Studies of residents in communities with high endemic concentrations of arsenic in drinking water suggest a deleterious effect on the circulatory system; however, studies among workers with high occupational exposures generally have shown either no or weak associations. This discrepancy could be a result of the healthy worker effect, including the healthy hire component and the healthy worker survivor effect (HWSE). Therefore, the authors conducted analyses of arsenic exposure in relation to circulatory disease mortality among 2,802 Tacoma, Washington, smelter workers by using 1) internal comparisons to control for the healthy hire effect and 2) the lagging method, adjustment for employment status, and the G-null test to control for the HWSE. Both lagging and adjustment for work status increased circulatory mortality rate ratios at all exposure levels, as compared with a baseline Poisson model. This excess mortality was limited to cardiovascular disease; no excess was observed for cerebrovascular disease. G-null analyses suggested no adverse effect, but power was very limited for this analysis. Overall, these results may indicate that the HWSE obscures an effect of arsenic on circulatory disease. Since cardiovascular deaths constitute about one-third of total mortality, small rate ratios translate into large numbers of excess deaths and, if causal, could be of wide public health significance. Further studies of arsenic exposure and cardiovascular disease are needed, and those conducted in occupational cohorts must control for the HWSE.

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This study investigated the chronic effects of emissions from three different waste incinerators on pulmonary function of both healthy and sensitive subjects with chronic respiratory symptoms. Participants were 8-80 years old, not currently smoking, and living in one of three communities each with an incinerator or one of three matched comparison communities. In total, 1018 subjects underwent a spirometric test once a year during 1992-1994. Exposure was assessed by three methods: living in an incinerator community; distance from the incinerator; and an incinerator exposure index, a function of the distance and direction of each subject's residence to the incinerator, days downwind, and average time spent outdoors. The results generally showed no statistically significant association between pulmonary function and these three incinerators, adjustment for gas oven/range use at home, length of residency, and smoking history in the mixed linear models. Two significant associations were that exposure to the hazardous waste incinerator in 1994 and to the municipal waste incinerator in 1993 were related to poor forced vital capacity. Sensitive subjects were not more adversely affected by incineration emissions than were hay fever or normal subjects. Possible explanations for the negative findings are low exposure levels and bias due to nondifferential misclassification of exposures.

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