SECRETARY MEMORANDUM FOR:' William J. .Dircks, Executive Director for Operations FROM: Samuel J. Chilk,' Secret f)

SUBJECT:

STAFF REQUIREMENTS - ORAL RESENTATIONS BY PARTIES ON TMI-l RESTART, 10:00 A.M. CONTINUED-AT 1:30 P.M., WEDNESDAY, AUGUST 15, 1984, COMMISSIONERS' CONFERENCE ROOM, D.C. OFFICE (OPEN TO PUBLIC ATTENDANCE)

The Commission

• heard oral presentations by the Parties in the TMI-l restart proceeding, pursuant to~the August.6, 1984 Commission Order. The following persons made oral presentations:

- Governor Richard Thornburgh Commonwealth of Pennsylvania

- William Kuhns, Chairman General Public Utilities (GPU)

- Philip Clark, President General Public Utilities Nuclear Corporation Norman and Marjorie Aamodt

- JoAnne Doroshow, TMIA

- Louise Bradford, TMIA

- Ellen Weiss, UCS

- NRC Staff Harold Denton Jack Goldberg Tom Murley Bill Russell The Commission inquired as to the status of the draft ' order on TMI-2 cleanup milestones requested at the May 30, 1984 Commission meeting with the Advisory Panel on TMI-2 Cleanup.

The staff indicated that it would be provided to the

-Commission within one week.

(Subsequently, on August 21, 1984 the EDO provided the Commission with a draft order.)

• Commissioner Roberts was not present.

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The Commission requested that staff prepare a response to the concerns raised by the Aamodt's. In the response, the staff should address the following:

1. botanical data on plant abnormalities which, the Aamodt's believe, suggest that the plants were exposed to radio-active fallout;

2. the health related effects data which, the Aamodt's

'believe, suggest that people in the area of TMI were exposed to radiation levels higher than reported at the time of the 1979 accident; and

3. action taken by NRC in response to the August 8, 1979 letter from Pennsylvania State Representative Steven Reed to then-Chairman Joseph M. Hendrie.

(NRR) (SECY Suspense: 9/7/84)

In responding to the above, the staff should include information on the following:

1. any group or organization presently performing an epidemiological study of persons who lived near TMI at the time-of the accident in March 1979;

2. a list of the scientific studies of probable exposures and health effects resulting from the 1979 accident; and

3. the usefulness of requesting the Center for Disease Control (CDC) i,n Atlanta to conduct an epidemiological study to determine if there are health effects that can be attributed

. to the radiation released during the TMI-2 accident.

(NRR) (SECY Suspense: 9/7/84)

The Commission requested the Aamodt's to provide names of

, individuals who would, in their opinion, be appropriate to carry out the epidemiological study noted in item 3.

The Commission indicated that options for TMI-l restart would be the subject of a Commission meeting presently scheduled for 10:00 a.m., Friday, September 7, and that the meeting is open to public attendance.

cc: Chairman Palladino Commissioner Roberts Commissioner Asselstine Commissioner Bernthal Commissioner Zech Commission Staff Offices PDR - Advance DCS - 016 Phillips

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