Agency For Toxic Substances And Disease Registry Research Articles

Health care disparities and bladder cancer mortality in the United States: A closer look at the social vulnerability index.

150 Background: Bladder cancer is a significant public health concern, with various factors influencing mortality rates. The Social Vulnerability Index (SVI) measures community resilience to external health stresses. This study investigates the association between bladder cancer mortality (BCM) and county-level SVI in the United States (U.S.). Methods: Mortality data from U.S. counties were obtained from the Centers for Disease Control (CDC) and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 2015 to 2019 using the International Classification of Diseases-10th Edition (Code C67). The CDC and Agency for Toxic Substances and Disease Registry (ATSDR) county-level SVI was used as a composite measure of social vulnerability. The SVI includes several U.S. census variables grouped into four themes: Socioeconomic Status (SES), Household Characteristics, Racial and Ethnic Minority Status, and Housing Type and Transportation. Vulnerable SES variables include individuals with incomes below 150% of the federal poverty line, unemployment, those with housing cost burdens, and those without high school diplomas or health insurance. Vulnerable household variables include seniors over 65 years, children under 17 years, disabled civilians, single-parent households, and those with limited English proficiency. SVI Quartiles (Q1 being the least vulnerable and Q4 the most vulnerable) were compared to assess their impact on BCM. Negative binomial regression models were used to estimate Incidence Rate Ratios (IRRs) with 95% Confidence Intervals (CIs) using SAS software. Results: From 2015 to 2019, a total of 82,994 people died from bladder cancer, and the age-adjusted mortality rate per 1,000,000 was 42.4. A higher SVI in intermediate vulnerability quartiles was associated with a higher risk of BCM (Q2 and Q3: IRR = 1.06; 95% CI = 1.01-1.10; p = 0.009) compared to the least vulnerable quartile, Q1. Vulnerable SES had an increased risk of BCM (Q2 and Q3: IRR = 1.07; 95% CI = 1.03-1.12; p < 0.001) compared to Q1. BCM was also increased in individuals with vulnerable household characteristics (Q2 and Q3: IRR = 1.06; 95% CI = 1.02-1.10; p = 0.004) compared to Q1. Q4 was not significant in comparison to Q1 for the groups mentioned above. Interestingly, Racial and Ethnic Minority Status (Hispanic, Latino, African American, etc.) was associated with lower BCM in Q2 and Q3 (IRR = 0.88; 95% CI = 0.84-0.92; p < 0.001) and Q4 (IRR = 0.77; 95% CI = 0.73-0.81; p < 0.001) compared to Q1. No significant mortality differences were observed among vulnerable Housing Types and Transportation. Conclusions: Bladder cancer mortality is linked to vulnerable socioeconomic and household characteristics, while racial and ethnic minority status correlates with decreased risk. Future targeted public health interventions are needed to reduce bladder cancer mortality in vulnerable populations. Bladder cancer mortality and its association with social vulnerability quartiles. Bladder Cancer Mortality Characteristic IRR 95% CI p-value Social Vulnerability Index Q1 — — Q2&Q3 1.06 1.01, 1.10 0.009 Q4 0.98 0.93, 1.03 0.4 Socioeconomic Status Q1 — — Q2&Q3 1.07 1.03, 1.12 <0.001 Q4 1.00 0.95, 1.05 >0.9 Household Characteristics Q1 — — Q2&Q3 1.06 1.02, 1.10 0.004 Q4 1.05 1.00, 1.10 0.052 Racial & Ethnic Minority Status Q1 — — Q2&Q3 0.88 0.84, 0.92 <0.001 Q4 0.77 0.73, 0.81 <0.001 Housing Type & Transportation Q1 — — Q2&Q3 1.03 0.99, 1.08 0.2 Q4 0.98 0.93, 1.03 0.4 IRR = Incidence Rate Ratio, CI = Confidence Interval.

Differentiating hazardous PM2.5 in ambient air of ecologically different districts of India

ABSTRACT Ambient PM2.5 and their toxic components were measured in six ecologically different districts of India. Cadmium (Cd), arsenic (As), chromium (Cr), copper (Cu), zinc (Zn), molybdenum (Mo), and lead (Pb) were present in most of the PM2.5 samples analysed. A new heavy metal exposure index (HEI) was formulated based on weighted geometric mean approach using substance toxicity points given by Agency for Toxic Substance and Disease Registry (ATSDR). The proposed HEI differentiates toxic PM2.5 and helps screen unhealthy air pollution regions, and can thus assist in forming adequate public health policy.

Quantifying levels of per- and polyfluoroalkyl Substances (PFAS) in water and serum after contamination from agricultural biosolid application

The National Academies of Sciences, Engineering, and Medicine recommends per- and polyfluoroalkyl substance (PFAS) blood testing for patients with risk of elevated exposure, and the Agency for Toxic Substances and Disease Registry (ATSDR) suggests PFAS blood testing based on exposure. Barriers to PFAS blood testing include cost, access to labs, and evolving laboratory methods. We quantify water and serum PFAS levels among a highly-exposed cohort in an area with groundwater contaminated by historical agricultural biosolid application. We compare the gold standard PFAS serum test with a commercial test and results from a one-compartment toxicokinetic model. Participants were adults (n = 30) whose household (n = 19) water had levels of the sum of six PFAS > 500 ng/L. Serum PFAS were measured using liquid chromatography-tandem mass spectrometry. Demographic and water consumption data were collected via telephone. Serum PFAS results from the commercial test were accessed via medical record. Statistical analysis included descriptive statistics and bivariate plots of serum levels. Perfluorohexanoic acid, perfluoroheptanoic acid (PFHpA), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorobutanesulfonic acid, perfluorohexanesulfonic acid (PFHxS), and perfluorooctanesulfonic acid (PFOS) were detected in 19 wells, and PFHpA, PFOA, PFNA, perfluorodecanoic acid, perfluoroundecanoic acid, PFHxS, and PFOS were detected in at least 19 participants’ serum. In well water, PFOA and PFOS levels had geometric means (GMs) of 1749 ng/L (geometric standard deviation [GSD] 2.4) and 887 ng/L (GSD 19.7), respectively. In serum, PFOA and PFOS had GMs of 116.2 µg/L (GSD 13.5) and 58.3 µg/L (GSD 13.8), respectively. Our results are comparable with and had a wider mix of PFAS than other high-exposure cohorts. There was good agreement between the commercial and gold standard tests for PFOA, PFNA, and PFHxS, and mixed agreement between the gold standard test and modeled predictions, suggesting water-based toxicokinetic models of serum PFAS may be inadequate for assessing exposure in this population.

Prevalence of ALS in all 50 states in the United States, data from the National ALS Registry, 2011–2018

Objective: To summarize the prevalence of ALS in all 50 states and Washington, DC in the United States from 2011 to 2018 using data collected and analyzed by the National ALS Registry. In October 2010, the federal Agency for Toxic Substances and Disease Registry (ATSDR) launched the congressionally mandated Registry to determine the incidence and prevalence of ALS within the USA, characterize the demographics of persons with ALS, and identify the potential risk factors for the disease. This is the first analysis of state-level ALS prevalence estimates. Methods: ALS is not a notifiable disease in the USA, so the Registry uses a two-pronged approach to identify cases. The first approach uses existing national administrative databases (Medicare, Veterans Health Administration, and Veterans Benefits Administration). The second method uses a secure web portal to gather voluntary participant data and identify cases not included in the national administrative databases. Results: State-level age-adjusted average prevalence from 2011–2018 ranged from 2.6 per 100,000 persons (Hawaii) to 7.8 per 100,000 persons (Vermont), with an average of 4.4 per 100,000 persons in the US. New England and Midwest regions had higher prevalence rates than the national average. Conclusions: These findings summarize the prevalence of ALS for all 50 states from 2011 to 2018. This is a continuing effort to identify ALS cases on a national population basis. The establishment of the National ALS Registry has allowed for epidemiological trends of this disease and the assessment of potential risk factors that could cause ALS.

Arsenic Contamination Needs Serious Attention: An Opinion and Global Scenario

Arsenic (As) contamination is a serious global concern, polluting our natural resources, including water and soil, and posing a danger to the environment and public health. Arsenic is present in the groundwater of several countries and this contaminated water is used for irrigation, drinking, and food preparation, which poses the greatest threat to public health. Nearly 106 countries are affected by groundwater arsenic contamination and an estimated 230 million individuals worldwide are exposed to its adverse health effects, including increased cancer risks, associated cardiovascular disease and diabetes, skin lesions, neurological effects, kidney damage, and foetal or cognitive-development-related complications. Arsenic is highly toxic and ranked first in the priority list of ATSDR (Agency for Toxic Substances and Disease Registry, 2022) and among the 10 chemicals of major public health concern on the World Health Organization (WHO) list. The maximum permissible level of arsenic in drinking water has been established at 10 µg/L by WHO, as well as by the Environmental Protection Agency (EPA) and European Union (EU). These regulatory standards underscore the gravity of the problem, and actions to prioritise the development of effective detection, mitigation strategies, and collaborative initiatives are necessary. This opinion article covers (i) arsenic footprints—global scenario and impact, (ii) awareness and education and (iii) mitigation approaches (detection and removal strategies) and future perspectives, which collectively will help in controlling and preventing As contamination of our global water resources. Regulatory and legislative bodies and development agencies are crucial for raising awareness and countering this alarming concern by implementing collaborative actions to protect our environment and public health and to provide safe drinking water for all.

Hydrogeochemical characterization and non-carcinogenic health risk assessment of fluoride and nitrate-affected groundwater in northern parts of Tumkur district, Karnataka, India

Groundwater contamination from geogenic and anthropogenic sources is a significant concern for the public health across the globe. In India, fluoride and nitrate contamination are the most prevalent contaminants in the groundwater. This study evaluated groundwater quality in four over-exploited sub-districts of Tumkur district in Karnataka by collecting 143 samples from post and pre-monsoon seasons and using different hydrogeochemical, statistical and bivariate graphical approaches. Comparison with Drinking Water Standard guidelines revealed elevated levels of fluoride, nitrate, and total dissolved solids (TDS), rendering the groundwater unsuitable for drinking. According to Chadha’s diagram, the predominant groundwater type is Na-Cl, and Gibbs diagram suggested the influence of rock dissolution and weathering. Bivariate plots indicated that hydrogeochemical characteristics were primarily influenced by silicate weathering of minerals, cation ion exchange processes, and anthropogenic factors. A non-carcinogenic health risk assessment was conducted using two different hazard index (HI) approaches from United States Environmental Protection Agency (USEPA) and Agency for Toxic Substances and Disease Registry (ATSDR). It was found that health risk associated with fluoride is more significant than the health risk from nitrate, with children being the most affected, followed by adolescents and adults. A holistic approach to assess cumulative health risks from fluoride and nitrate contamination in groundwater, as demonstrated in this study, promotes the synergistic advancement of SDG 3: Good health and well-being and SDG 6: Clean water and sanitation.

Camp Lejeune Marine Cancer Risk Assessment for Exposure to Contaminated Drinking Water From 1955 to 1987

This study utilizes guidance from the United States Environmental Protection Agency (USEPA) and the Agency for Toxic Substances and Disease Registry (ATSDR) to calculate the cancer risk to United States Marines who were exposed to carcinogens in drinking water at Marine Corps Base Camp Lejeune. Camp Lejeune is a 233-square-mile Marine Corps training facility in North Carolina. From 1953 to 1987, nearby dry cleaners, landfills, and underground storage tanks contaminated drinking water systems that served Camp Lejeune (ATSDR, 2017). Some of the most toxic contaminants found in the drinking water modeled by ATSDR include benzene, tetrachloroethylene (PCE), trichloroethylene (TCE), trans-1,2-dichloroethylene (DCE), and vinyl chloride (VC). ATSDR utilized MODFLOW and EPANET modeling software to determine the level of contamination in the three main drinking water systems at Camp Lejeune: Tarawa Terrace, Holcomb Boulevard, and Hadnot Point. This paper presents an application of methodology to quantify cancer risk for the Marines who lived and served at Camp Lejeune from 1953 to 1987 using ATSDR’s health assessment, chemical contaminant modeling, and USEPA methodology. While VC and TCE were found to be the main risk drivers, benzene and PCE also contributed to the cumulative cancer risk. This analysis shows (1) That the cancer risk was greatest during the 1970s and 1980s and (2) that the inhalation exposure pathway had the greatest contribution to overall cancer risk followed by ingestion, with the smallest contribution from dermal absorption.

One Health assessment of persistent organic chemicals and PFAS for consumption of restored anadromous fish.

Restoration efforts have led to the return of anadromous fish, potential source of food for the Penobscot Indian Nation, to the previously dammed Penobscot River, Maine. U.S. Environmental Protection Agency (EPA), Penobscot Indian Nation's Department of Natural Resources (PINDNR), and Agency for Toxic Substances and Disease Registry (ATSDR), measured contaminants in six species of anadromous fish. Fish tissue concentrations were then used, along with exposure parameters, to evaluate potential human and aquatic-dependent wildlife risk. PINDNR collected, filleted, froze, and shipped fish for analysis of polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), dioxins/furans, and per- and polyfluoroalkyl substances (PFAS). Contaminant levels were compared to reference doses (where possible) and wildlife values (WVs). Chemical concentrations ranged from 6.37 nanogram per gram (ng/g) wet weight (ww) in American Shad roe to 100 ng/g ww in Striped Bass for total PCBs; 0.851 ng/g ww in American Shad roe to 5.92 ng/g ww in large Rainbow Smelt for total PBDEs; and 0.037 ng/g ww in American Shad roe to 0.221 ng/g ww in Striped Bass for total dioxin/furans. PFAS concentrations ranged between 0.38ng/g ww of PFBA in Alewifeto 7.86 ng/g ww of PFUnA in Sea Lamprey. Dioxin/furans and PFOS levels indicated that there are potential human health risks. The WV for mink for total PCBs (72 ng/g) was exceeded in Striped Bass and the WV for Kestrel for PBDEs (8.7 ng/g) was exceeded in large Rainbow Smelt. Mammalian wildlife consuming Blueback Herring, Striped Bass, and Sea Lamprey may be at risk based on PFOS WVs from Canada. Anadromous fish returning to the Penobscot River potentially could represent the restoration of a major component of tribal traditional diet. However, information about contaminant levels in these fish is needed to guide the tribe about consumption safety. Analysis of select species of fish and risk calculations demonstrated the need for a protective approach to consumption for both humans and wildlife. This project demonstrates that wildlife can also be impacted by contamination of fish and their risks can be as great or greater than those of humans. A One Health approach addresses this discrepancy and will lead to a healthier ecosystem.

Heavy Metals in Follicular Fluid Affect the Ultrastructure of the Human Mature Cumulus-Oocyte Complex.

It is known that exposure to heavy metal such as lead (Pb) and cadmium (Cd) has several adverse effects, particularly on the human reproductive system. Pb and Cd have been associated with infertility in both men and women. In pregnant women, they have been associated with spontaneous abortion, preterm birth, and impairment of the development of the fetus. Since these heavy metals come from both natural and anthropogenic activities and their harmful effects have been observed even at low levels of exposure, exposure to them remains a public health issue, especially for the reproductive system. Given this, the present study aimed to investigate the potential reproductive effects of Pb and Cd levels in the follicular fluid (FF) of infertile women and non-smokers exposed to heavy metals for professional reasons or as a result of living in rural areas near landfills and waste disposal areas in order to correlate the intrafollicular presence of these metals with possible alterations in the ultrastructure of human cumulus-oocyte complexes (COCs), which are probably responsible for infertility. Blood and FF metals were measured using atomic absorption spectrometry. COCs corresponding to each FF analyzed were subjected to ultrastructural analyses using transmission electron microscopy. We demonstrated for the first time that intrafollicular levels of Pb (0.66 µg/dL-0.85 µg/dL) and Cd (0.26 µg/L-0.41 µg/L) could be associated with morphological alterations of both the oocyte and cumulus cells' (CCs) ultrastructure. Since blood Cd levels (0.54 µg/L-1.87 µg/L) were above the current reference values established by the guidelines of the Agency for Toxic Substances and Disease Registry (ATSDR) and the Environmental Protection Agency (EPA) (0.4 µg/L), whereas blood Pb levels (1.28 µg/dL-3.98 µg/dL) were below the ATSDR reference values (≤5 µg/dL), we believe that these alterations could be due especially to Cd, even if we cannot exclude a possible additional effect of Pb. Our results highlighted that oocytes were affected in maturation and quality, whereas CCs showed scarcely active steroidogenic elements. Regressing CCs, with cytoplasmic alterations, were also numerous. According to Cd's endocrine-disrupting activity, the poor steroidogenic activity of CCs might correlate with delayed oocyte cytoplasmic maturation. So, we conclude that levels of heavy metals in the blood and the FF might negatively affect fertilization, embryo development, and pregnancy, compromising oocyte competence in fertilization both directly and indirectly, impairing CC steroidogenic activity, and inducing CC apoptosis.

Biomonitoring equivalents for perfluorooctanoic acid (PFOA) for the interpretation of biomonitoring data

BackgroundPerfluorooctanoic acid (PFOA) is detected in the blood of virtually all biomonitoring study participants. Assessing health risks associated with blood PFOA levels is challenging because exposure guidance values (EGVs) are typically expressed in terms of external dose. Biomonitoring equivalents (BEs) consistent with EGVs could facilitate health-based interpretations. ObjectiveTo i) derive BEs for serum/plasma PFOA corresponding to non-cancer EGVs of the U.S. Environmental Protection Agency (U.S. EPA), the Agency for Toxic Substances and Disease Registry (ATSDR) and Health Canada, and ii) compare with PFOA concentrations from national biomonitoring surveys. MethodsStarting from EGV points of departure, we employed pharmacokinetic data/models and uncertainty factors. Points of departure in pregnant rodents (U.S. EPA 2016, ATSDR) were converted into fetus and pup serum concentrations using an animal gestation/lactation pharmacokinetic model, and equivalent human fetus and child concentrations were converted into BEs in maternal serum using a human gestation/lactation model. The point of departure in adult rodents (Health Canada) was converted into a BE using experimental data. For epidemiology-based EGVs (U.S. EPA 2023, draft), BEs were directly based on epidemiological data or derived using a human gestation/lactation pharmacokinetic model. BEs were compared with Canadian/U.S. biomonitoring data. ResultsNon-cancer BEs (ng/mL) were 684 (Health Canada, 2018) or ranged from 15 to 29 (U.S. EPA, 2016), 6–10 (ATSDR, 2021) and 0.2–0.8 (U.S. EPA, 2023, draft). Ninety-fifth percentiles of serum levels from the 2018–2019 Canadian Health Measures Survey (CHMS) and the 2017–2018 National Health and Nutrition Examination Survey (NHANES) were slightly below the BE for ATSDR, and geometric means were above the non-cancer BEs for the U.S. EPA (2023, draft). ConclusionNon-cancer BEs spanned three orders of magnitude. The lowest BEs were for EGVs based on developmental endpoints in epidemiological studies. Concentrations in Canadian/U.S. national surveys were higher than or close to BEs for the most recent non-cancer EGVs.

Dietary exposure to cadmium from six common foods in the United States.

Recently, the United States (US) Food and Drug Administration (FDA) launched a Closer to Zero Action Plan to assess the risks of and develop action levels for certain heavy metals in food including cadmium (Cd). The problem of foodborne metal contamination has taken on new urgency, thanks in part to a 2021 US Congressional Report detailing high levels of metals found in infant food. Our risk assessment aids this FDA Action Plan by estimating the American population's Cd exposures in food, by age group and consumption patterns of certain high-risk foods; and by determining circumstances in which exposures exceed tolerable daily intakes developed by policymaking groups in the US and worldwide. We found that the age groups 6-24 months and 24-60 month old are the most highly exposed to Cd in common foodstuffs. American infants and young children of these age groups who regularly consumed rice, spinach, oats, barley, potatoes, and wheat had mean Cd exposures exceeding maximum tolerable intake level was set by the Agency for Toxic Substances and Disease Registry (ATSDR). We have identified age groups at highest potential risk, and therefore of interest for developing food safety policies to improve safety of commercial food for children.

Association Between Social Vulnerability Index and Mortality Following Acute Myocardial Infarction in the US Counties

Social determinants of health (SDOH) play a major role in cardiovascular outcomes. The social vulnerability index (SVI) is a tool designed by the Center for Disease Control (CDC) to measure a community's vulnerability to respond and recover from disasters. The parameters of SVI can be used to gauge social disparities amongst different US counties and its association with acute myocardial infarction (AMI) related to age- adjusted mortality rate (AAMR) by using the multiple causes of death database from CDC, Prevention's Wide-Ranging Online Data for Epidemiological Research (WONDER 2016-2020) and Agency for Toxic Substances and Disease Registry (ATSDR). We used segmented regression models to evaluate the association between quintiles of SVI scores and AAMR using STATA. A total of 2908 of 3289 US counties were used in the analysis. The mean AAMR was 89.3 per 100,000 (95% CI: 87.1-91.5) from 2016 to 2020. US counties with higher SVI were associated with higher AMI-related age-adjusted mortality when compared to counties with lower SVI. Counties with the highest SVI and AAMR were in the mid-western and southern states The findings of our study can guide focused care for a uniform upliftment of CV health across the nation by identifying the distribution of socio-economically disadvantaged counties.•Does the social vulnerability index affect Acute Myocardial Infarction (AMI) related mortality in US counties?•US counties with higher SVI were associated with higher AMI-related age-adjusted mortality when compared to counties with lower SVI.

Analysis of Ambient Air Mercury Levels in The Mercury Laboratory and Metrology Centre for Environmental Quality Instrumentation Standardization

Today the use of heavy metals can be found in almost all aspects of life. However, the use of heavy metals causes a process of bioaccumulation of toxins from heavy metals into the body. One type of heavy metal that is very toxic is Mercury (Hg). According to the list of hazardous substances published by the Agency for Toxic Substances and Disease Registry (ATSDR), mercury occupies the third position among 275 substances harmful to human health. The mercury and metrology laboratory is a laboratory that functions to test mercury levels in both water, soil and air matrix samples. In carrying out a test or measurement of Mercury levels, employees at the Mercury and Metrology Laboratory of Centre for Environmental Quality Instrumentation Standardization (PSIKLH) always use Mercury in the process, so there is a possibility that the air in the Mercury and Metrology laboratory of PSIKLH is contaminated with Mercury because of the activities in it. That is the reason of researchers to test mercury levels in the ambient air around the Mercury laboratory and Metrology PSIKLH. This study aims to determine the level of mercury in the ambient air around the mercury and metrology laboratory of PSIKLH. The method used in this study is a quantitative analysis method using the Mercury Analyzer WA-5F from Nippon Instruments Corporation (NIC) which includes curve making, sampling, and measuring mercury levels in the sample. This research was conducted at the Mercury and Metrology Laboratory of PSIKLH. Based on research that was conduct, it shows that the highest concentration of mercury in the ambient air around the PSIKLH Mercury and Metrology Laboratory is found in the Atomic Absorption Spectrophotometer (AAS) room, the sampling equipment room, and the Hg tool room. Mercury levels contained in the three rooms were more than 0.01 mg/m3. However, mercury levels in the Mercury and Metrology Laboratory are still classified as normal because they have not passed the threshold of 0.05 mg/m3.

Arsenic in Drinking Water and Diabetes.

Arsenic is ubiquitous in soil and water environments and is consistently at the top of the Agency for Toxic Substances Disease Registry (ATSDR) substance priority list. It has been shown to induce toxicity even at low levels of exposure. One of the major routes of exposure to arsenic is through drinking water. This review presents current information related to the distribution of arsenic in the environment, the resultant impacts on human health, especially related to diabetes, which is one of the most prevalent chronic diseases, regulation of arsenic in drinking water, and approaches for treatment of arsenic in drinking water for both public utilities and private wells. Taken together, this information points out the existing challenges to understanding both the complex health impacts of arsenic and to implementing the treatment strategies needed to effectively reduce arsenic exposure at different scales.

Socioeconomic vulnerability and the risk of genitourinary cancer mortality among United States counties.

116 Background: The impact of socioeconomic status on genitourinary (GU) cancer mortality in the United States (US) is unclear. Hence, we evaluated the association of the socioeconomic status with GU cancer mortality across the US counties. Methods: County-level age-adjusted mortality rates (AAMR) per 100,000 person-years (PY) for populations diagnosed with GU cancers were abstracted from the wide-ranging online data for epidemiological research (WONDER) database. The agency for toxic substances and disease registry (ATSDR) was queried to obtain county-level social vulnerability indices from 2014-2018. Percentile ranking scores (PRS: ranging from 0-1) were computed for each US county and further categorized into quartiles (Q: 1st: 0-0.25 [least vulnerable]; 4th: 0.75-1.00 [most vulnerable]). AAMRs were then linked with quartile rankings. A population-weighted, Poisson regression analysis was conducted to compute rate ratios (RR) of AAMRs between 4th and 1st Q with the corresponding 95% confidence intervals (CI). Results: A total 3142 US counties were included in this analysis. The AAMR for GU cancers was 22.6 overall deaths (OD) and 4.20 premature deaths (PD; defined as death at age <65 years) per 100,000 PY. GU cancer-related mortality increased in a stepwise fashion from the 1st Q to the 4th Q (OD: 21.6 vs 24.1; PD: 3.48 vs 5.19). In terms of OD by specific GU cancers, significantly higher AAMRs were observed in the 4th Q compared to the 1st Q for patients with prostate cancer (RR; 1.19 [95% CI;1.14-1.24]), and renal cell carcinoma (RCC; 1.12 [1.04-1.21]) but not for those with lower urothelial tract cancers (0.92 [0.87-0.96]). Among subgroups, non-Hispanic Blacks (1.19 [1.07-1.33]), and Hispanics (1.28 [1.08-1.51]) with prostate cancer and men with RCC (1.11; 1.03-1.19) in the 4th Q experienced significantly higher overall mortality when compared to those in the 1st Q. With regards to PD, significantly higher AAMRs were observed in the 4th Q vs 1st Q for patients with prostate cancer (1.54 [1.34-1.77]), and RCC (1.28 [1.12-1.45]). Consistently, men with RCC in the 4th Q also experienced higher premature mortality when compared to the 1st Q. Sparsity of mortality data among different ethnic/racial subgroups across the US counties precluded any formal assessment of disparity by specific GU cancers. A sensitivity analysis, conducted using the weighted linear regression approach, showed consistent results. Conclusions: Population level data suggest that socially vulnerable populations, especially Non-Hispanic Black and Hispanic men with prostate cancer, and men with renal cell carcinoma may be at an increased risk of cancer-related mortality. Hence, there is a dire need to address this mortality gap across different socioeconomic subgroups to ensure health-care equity. Investigations at the patient level are required to further ascertain these findings.

Social vulnerability and gastrointestinal cancer mortality among United States counties.

499 Background: The impact of socioeconomic status on gastrointestinal (GI) cancer mortality in the United States (US) is not well-established. We hypothesized that socially vulnerable populations have disproportionately higher mortality rates. Hence, we assessed the association of the social vulnerability index (SVI) with GI cancer mortality across US counties. Methods: Social vulnerability indices were obtained from the agency for toxic substances and disease registry (ATSDR) from 2014-2018 to compute percentile ranking scores (PRS: ranging from 0-1) for each US county. PRS were further categorized into quartiles (Q: 1st: 0-0.25 [least vulnerable]; 4th:0.75-1.00 [most vulnerable]). The wide-ranging online data for epidemiological research (WONDER) database was queried to abstract county-level age-adjusted mortality rates (AAMR) per 100,000 person-years (PY) for populations diagnosed with GI cancers. AAMRs were then linked with quartile rankings. Rate ratios (RR) of AAMRs between 4th and 1st Q were subsequently estimated with 95% confidence intervals using population-weighted, Poisson regression. Results: A total of 3142 counties were included in this analysis. The AAMR for overall deaths (OD) and premature deaths (PD; defined as death at age <65) in the GI cancer population was 53.8 and 17.7 per 100,000 PY. A gradient increase in GI cancer-related mortality was observed from 1st Q to 4th Q (OD: 49.2 vs 59.3; PD: 14.1 vs 21.3). This stepwise increase in AAMR over the quartiles was consistent across gender, different racial/ethnic subgroups, and rural/urban categories of counties. The AAMRs for OD were significantly higher in the 4th Q as compared to the 1st Q for gastric (RR: 1.67 [95% CI, 1.51-1.86]), hepatocellular including intrahepatic biliary (1.52 [1.45-1.61]), colorectal (1.21 [1.16-1.26]) and biliary (1.17 [1.06-1.28]) cancer. Similarly, significantly higher AAMRs for PD were observed in 4th Q vs1st Q for gastric (1.81 [1.60-2.05]), hepatocellular including intrahepatic biliary (1.78 [1.58-2.00]), biliary (1.64 [1.35-1.99]), colorectal (1.29 [1.21-1.39]) and pancreatic (1.16 [1.07-1.25]) cancer. However, no significant differences were observed for esophageal and small intestinal cancers. Men with gastric (1.58 [1.41-1.78]) and hepatocellular cancer (1.54 [1.43-1.66]), non-Hispanic Black population (1.54 [1.31-1.80]) with hepatocellular cancer, and Hispanic population with colorectal cancer (1.50 [1.31-1.72]) were observed to have higher overall mortality in the 4th Q compared to the 1st Q. The findings were similar for premature mortality. Conclusions: Population-level data suggests that the US counties with higher socio-economic adversities may be at an increased risk of GI cancer-related mortality. Investigations using patient-level data are required to probe the impact of socioeconomic vulnerabilities on cancer-related mortality.

Predictors of Evacuation Rates during Hurricane Laura: Weather Forecasts, Twitter, and COVID-19

Abstract Machine learning was applied to predict evacuation rates for all census tracts affected by Hurricane Laura. The evacuation ground truth was derived from cellular telephone–based mobility data. Twitter data, census data, geographical data, COVID-19 case rates, the social vulnerability index from the Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR), and relevant weather and physical data were used to do the prediction. Random forests were found to perform well, with a mean absolute percent error of 4.9% on testing data. Feature importance for prediction was analyzed using Shapley additive explanations and it was found that previous evacuation, rainfall forecasts, COVID-19 case rates, and Twitter data rank highly in terms of importance. Social vulnerability indices were also found to show a very consistent relationship with evacuation rates, such that higher vulnerability consistently implies lower evacuation rates. These findings can help with hurricane evacuation preparedness and planning as well as real-time assessment. Significance Statement This study evaluates the usefulness of Twitter data, COVID-19 case rates, and the social vulnerability index from the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry in predicting evacuation rates during Hurricane Laura, in the context of other relevant geographic, and weather-related variables. All three are found to be useful, to different extents, and this work suggests important directions for future research in understanding the reasons behind their relevance to predicting evacuation rates.

Arsenic exposure induces urinary metabolome disruption in Pakistani male population

Millions of people are at risk of consuming arsenic (As) contaminated drinking water in Pakistan. The current study aimed to investigate urinary arsenic species [iAsIII, iAsV, dimethylarsinic acid (DMA), methylarsonic acid (MMA)] and their potential toxicity biomarkers (based on urinary metabolome) in order to characterize the health effects in general adult male participants (n = 588) exposed to various levels of arsenic in different floodplain areas of Pakistan. The total urinary arsenic concentration (mean; 161 μg/L) of studied participants was lower and/or comparable than those values reported from other highly contaminated regions, but exceeded the Agency for Toxic Substances and Disease Registry (ATSDR) limits. For all the participants, the most excreted species was DMA accounting for 65% of the total arsenic, followed by MMA (20%) and iAs (16%). The percentage of MMA detected in this study was higher than those of previously reported data from other countries. These results suggested that studied population might have high risk of developing arsenic exposure related adverse health outcomes. Furthermore, random forest machine learning algorithm, partial correlation and binary logistic regression analysis were performed to screen the arsenic species-related urinary metabolites. A total of thirty-eight metabolites were extracted from 2776 metabolic features and identified as the potential arsenic toxicity biomarkers. The metabolites were mainly classified into xanthines, purines, and amino acids, which provided the clues linking the arsenic exposure with oxidative stress, one-carbon metabolism, purine metabolism, caffeine metabolism and hormone metabolism. These results would be helpful to develop early health warning system in context of arsenic exposure among the general populations of Pakistan.

Cadmium dietary exposure assessment in the adult population and pre-school children in the Republic of Serbia

Cadmium (Cd) is a toxic metal, present in all matrices of the environment and a common food contaminant. Human exposure to it may elicit many diverse health impairments. The aim of this study was to assess the dietary exposure to Cd for the adult population and preschool children in Serbia using probabilistic methodology. We measured Cd in 11,227 food samples belonging to 50 food items on the Serbian market. Cd was detected in 90% of the tested food items, and in 30.8% of the overall tested samples. The food item that contributed the most to total dietary Cd intake was potatoes (median Cd concentration of 7 ng/g) in adults, and fruit and vegetable juices in children (median Cd concentration of 19 ng/g). Weekly Cd intake shown as 50th and 95th percentiles were 2.54 and 4.74 µg/kg bw in the adult population, and 3.29 and 4.93 µg/kg bw in children. The results of this study are rather preliminary and should be considered as an indication of the need for further, more refined research, which would contribute to a more realistic risk assessment as a high-priority approach, especially in the case of vulnerable subpopulations such as children. Abbreviations: AT SDR: Agency for Toxic Substances and Disease Registry; EEA: European Environment Agency; EFSA: European Food Safety Authority; FAO/WHO: Food and Agriculture Organization/World Health Organization; HI: hazard index; IARC: International Agency for Research on Cancer; JECFA: Joint FAO/WHO Expert Committee on Food Additives; LOD: limit of detection; Cd: cadmium; TWI: tolerable weekly intake; UNEP: United Nations Environment Program; WI: weekly intake

Synthesis of Nanosilica for the Removal of Multicomponent Cd2+ and Cu2+ from Synthetic Water: An Experimental and Theoretical Study.

Copper and cadmium ions are among the top 120 hazardous chemicals listed by the Agency for Toxic Substances and Disease Registry (ATSDR) that can bind to organic and inorganic chemicals. Silica is one of the most abundant oxides that can limit the transport of these chemicals into water resources. Limited work has focused on assessing the applicability of nanosilica for the removal of multicomponent metal ions and studying their interaction on the surface of this adsorbent. Therefore, this study focuses on utilizing a nanosilica for the adsorption of Cd2+ and Cu2+ from water. Experimental work on the single- and multi-component adsorption of these ions was conducted and supported with theoretical interpretations. The nanosilica was characterized by its surface area, morphology, crystallinity, and functional groups. The BET surface area was 307.64 m2/g with a total pore volume of 4.95×10-3 cm3/g. The SEM showed an irregular amorphous shape with slits and cavities. Several Si-O-Si and hydroxyl groups were noticed on the surface of the silica. The single isotherm experiment showed that Cd2+ has a higher uptake (72.13 mg/g) than Cu2+ (29.28 mg/g). The multicomponent adsorption equilibrium shows an affinity for Cd2+ on the surface. This affinity decreases with increasing Cu2+ equilibrium concentration due to the higher isosteric heat from the interaction between Cd and the surface. The experimental data were modeled using isotherms for the single adsorption, with the Freundlich and the non-modified competitive Langmuir models showing the best fit. The molecular dynamics simulations support the experimental data where Cd2+ shows a multilayer surface coverage. This study provides insight into utilizing nanosilica for removing heavy metals from water.