United States
Environmental Protection
Agency
Health Effects Research
Laboratory
Cincinnati OH 45268
EPA 600 1 79-003
Jrinunry 1 979
Research and Development
c/EPA
Health Effects of
Human Exposure to
Barium in
Drinking Water
r,;> eo VI
79-013
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RESEARCH REPORTING SERIES
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EPA-600/1-79-003
January 1979
HEALTH EFFECTS OF HUMAN EXPOSURE
TO BARIUM IN DRINKING WATER
by
G.R. Brenniman, W.H. Kojola, P.S. Levy,
B.W. Carnow, T. Namekata and E.G. Breck
The University of Illinois at the
Medical Center
Chicago, Illinois 60612
Grant No. R803918
Project Officer
Edwin C. Lippy
Field Studies Division
Health Effects Research Laboratory
Cincinnati, Ohio 45268
HEALTH EFFECTS RESEARCH LABORATORY
OFFICE OF RESEARCH AND DEVELOPMENT
U.S. ENVIRONMENTAL PROTECTION AGENCY
CINCINNATI, OHIO 45268
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DISCLAIMER
This report has been reviewed by the Health Effects Research Laboratory,
U.S. Environmental Protection Agency, and approved for publication. Approval
does not signify that the contents necessarily reflect the views and policies
of the U.S. Environmental Protection Agency, nor does mention of trade names
or commercial products constitute endorsement or recommendation for use.
11
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FOREWORD
The primary mission of the Health Effects Research Laboratory is to
provide data which are based on health-related research to support the re-
gulatory activities of the Environmental Protection Agency. Research data
are used in the Agency's standards setting procedures to insure that man and
his environment are protected.
The objectives of the investigation reported herein were to determine
whether health effects could be identified in a population exposed to barium
in their drinking water. The investigation consisted of an analysis of
death rates for communities exposed to barium at a concentration of 2 mg/1
or greater as opposed to those with no significant exposure. This analysis
showed higher death rates for the communities exposed to barium. The in-
vestigation also included a comparison of health data that was collected by
household survey from nearly 2,400 people living in two communities whose
water supply contained 7 mg/1 (West Dundee) and 0.1 mg/1 of barium (McHenry)
respectively. The comparison of health data showed significant differences
in blood pressure with higher readings notable in the male population of
West Dundee when the data were refined to correct for the influences of water
softening, blood pressure medication, hypertension, and duration of exposure.
The investigators emphasize that the analysis of death rates must be
interpreted with caution because of factors that could not be controlled in-
cluding a greater population change in the high barium communities and the
use of home water softeners. They further noted that their household survey
data were inconclusive because the blood pressure elevations were not con-
sistent for the total West Dundee population and that additional study was
necessary.
This study did not produce a distinctive conclusion that permits us to
recommend a safe standard for barium in drinking water. However, the dif-
ferences identified in death rates at a barium concentration of greater than
2 mg/1 and the elevation in blood pressures at 7 mg/1 are of primary public
health concern. We agree that further study is necessary and plan to con-
duct a morbidity survey of a population exposed to 2 mg/1 of barium in
drinking water in order to better identify a no-effect level. In the in-
terim, we do not think it is advisable for the current barium limit of 1 mg/1
to be relaxed and we think that communities exceeding the MCL should proceed
with plans to reduce barium exposure and avoid the possibility of the occur-
rence of adverse health effects.
R. J. Garner, M.A., DVSc, FRCVS, ARIC
Director
Health Effects Research Laboratory
iii
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ABSTRACT
The overall objective of this study was to examine by epidemiologic and
supportive laboratory studies, the human health effects associated with in-
gestion of barium in Illinois drinking water exceeding the maximum contami-
nant level (MCL) for barium of 1.0 mg/1 as stipulated in the National Interim
Primary Drinking Water Regulations (NIPDWR). This study is the first of its
kind to assess the chronic human health effects associated with ingest ion of
elevated barium levels in drinking water.
A retrospective epidemiological analysis of age and sex-adjusted cardio-
vascular death rates for the years 1971-1975 was conducted to examine differ-
ences between Illinois communities with elevated drinking water barium levels
(>1.0-10.0 mg/1) and communities with little or no barium (0.0-0.2 mg/1).
Results of the mortality study revealed that the high barium communities had
significantly higher (P <0.05) death rates for "all cardiovascular diseases"
and "heart disease" compared to the low barium communities. Since there was
a greater population change in some of the high barium communities compared
to the low barium communities and no method of controlling for removal of
barium by home water softeners, any inferences drawn about this finding must
be interpreted with caution.
A morbidity study was conducted in West Dundee, and McHenry, Illinois to
examine whether or not there are differences in mean blood pressure levels
and the prevalence of hypertension, cardiovascular, cerebrovascular and renal
disease between the populations of these two communities. The major differ-
ence between the two communities is that West Dundee has a mean barium con-
centration in its drinking water approximately 70 fold greater than that
found in McHenry's drinking water. Although some significant differences
(P <0.5) were found for mean age and sex-adjusted levels of systolic blood
pressures between the high barium and low barium communities, the blood
pressure data were inconclusive because of inconsistencies in the findings.
For instance, a significant difference was found for females living 10 years
or less in the community, while no difference was found for females living
greater than 10 years in the community. A significant difference was found
for males living greater than 10 years in the community when the data were
corrected for water softeners and high blood pressure medication. Female
blood pressures were not significantly different under these circumstances.
Finally, no significant differences were found between the two communities
with respect to the prevalence of hypertension, heart disease, stroke, or
kidney disease.
This report was submitted in fulfillment of Grant No. R-803918 by the
University of Illinois, School of Public Health, Chicago, under the sponsor-
ship of the U.S. Environmental Protection Agency. This report covers the
period August 11, 1975 to October 31, 1978.
iv
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CONTENTS
Foreword
Abstract iv
Figures vi
Tables vii
Acknowledgments xiii
1. Introduction 1
2. Conclusions 2
3. Recommendations 3
4. Background Information 4
Water data 4
Toxicity 4
Metabolism 6
Cardiovascular effects 6
Hormonal system effects 7
Epidemiological studies 8
Barium water standard 8
5. Project Design and Methodology 9
Mortality methodology 9
Morbidity methodology 16
Analytical procedures 20
Statistical procedures 21
6. Results and Discussion 22
Mortality study 22
Morbidity study 27
Characteristics of populations studied 27
Health indicies 30
Refusals 72
Water sample analysis 72
Drinking water sodium concentrations and blood
pressure levels 89
Drinking water sodium concentrations and prevalence
rates of heart disease, hypertension, stroke and
kidney disease 89
References 98
Appendices
A. Household listing and survey of minerals and health 104
B. Letter to refusals 120
C. Standard Illinois population and age-specific death rates . . . 121
D. Mantel Haenszel test 125
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FIGURES
Number Page
1 Mean age-specific systolic and diastolic blood pressure among males
18-75+ years of age: West Dundee and McHenry,Illinois, 1976-77. . . 36
2 Mean age-specific systolic and diastolic blood pressure among
females 18-75+ years of age: West Dundee and McHenry,Illinois,
1976-77 37
3 Mean age-specific systolic and diastolic blood pressure among males
18-75+ years of age who have lived greater than 10 years in: West
Dundee and McHenry, Illinois, 1976-77 40
4 Mean age-specific systolic and diastolic blood pressure among
females 18-75+ years of age who have lived greater than 10 years in:
West Dundee and McHenry, Illinois 1976-77 41
VI
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TABLES
Number Page
1 Elevated Barium Levels in Illinois Drinking Water 5
2 Characteristics of Persons in Illinois Communities With 2.0 mg/1
Barium or Greater in Their Drinking Water 10
3 Characteristics of Persons in Illinois Communities With 0.2 mg/1
Barium or Less in Their Drinking Water 11
4 High and Low Barium Communities Used for Mortality Study 13
5 Eighth Revision International Classification of Diseases 14
6 Population Information by Age Group 15
7 General Characteristics of Persons Residing in West Dundee or
McHenry, Illinois 17
8 Occupations of Persons Residing in West Dundee or McHenry,
Illinois 18
9 Age-Adjusted Death Rates for Cardiovascular Diseases in High and
Low Barium Communities 23
10 Age-Adjusted Death Rates for Cardiovascular Diseases in the City
of DeKalb and Low Barium Communities 24
11 Age-Adjusted Death Rates for Cardiovascular Diseases in High
Barium Communities, the City of DeKalb, Low Barium Communities,
and the Average Death Rates Between 1970 and 1975 for the
Illinois Population 25
12 Death Rates for Cardiovascular Diseases in the State of Illinois . . 26
13 Ages and Residence Times of Persons in West Dundee and McHenry .... 28
14 Characteristics of White Persons 18 Years Old and Over Residing
in West Dundee and McHenry 29
15 Mean Number of Visits to a Doctor's Office for West Dundee and
McHenry Residents 31
VI1
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Tables (cont.)
Number Page
16 Mean Number of Days Spent in a Hospital For West Dundee and
McHenry Residents 32
17 Mean Number of Days Away from Work or Unable to Carry Out Usual
Activities for West Dundee and McHenry Residents 33
18 Mean Blood Pressures for West Dundee and McHenry Residents 35
19 Mean Blood Pressures for Persons Living in the United States 38
20 Mean Blood Pressures for Persons Living in West Dundee or McHenry,
> 10 Years 39
21 Mean Blood Pressures for Persons Living in West Dundee for < 10
Years or For > 10 Years 7 42
22 Mean Blood Pressures for Persons Living in McHenry for <_ 10 Years
or for > 10 Years 43
23 Mean Blood Pressures for Persons Living in West Dundee or McHenry
<_ 10 Years 44
24 Mean Blood Pressures for Persons Living in West Dundee or McHenry
> 10 Years and Are not Taking Blood Pressure Medication 46
25 Mean Blood Pressures for Persons Living in West Dundee or McHenry
<_ 10 Years and Are Not Taking Blood Pressure Medication 47
26 Mean Blood Pressures for Persons Living in West Dundee or McHenry
> 10 Years, Who Do Not Have Hypertension and Are Not Taking Blood
Pressure Medication 48
27 Mean Blood Pressures for Persons Living in West Dundee or McHenry
<^ 10 Years, Who Do Not Have Hypertension and Are Not Taking Blood
Pressure Medication , 49
28 Mean Blood Pressures for West Dundee and McHenry Residents Who Do
Not Have Hypertension Nor are Currently Taking Blood Pressure
Medication 50
29 Mean Blood Pressures for West Dundee and McHenry Residents Who
Have Definite Hypertension or are Currently Taking Blood
Pressure Medication 51
30 Mean Blood Pressures for West Dundee and McHenry Residents Who are
on High Blood Pressure Medicine 52
Yin
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Tables (cont.)
Number Page
31 Mean Blood Pressures for West Dundee and McHenry Residents Who
No Longer are Taking High Blood Pressure Medicine 53
32 Mean Blood Pressures for West Dundee and McHenry Residents Who
Do Not Have Home Water Softeners 55
33 Mean Blood Pressures for Persons Who Do Not Have Water Softeners
and Have Lived in West Dundee or McHenry for > 10 Years 56
34 Mean Blood Pressures for Persons Who Do Not Have Water Softeners
and Have Lived in West Dundee or McHenry for <_ 10 Years 57
35 Mean Blood Pressures for Persons Living in West Dundee or McHenry
Who Do Not Have Water Softeners and Are Not Taking Blood Pressure
Medication 58
36 Mean Blood Pressures for Persons Who Do Not Have Water Softeners,
Are Not Taking High Blood Pressure Medication and Have Lived >
10 Years in West Dundee or McHenry 59
37 Mean Blood Pressures for Persons Who Do Not Have Water Softeners,
Are Not Taking High Blood Pressure Medication and Have Lived <
10 Years in West Dundee or McHenry 60
38 Mean Blood Pressures for Persons Living in West Dundee or McHenry
Who Do Not Have Water Softeners, Do Not Have Hypertension and Are
Not Taking Blood Pressure Medication 62
39 Mean Blood Pressures for Persons Who Do Not Have Water Softeners,
Do Not Have Hypertension, Are Not Taking Blood Pressure
Medication ajid Have Lived >10 years, in West Dundee or McHenry ..... 63
40 Mean Blood Pressures for Persons Who Do Not Have Water Softeners,
Do Not Have Hypertension, Are Not Taking Blood Pressure
Medication and Have Lived <_ 10 Years in West Dundee or McHenry .... 64
41 Mean Blood Pressures for West Dundee and McHenry Residents Who
Have Never Smoked 65
42 Mean Blood Pressures for West Dundee and McHenry Residents Who
Have Smoked Sometime During Their Lifetime 66
43 Mean Blood Pressures for West Dundee and McHenry Residents Who
Have Been Determined Obese by Skinfold Readings 67
44 Mean Blood Pressures for West Dundee and McHenry Residents Who
Have Been Determined Nonobese by Skinfold Readings 68
IX
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Tables (cont.)
Number Page
45 Mean Pulse Rates for West Dundee and McHenry Residents 69
46 Prevalence Rates of Definite Hypertension for West Dundee and
McHenry Residents 73
47 Prevalence Rates of Borderline Hypertension for West Dundee and
McHenry Residents 73
48 Prevalence Rates of Definite Hypertension for Persons Living in the
United States 74
49 Prevalence Rates for West Dundee and McHenry Residents Who Have
Definite Hypertension or are Currently Taking Blood Pressure
Medication 74
50 Prevalence Rates for West Dundee and McHenry Residents Who Have
Had a Stroke 75
51 Prevalence Rates for West Dundee and McHenry Residents Who Have
Heart Disease 75
52 Prevalence Rates for West Dundee and McHenry Residents Who Have
Diabetes 76
53 Prevalence Rates for West Dundee and McHenry Residents Who Have
Kidney Disease 76
54 Mean Blood Pressures of West Dundee and McHenry Residents Who
Initially Refused to Participate but Volunteered To Be Part Of
The Study When Asked A Second Time 77
55 Analysis of Water Treatment Plant Samples From West Dundee and
McHenry 79
56 Proton Induced X-Ray Emission Analysis of Water Treatment Plant
Samples From West Dundee and McHenry 80
57 Analysis of Water Samples From West Dundee and McHenry Households
With and Without Water Softeners 81
58 Analysis of Water Samples From West Dundee and McHenry Households
with Water Softeners 82
59 Analysis of Water Samples From West Dundee and McHenry Households
Without Water Softeners 84
60 Analysis of Water Samples From West Dundee and McHenry Households
With Sodium Concentrations < 25 mg/1 85
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Tables (cont.)
Number Page
61 Analysis of Water Samples From West Dundee and McHenry Households
With Sodium Concentrations > 25 mg/1 86
62 Analysis of Water Samples From West Dundee and McHenry Households
With Sodium Concentrations <_100 mg/1 87
63 Analysis of Water Samples From West Dundee and McHenry Households
With Sodium Concentrations > 100 mg/1 88
64 Mean Systolic Blood Pressures for Males From McHenry Who are
Exposed to Diverse Sodium Concentrations in Their Drinking
Water 90
65 Mean Diastolic Blood Pressures for Males From McHenry Who are
Exposed to Diverse Sodium Concentrations in Their Drinking
Water 91
66 Mean Systolic Blood Pressures for Females From McHenry Who are
Exposed to Diverse Sodium Concentrations in Their Drinking
Water 92
67 Mean Diastolic Blood Pressures for Females From McHenry Who are
Exposed to Diverse Sodium Concentrations in Their Drinking
Water 93
68 Prevalence Rates of Males From West Dundee and McHenry Who Have
Heart Disease and are Exposed to Varying Sodium Concentrations
in Their Drinking Water 94
69 Prevalence Rates of Females From West Dundee and McHenry Who Have
Heart Disease and are Exposed to Varying Sodium Concentrations in
Their Drinking Water 94
70 Prevalence Rates of Males From West Dundee and McHenry Who Have
Definite Hypertension and are Exposed to Varying Sodium Concen-
Trations in Their Drinking Water 95
71 Prevalence Rates of Females From West Dundee and McHenry Who Have
Definite Hypertension and are Exposed to Varying Sodium Concen-
trations in Their Drinking Water 95
72 Prevalence Rates of Males From West Dundee and McHenry Who Have
had a Stroke and are Exposed to Varying Sodium Concentrations
in Their Drinking Water 96
xo.
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Tables (cont.)
Number Page
73 Prevalence Rates of Females From West Dundee and McHenry Who Have
had a Stroke and are Exposed to Varying Sodium Concentrations in
Their Drinking Water 96
74 Prevalence Rates of Males From West Dundee and McHenry Who Have
Kidney Disease and are Exposed to Varying Sodium Concentrations
in Their Drinking Water 97
75 Prevalence Rates of Females From West Dundee and McHenry Who Have
Kidney Disease and are Exposed to Varying Sodium Concentrations
in Their Drinking Water 97
76 Standard Illinois Population (April, 1970) 121
77 Person Years, By Age Groupings and Sex, Used to Calculate Age-
Specific Death Rates In Study Communities 121
78 Age-Specific Death Rates For Cardiovascular Diseases For Persons
Who Lived in High Barium Communities 122
79 Age-Specific Death Rates for Cardiovascular Diseases For Persons
Who Lived in the City of DeKalb 123
80 Age-Specific Death Rates for Cardiovascular Diseases For Persons
Who Lived in Low Barium Communities i ... . 124
81 Mantel-Haenszel Test With An Illustrative Example From The Study... 126
xii
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ACKNOWLEDGMENTS
The Survey Research Laboratory, University of Illinois at Chicago Circle,
assisted with questionnaire development, coding, key punching, and cleaning of
computer tapes. Computer services used in this research were provided by the
University of Illinois at Chicago Circle. Their assistance is gratefully
acknowledged.
Permission to use Illinois mortality tapes was given by Joyce C. Lashof,
Director, State of Illinois Department of Public Health in 1976. Her co-
operation was especially appreciated.
Analysis of the water samples in 1976-77 was conducted by the Illinois
Environmental Protection Agency, Chicago Laboratory. James Miller, Manager,
Division of Laboratory Services, approved the use of the Chicago Laboratory
for this project; John Murray and James Daugherty directed the water analysis;
and Pankaj Parikh performed the atomic absorption analysis. Quality control
was conducted by the U.S. Environmental Protection Agency, Region V, Central
Regional Laboratory, Chicago, under the direction of Thomas Yeates, Richard
Ronan, and Edmund Huff. We are especially grateful to Dorothy Bennett,
Division of Public Water Supplies, Illinois Environmental Protection Agency,
for supplying us with film records of mineral analyses for water treatment
plants in Illinois.
A very special acknowledgment goes to our survey workers, LaFern Kuntz,
June Detwiler, Lois Stolldorf, and Sheila Bambrick, for their devotion and
enthusiasm.
The cooperation of the West Dundee Village Board, McHenry City Council,
McHenry County Department of Health and all residents of these two Illinois
communities who participated in the study was greatly appreciated.
We are particularly indebted to Edwin Lippy, EPA Project Officer, for
his untiring efforts, cooperation, and patience with this project.
Finally, a special thank you should be given to Velma Kuykendall for
typing this manuscript.
Kill
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SECTION 1
INTRODUCTION
The Illinois Environmental Protection Agency (IEPA) has identified
several communities in northeastern Illinois which have drinking water sources
that exceed the maximum contaminant level (MCL) for barium of 1.0 mg/1 as
stipulated in the National Interim Primary Drinking Water Regulations
(NIPDWR). The standard is exceeded in this area by as much as tenfold and in-
cludes an exposed population of more than 150,000 individuals.
The health criteria used in establishing the MCL for barium is based
upon an extrapolation from the occupational air standard of 0.5 mg/m3, which
itself incorporates an unknown degree of safety. There are no epidemiologi-
cal studies which have examined the human health effects associated with bar-
ium intake from drinking water.
An examination of the literature on experimental animal studies and
human accidental poisonings demonstrates adverse health effects of barium,
including stimulation of smooth, striated, and cardiac muscle, vasoconstric-
tion and elevation of blood pressure, rapid and preferential deposition in
bone, and initiation of catecholamine release from the adrenal medulla and
adrenergic synapses. Recent evidence indicates that individuals with essen-
tial hypertension have significantly higher plasma catecholamine levels than
normotensives.
The present study has examined by epidemiologic and supportive laboratory
studies whether or not human mortality and morbidity rates were significantly
higher (P<0.05)in populations ingesting greater than 1.0 mg/1 barium from
their drinking water, as compared to populations that ingest very little or
no barium from their drinking water. Differences in cardiovascular mortality,
blood pressure levels, and the prevalence rates for hypertension, heart dis-
ease, stroke and kidney disease were examined.
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SECTION 2
CONCLUSIONS
PRIMARY CONCLUSIONS
A retrospective epidemiological analysis for the years 1971-1975 of age-
adjusted death rates for all cardiovascular diseases, heart disease, cerebro-
bascular disease, general arteriosclerosis, hypertension without mention of
heart, -and other circulatory disease found significantly higher (P< 0.05)
death rates for "all cardiovascular diseases" and "heart disease" between
the high barium (> 2.0 mg/1) and the low barium (< 0.2 mg/1) communities.
Since there wa,s a greater population change in some of the high barium com-
munities compared to the low barium communities, and no method of controlling
for removal of barium by home water softeners, any inferences drawn about
this finding must be interpreted with caution.
A morbidity study performed on residents of West Dundee, Illinois, which
has a mean barium concentration of 7.3 mg/1 in its drinking water, and on
those of McHenry, Illinois, which has a mean barium level of 0.1 mg/1 in its
drinking water, showed some significant differences (P< 0.05) between these
two communities with respect to mean age and sex-adjusted levels of systolic
blood pressures. Although some differences in systolic blood pressure levels
were found between the high barium and low barium communities, the results
are inconclusive because of inconsistencies in the data. For instance, when
the data was adjusted for duration of exposure, a difference in systolic
blood pressures was noted for females living in the community for 10 years
or less, but not for females residing there for greater than 10 years. Also,
male systolic blood pressure were significantly higher in West Dundee when
the data was adjusted for duration of exposure, home water softeners and high
blood pressure medication. This finding was not found for female systolic
blood pressures when adjustment was made for the same factors. No signifi-
cant differences were observed between these two communities with respect
to the prevalence of hypertension, heart disease, stroke, or kidney disease.
Further study is needed to resolve the inconclusiveness of the results due
to inconsistencies in the data.
SECONDARY CONCLUSIONS
No significant differences (P > 0.05) were found for males and females
from either community with respect to the prevalence of hypertension, heart
disease, stroke or kidney disease and sodium concentration. In addition,
sodium concentrations greater than 100 mg/1 had no significant effect on
male or female blood pressures. As a consequence, home water softeners were
found to have no association with cardiovascular disease in this study.
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SECTION 3
RECOMMENDATIONS
PRIMARY RECOMMENDATIONS
Any subsequent investigations of the health effects of ingestion of
barium from drinking water should not conduct a retrospective epidemiological
analysis of death rates because home water softener use cannot be controlled.
Since water softeners remove barium from the water, it is practically im-
possible to relate cardiovascular mortality to high barium concentrations.
An epidemiological study of humans residing in a community for greater
than 10 years and exposed to at least 5.0 mg/1 barium in their drinking water
should be conducted to determine whether or not there are any long term
health effects that could not be detected from this study. This study should
examine possible physiological and biochemical effects of barium ingestion
through the collection of blood and urine samples.
SECONDARY RECOMMENDATION
A chronic animal study designed to examine adverse effects of ingested
barium on the cardiovascular system including the production of hypertension
and the release of catecholamines should be conducted.
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SECTION 4
BACKGROUND INFORMATION
WATER DATA
The IEPA has identified 16 cities and 2 subdivisions, totaling more than
150,000 individuals, that have drinking water sources with barium concentra-
tions above the current Illinois Standard and Federal MCL of 1.0 mg/1 (1,2,
3,4) (Table 1). Most of these community water supplies do not employ treat-
ment to reduce the barium concentration in finished water. One community,
Crystal Lake, Illinois, softens its water to remove barium but blends this
soft, low-barium water with unsoftened water to produce a water that will not
be corrosive to interior surfaces of the mains in the distribution system.
With this procedure, barium concentration is reduced by approximately 40 per-
cent, resulting in a barium level in the finished water at Crystal Lake that
remains above the MCL of 1.0 mg/1 (1).
All of the Illinois water supplies with barium exceeding 1.0 mg/1 are
from deep rock or drift wells found in northern Illinois. These barium con-
centrations are the results of a naturally occurring geochemical pollutant
found almost exclusively in the Cambrian-Ordoviclan Aquifer in northern Illi-
nois (2). The concentrations of barium reported in Table 1 are results of well
samples which were collected at the treatment plant site and do not neces-
sarily represent the levels in drinking water of individual homes, as home
water softeners will remove barium. Additionally, home concentrations can
differ from that reported at the treatment plant because water systems using
multiple wells will often mix water from several wells before distributing it.
The range of barium concentrations listed in Table 1 represent concentrations
found in individual wells at the treatment plant before mixing.
TOXICITY
Acute human and animal exposures have demonstrated that the single most
characteristic action following barium ingestion is an intense stimulation
of smooth, striated, and cardiac muscle (5,6,7) . Symptoms in humans following
acute accidental ingestion include salivation, vomiting, diarrhea, ventricular
tachycardia, hypertension, hypokalemia, twitching, flaccid paralysis of
skeletal muscle and, if poisoning is severe, respiratory muscle paralysis and
ventricular fibrillation which can lead to death. The fatal dose of ingested
barium chloride for humans is 0.8-0.9 gm (550-660 mg as barium), while barium
carbonate and barium sulfide are also toxic but act more slowly (8). Chronic
health effects from exposure to low levels of barium in drinking water have
not been extensively studied. A subchronic oral toxicity study of barium
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TABLE 1. ELEVATED BARIUM LEVELS IN ILLINOIS DRINKING WATER
County
Bureau
Carroll
Cook
DeKalb
DeKalb
DeKalb
DeWitt
DuPage
Kane
Kane
Kane
Kane
Kendel
Knox
Lake
McHenry
McHenry
Rock Island
Stephenson
Winnebago
City or Total (1970)
Village Population
Seaton
Shannon
Hoffman Estates
Briarwood Subdiv.
Dekalb
Malta
Farmer City
Hanover Park
Burlington
Elgin
West Dundee
Elgin State Hospital
Hollis Park Subdiv.
One i da
Lake Zurich
Algonquin
Crystal Lake
Croppers
German Valley
Rock Cut State Park
251
848
22,238
NA
32,949
961
2,217
11,916
456
55,691
3,295
NA
NA
728
4,082
3,515
14,541
NA
206
NA
Raw Water *, +
Concentration (mg/1)
1.8
2.9-4.7
1.6-5.1
1.1
1.1-1.9
1.5-2.3
1.2
1.4-7.0
1.8-2.3
1.7-6.8
2.9-10.0
2.8
1.1
1.25
1.3-2.7
4.0-8.3
2.2-10.0
1.4
4.4-5.6
2.0
153,894
NA - Data not available
* - Sources of drinking water is predominatly from rock wells
+ - Values represented from at least one well supply
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chloride fed to rats in drinking water (0 to 250 mg/1) revealed no adverse
effects in pathology, hematologic and serum parameters, and clinical signs
(9). However, a slight decrease in relative weights of adrenal glands of
treated animals was observed but may not have been attributable to barium
exposure. A chronic study of rats ingesting drinking waiter containing 5 mg/1
of barium acetate reported no adverse health effects. (10).
METABOLISM
Barium, like other alkaline earth metals, is a bone-seeking element (11,
12,13). The human whole body content of barium is approximately 22-24 mg;
more than 90 percent is found in the bone (14,15). Barium is believed to be
a nonessential human trace element, and little is known about its biochemical
functions in bone or soft tissues (15).
Following injection of radioactive isotopes of barium, the barium is
rapidly and preferentially transferred from blood plasma to the bone both in
rats and humans (11,12,13,16,17). Oral administration of barium chloride in
weanling male rats demonstrates that barium is rapidly absorbed from the
gastrointestinal tract, and transmitted to various organs within 30 minutes.
Peak concentrations of barium following ingestion were found in one half hour
for soft tissues and two hours in the skeleton. After two hours' exposure,
the greatest total concentration of absorbed barium was found in the skeleton,
compared with that in any of the soft tissues (18). There are no reports
which have examined differences in absorption of ingested barium salts other
than that of barium chloride. The main reason for using barium chloride for
metabolic studies is because it is more soluble in water than any of the
other barium salts.
Bone deposition sites of barium appear to occur preferentially in the
most active areas of bone growth (19) , although recent research indicates
that the preferential uptake of barium is localized primarily at bone
surfaces (20). Other factors important in absorption and deposition include
age, with older rats exhibiting a decreased absorption and bone concentration
of barium, and dietary starvation, which elicits a three-fold increase in
barium absorption (21,22).
Excretion of either injected or ingested barium in both man and animals
occurs principally in the feces rather than the urine (11,13,17,18,23). In
humans, rapid removal of a single injected dose of barium is indicated because
85 percent is excreted in the first eight days (16,17) , An estimate of
the biological half-life for barium in the rab is 90 to 120 days (18) .
CARDIOVASCULAR EFFECTS
The barium ion has a profound effect on the electrical and mechanical
activity of all muscle types, particularly that of cardiac muscle. Dogs
given an intravenous injection of less than 0.01 mM barium chloride per kilo-
gram develop arterial hypertension, extrasystoles, and spontaneous skeletal
muscle contractions (5,24). If the injection is increased, multiple premature
ventricular contractions, blood pressure drop, flaccid paralysis of skeletal
and respiratory muscles, and ventricular fibrillation occur, followed by
-------
cardiac arrest leading to death.
Barium chloride perfusion of cat and rat ventricular muscle fibers will
initiate pacemaker activity which then leads to spontaneous beating (25,26).
Additionally, several studies have reported that barium will initiate pace-
maker activity in embryonic chick heart cells that had been "quiescent" and,
furthermore, that barium will generate deplorization leading to the generation
of action potentials (27,28,29).
Human experimental studies relating cardiovascular effects and barium
exposure are virtually nonexistant. However, several authors have carefully
monitored electrocardiographic changes associated with the routine radiologic
use of the barium enema (30,31,32,33,34). These authors have observed that
humans over 60 years of age, with or without a history of previous heart
disease, appear to be at high risk to developing cardiac arrhythmias following
a barium enema. These observations may not necessarily be attributable to
the barium ion but could result from such variables as bowel distention,
muscle straining, vagal stimulation, anxiety or dehydration.
HORMONAL SYSTEM EFFECTS
Barium possesses chemical and physiological properties which allow it to
replace calcium in processes mediated naturally by calcium, particularly per-
taining to its participation in the release of the adrenal catecholamine
hormones, epinephrine and norepinephrine, and the release of the neurotrans-
mitter substance norepinephrine from adrenergic synapses (35,36,37).
Calcium assumes a specific role in "stimulus-secretion coupling,"
associated with the adrenal medulla. Acetylcholine interacts with the plasma
membrane of the adrenal chromaffin cell, allowing calcium ions to enter the
cells, thus stimulating the release of catecholamines. When calcium in the
perfusing medium is replaced with barium, the perfused adrenal gland releases
norepinephrine, indicating that barium mimics the action of calcium (38,39).
However, barium, unlike calcium, will initiate catecholamine release in the
absence of acetylcholine.
The presence of extracellular calcium is necessary for the release of
norepinephrine from adrenergic synapses following stimulation of the post-
ganglionic nerve fibers. Barium can substitute for calcium in this release
process and, in fact, nearly doubles the output of norepinephrine as compared
to that released with calcium (40,41,42) .
The: catecholamines produce numerous effects on the cardiovascular system
(7) . Epinephrine acts generally as a vasodilator while norepinephrine acts
as a strong vasoconstrictor leading to an increase in blood pressure. Each
of these catecholamines produces an increase in arrhythmias. Furthermore,
recent evidence indicates that individuals with essential hypertension have
significantly higher plasma catecholamine levels than normotensives (43,44,
45) . Experimental studies have shown that barium stimulates the release of
catecholamines while other studies demonstrate that barium elicits an in-
crease in blood pressure. However, there are no published studies which have
examined a possible role of barium in the production of hypertension.
7
-------
EPIDEMIOLOGICAL STUDIES
An epidemiological study of the chronic human health effects associated
with the ingestion of barium above 1.0 mg/1 has not, until this study, been
performed. A mortality study of trace elements in water samples- from South
Wales has shown that increased barium levels in water are correlated with a
decrease in both total and cardiovascular mortality rates for individuals
35-64 years of age (46). However, the average value for barium concentration
from these samples was only 0.04 mg/1.
In the United States, analysis of mortality rates and correlations with
35 drinking water constituents from 94 major cities has been completed (47).
The mean concentration of barium in these cities was 0.037 mg/1, ranging from
0.0017 to 0.260 mg/1. Significant negative correlations of barium levels
with mortality rates from hypertensive heart disease, arteriosclerotic heart
disease and cerebral thrombosis were observed. Barium levels ingested from
drinking water by the Illinois population studied in this project are two
hundredfold greater (Table 1) than that reported in the U.S. study.
BARIUM WATER STANDARD
The present drinking water standard of 1.0 mg/1 was developed utilizing
an extrapolation from the occupational air standard of 0.5 mg/m (48,49,50).
This occupational standard itself is based upon a "suggested" safe level
obtained from workers inhaling barium nitrate; and it is not known what degree
of safety, if any, this limit incorporates. Furthermore, as there are no
studies examining the adverse human health effects associated with drinking
water intake, the extrapolation required several assumptions, including an
absorption factor of 0.75 for inhalation and 0.90 through the gastro-
intestinal tract, both of which are undocumented. The absence of definitive
water intake studies and the weaknesses inherent in the air standard indicate
the need for additional experimentation to determine more accurately a safe
water level for barium.
-------
SECTION 5
PROJECT DESIGN AND METHODOLOGY
The project was designed to examine epidemiologically whether or not
human mortality and morbidity rates were significantly different in popula-
tions ingesting greater than 1.0 mg/1 barium in their drinking water, as
compared to control populations that ingest very little or no barium from
their drinking water. In reviewing the literature, the principle health
effects associated with barium relate predominantly to the cardiovascular
system.
MORTALITY METHODOLOGY
Mortality rates for cardiovascular diseases, classified by the Inter-
national Classification of Disease (ICD) (51), were retrospectively deter-
mined from Illinois State Death Data for the years 1971-1975. Comparisons
of these age-adjusted death rates were made between communities with
high barium levels (>2.0-10 mg/1) and communities with low or no barium
(0.0-0.2 mg/1) in their public water supplies. Mortality rates for the
communities with high barium levels were also compared with those from the
total population of Illinois in 1970,
In choosing the high and low barium communities for comparison, those
with more than 2500 residents were selected because population information
in the 1970 Census Report (58) by age is not available in communities with
less than 2500 residents. In addition, it was not possible to get death
rates for the years 1971 and 1972 for a specific community with less than
2500 people because this information was combined with other communities of
similar size on the death certificate tapes that were received from the
state of Illinois.
Both the high and low barium communities, chosen from the same counties,
were matched for similar demographic and socioeconomic status (SES) charac-
teristics (Tables 2 and 3). One notable exception to the similarities
between the high barium communities is seen for the city of DeKalb (Table 2).
This community has a larger population, a higher percent of Negro and other
races, a lower percent of persons under 18 years old, fewer persons per
household, and a younger median age than the other high barium communities.
It was included in the mortality part of the study because it has a barium
concentration in its drinking water supply between > 1.0-2.0 mg/1. Since
this concentration of barium falls between the high barium (2.0 mg/1 or
greater) and the low barium communities (0.2 mg/1 or less), a comparison
can be made to see whether or not cardiovascular mortality increases in
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proportion to the barium concentration. Communities with high rates of pop-
ulation change and/or high industrialization were excluded from the study
as much as possible to minimize variations in barium exposure to other con-
founding environmental pollutants. The 1970 population number and percent
change in population between 1960 and 1970, for the high and low barium
communities used in the mortality study, are presented in Table 4. It is
also noted in Table 4 that three of the selected high barium communities
had greater than 74 percent change in population between 1960 and 1970. The
selection of these communities could not be avoided because there were no
other communities that had high barium and similar demographic and SES
characteristics which could have served as a satisfactory replacement. The
city of McHenry was not chosen as a low barium community for the mortality
part of the study because it was listed in the 1970 Census Report (58) as
having a population increase of 103 percent between 1960 and 1970. Although
McHenry was not used for the mortality study, it was used for the morbidity
study in the project because this population change had no bearing on that
part of the study (Table 7, p. 17) .
Using the Illinois Death Certificate tapes for the years 1971-1975, the
communities in Table 4 were screened for deaths attributable to the cardio-
vascular diseases listed in Table 5 . Deaths by specific causes were counted
for specific age groups using standard population information for each age
group as obtained from the 1970 Census Report (58) (Table 6) . Then a death
rate by cause was computed for each age group of a target population. The
average annual age -ad justed death rates for a target population were calcu-
lated using the following formula:
s(i,t) = t .100,000
A(t) =
where :
S(i,t) = The age-specified death rate in age group i over t years
A(t) = The age-adjusted death rate over t years
D(i,t) = The number dead in age group i over t years
R(i,t) = The number in age group i in the population at risk over t
years
P(i) = The number iffl age group i in the standard population in the
base year
t = The number of years observed
i = A particular age group m years wide
n = The number of age groups
12
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TABLE 4 HIGH AND LOW BARIUM COMMUNITIES USED FOR MORTALITY STUDY (58)
High Barium (> 2.0 mg/1) Communities
1970 Population % Population Change
County
McHenry
McHenry
DeKalb
Lake
Kane
* DeKalb
Lake
Kane
Lake
Kane
McHenry
Lake
McHenry
Community
Algonquin
Crystal Lake
DeKalb *
Lake Zurich
West Dundee
has a barium water level
Low Barium (<_
Antioch
Batavia
Fox Lake
Geneva
Harvard
Libertyville
Marengo
(Total Population)
3,515
14,514
32,949
4,082
3,295
(58,382)
between > 1.0-2.0 mg/1
0.2 mg/1) Communities
3,189
8,994
4,511
9,115
5,177
11,684
4,235
(1960-1970)
74.5
74,9
78.2
18.0
30.2
40.6
20.0
21.9
19.2
21.9
36.5
18.7
(46,905)
13
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TABLE 5 EIGHTH REVISION INTERNATIONAL CLASSIFICATION OF DISEASES (ICD)(51)
All Cardiovascular Disease
ICD Code Number
All ICD Code #"s listed
in a - e
a. Heart Disease
1. Arteriosclerosis
2. Other
All ICD Code #'s listed
in (1) and (2)
393-399, 410, 412
402, 404, 411, 413, 414,
420-423, 425-429
b. Cerebrovascular Disease
430-438
c. Other Circulatory Diseases
390-392, 424, 441-458
d. General Arteriosclerosis
440
e. Hypertension without
Mention of Heart
400, 401, 403
All Causes
All ICD Code #'s
14
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TABLE 6 POPULATION INFORMATION BY AGE GROUP FOR HIGH BARIUM COMMUNITIES,
CITY OF DEKALB, LOW BARIUM COMMUNITIES, AND STATE OF ILLINOIS
Age Group
(Years)
0-4
5-14
15-24
25-44
44-64
65+
Total
Population
1970 Census Population (58)
High Barium
Communities
2,387
5,909
3,933
6,749
4,626
1,829
25,433
City of
DeKalb-*
1,754
3,570
16,776
5,372
3,785
1,692
32,949
Low Barium
Communities
3,953
9,830
7,465
10,906
10,106
4,645
46,905
State of
Illinois
936,950
2,233,280
1,854,706
2,652,796
2,342,590
1,093,654
11,113,976
* The city of DeKalb was treated separately from the other high barium
communities because it has a barium level between 1.0 and 2.0 mg/1,
while all the other high barium communities had barium levels greater
than 2.0 mg/1. Also, DeKalb's demographic and SES characteristics
were not quite as similar as those of the other high barium communi-
ties (Table 2).
15
-------
The Illinois death certificate information was obtained from the 111-
nois Department of Public Health under the conditions that these tapes be
used in the strictest confidence, no personal identification would be used,
and that only people associated directly with the study were to have access
to the tapes. Mortality rates for the total Illinois population were ob-
tained from the Annual Statistics Reports of Illinois (56). The mortality
data was analyzed on an IBM system/370 computer CModel 158}.
MORBIDITY METHODOLOGY
A morbidity study was performed in two northeastern Illinois communi-
ties with different concentrations of barium in their drinking water to ex-
amine differences in blood pressure levels as well as prevalence rates for
hypertension, cardiovascular, cerebrovascular and renal disease. West
Dundee was selected as the high barium community because it has a mean con-
centration of barium in its public water supply of 7.3 mg/1 (57), which is
more than seven times the Federal MCL. Furthermore, West Dundee was chosen
because it supplies drinking water to the community from one well with a
back-up well for emergency use only, so that mixing of various barium con-
centrations from multiple wells was not a confounding factor. The routinely
used well is drilled to a depth of 365.8 meters and has supplied West Dundee
with its water since 1959. Prior to 1959, West Dundee received water from
an East Dundee spring that did not have any barium.
A control community, McHenry, was matched with West Dundee for as many
demographic and SES characteristics as possible (Tables 7 and 8) (58) , ex-
cept that the mean barium concentration in McHenry public water was 0.1 mg/1
(57). McHenry has received its public water from four shallow wells. The
first well was drilled in the early 1930's at a depth of 36.6 meters. A
second well was drilled in 1961, at 17.4 meters. A third well was drilled
in 1967, at 54.8 meters; and, in 1976, a fourth well was drilled at 39.6
meters.
After West Dundee and McHenry were selected, it was decided that a
minimum of 1000 people 18 years of age and older in each of the communities
would'be randomly selected by blocks. Adults 18 years of age and older
were chosen for this study because it is well known that cardiovascular
diseases are more prevalent in adults than children. In addition, the in-
clusion of children in the study would have added more age groupings with
some age groups having a short exposure period to the barium. As a con-
sequence, it was felt that if only adults were used, a stronger more bene-
ficial study could be designed.
A sample size of 1000 people from each community was chosen to be large
enough so that if the prevalences of hypertension were 10 per 100 persons
or higher in the high barium community, and 5 per 100 persons or lower in
the low barium community, there would be a 90 percent probability of detect-
ing these differences statistically by means of hypothesis tests using the
5 percent level of significance as the criterion. The methodology used in
the sample size calculations is similar to that discussed in the textbook by
Fleiss (59). Once a block was selected, all households in the entire block
were surveyed.
16
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TABLE 7 GENERAL CHARACTERISTICS OF PERSONS RESIDING IN WEST DUNDEE OR
McHENRY,ILLINOIS (58)
Population
Males
Females
% Negro & other races
% under 18 years old
% 65 years old and over
Persons/household
Households
% change pop. 1960-1970
Median school years completed
Mean income
Income less than poverty level
(% of all families)
West
Dundee
3,295
1,626
1,669
0.4
33.5
10.7
3.11
1,015
+30.2
12.4
13,795
3.0
McHenry
6,772
3,268
3,504
0.2
35.2
12.1
3.16
2,138
+103.0*
12.1
12,789
3.2
* The reason for a high percent change in population is that a large area
with approximately 2600 people was annexed to McHenry in 1967. The
annexed area was not connected to the public water supply and was not
included in this study. Therefore, the actual change in the McHenry
study population from 1960-1970 was approximately 20 percent greater
in 1970 than it was in 1960.
17
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TABLE 8 OCCUPATIONS OF PERSONS,16 YEARS OLD AND OVER, RESIDING IN
WEST DUNDEE OR McHENRY,ILLINOIS (58)
Occupation West
(16 years old and over) Dundee (%) McHenry (%)
Professional, technical,and kindred workers 19.6 15.6
Managers and administrators 9.4 8.4
Sales workers 11.5 9.3
Clerical and kindred workers 15.5 17.1
Craftsmen, foreman, and kindred workers 16.3 18.8
Operatives, except transport 9.6 12.3
Transport equipment operatives 1.3 4.8
Laborers, except farm 1.4 2.8
Service workers 7.6 10.4
Private Household workers 0.8 0.6
Farmers and farm managers 0.3
Farm laborers and farm foremen 6.5
Total 99.8 100.1
18
-------
Permission to conduct this survey was obtained from the Village Board of
West Dundee and the City Council of McHenry. Publicity for the study was
obtained primarily through news releases to the local newspapers in the
communities and through the local radio stations.
Pour survey workers were hired and trained to take blood pressures,
pulse readings, skinfold readings, to administer a health questionnaire and
to collect a tap water sample from each household. They were trained to
take blood pressure and pulse and skinfold readings by a physician from our
research team. Survey Research Laboratory (SRL), University of Illinois
Chicago Circle Campus, through the use of a training manual, explained the
proper procedure for adminstration of the health questionnaire. The survey
workers collected the above data over a twelve month period with each worker
alternating back and forth between both communities.
Blood pressures were taken with an electronic blood pressure apparatus,
Sphygmostat Model B-250. This battery operated electronic apparatus has
been designed specifically to overcome the disadvantages of hearing the
Korotkow sounds with a stethoscope. A special microphone in the cuff detects
the Korotkow sounds as the cuff is deflated; these signals are processed
electronically, such that the pressures on the manometer correspond to the
first and last flashed of a red light on the instrument panel representing
systolic and diastolic pressures respectively (60) . These instruments were
checked for accuracy once a month during the twelve months of field work
against a sphygmomanmeter. Once trained, the survey workers took three
blood pressure readings of each male and female household member 18 years of
age and older. These blood pressure readings were taken to estimate the pre-
valence of hypertension in the two communities. They were taken at the
beginning, middle and end of the period during which the questionnaire was
administered. All blood pressures were taken with the individual seated and
with his or her arm resting on a table. If a blood pressure above normal was
recorded by a survey worker, the individual was advised to see a physician.
Pulse and skinfold readings were obtained following the administration
of the health questionnaire. Each volunteer had his/her pulse taken for 30
seconds on the wrist. Two skinfold readings were taken in the area of the
triceps using a Lang Caliper. If the skinfold reading is to have any mean-
ing, it is important that the location of measurement be precise. Therefore,
the triceps' skinfold measurement was made at the back of the upper arm, at
the level midway between the tip of the acromial process of the scapula and
the tip of the elbow with the arm pendant (61). The significance of the
skinfold test is that it is a direct, simple and accurate method for estima-
ting the leanness-fatness of an individual.
The health survey questionnaire used in this study was developed in con-
sultation with Survey Research Laboratory (SRL), University of Illinois
Chicago Circle Campus and reviewed by the U.S. Department of Health Educa-
tion, and Welfare, Center for Disease Control (Appendix A). The question-
naire was developed with the objective of obtaining morbidity information
related to the history of stroke and myocardial infarction, and the preva-
lance of hypertension, peripheral vascular and renal diseases. An inter-
viewer training manual was developed by SRL for use by the survey workers,
19
-------
a pretest of five households by each worker was conducted, and a follow-up
meeting with SRL took place upon completion of the pretest to resolve pro-
blems with the questionnaire and/or interview process. In addition, a meet-
ing was held once a month with the survey workers to resolve problems and to
check the calibration of the equipment.
A final part of the household morbidity study was for the survey worker
to collect one water sample from each participating household. The procedure
for collection of the sample was as follows: "Use the cold water tap in the
kitchen. Turn on the cold water tap and let it run for 30 seconds. Fill
the quart plastic container to the top and cap it tightly." Inquiry was
made in the health questionnaire as to whether or not this cold water tap was
connected to a home water softener. Since there is a concern about the re-
lationship of softened water and cardiovascular disease (52, 53, 54, 55), it
was important to gather information about home water softeners because of the
possible effect these softeners could have in masking any effect barium might
have on cardiovascular disease. One of the survey workers collected a water
sample on a bimonthly basis from the West Dundee and McHenry water treatment
plants. See Section 5, Analytical Procedures, for details of collection and
analysis of the water samples.
All survey workers presented themselves at households in the study
communities with a University of Illinois identification, a letter signed by
the mayor endorsing the study, and newspaper clippings describing the study.
All the survey workers selected were females because it was felt that they
would be more successful in recruiting housewives alone at home for the
study. Finally, ten percent of the households that volunteered for the
study were called on the telephone to verify questionnaire information that
had been collected by the survey workers.
The procedure for recruitment of households for this study was for the
survey worker to go to a selected household, describe the study, and en-
courage the household member to participate. If a household member voluntee-
red for the study, he/she was immediately interviewed. Appointments were
made for the other household members 18 and older, if they were not home at
the time of recruitment. If a household refused to participate in the study
when contacted by the survey worker, a personal letter from the project
manager of this study was sent to the household describing the study in
greater detail, telling of the importance for their participation in the
study, and mentioning that they would be contacted via telephone in a few
days to see if a convenient time could be found for an interview (Appendix B).
The collected data was coded, key punched and verified onto computer
tapes by SRL. After the data was transferred to computer tapes, a program
was written to SRL to "clean" the tapes before analysis. Analysis of the
data was performed using an IBM 370/158 computer and the Statistical Package
for Social Sciences (62).
ANALYTICAL PROCEDURES
Collection and Preservation of Samples
20
-------
Household and treatment plant water samples were collected in 946 ml
(32) oz.) polyethylene containers containing a preservative of 20 ml of 1:1
(one part HNO3 to one part H^O) in each container. Ten percent of these
water samples were collected in a 1,892 ml (half ga,llon) container and split
into two 946 ml (32 oz.) containers for quality control.
Analysis of Water Samples
The Illinois Environmental Protection Agency (IEPA) used a Perkin-Elmer
Model 403 and Jarrell-Ash Model 810 atomic absorption units to analyze all
the collected water samples for calcium, magnesium, sodium, barium, cadmium,
chromium (total), copper, lead, nickel, zinc, and strontium. Mercury was
analyzed using an Air Pollution Technology Corporation Mercometer Model
2006-1. The IEPA used their standard procedures for all atomic absorption
analysis (63).
Ten percent of the split samples were analyzed by the U.S. EPA, Region
V, Central Regional Laboratory (CRL) for quality assurance purposes. The
U.S. EPA analyzed all of the above elements except mercury, using an induct-
ively coupled argon plasma system (64). Mercury was run by an alternate
test procedure (65) . Analytical results between the two laboratories were
considered in control for concentrations significantly above the detection
limits if the agreement between laboratories was better than ten percent.
STATISTICAL PROCEDURES
Since the a priori feeling was that a high barium community could have
excess morbidity and mortality, all statistical tests of hypotheses were
one-sided in that the null hypothesis would be rejected if the rates were
sufficiently higher in a barium community, but not if they were higher in a
low barium community. This use of one-sided tests increases the power of
the test against the alternatives that are of interest.
Since the data were collected from a complex cluster sample in which
blocks were primary sampling units, households were listing units and more
than one person per household could appear in the sample, use of "classical"
statistical techniques such as analysis of variance and regression would be
inappropriate. Instead, use was made of the signed rank test, which is a
nonparametric test having high efficiency and which is relatively insensitive
to violations of assumptions of independence and simple random sampling. In
using this test, each age-sex grouping was considered as a statistical
sample of size one, and the signed rank statistic was computed over all age-
sex groups. Examination of statistical difference in age-sex adjusted total
population means was performed using a weighted Z test.
The Mantel-Haenszel Test (59) was used to examine whether or not there
was a relationship between age-adjusted mortality from cardiovascular dis-
eases in communities with barium levels exceeding the Federal MCL as com-
pared to communities with little or no barium in their drinking water. This
statistical test was also used to examine whether or not there was a rela-
tionship between heart disease, hypertension, stroke or kidney disease and
softened water. These morbidity analyses were adjusted for sex, age and
community.
21
-------
SECTION 6
RESULTS AND DISCUSSION
MORTALITY STUDY
In Table 9, age and sex-adjusted death rates for cardiovascular diseases
in communities with barium levels 2.0 mg/1 or greater are compared to age
and sex-adjusted death rates for cardiovascular diseases in communities with
barium levels 0.2 mg/1 or less for the years 1971-1975. For the most part,
it is noted that these death rates are higher in the high barium communities
when compared to the death rates in the low barium communities. Of those
death rates which were higher in the high barium communities, a significant
difference (P.< 0.05), using the Mantel-Haenszel Test (59), was found
for male and female deaths combined for "all cardiovascular diseases,"
"heart disease (arteriosclerosis)" and "all causes." When males and females
were analyzed separately, a significant difference (P < 0.05) was found only
for male deaths from "all cardiovascular diseases," and for female deaths
from "all causes." The 65+ age group accounted for the largest difference
between observed and expected deaths. Although "hypertension without mention
of heart" had the largest death ratio of the high barium to low barium
communities, it was not significant possibly because the small number of re-
corded deaths make the resulting estimates too unstable for any conclusions
or inferences to be drawn.
In Table 10, age-adjusted death rates for cardiovascular diseases in the
City of DeKalb with a barium level greater than 1.0 mg/1 and less than 2.0
mg/1 are compared to age-adjusted death rates for cardiovascular diseases in
communities with barium levels 0.2 mg/1 or less for the years 1971-1975.
Generally, the death rates in the City of DeKalb are lower than those in the
low barium communities. Two exceptions are the death rates for "heart dis-
ease (other)" and "other circulatory disease" which are higher in the City
of DeKalb. Of those disease categories, only "other circulatory disease" is
significantly different (P < 0.05) for males and females combined between
the City of DeKalb and the low barium communities. When male and female
deaths from "other circulatory disease" were analyzed separately, a signifi-
cant difference (P < 0.05) was found for the females. Once again the 65+
age group had the largest difference between observed and expected deaths.
Age-adjusted death rates for cardiovascular diseases in communities with
barium levels 2.0 mg/1 or greater, greater than 1.0 mg/1 but less than 2.0
mg/1, and 0.2 mg/1 or less are compared to the average death rates between
1970 and 1975 for cardiovascular diseases for the total Illinois population
(Table 11). Generally, both the high and low barium communities had higher
22
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death rates for cardiovascular diseases than the state of Illinois, while
the City of DeKalb had lower death rates for these diseases when compared to
the state average. No statistical tests were run on the above comparisons
because differences in such regional factors as SES and demographic charac-
teristics, and urban/rural residencies for the state of Illinois were not
controllable in this part of the study. As a consequence, no conclusions
can be drawn between difference in death rates in high and low barium com-
munities when compared to the state of Illinois. The average death rates
between 1970 and 1975 were used for the state of Illinois because deaths
from cardiovascular diseases declined between 1970 (58) and 1975(56) (Table
12) .
TABLE 12 DEATH RATES PER 100,000 PERSONS FOR CARDIOVASCULAR DISEASES IN
THE STATE OF ILLINOIS
Category
Death Rates
in 1970(58)
Death Rates
in 1975(56)
Average Death
Rates Between
1970 and 1975
All Cardiovascular Diseases 568.1
a. Heart Disease 429.1
1. Arteriosclerosis 385.6
2. Other 43.5
b. Cerebrovascular Disease
c. General Arteriosclerosis
98.7
16.2
d. Hypertension Without
Mention of Heart 5.7
e. Other circulatory Disease 18.4
All Causes 994.0
496.6
375.5
339.0
36.5
86.2
12.3
4.6
18.0
903.8
532.4
402.3
362.3
40.0
92.5
14.3
5.2
18.2
948.9
See Appendix C for the 1970 Standard Illinois Population broken down by
age and sex, the number of person years broken down by age and sex which
were used to calculate death rates, and the age-sex specific death rates in
Illinois which were used for the Mantel-Haenszel Analyses (59). Appendix D
discusses a generalized solution for the Mantel Haenzel Test (59) with an
illustrative example from this study.
In summary, Illinois Death Certificates tapes were analyzed for a period
of five years to eliminate yearly fluctuations in death rates. Although
death rates were age-adjusted and as many demographic and socioeconomic
status (SES) characteristics were controlled as possible, additional factors
associated with death, other than barium, are of concern in drawing infer-
ences about differences in death rates between high and low barium communi-
ties. For example, this retrospective mortality study was not able to con-
trol for home water softeners; and as mentioned previously, there appears to
be a relationship between softened water and cardiovascular diseases (52, 53
26
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54, 55). Another factor was the population change between 1960 and 1970 in
the high and low barium communities (Table 4). Some communities in the
high barium group had a considerable increase of population, while all com-
munities in the low barium group had a more stable population. Therefore, it
is possible that the death rates in the high barium group for the years 1971-
1975, which are based on the 1970 census population, could be higher than
the true death rates based on real population figures for the years 1971-
1975. These death rates were not available for this study. Therefore, the
difference in the death rates between the high and low barium groups could
be partly attributed to the difference in population change between these
groups. Also, duration of exposure to the barium is certainly a factor to
be considered, if cardiovascular deaths are to be associated with barium in-
gestion. Since many of the individuals in the high barium group who died
from cardiovascular disease were exposed to barium for a relatively short
period of time, death from cardiovascular disease in these people probably
was not related to barium ingestion. In addition, of the six age groups ob-
served for each cardiovascular disease, only the 65+ age group consistently
showed excess deaths in the high barium communities. Since there were many
uncontrollable factors that could have a decided impact on the results in
the mortality study, any inferences drawn about differences in death rates
between high and low barium communities must be interpreted with caution.
MORBIDITY STUDY
Characteristics Of Populations Studied
Several characteristics of the 1175 individuals from West Dundee and the
1203 individuals from McHenry, Illinois, who participated in the morbidity
study, are given as follows (Tables 13-14): (a) 506 males and 669 females 18
years old and over from West Dundee, and 532 males and 671 females 18 years
old and over from McHenry participated in the study. The mean age in years
of the males and females in West Dundee was 42.6 and 43.3 respectively,
while the mean age in years for the males and females in McHenry was 51.2
and 51.3 respectively. (b) The mean residence time for both males and
females in West Dundee and McHenry was 14.0 and 15.1 years respectively.
Males and females in West Dundee 65+ years old had a residence time more
than twice that of the same age males and females in McHenry, while the males
and females between 18-44 years old had a residence time in West Dundee about
one-half as long as those of the same age in McHenry. (c) 82.7 percent of
the persons from West Dundee and 76.7 percent from McHenry had completed
high school. (d) There is a greater percent of full-time employed persons
in West Dundee than McHenry (53.2% vs. 38.6%); and West Dundee had fewer
people retired or disabled compared with McHenry (12.0% vs. 23.8%) . (e)
Approximately one-third of the people 18 years old and over presently smoke
in both West Dundee and McHenry.
In summary, the characteristics of the populations studied are quite
similar. One major difference is that McHenry's population, with more
people retired or disabled, has a mean age 8.3 years older than that of West
Dundee's population. However, data were analyzed using age-specific means
and total population means which were age-adjusted to the total sample size
by the direct method of adjustment. This age adjustment allowed for
27
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TABLE 13 AGES AND RESIDENCE TIMES OF WHITE PERSONS 18 YEARS OLD AND OVER
RESIDING IN WEST DUNDEE AND McHENRY, ILLINOIS, 1976-77
Parameter
Years
Age
Males & Females
a. Males
1. 18-44
2. 45-64
3. 65+
b . Females
1. 18-44
2. 45-64
3. 65+
Residence
Males & Females
a. Males
1. 18-44
2. 45-64
3. 65+
b. Females
1. 18-44
2. 45-64
3. 65+
West Dundee
Population
ampled
1175
506
291
158
57
669
394
166
109
1175
506
291
158
57
669
393
167
109
Mean
43.0
42.6
30.3
53.8
74.4
43.3
30.4
53.7
74.0
14.0
13.9
7.8
18.6
32.3
14.1
7.1
18.8
32.2
TANDARD
Deviation
17.6
16.9
7.4
5.8
6.4
18.1
7.6
5.4
6.5
16.6
16.2
9.4
16.5
23.1
17.0
7.6
15.9
25.3
McHenry
POPULATION
ampled
1203
532
205
152
175
671
252
226
193
1203
532
205
152
175
671
251
227
193
Mean
51.3
51.2
30.9
54.9
71.9
51.3
31.4
55.8
72.1
15.1
14.7
13.0
18.8
13.1
15.5
13.1
17.9
15.8
STANDARD
Deviation
18.2
18.6
7.7
5.6
5.2
17.9
7.4
6.0
5.7
15.3
14.8
10.4
15.8
17.5
15.6
11.5
15.9
19.1
28
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TABLE 14 CHARACTERISTICS OF WHITE PERSONS 18 YEARS OLD AND OVER RESIDING
IN WEST DUNDEE AND McHENRY, ILLINOIS, 1976-77
Parameter
Sex
a. Male
b. Female
Education
a . None
b. Grade school
c . Some high school
d. High school
e . Some college
f . College Graduate or more
Work Status
a. Full-time
b. Part-time
c. Housewife
d. Student
e . Unemployed
f . Retired or disabled
Job Location
a. West Dundee
b . McHenry
Presently Smoke
a. Less than 1 pack/day
b. 1 pack/day
c . Greater than 1 pack/day
West Dundee
Relative Frequency (%)*
43.0
57.0
0.1
7.9
9.3
38.8
25.1
18.8
53.2
11.2
19.8
1.0
2.7
12.0
17.0
0.2
38.9
12.3
13.0
13.6
McHenry
Relative Frequency (%)**
44.1
55.9
0.0
12.4
10.9
42.0
20.0
14.7
38.6
10.1
24.0
1.2
2.3
23.8
0.2
31.0
30.8
8.3
12.3
10.2
* Population sample = 1175
** Population sample = 1203
29
-------
meaningful comparisons of total population means from communities with dif-
ferent age distributions.
Health Indices
Several health parameters were analyzed using the Wilcoxon Signed-Rank
Test on age-specific means (66) and a weighted Z test on total population
means to test for statistical differences between the health of West Dundee
residents and McHenry residents. All data are presented as age-specific
means with standard deviations. The total population means are age-adjusted.
Whenever a significant difference was found, it was for a P value < 0.05
unless stated otherwise.
A. Visits to Physicians, Hospitalization and Inability to Carry Out Acti-
vities (Tables 15-17).
The mean number of visits to a doctor's office or clinic during the 12
month period from 1975-76 or 1976-77 was essentially the same for all age
groups of residents from West Dundee and McHenry (Table 15). Generally,
males in both communities visit a physician an average of twice a year, while
females make three visits. It is not known why males in McHenry 18-24 years
of age had four visits to a physician, while males in the same age category
from West Dundee had only two.
Persons were hospitalized an average of approximately 10 days per year
in both West Dundee and McHenry (Table 16). The small sample size, in most
of the age groups, can account for the variability in hospital stay for some
of the age groups, between sexes in the same community, and/or between com-
munities for the same sex. However, a national health interview survey con-
ducted in 1972 found that an estimated 21.6 million hospitalized people in
the U.S. spent an average of 10.0 days in the hospital during a 12 month
period preceding the interview (67). This national survey, as well as the
West Dundee and McHenry survey (Table 16), pointed out that increasing age
resulted in an increasing average number of days in the hospital during the
reference period. In addition, it was found that a larger proportion of
females were hospitalized compared with males. Pregnancies during the 18-44
age categories accounted primarily for this difference. Of people hospital-
ized in West Dundee during the reference period, 39% were for surgery, 28%
for illness, 21% for pregnancy, 5% for injury, and 7% for other. McHenry
had hospitalizations as follows: 31% surgery, 39% illness, 18% pregnancy,
6% injury and 6% other.
The mean number of days that persons from West Dundee and McHenry were
unable to work or carry out usual activities during reference period was
approximately six to seven days (Table 17). It is not known why the males
65-74 years of age from West Dundee and the males and females 75+ years of
age had so few days attributed to illness, disability or injury.
In summary, no significant differences were found for the total popula-
tion age-adjusted means for males or females between the two communities
when visits to physicians, hospitalization and inability to carry out
activities were compared. These tables were only constructed to show that
30
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the above mentioned health characteristics of the two communities were quite
similar.
B. Blood Pressures and Pulse Rates (Tables 18-45)
Since it was found in the literature (Background Section) that barium
can have an effect on elevating blood pressure in animals, this study col-
lected blood pressure data from both communities to examine the effects of
barium on human blood pressure levels. As expected, highly significant chi
square differences were found for blood pressures when age was varied con-
trolling for sex, smoking, years residing in the community, obesity, barium
concentration, or sodium concentration. Since it has been shown that blood
pressure varies significantly with age (67), the importance of this finding
in West Dundee and McHenry verifies the reliability of the collected data.
In Table 18 and Figures 1 and 2, systolic and diastolic blood pressures
are presented for persons in West Dundee and McHenry by age and sex. When
the data from Table 18 were compared to a blood pressure averages for the
U.S. population (Table 19) (68), it was noted that the systolic and diastolic
blood pressures in both of the above communities were, on the whole, slightly
lower than those in the United States, A signed rank test of the age-speci-
fic means of West Dundee male and female systolic and diastolic blood pres-
sures, and a weighted Z test of the age-adjusted total population means for
these males and females were not significantly different when compared to
the mean blood pressures of McHenry males and females.
Since no statistical differences were found for blood pressures between
all males and females in West Dundee when compared to the males and females
in McHenry (Table 18), it was felt that a difference might be masked by
those people: (1) Living in the communities for a relatively short period
of time, (2) taking high blood pressure medication, (3) having a home water
softener which removes barium, (4) smoking cigarettes, and (5) having obesity
problems. As a consequence, the following presentation of the results and
discussion section will reflect the above concerns.
First of all, when blood pressures for males and females living in West
Dundee greater than 10 years were compared to McHenry males and females for
the same two reference periods, no statistical differences were found between
the total population means or the age-specific means (Table 20, Figures 3
and 4). However, when systolic and diastolic blood pressures for West Dundee
males and females living in the community greater than 10 years were compared
to West Dundee males and females living in the community 10 years or less, a
significant difference was found for the males (Table 21). When McHenry
males and females living in the community either greater than 10 years or
10 years and less were compared similarly, no significant differences were
found (Table 22).
When West Dundee and McHenry males and females living 10 years or less
in their respective communities were compared for blood pressure differences
(Table 23), a significant difference was found for the systolic blood pres-
sures between the West Dundee and McHenry females for both total population
means and age-specific means (P values were respectively equal to 0.06 and
34
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01
160r
150
140
130
120
110
100
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D=SYSTOLIC, WEST DUNDEE
0=SYSTOLIC, MCHENRY
I
I
D=DIASTOLIC, WEST DUNDEE
0=DIASTOLIC, MCHENRY
I
18-24 25-34 35-44 45-54 55-64 65-74 75+
AGE GROUP
Figure 1. Mean age-specific systolic and diastolic blood pressure among males
18-75+ years of age: West Dundee and McHenry, Illinois, 1976-77.
36
-------
en
I
ID
CL
ID
03
CO
LU
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160
150
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D=SYSTOLIC, WEST DUNDEE
0=SYSTOLIC, MCHENRY
ODIASTOLIC, WEST DUNDEE
0 = DIASTOLIC, MCHENRY
1
18-24 25-34 35-44 45-54 55-64 65-74 75+
AGE GROUP
Figure 2. Mean age-specific systolic and diastolic blood pressure among
females 18-75+ years of age: West Dundee and McHenry, Illinois, 1976-77.
37
-------
TABLE 19 AGE-SPECIFIC MEANS (mm. Hg) OF SYSTOLIC AND DIASTOLIC BLOOD
PRESSURE AMONG WHITE PERSONS 18-74 YEARS OF AGE: UNITED
STATES 1971-74.(68)
Blood Pressure
and Age
(Years)
Systolic
18-24
25-34
35-44
45-54
55-64
65-74
Diastolic
18-24
25-34
35-44
45-54
55-64
65-74
Male
Mean
123.7
125.2
127.0
134.7
139.6
146.0
76.4
80.8
84.2
87.5
86.4
84.9
Female
Mean
115.1
116.2
122.6
131.1
143.0
151.6
71.3
74.6
79.3
82.6
86.2
85.4
38
-------
TABLE 20 AGE-SPECIFIC MEANS AND STANDARD DEVIATIONS (mm.Hg) OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE
AMONG WHITE PERSONS 18-75+ YEARS OF AGE, WHO HAVE LIVED GREATER THAN 10 YEARS IN: WEST
DUNDEE OR McHENRY, ILLINOIS, 1976-77
McHenry
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Age
(Years)
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D SYSTOLIC, WEST DUNDEE
O SYSTOLIC, MC HENRY
D DIASTOLIC, WEST DUNDEE
O DIASTOLIC, MC HENRY
18-24 25-34 35-44 45-54 55-64 65-74 75 +
AGE GROUP
Figure 3. Mean age-specific systolic and diastolic blood pressure among males
18-75+ years of age who have lived greater than 10 years in: West Dundee and
McHenry, Illinois, 1976-77.
40
-------
160.
150
140
130
en
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D SYSTOLIC, WEST DUNDEE
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D DIASTOLIC, WEST DUNDEE
O DIASTOLIC, MC HENRY
I
18-24 25-34 35-44 45-54 55-64 65-74 75+
AGE GROUP
Figure 4. Mean age-specific systolic and diastolic blood pressure among
females 18-75+ years of age who have lived greater than 10 years in: West
Dundee and McHenry, Illinois, 1976-77.
41
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42
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43
-------
TABLE 23 AGE-SPECIFIC MEANS AND STANDARD DEVIATIONS (mm.Hg) OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURI
AMONG WHITE PERSONS 18-75+ YEARS OF AGE, WHO HAVE LIVED 10 YEARS OR LESS IN: WEST DUNDEE
OR McHENRY, ILLINOIS, 1976-77
><
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c
CO
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c
(U
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Q)
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Standard
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0)
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ft CO
Blood
Pressure
Age
(Years)
CT,
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18-24
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ffl r~'
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44
-------
and < 0.05). This finding would be more meaningful if a significant differ-
ence in blood pressures would have been found in West Dundee females living
in the community greater than 10 years when compared to McHenry females re-
siding in the community for the same time span (Table 20).
Since individuals taking high blood pressure medication could also
possibly mask any effect barium might have on blood pressure, West Dundee
male and female blood pressures were compared to see if there were any dif-
ferences in those individuals who were not taking high blood pressure medica-
tion, and have lived either greater than 10 years or 10 years and less in
their respective communities (Tables 24 and 25). With the exception of
systolic blood pressures for females living 10 years and less in their re-
spective communities (Table 25), no significant differences were found in
either age-specific or total population mean blood pressures when males and
females from West Dundee, not taking blood pressure medication, were compared
similarly to males and females in McHenry according to time of residence.
In Tables 26 and 27, the same comparisons as in Tables 24 and 25 were made
with the exception of removing those individuals diagnosed as having definite
hypertension from the data analysis. A significant difference was found
between West Dundee and McHenry female systolic total population means
whether they lived in the community greater than 10 years or 10 years and
less. The mean age-specific female systolic blood pressure were only sig-
nificantly different when time of residence was 10 years and less (Table 27) .
Finally, when a comparison of blood pressures of males and females from West
Dundee, who do not have definite hypertension nor are currently taking high
blood pressure medication, was made against a similar population in McHenry
regardless of time in residence, no significant differences were found in
either the age-specific or total population means (Table 28). Although no
significant differences were noted in Table 28, five of seven West Dundee
female age groupings beginning at 35-44 have higher blood pressure than
McHenry females in these same age groupings.
Blood pressure comparisons were also made between communities for those
individuals with definitive hypertension or currently taking blood pressure
medication (Table 29), for those individuals taking blood pressure medica-
tion (Table 30), and for those individuals no longer taking blood pressure
medication (31). No significant differences were found between West Dundee
males and females when the above blood pressure comparisons were made to a
similar population of McHenry males and females.
In addition to looking at the blood pressures of those individuals from
West Dundee and McHenry with definite hypertension or who are currently tak-
ing blood pressure medication (Table 29), the Mantel-Haenszel Test (59) was
used to see if there were any statistical difference between West Dundee and
McHenry in the numbers of males and females who have this disease or are
currently taking medication. No significant differences were found when the
number of males and females from each of the seven age groupings from West
Dundee were compared similarly to males and females in McHenry (See Appendix
D for the statistical computation).
It should be noted in Table 30 that the male age-groups in West Dundee
generally have a higher proportion of the total population in each age group
45
-------
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47
-------
TABLE 26 AGE-SPECIFIC MEANS AND STANDARD DEVIATIONS (mm.Hg) OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE
AMONG WHITE PERSONS 18-75+ YEARS OF AGE, WHO DO NOT HAVE DEFINITE HYPERTENSION,"1" NOR ARE
CURRENTLY TAKING HIGH BLOOD PRESSURE MEDICATION, AND HAVE LIVED GREATER THAN 10 YEARS IN:
WEST DUNDEE OR McHENRY, ILLINOIS, 1976-77
McHenry
West Dundee
Female
0)
rH
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m 10
i- *
CM ^J1
en cn
in ro
cn t-
CO ro
ro ID
en r~-
in ro
VD rH
ro cn
rH
o t
i1 cn
co cn
i1 co
t I
in in
cn
l
r- i
CO O
m f
oo co
vD i I
CO CM
cn cn
I-H m
o co
o r-
i-H
in CM
rH rH
rH CM
CM rH
rH CM
CO O
co cn
<* m
o
m l
rH
VD r^
i-H CM
co cn
CO i-H
+
1
in
v£
rH
rH
VO
CO
CO
rH
CM
o
O
r-H
CM
co
CO
CM
rH
in
CO
in
CM
ro
i-H
cn
CO
cn
rH
H *
<0
P O4
0 0
EH Ai
iH
Cfl
I
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0
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I
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on high blood pressure medication than the comparable male age-groups in
McHenry (See Table 18 to get total number of individuals for each age group).
A significant difference, using the Mantel-Haenszel Test (59), was found for
the above comparison. Since there was not a significant difference found
for individuals either having definite hypertension or taking blood pressure
medication between the two communities (Table 29), it can be concluded that
more males with hypertension in West Dundee take medication than males with
hypertension in McHenry. It is not known why more males Ln West Dundee take
medication for their hypertension than males in McHenry. When the above com-
parison is made for females, no significant difference was found.
Another important factor that could be masking a possible effect of
barium on blood pressure is the home water softener. As mentioned previously,
water softeners remove barium from the water. As a consequence, blood
pressures for males and females in West Dundee, who do not have home water
softeners, were compared to a similar population of males and females in
McHenry (Table 32). Males and females from West Dundee without water soft-
eners did not have blood pressures that were significantly higher than their
counterparts in McHenry.
Since water softeners could also possibly mask the effect of barium as
related to residence time in the community, West Dundee male and female
blood pressures were compared to McHenry male and female blood pressures to
see if there were any differences in the blood pressures of those individuals
who do not have home water softeners, and have lived greater than 10 years
in their respective communities (Table 33). A significant difference was
found when West Dundee male mean age-specific and total population mean
(P = 0.06) systolic blood pressures were compared to these same mean blood
pressures in McHenry males. No significant differences were found between
female systolic blood pressures or between male or female diastolic blood
pressures. When the same comparisons were made for individuals living 10
years or less in their respective communities, no significant differences
were found between male and female systolic or diastolic blood pressures
(Table 34). The West Dundee female systolic blood pressures were elevated
in the 55-64, 65-74 and 75+ age groups in comparison to McHenry's female
systolic blood pressures for these same three age groupings.
The next series of Tables (35-40) deal with those individuals in West
Dundee and McHenry who do not have home waters, are not taking high blood
pressure medication, do not have hypertension, and have lived either greater
than 10 years or 10 years and less in the community. In Table 35, no sig-
nificant differences were found when West Dundee male and female blood
pressures were compared to a similar population of McHenry males and females
who do not have home water softeners and are not. taking high blood pressure
medication. However, when a correction is made for time of residence in the
community, a significant difference is found for systolic blood pressures
between West Dundee and McHenry males living greater than 10 years in the
community (Table 36). The total population mean and mean age-specific systo-
lic blood pressures had P values of 0.05 and 0.08 respectively. The only sig-
nificant difference (Table 37) found for individuals living 10 years and
less in their community, without water softeners, and not taking high blood
pressure medication was between West Dundee and McHenry female systolic mean
54
-------
K H
P W
CO P
tn £;
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00
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in
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CO
rH
CN
CN
CO
rH
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CM
CO
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rH
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ro
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0
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ro
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o
CO
rH
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Total
*
ft
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-------
TABLE 33 AGE-SPECIFIC MEANS AND STANDARD DEVIATIONS (mm.Hg) OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURI
AMONG WHITE PERSONS 18-75+ YEARS OF AGE, WHO DO NOT HAVE WATER SOFTENERS AND HAVE LIVED
GREATER THAN 10 YEARS IN: WEST DUNDEE OR McHENRY . ILLINOIS. 1976-77
McHenry
West Dundee
Female
r-H
Female I
0)
rH
£
Standard
Deviation
03
0)
s
ft N
O -rl
CM co
Standard
Deviation
rd
s
0)
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O -rt
CM co
Standard
Deviation
§
ID
S
ft N
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CM 10
Standard
Deviation
c
id
CN) H H
CTi CM CO
^y cn VD
H H ro
rH rH rH
vD co [*>
H CM rH
CN CO H
ro ro O
rH rH CM
IX) H CO
m m co
CM CN CO
H H rH
CM VD O
rH H H
rH in CN]
<^ !"* cn
rH rH rH
H CO IX)
CNJ o co
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rH rH rH
^ CTi CTi
CN CN CM
<* C- 1-
rH rH CN]
rH O CO
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r- o in
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sf in VD
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ro M< in
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CO iX)
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rH rH
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I-H cn
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CN CN
in cr>
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oo co
O CM
co vO
CN CN
^P CTt
VD H
ro in
rH rH
ro O
CN CO
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CN] H
rH CTV
m CN
in
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r*"* f1*1*
1
m
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CN
CO
m
CM
rH
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CO
rH
rH
ro
rH
IX)
ID
CN
10
in
CM
rH
0
in
rH
cn
o
CN
in
ro
H
rH
rH
Total
Pop. *
Diastolic
o CD
r^ ro
H
cn «3
r^ r--
ix> ro
H H
<* CM
H 0
H iH
VD ro
CN] ^
IX) (X)
rH
r^ CM
H
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ro CTi
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r- oo
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rH
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ro o l>
co ix> ro
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CN ^tf -31
CO CO CT!
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co o r-
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m in ID
CM CTi CM
rH rH
CO IX) CO
cn CN in
r^ co co
^ cn cn
CN CN] CN
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rH i-H
in VD CTI
ro ix) iX)
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r^ o in
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co cn
rH
r^ m
CM <*
co cn
rH O
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m m
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cn ^j*
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oo cn
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cn H
m o
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VD m
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<* m
i
in
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rH
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o
rH
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rH
CN]
oo
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f-
ro
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cn
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CN]
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r -1
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56
-------
TABLE 34 AGE -SPECIFIC MEANS AND STANDARD DEVIATIONS (mm. fig) OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURl
AMONG WHITE PERSONS 18-75+ YEARS OF AGE, WHO DO NOT HAVE WATER SOFTENERS AND HAVE LIVED
10 YEARS OR LESS IN: WEST DUNDEE OR McHENRY, ILLINOIS, 1976-77
McHenry
West Dundee
Female
cn
t~~ ^F CM
I 1 1
in in in
CN ro ^
r~ o r-
r~ vo o
H rH CN
CM ro ro
r- ro -sj1
CN ro ^
rH rH rH
r- co en
i-H CN
^ cn r^
O in tN
CN rH CN
^* ro r^*-
0 0 r-
^^ ^* LO
H H rH
[~~ VD rH
tN rH
cn CN ro
iH CN in
CN CN iH
VO rH i I
r"- co r~
ro ^ yj
rH iH rH
rH VO CO
O O t~-
m o CN
ro ro oo
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tN ro ^
rH H rH
H
+
^ 1
m m
m vo
0
CN
CN
i-H
iH
CO
o
H
cn
o
CN
H
CN
cn
CN
tn
rH
r-
rH
H
ro
in
CN
en
iH
CN
in
IN
rH
O
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CN
Total
Pop. *
Diastolic
ro ^o
f-^ en
^r o
ro -sT
r-- r~-
cn ro
CN
ro in
<* o
rH rH
co oo
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r^ CN
CN
VO rH
E^ rH
rH
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H <3«
ro cn
in r~
c^ *sj<
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rH rH
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ro r~
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1 1
co in
rH tN
ro r- 00
ro m en
rH rH
tN CO O
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co co co
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CN I^ VO
CO CO CO
o cn r~
rH
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c~^ co- cn
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co m cn
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rH rH
CO ro 10
IN CN cn
oo oo r^
<* en rr
q1 CN iH
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t i i
m m m
ro ^ m
r~- CN
in oo
rH rH
vo ro
00 O
co co
oo cn
CN
tn co
*y ro
rH rH
r- cn
in r-
co co
VO rH
CM rH
O rH
CN cn
rH
vo ro
in cn
co r-
VO CO
rH
o m
O ro
r- cn
CO CO
r- r^
rH^
M1 m
i
in
vo
CM
H
vo
tn
t--
co
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i-H
CN
ro
rH
in
i-H
CO
tN
cn
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rH
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CO
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c
Q)
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cn
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cn
k
a
ft
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rH
(0
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0
57
-------
D 2
ro H
EH
Q O
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S CO W
WWW
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ft O D
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H W
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H a,
p^ nq
H EH Q
U H O
W ffi O
W CQ
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I '& ffi
H O O
rp S i i
CD
OH N
0 -H
Pu w.
Standard
Deviation ,
C
fd
CD
a
CD
a N
o -H
Standard
Deviation
c
rd
(U
a
CD
D, N
O -H
n, w
Blood
Pressure
Age
(Years)
rH
H
rH
r^
o
rH
in
CO
CO
H
CT-,
cn
rH
r-l
CO
CN
cn
cn
ro
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rH
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ID
tD
CN
rH
CTl
rH
CM
rH
-
U
rH CM
O 1
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V! rH
CO
to to
rH CO
rH rH
cn o
r-~ CM
O rH
rH rH
to in
ro CM
CO O
rH 1^
rH H
cn CM
rH in
CM CM
rH rH
P- rH
CN CM
0 rH
CO CO
rH rH
to M.
r~ cn
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rH rH
to to
co r^
to co
CM <*
H rH
CO rH
CM ro
CN CN
rH H
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co m
CO ^
1 1
in in
CM CO
O rH
O r--
CM H
in to
o r-
CM CM
rH rH
H to
CO CM
H in
in cn
rH rH
<3' O
tO O
CM <*
rH H
CN in
CN H
m ^
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rH H
O O
H CO
CN CN
H H
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m CM
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co in
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in cn
cn CM
CM ro
rH H
CT1 rH
co c")
in to
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ro in
to co
rH rH
r- cr>
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CO ^
H rH
CTi CO
CN H
CTi ^f
CO CM
H CM
CO CM
CM VD
rH rH
o to
CO rH
r~ co
CO CM
rH CN
r- r-
tO rH
co in
rH rH
to in
CM CM
^J1 in
sf in
rH CN
in co
co cn
co "3*
rH rH
r^ to
rH
^ m
I
in
cn
H
cn
H
H
in
CO
rH
CN
cn
rH
CO
cx>*
CM
H
in
rH
in
o
CM
in
r-°
rH
rH
rH
in
co
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CO
rH
rH
00
CN
rH
to
r-
CN
Total
Pop. *
Diastolic
O rH -sf
r^ H CM
rH H
^J tO CN
CM ^r H
r-- r^ co
in to m
CM CO CM
O CO CN
CM cn CM
rH rH.
O CTi Oi
CM r- ^j1
r^ r^ co
ro r-- rH
CN CN CN
1 j r-^ Q
CO O rH
H rH
1,0 r- CN
H ^ to
o to to
to co r^
o in cn
o o cn
H H
to in CM
co r~ CM
r~- r^ oo
r- o to
xf co in
CM ro M<
l 1 l
co in in
rH CM CO
in en
to CM
H H
to o
in to
co co
rH tO
CO CM
H CO
ro ro
H H
un O
in r-
co co
CM in
CM rH
cn ^i1
0 rH
H H
CO CO
CN CN
co co
O CO
in CN
tf CO
H H
rH tO
ro ro
CO CO
cn H
ro ro
1 1
-------
TABLE 36 AGE-SPECIFIC MEANS AND STANDARD DEVIATIONS (mm.Hg) OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE
AMONG WHITE PERSONS 18-75+ YEARS OF AGE, WHO DO NOT HAVE WATER SOFTNERS, ARE NOT TAKING
HIGH BLOOD PRESSURE MEDICATION AND HAVE LIVED GREATER THAN 10 YEARS IN: WEST DUNDEE OR
McHENRY, ILLINOIS, 1976-77
McHenry
West Dundee
0)
rH
rd
<3J
0
rH
S
0
r-l
as
-OJ
Q)
tH
Standard
Deviation
rd
CD
S
0)
Qi N
C -H
CM CO
C
"0 O
M -H
t! rd
rd >
P 0
CO P
a
0)
ft N
O -r-
P-l CO
Standard
Deviation >
c
0)
ft N
O vH
PM co
rd 6
M -r-l
rd -P
fi -H
ro >
P Qj
CO P
s
0)
0)
Oi M
O -H
f'i CO
Blood
Pressure
Age
(Years)
CM CO in ^ O VD CM
rH CM O t~- [~~ CTi VO
H rH CM H H rH rH
CM CD CTi CTi r-- ro rH
O O H rH ro ro in
rH rH rH rH rH H H
VO ro CO O CN CTi P^
rH rH H CN rH
H ro in O H in CTi
CN CTi CN rf O CD rH
rH rH H CN CN CN
rH CO CTi O ro ^J1 O
CM CM ro VO CO in CO
CN CN CM CN ro =* ro
rH rH rH rH H rH rH
co *£> rH «cj o r-- r*~
rH rH rH rH
CN rH CN CD * CTi ^
^}< <3< *^F r~- CTI CN in
rH rH rH rH rH i 1 CM
i£> ro ID rsj *3< tT> CTi
in CTi rH O CD CTi O
O O rH CM CM CN in
rH i 1 rH rH rH rH rH
co r ro in rji ^r o
CN CM rH rH CM
rH 1*0 CTl O ^J1 r~~ O
CN co co r-- co in CTI
rH rH rH rH CN rH rH
r- co LD CN <* o CM
CN r- ^f r- ro CTI CN
CN CM CM ro * ro in
rH rH rH rH rH rH rH
CM CO ^O ^ r~~ ^Q CN
rH rH rH rH rH
U 4
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60
-------
age-specific blood pressures (P = 0.08).
A comparison between West Dundee and McHenry blood pressures for indivi-
duals who do not have home water softeners, who do not have definite hyper-
tension, and who are not taking high blood pressure medication was not found
to be statistically significant (Table 38). However, when the above com-
parison was made for those individuals living greater than 10 years in the
community, a significant difference was found between West Dundee and McHenry
male systolic total population and age-specific mean blood pressures (Table
39). When the same comparison was made between West Dundee and McHenry males
and females living 10 years and less in the community, only female systolic
age-specific mean blood pressures were significantly different (Table 40).
Another factor considered in the data analysis was the comparison of
blood pressures of males and females from West Dundee who have never smoked
against the nonsmoking males and females in McHenry (Table 41). No signi-
ficant differences in blood pressures were found when the nonsmoking persons
from West Dundee were compared to the nonsmoking persons in McHenry. Like-
wise, no differences in blood pressures were found when the nonsmoking
persons from West Dundee or McHenry were compared to the total study popula-
tion of West Dundee and McHenry (Tables 18 and 41). In addition, the above
findings apply to individuals from West Dundee and McHenry who have smoked
sometime during their lifetime (Table 42). When the blood pressures between
the nonsmokers and smokers from West Dundee and McHenry were compared, no
significant differences were noted (Tables 41 and 42). Since no differences
in blood pressures between the nonsmokers and smokers in the two communities
were noted, it is felt that smoking did not mask any possible effect of
barium on blood pressure.
A separate analysis of blood pressures was made for those persons in
West Dundee and McHenry who were determined obese by triceps skinfold read-
ings (Table 43), and for those who were determined nonobese by skinfold read-
ings (Table 44). Males were determined obese if the triceps skinfold
measurement was greater than 20 mm., while females were obese if this
measurement was greater than 25 mm. (69). No statistical differences were
found when blood pressures for obese or nonobese males and females from West
Dundee were compared respectively to McHenry obese or nonobese males and
females.
In addition to blood pressure readings, pulse rates of males and females
from West Dundee and McHenry were taken during the study period (Table 45).
No significant differences (P > 0.05) were found when age-specific or total
population pulse rate means for West Dundee males and females were compared
in a similar fashion to McHenry males and females.
In summary, blood pressure data were analyzed using the signed rank and
weighted Z tests to see if there were any differences between systolic and
diastolic blood pressures of males and females from West Dundee and McHenry.
The blood pressure data were analyzed in the following manner for both com-
munities : (1) all males and females in the study population, (2) males and
females who have lived greater than 10 years or 10 years and less in West
Dundee and McHenry, (3) males and females who are not taking high blood
61
-------
8
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62
-------
TABLE 39 AGE-SPECIFIC MEANS AND STANDARD pEVIATIONS (mm.Hg) OF SYSTOLIC AND DIASTOLIC BLOOD PRESSUR
PRESSURE AMONG WHITE PERSONS 18-75+ YEARS OF AGE, WHO DO NOT HAVE WATER SOFTENERS, WHO DO
NOT HAVE DEFINITE HYPERTENSION,"1" NOR ARE CURRENTLY TAKING HIGH BLOOD PRESSURE MEDICATION,
AND HAVE LIVED GREATER THAN 10 YEARS IN: WEST DUNDEE OR MnHFNRY . TT.T.TMnT.q iQ7fi-"77
McHenry
Dundee
4J
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c
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1
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63
-------
FABLE 40 AGE-SPECIFIC MEANS AND STANDARD DEVIATIONS (mm.Hg) OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE
AMONG WHITE PERSONS 18-75+ YEARS OF AGE, WHO DO NOT HAVE WATER SOFTENERS, WHO DO NOT HAVE
DEFINITE HYPERTENSION,4" NOR ARE CURRENTLY TAKING HIGH BLOOD PRESSURE MEDICATION, AND HAVE
LIVED 10 YEARS OR LESS IN WEST DUNDEE OR McHENRY , ILLINOIS, 1976-77
McHenry
West Dundee
Female
Q)
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ft 10.
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c
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Blood
Pressure
Age
(Years)
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pressure medication and have lived greater than 10 years or 10 years and
less in the community, (4) males and females who do not have definite hyper-
tension, nor are taking high blood pressure medication, and have lived
greater than 10 years or 10 years and less in the community, (5) males and
females who do not have definite hypertension nor are currently taking high
blood pressure medication, (6) males and females with definite hypertension
or taking blood pressure medication, C7) males and females on high blood
pressure medication, (8) males and females no longer taking high blood
pressure medication, (9) males and females who do not have water softeners,
(10) males and females who do not have water softeners and have lived greater
than 10 years or 10 years and less in the community, (11) males and females
who do not have water softeners and are not taking blood pressure medication,
(12) males and females who do not have water softeners, are not taking blood
pressure medication, and have lived greater than 10 years or 10 years and
less in the community, (13) males and females who do not have water softeners,
who do not have definite hypertension, nor are taking high blood pressure
medication, (14) males and females who do not have water softeners, who do
not have definite hypertension, are not taking high blood pressure medica-
tion, and have lived greater than 10 years or 10 years and less in the com-
munity, (15) males and females who have never smoked, or have smoked some-
time during their lifetime, and (17) obese and nonobese males and females.
When systolic and diastolic blood pressures for males and females from
West Dundee were compared to blood pressures for males and females from
McHenry for all of the above categories, significant differences (P < 0.05)
unless stated otherwise were found as follows:
1. Systolic total population (P = 0.06) and age-specific means for females
living 10 years or less in the community (Table 23).
2. Systolic total population and age-specific (P = 0.06) means for females
who are not taking blood pressure medication and have lived 10 years or
less in the community (Table 25).
3. Systolic total population means for females who do not have definite
hypertension, are not taking high blood pressure medication, and have
lived greater than 10 years or 10 years and less in the community (Table
26 and 27). The age-specific mean systolic blood pressures were only
significantly different between West Dundee and McHenry females living
10 years and less in the community.
4. Systolic total population (P = 0.06) and age-specific means for males
who do not have water softeners and have lived greater than 10 years in
the community (Table 33).
5. Systolic total population (P = 0.05) and age-specific (P = 0.08) means
for males who do not have water softeners, are not taking high blood
pressure medication, and have lived greater than 10 years in the com-
munity (Table 36). Also, systolic age-specific (P = 0.08) means for
females having the same corrections made as for the males above with
the exception of living in the community for 10 years and less (Table
37) .
70
-------
6. Systolic total population and age-specific means for males who do not
have water softeners, who do not have definite hypertension, are not
taking high blood pressure medication, and have lived greater than 10
years in the community (Table 39). Also, systolic age-specific means
for females having the same corrections made as for the males above with
the exception of living in the community for 10 years and less (Table 40).
In addition to making comparisons for blood pressure differences between
communities and time of residence, a comparison was made for possible blood
pressure differences within the study communities with respect to time of
residence. The only significant difference found was for both systolic and
diastolic total population and age-specific mean blood pressures among males
who have lived in West Dundee greater than 10 years compared to those males
who have lived in West Dundee for 10 years or less (Table 21).
Further analysis indicates that there are no significant differences for
the proportion of males and females from West Dundee who have definite hyper-
tension or are taking blood pressure medication when compared to McHenry
males and females under the same conditions. More West Dundee males were
found to take blood pressure medication for their hypertension than McHenry
males. Finally, no significant differences were found in West Dundee male
and female pulse rates when compared to the pulse rates of males and females
in McHenry.
Although there were some significant differences found in the blood
pressure data between the high barium and the low barium communities, the
data is inconclusive mainly because of inconsistencies in the findings. For
instance, significant difference in female systolic blood pressures occurred
for those females residing in the community for 10 years or less, while no
significant difference was found for females residing greater than 10 years
in the community. This same finding was also shown for females living 10
years or less in the community and not on high blood pressure medication.
Sometimes a significant difference would be found for males living greater
than 10 years in the community and for females living 10 years or less in
the community. Finally, since over 100 analyses were run to test for sig-
nificant difference in the total population and age-specific mean systolic
blood pressures, and over 100 tests for differences in these means for dia-
stolic blood pressures, some of the significant differences happened by
chance alone. It must be pointed out that all of the findings could not
have happened by chance alone, and that significant differences between West
Dundee and McHenry residents were found for male systolic blood pressures
when corrections were made for water softeners, and time of residence; water
softeners, time of residence, and blood pressure medication; and water soft-
eners, time of residence, blood pressure medication, and hypertension. Also,
female systolic blood pressures were found significantly different between
these high barium and low barium populations when corrections were made for
time of residence, hypertension, and blood pressure medication.
71
-------
C. Prevalence rates of hypertension, stroke, heart disease, diabetes and
kidney disease (Tables 46-53}.
All age-specific prevalence rates for males and females were analyzed
using the signed rank test for age-specific rates and the weighted Z test
for total population rates. The prevalence rates for definite and border-
line hypertension in males and females from West Dundee were not signifi-
cantly different from the prevalence rates for these two types of hyperten-
sion in the males and females of McHenry (Tables 46 and 47). In addition,
the prevalence rates for both males and females in West Dundee and McHenry
with definite hypertension were slightly lower when compared with those
males and females in the United States as a whole (Table 48} (68). The
above comparisons might not be totally meaningful because those individuals
on blood pressure medication were not considered. However, when those males
and females from West Dundee taking blood pressure medication or having defi-
nite hypertension were compared to the same type of male and female populat-
ions in McHenry (Table 49), no significant differences were found. Although
no significant differences were found, these prevalence rates were now sligh-fe-
ly higher for both communities when compared with those males and females in
the United States as a whole (Table 48) (68). Also, five of the seven age
grouping had higher prevalence rates for West Dundee males in comparison to
McHenry males (Table 49).
The prevalence rates for stroke, heart disease, diabetes and kidney dis-
ease in males and females from West Dundee were not significantly different
from the prevalence rates for these respective diseases in males and females
of McHenry (Tables 50-53). In Table 50, more males in West Dundee in age-
groups 45 years old and older have higher rates of stroke than their counter-
parts in McHenry. Therefore, an additional statistical test (Mantel-
Haenszel) (59) was run to see if there was a difference in actual numbers of
stroke between these West Dundee and McHenry males. No significant differ-
ences were found.
Refusals
West Dundee had 165 households (20.1%) refusing to participate in the
study, while McHenry had 181 households (21.4%) that refused. As mentioned
previously (Section 5), an attempt was made to bring the refusals into the
study. However, it was felt that the health data obtained from the refusals
should be treated separately from the data collected from those who volun-
teered initially to prevent biasing the data in any manner. As it turned
out, there were not enough refusals, who agreed to participate when asked a
second time, to warrant analysis of the data separately. Ten households
totaling 18 people from West Dundee, and 28 households totaling 46 people
from McHenry agreed to participate, after initially refusing. The blood
pressure data from this population sample is presented in Table 54.
Water Sample Analysis
A water sample was collected and analyzed for each household surveyed
to see if the concentration of various metals in specific household water
was different from the community's water treatment plant metal analysis.
72
-------
TABLE 46 AGE-SPECIFIC PREVALENCE RATES OF DEFINITE HYPERTENSION FOR
PERSONS 18-75+ YEARS OF AGE: WEST DUNDEE AND McHENRY, ILLINOIS,
1976-77
Definite
Hyper-
tension
and Age
(Years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop. *
West Dundee
Male
Pop.
Size
77
122
92
89
69
29
28
506
Rate/100
Pop.
5.2
7.4
12.0
15.7
14.5
31.0
21.4
14.8
Female
Pop.
Size
114
147
133
91
75
60
49
669
Rate/100
Pop.
0.0
2.7
6.0
17.6
20.0
21.7
44.9
13.7
McHenry
Male
Pop.
Size
54
77
74
75
77
128
47
532
Rate/100
Pop.
3.7
5.2
13.5
18.7
23.4
28.9
38.3
17.0
Female
Pop.
Size
53
111
88
90
136
137
56
671
Rate/100
Pop.
0.0
1.8
11.4
13.3
27.9
29.2
32.1
15.3
TABLE 47 AGE-SPECIFIC PREVALENCE OF BORDERLINE HYPERTENSION FOR PERSONS
18-75+ YEARS OF AGE: WEST DUNDEE AND McHENRY ILLINOIS, 1976-77
Border-
line
Hyper-
tension"1"1"
and Age
(Years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop. *
West Dundee
Male
Pop.
Size
77
122
92
89
69
29
28
506
Rate/ 100
Pop.
13.0
14.8
10.9
19.1
20.3
24.1
53.6
19.6
Female
Pop.
Size
114
147
133
91
75
60
49
669
Rate/100
Pop.
0.0
2.7
6.8
15.4
17.3
25.0
32.7
12.7
McHenry
Male
Pop.
Size
" 54
77
74
75
77
128
47
532
Rate/100
Pop.
11.1
13.0
13.5
17.3
22.1
24.2
25.5
17.3
Female
Pop.
Size
53
111
88
90
136
137
56
671
Rate/100
Pop.
0.0
8.1
11.4
12.2
16.2
22.6
39.3
14.0
+ Systolic blood pressure of at least 160 mm. Hg or diastolic blood
pressure of at least 95 mm. Hg.
++ Systolic blood pressure 160 mm. Hg and below 95 mm. Hg. diastolic
blood pressure, but not simultaneously below 140 and 90 mm. Hg.
*
Total population rates are age-sex adjusted to the total sample size.
73
-------
TABLE 48 AGE-SPECIFIC PREVALENCE RATES OF DEFINITE HYPERTENSION AMONG
WHITE PERSONS 18-74 YEARS OF AGE: UNITED STATES,1971-74(68)
Definite
Hypertension +
and Age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
To-l-al
Male
Rate/100
Population
4.9
8.2
17.3
25.8
31.1
35.3
18.5
Female
Rate/100
Population
1.4
3.7
10.1
18.9
31.7
42.3
15.7
+ Systolic blood pressure of at least 160 ram. Hg or_ diastolic blood
pressure of at least 95 mm. Hg.
TABLE 49" AGE-SPECIFIC PREVALENCE RATES FOR PERSONS 18-75+ YEARS OF AGE WITH
DEFINITE HYPERTENSION OR WHO ARE CURRENTLY TAKING HIGH BLOOD PRES-
SURE MEDICATION: WEST DUNDEE AND McHENRY, ILLINOIS 1976-77
Hyper-+
tension
or on
medica-
tion
and age
(Ypars)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
West Dundee
Male
Total
No.
77
122
92
89
69
29
28
506
Rate/100
Population
6.5
7.4
18.5
30.3
29.0
48.3
35.7
24.1
Female
Total
No.
114
147
133
91
75
60
49
669
Rate/100
Population
0.9
2.7
9.8
29.7
36.0
46.7
61.2
23.7
McHenry
Male
Total
No.
54
77
74
75
77
L28
47
532
Rate/100
Population
3.7
5.2
14.9
28.0
31.2
40.6
46.8
22.3
Female
Total
No.
53
111
88
90
136
137
56
671
Rate/100
Population
0.0
2.7
12.5
18.9
40.4
48.2
44.6
22.1
+ Systolic Blood Pressure of at least 160 mm. Hg or Diastolic Blood
Pressure of at least 95 mm. Hg.
* Total population rates are age-sex adjusted to the total sample size.
74
-------
TABLE 50 AGE-SPECIFIC PREVALENCE RATES OF WHITE PERSONS 18-75+ YEARS OF
AGE, WHO HAVE HAD A STROKE DIAGNOSED BY A PHYSICIAN: WEST
DUNDEE AND McHENRY, ILLINOIS, 1976-77
Stroke
and Age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop. *
West Dundee
Male
Pop.
Size
77
122
92
89
69
29
28
506
Rate/100
Pop.
0.0
0.0
0.0
0.0
2.9
13.8
17.9
3 = 8
Female
Pop.
Size
114
147
133
91
75
60
49
669
Rate/100
Pop.
0.0
0.0
1.5
1.1
2.7
8.5
4.1
2.4
McHenry
Male
Pop.
Size
54
77
74
75
77
128
47
532
Rate/100
Pop.
1.9
0.0
0.0
1.3
6.5
5.5
6.4
2.7
Female
Pop.
Size
53
111
88
90
136
137
56
671
Rate/100
Pop.
0.0
0.0
0.0
1.1
3.7
8.0
8.9
2.6
TABLE 31 AGE-SPECIFIC PREVALENCE RATES OF WHITE PERSONS 18-75+ YEARS OF
AGE, WHO HAVE HAD HEART DISEASE DIAGNOSED BY A PHYSICIAN: WEST
DUNDEE AND McHENRY, ILLINOIS, 1976-77
Heart
Disease
and Age
(Years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
* Total
West Dundee
Male
Pop.
Size
77
122
92
89
69
29
28
506
Rate/ 100
Pop.
0.0
0.0
3.3
3.4
4.3
13.8
21.4
5.3
Female
Pop.
Size
.114
147
133
91
75
60
49
669
Rate/ 100
Pop.
0.0
0.0
1.5
4.4
4.0
5.0
8.2
2.8
population rates are age-sex adj\
McHenry
Male
Pop.
Size
54
77
74
75
77
128
47
532
isted t
Rate/ 100
Pop.
0.0
0.0
0.0
6.7
13.0
15.6
14.9
6.3
o the tot
Female
Pop.
Size
53
111
88
90
136
137
56
671
al samp
Rate/100
Pop.
0.0
0.0
2.3
4.4
9.6
8.0
16.1
4.9
.e size .
75
-------
TABLE 52 AGE-SPECIFIC PREVALENCE RATES OF WHITE PERSONS 18-75+ YEARS OF
AGE, WHO HAVE HAD DIABETES DIAGNOSED BY A PHYSICIAN: WEST
DUNDEE AND McHENRY, ILLINOIS, 1976-77
Diabetes
and Age
(Years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
West Dundee
Male
Pop.
Size
77
122
92
89
69
29
28
506
Rate/100
Pop.
1.3
1.6
1.1
5.6
11.6
10.3
21.4
6.3
Female
Pop.
Size
114
147
133
91
75
60
49
669
Rate/100
Pop.
0.0
6.1
3.0
5.5
8.0
8.3
8.2
5.1
McHenry
Male
Pop.
Size
54
77
74
75
77
128
47
532
Rate/100
Pop.
1.9
1.3
12.2
6.7
14.3
20.3
21.3
10.1
Female
Pop.
Size
53
111
88
90
136
137
56
671
Rate/ 100
Pop.
3.8
4.5
5.7
4.4
7.4
9.5
17.9
6.9
TABLE 53 AGE-SPECIFIC PREVALENCE RATES OF WHITE PERSONS 18-75+ YEARS OF
AGE, WHO HAVE HAD KIDNEY DISEASE DIAGNOSED BY A PHYSICIAN: WEST
DUNDEE AND McHENRY, ILLINOIS, 1976-77
Kidney
Disease
and Age
(Years)
18-24.
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop. *
West Dundee
Male
Pop.
Size
77
122
92
89
69
29
28
506
Rate/100
Pop.
5.2
7.4
4.3
13.5
7.2
6.9
3.7
7.3
Female
Pop.
Size
114
147
133
91
75
60
49
669
Rate/ 100
Pop.
21.1
21.8
9.0
16.5
10.7
10.0
14.3
14.9
McHenry
Male
Pop.
Size
54
77
74
75
77
128
47
532
Rate/ 100
Pop.
1.9
9.1
6.8
10.7
10.4
10.9
14.9
8.9
Female
Pop.
Size
53
111
88
90
136
137
56
671
Rate/ 100
Pop.
9.4
16.2
13.6
20.0
8.8
18.2
12.5
14.3
Total population rates are age-sex adjusted to the total sample size.
76
-------
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West Dundee
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Age
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77
-------
Also, household water samples were analyzed to make sure that some toxic
metal, like cadmium or lead, was not present to bias interpretation of the
data.
Results of West Dundee and McHenry water treatment plant sample analysis
for 12 metals are shown in Table 55. The major differences found between the
metal concentrations in the two water supplies occurred with barium and
strontium. The mean concentration for barium and strontium in West Dundee
treatment plant water exceeded that of McHenry treatment plant water by
approximately 75 and seven-fold respectively.
In addition, 12 samples were collected on a biweekly basis for six
months and analyzed by Purdue University (under contract to Health Effects
Research Laboratory, US. EPA) using proton induced x-ray emission (Table 56).
The samples were analyzed for 81 elements to detect if there were any other
differences between the two water supplies. Major differences from the above
analyses were as follows: (1) an eight and six-fold increase in rubidium
and potassium in West Dundee treatment plant water when comapred to McHenry
treatment plant water respectively (a mean of 0.00560 mg/1 vs. 0.00067 mg/1
rubidium and 8.51 vs. 1.44 mg/1 potassium). (2) a 19 fold increase in iron
was found in McHenry treatment plant water when compared to the plant at
West Dundee (a mean of 0.632 mg/1 vs. 0.033 mg/1 iron). (3) a mean of 14.9
mg/1 sulfur was found in McHenry treatment plant water, while sulfur in West
Dundee treatment plant water was below the limit of detection (< 0.1 mg/1).
Although there were some differences between the two water supplies, barium
was the only substance analyzed that exceeded the National Interim Primary
Drinking Water Regulations (3). Also, no possible health effects from con-
sumption of rubidium, potassium, iron, or sulfur from drinking water were
even suggested or discussed in these drinking water regulations (3), in Water
Quality Criteria 1972 (70), or in Quality Criteria for Water (71).
Results of West Dundee and McHenry household water sample analysis are
shown in Tables 57-63. These results are depicted in seven tables to show
the impact home water softeners have on altering the metal concentrations
of treatment plant water.
Tables 57-59 are directed toward question number 21 in the questionnaire
(Appendix A) which asks, "Is there a water softening unit for your home water
supply?" Table 57 presents the water sample analysis for 12 metals in all
households. When Table 57 was compared with Table 55 (Water Treatment Plant
Samples), the major differences noted, particularly in McHenry, were a de-
crease in calcium and magnesium concentrations and an increase in sodium.
These differences in calcium, magnesium and sodium concentrations became
more pronounced when only households that answered yes to the water soften-
ing question were compared to the same water parameters of their respective
treatment plants (Tables 58 and 55). In addition to altering the concentra-
tions of calcium, magnesium and sodium, home water softeners removed barium
and strontium from West Dundee water (Tables 58 and 55). Also, the copper
concentrations in the softened water houses showed an increase over those of
the treatment plants (Tables 58 and 55). This increase in copper might be
due to the more corrosive softened water leaching copper out of home plumb-
ing systems. When the results of water sample analysis from households
78
-------
TABLE 55 ANALYSIS OF WATER TREATMENT PLANT SAMPLES USING ATOMIC ABSORPTION
FROM WEST DUNDEE AND McHENRY, ILLINOIS, 1976-77
METAL
Barium
Cadmium
Calcium
Chromium (Total)
Copper
Lead
Magnesium
Mercury
Nickel
Sodium
Strontium
Zinc
West Dundee
Treatment Plant*
Mean +
6.78
<0.01
53.26
<0.01
0.01
<0.05
22.90
<0.0001
<0.10
18.58
3.12
0.09
Standard Deviation
1.15
7.99
.02
1.40
0.98
0.36
0.14
McHenry
Treament Plant**
Mean +
0.09
<0.01
85.50
<0.01
0.01
<0.05
41.50
<0.0001
<0.10
19.58
0.46
0.01
Standard Deviation
0.13
8.50
0.01
2.81
1.80
0.08
0.02
* 19 Samples
** 20 Samples
+ Mean values with (<) are below instrumental detection limits
79
-------
TABLE 56 PROTON INDUCED X-RAY EMISSION ANALYSIS (ug/1) FOR ELEMENTS FOUND IN
WATER SAMPLES COLLECTED OVER A SIX MONTH PERIOD (OCTOBER, 1976-
MARCH, 1977) FROM THE WATER TREATMENT PLANTS IN WEST DUNDEE AND
McHENRY, ILLINOIS
Element
Arsenic
Barium
Bromine
Calcium
Chlorine
Copper
Iodine
Iron
Lead
Maganese
Nickel
Potassium
Rubidium
Sodium
Strontium
Sulfur
Zinc
Wes
#
Samples
5*
12
12
12
11*
12
6*
12
12
12
10*
12
12
12
12
0*
12
t Dundee
Mean
1.6
7307.5
16.0
55178.8
2986.3
10.0
7.6
33.3
4.9
26.1
0.5
8510.4
5.6
20716.7
2937.0
36.6
Standard
Deviation
1.2
858.4
2.8
8502.3
3437.7
9.1
2.7
6.9
1.9
6.3
0.4
1386.0
4.3
560.6
236.1
16.6
#
Samples
9*
11
11
11
9*
11
4*
11
9*
11
8*
11
2*
11
11
11
11
McHenry
1
Mean
1.9
104.1
29.5
84234.3
6009.0
16.3
4.98
632.3
2.1
73.1
0.8
1437.5
0.7
21354.5
503.3
14906.1
40.9
Standard
Deviation
2.4
15.5
3.3
9863.1
4872.5
8.7
0.9
724.0
1.3
57.9
0.5
335.7
0.3
2443.5
61.0
5666.8
36.1
* Only those collected samples above the
are included in this table.
detection limits of the instrument
80
-------
TABLE 57 ANALYSIS OF WATER SAMPLES, FOR 12 METALS IN mg/1, FROM HOUSEHOLDS
WITH AND WITHOUT WATER SOFTENERS, PLUS THOSE HOUSEHOLDS NOT KNOWING
WHETHER OR NOT A SOFTENER IS USED: WEST DUNDEE AND McHENRY,
ILLINOIS, 1976-77
Metal
Barium
Cadmium
Calcium
Chromium (total)
Copper
Lead
Magnesium
Mercury
Nickel
Sodium
Strontium
Zinc
West Dundee *
Mean+
6.40
<0.01
47.31
<0.01
0.03
<0.05
19.53
<0.0001
<0.10
32.06
2.73
0.09
Standard Deviation
2.45
18.39
0.04
7.53
36.27
1.05
0.18
McHenry **
Mean +
0.09
<0.01
54.25
<0.01
0.25
<0.05
30.32
<0.0001
<0.10
64.42
0.31
0.10
Standard Deviation
0.11
r-
35.57
0.32
20.62
75.06
0.27
0.25
* 631 Samples
** 643 Samples
+ Mean values with (<) are below instrumental detection limits.
81
-------
TABLE 58 ANALYSIS OF WATER SAMPLES, FOR 12 METALS IN mg/1 FROM HOUSEHOLDS
WITH WATER SOFTENERS: WEST DUNDEE AND McHENRY, ILLINOIS, 1976-77
Metal
Barium
Cadmium
Calcium
Chromium (total)
Copper
Lead
Magnesium
Mercury
Nickel
Sodium
Strontium
Zinc
West Dundee *
Mean+
4.32
<0.01
33.38
<0.01
0.03
<0.05
13.98
<0.0001
<0.10
62.315
1.86
0.10
Standard Deviation
3.39
26.39
0.04
11.03
53.29
1.48
0.19
McHenry **
Moan +>
0.08
<0.01
43.64
<0.01
0.28
<0.05
24.93
<0.0001
<0.10
86.51
0.25
0.09
Standard Deviation
0.10
--
37.92
0.34
21.93
81.49
0.26
0.25
* 189 Samples
** 426 Samples '
+ Mean values with (<) are below instrumental detection limits.
82
-------
without water softeners were compared to their respective treatment plants,
it was noted that the concentrations for the 12 metals were very similar
(Tables 59 and 55).
Since many people do not properly maintain their home water softener,
there could be some masking of the true impact that water softeners have on
changing the concentrations of specific metals. As a consequence, households
with low and high concentrations of sodium were compared with one another
(Tables 60-63). Tables 60 and 61 compare the analysis of household water
samples that had concentrations of sodium equal to or less than 25 mg/1 with
water samples exceeding 25 mg/1 sodium. A concentration of 25 mg/1 sodium
was chosen because neither water treatment plant exceeded this concentration.
Therefore, it was assumed that a sodium concentration greater than 25 mg/1
was due to the home water softener. In Table 60, with sodium concentrations
<_ 25 mg/1, the concentrations of the 12 metals from both communities were
quite similar when compared to their respective treatment plant (Table 55).
However, when the treatment plant data was compared with households that had
greater than 25 mg/1 in their water (Table 61) changes in concentration were
observed for several of the metals. As expected, water softeners were re-
moving the divalent cations and exchanging them with sodium, a monovalent
cation. Both communities showed a decrease in calcium and magnesium, and an
increase in sodium. Also, West Dundee had a marked reduction in barium and
strontium. In fact, the barium concentration was reduced five-fold, leaving
a mean concentration just above the water quality standard of 1.0 mg/1.
Since there are differences in the functioning and maintenance of home
water softeners, a comparison was made between households with 100 mg/1 or
less sodium in their water and those with a greater than 100 mg/1 sodium
(Tables 62 and 63). As noted in Table 62, (households with sodium concen-
trations < 100 mg/1), the metal concentrations closely resembled those of
their respective treatment plant. However, those households exceeding 100
mg/1 sodium in their water (Table 63) showed a decrease in the barium, cal-
cium, magnesium and strontium concentrations to negligible amounts when com-
pared to the treatment plant concentrations of these metals (Table 55). It
can be noted from the above tables that households with water softeners con-
tributing to greater than 100' mg/1 sodium in their water were able to easily
reduce the barium levels below the MCL of 1 0 mg/1.
Althoush household water data were analyzed in many different ways, only
one metal found in West Dundee household water and two metals found in Mc-
Henry water exceeded either the U.S. (3) or Illinois drinking water regula-
tions (4). In West Dundee, barium exceeded the 1.0 mg/1 standard in 555 of
the 631 household water samples analyzed. Water softeners in 76 households
were able to reduce the barium levels below the standard. In McHenry, the
lead standard for water (0.05 mg/1) was exceeded in 3 households out of 643
surveyed. Of those three households exceeding the lead standard, two of
them had a water softener. All three households exceeding the lead standard
had newly installed copper plumbing. The lead was probably coming from
solder in the plumbing joints that had not been thoroughly washed out of the
system. Although there is not a specific U.S. drinking water regulation for
copper, Illinois has a copper drinking water standard of 1.0 mg/1 (maximum
allowable twelve-month average concentration). This limit is based on ones
83
-------
TABLE 59 ANALYSIS OF WATER SAMPLES, FOR 12 METALS IN mg/1, FROM HOUSEHOLDS
WITHOUT WATER SOFTENERS: WEST DUNDEE AND McHENRY, ILLINOIS, 1976-77
Metal
Barium
Cadmium
Calcium
Chromium (total)
Copper
Lead
Magnesium
Mercury
Nickel
Sodium
Strontium
Zinc
West Dundee *
Mean +
7.J5
<0.01
53.54
<0.01
0.03
<0.05
22.10
<0.0001
<0.10
18.36
3.12
0.09
Standard Deviation
0.85
7.26
0.03
2.84
5.12
0.34
0.17
McHenry **
Mean +
0.12
<0.01
76.75
<0.01
0.19
<0.05
41.72
<0.0001
<0.10
17.20
0.44
0.10
Standard Deviation
0.12
-
12.28
0.26
10.53
16.11
0.20
0.23
* 390 Samples
** 206 Samples
+ Mean values with (<) are below instrumental detection limits.
84
-------
TABLE 60 ANALYSIS OF WATER SAMPLES, FOR 12 METALS IN mg/1, FROM HOUSEHOLDS
WITH SODIUM CONCENTRATIONS <_ 25 mg/1: WEST DUNDEE AND McHENRY,
ILLINOIS, 1976-77
Metal
Barium
Cadmium
Calcium
Chromium (total)
Copper
Lead
Magnesium
Mercury
Nickel
Sodium
Strontium
Zinc
West Dundee *
Mean +
7.32
<0.01
54.11
<0.01
0.03
<0.05
22.22
<0.0001
<0.10
18.11
3.13
0.08
Standard Deviation
0.84
6.54
0.03
2.69
0.82
0.30
0.17
McHenry **
Mean +
0.12
<0.01
77.57
<0.01
0.23
<0.05
42.27
<0.000]
<0.10
15.81
0.44
0.10
Standard Deviation
0.12
11.57
0.31
9.85
5.85
0.21
0.23
* 545 Samples
** 420 Samples
+ Mean values with (<) are below instrumental detection limits.
85
-------
TABLE 61 ANALYSIS OF WATER SAMPLES, FOR 12 METALS IN mg/1, FROM HOUSEHOLDS
WITH SODIUM CONCENTRATIONS > 25 mg/1: WEST DUNDEE AND McHENRY,
ILLINOIS, 1976-77
Metal
Barium
Cadmium
Calcium
Chromium (total)
Copper
Lead
Magnesium
Mercury
Nickel
Sodium
Strontium
Zinc
West Dundee *
Mean+
1.29
<0.01
9.39
<0.01
0.05
<0.05
4.57
<0.0001
<0.10
109.56
0.54
0.11
Standard Deviation
2.13
16.81
0.06
8.16
38.55
1.00
0.22
McHeniy **
Mean +
0.05
<0.01
13.08
<0.01
0.29
<0.05
9.10
<0.0001
<0.10
151.49
0.08
0.10
Standard Deviation
0.07
25.13
0.34
1 / . 42
62.48
0.14
0.27
* 101 Samples
** 235 Samples
+ Mean values with (<) are below instrumental detection limits.
86
-------
TABLE 62 ANALYSIS OF WATER SAMPLES, FOR 12 METALS IN mg/1, FROM HOUSEHOLDS
WITH SODIUM CONCENTRATIONS £ 100 mg/1: WEST DUNDEE AND McHENRY,
ILLINOIS, 1976-77
Metal
Barium
Cadmium
Calcium
Chr omi um (total)
Copper
Lead
Magnesium
Mercury
Nickel
Sodium
Strontium
Zinc
West Dundee *
Mean-*-
7.21
<0.01
53.38
<0.01
0.03
<0.05
22.07
<0.001
<0.10
19.15
3.09
0.08
Standard Deviation
1.05
.
7.76
0.03
2.94
6.46
0.39
0.17
McHenry **
Meant-
0.12
<0.01
75.45
<0.01
0.23
<0.05
42.00
<0.0001
<0.10
18.92
0.43
0.10
Standard Deviation
0.11
15.11
0.30
10.89
12.45
0.21
0.22
* 568 Samples
** 466 Samples
+ Mean values with (<) are below instrumental detection limits.
87
-------
TABLE 63 ANALYSIS OF WATER SAMPLES, FOR 12 METALS IN mg/1, FROM HOUSEHOLDS
WITH SODIUM CONCENTRATIONS > 100 mg/1: WEST DUNDEE AND McHENRY,
ILLINOIS, 1976-77
Metal
Barium
Cadmium
Calcium
Chromium (total)
Copper
Lead
Hagnesium
Mercury
Nickel
Sodium
Strontium
Zinc
West Dundee *
Mean +
0.27
<0.01
1.55
<0.01
0.05
<0.05
0.42
<0.0001
<0.10
128.92
0.05
0.10
Standard Deviation
0.32
6.87
0.06
0.83
12.37
0.08
0.23
McHenry **
Mean +
0.03
<0.01
2.62
<0.01
0.30
<0.05
1.69
<0.0001
<0.10
176.86
0.02
0.09
Standard Deviation
0.05
"T~~
7.65
0.35
4.58
38.27
0.06
0.29
* 78 Samples
** 189 Samples
+ Mean values with (<) are below instrumental detection limits.
88
-------
ability to taste it rather than on a health hazard (70). Copper exceeded 1.0
mg/1 in 22 of 643 households surveyed in McHenry. Seventeen of the 22 house-
holds replied in the questionnaire that they had a water softener.
Drinking Water Sodium Concentrations And Blood Pressure Levels
Age-specific systolic and diastolic blood pressures for males and fe-
males from McHenry, exposed to diverse sodium concentrations in their drink-
ing water, were analyzed using the Wilcoxon Signed-Rank Test (66) (Tables 64-
67). Only males and females from McHenry were used to determine whether or
not increased sodium levels had an effect on blood pressure because barium
in the West Dundee water supply might also effect blood pressure and possibly
mask any health effects of elevated sodium levels. A drinking water concen-
tration of < 25 mg/1 sodium was used as the baseline for comparison because
that was the level found at the McHenry treatment plant (Tables 55 and 56).
Any sodium concentration greater than 25 mg/1 could be attributed to home
water softeners. Therefore, male and female blood pressures that were ex-
posed to < 25 mg/1 sodium were compared to those male and female blood
pressures that were exposed to > 25 mg/1, 25-99 mg/1, <_ 100 mg/1, >100 mg/1,
100-200 mg/1 and > 200 mg/1 sodium respectively. The only significant dif-
ference found for any of the above comparisons was between male systolic and
diastolic blood pressures when exposed to greater than 200 mg/1 sodium in
comparison to those males who were exposed to 25 mg/1 or less sodium (Tables
64 and 65). Since the sample size for those exposed to greater than 200 mg/1
sodium is small and all of the other comparisons were not significant, there
is little relevance to this finding. It can be concluded that elevated
sodium concentrations in McHenry drinking water had little effect on the
blood pressures of McHenry residents.
Drinking Water Sodium Concentrations And Prevalence Rates Of Heart Disease,
Hypertension, Stroke, And Kidney Disease
It was mentioned previously that softened water may be associated with
cardiovascular disease (52,53,54,55). Therefore, persons exposed to greater
than 100 mg/1 sodium from home water softeners were compared to those persons
exposed to 100 mg/1 or less sodium in their water to ascertain if there were
differences in heart disease, hypertension, stroke, and kidney disease. The
Mantel-Haenszel Chi Square Statistics (59) with adjustment for sex, age
(18-44 and 45 75+), and town (West Dundee and McHenry) was used to decide
whether or not there was a relationship between the above diseases and sodium
concentration. Age was adjusted for only two groupings because further re-
finement into numerous groupings would have resulted in too few people with
a particular disease in each group. The Mantel-Haenszel Chi Square Statis
tics (59) for the above diseases were not significant (Tables 68-75) . This
finding indicates that there were no significant differences- between-the high
and low sodium groups with respect to heart disease, hypertension, stroke,
and kidney disease.
89
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ro rH CM
r^ * '
f-^.
rH O
CTl CM ID
[^ r-H rH
*
f .
1^ CO
oo H r>
r~ H H
V
s~~.
ro ^t
CM "^ CN
co H r~-
s
, ,
rH CM
CO H
* '
, ,
o m
O rH LO
CO r-H CM
'
, ,
ro CTi
c^ ^* ^*
CO H t£)
x^
^
in
i
in
^p
, .
>D O
ro r-H ID
CO rH
* '
*-*.
>D CTl
CO VD CTl
CO rH CM
'
r~*
r^ o
r^ VD m
CO rH ro
* *
f ,
<* o
ID m m
CO rH CT)
- '
f~^
r- ro
CO rH r-H
, ^
r- co
1^ ID CTi
00 H ^
, ,
rH
^-x
r~ H
'S' CN ID
CTi CM
^ '
f~ ^
3- [^.
CO H "*
* '
^-^
r- r-
ID 'J CN
co rH en
-.
^
r^
I
in
VD
^^
O CTl
<* r- CM
CTl rH
f ,
93
-------
TABLE 68
AGE-SPECIFIC PREVALENCE RATES OF WHITE MALES 18-75+ YEARS OF AGE
WHO HAVE HAD HEART DISEASE DIAGNOSED BY A PHYSICIAN AND ARE EX-
POSED TO VARYING SODIUM CONCENTRATIONS IN THEIR DRINKING WATER:
WEST DUNDEE AND McHENRY, ILLINOIS, 1976-77
West Dundee
McHenry
Heart
Disease
and age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
Sodium <100mg/l
Male
Total
No.
73
108
77
72
58
28
26
442
Rate/100
Population
0.0
0.0
3.9
4.2
5.2
14.3
19.2
5.5
Sodium >100mg/l
Male
,Total
No.
4
13
' 13
15
9
1
2
57
Rate/ 100
Population
0.0
0.0
0.0
0.0
0.0
0.0
50.0
2.9
Sodium -tlOOmg/l
Male
Total Rate/100
No . Population
40 0.0
52 0.0
49 0.0
54 9.3
49 14.3
94 13.8
37 18.9
375 6.9
Sodium >100mg/l
Male
Total
No.
13
25
24
21
24
34
9
150
Rate/ 100
Population
0.0
0.0
0.0
0.0
8.3
20.6
0.0
4.8
TABLE 69
AGE-SPECIFIC PREVALENCE RATES OF WHITE FEMALES 18-75+ YEARS OF AGE
WHO HAVE HAD HEART DISEASE DIAGNOSED BY A PHYSICIAN AND ARE EX-
POSED TO VARYING SODIUM CONCENTRATIONS IN THEIR DRINKING WATER:
WEST DUNDEE AND McHENRY, ILLINOIS, 1976-77
West Dundee
McHenry
Heart
Disease
and age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
Sodium <100mg/l
Female
Total
No.
104
121
106
82
63
55
48
579
Rate/ 100
Population
0.0
0.0
1.9
4.9
4.8
5'. 5
8.3
3.2
Sodium >100mg/l
Female
Total
No.
7
25
24
8
11
3
1
79
Rate/ 100
Population
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Sodium <100mg/l
.
Female
Total
No.
40
75
60
73
95
98
40
481
Rate/100
Population
0.0
0.0
3.3
4.1
6.3
4.1
17.5
4.0
Sodium >100mg/l
Fenale
Total
No.
13
34
28
17
36
39
14
181
Rate/100
Pepulation
0.0
0.0
0.0
5.9
13.9
17.9
7.1
7.7
* Total population rates are age-adjusted to the total sample size.
94
-------
TABLE 70 AGE-SPECIFIC PREVALENCE RATES OF WHITE MALES 18-75+ YEARS OF AGE
WHO HAVE DEFINITE HYPERTENSION+ AND ARE EXPOSED TO VARYING SODIUM
CONCENTRATIONS IN THEIR DRINKING WATER: WEST DUNDEE AND McHENRY,
ILLINOIS, 1976-77
West Dundee
McHenry
Defin-
ite Hy~
perten-
sior.+
and age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
754
Total
Pop.*
Sodium '<100mg/l
Male
Total
No,
73
108
77
72
58
28
26
442
Rate/ 100
Population
5^5
6.5
13.0
18.1
15.5
32.1
23.1
15.4
Sodium >100mg/l
Male
Total '
No.
4
13
13
15
9
1
2
57
Rate/100
Population
0.0
15.4
7.7
6.7
11.1
0.0
0.0
7.2
Sodium <100mg/l
Male
Total
No.
40
52
49
54
49
94
37
375
Rate/100
Population .
5.0
3.8
12.2
18.5
24.5
24.5
43.2
16.3
Sodium >100mg/l
Male
Total
No. :
13
25
24
21
24
34
9
150
late/ 100
'opulation
0.0
8.0
16.7
19.0
16.7
41.2
22.2
18.4
TABLE 71 AGE-SPECIFIC PREVALENCE RATES OF WHITE FEMALES 18-75+ YEARS OF AGE
WHO HAVE DEFINITE HYPERTENSION+ AND ARE EXPOSED TO VARYING SODIUM
CONCENTRATIONS IN THEIR DRINKING WATER: WEST DUNDEE AND McHENRY,
ILLINOIS, 1976-77
West Dur
Defin-
nite Hy-
pe rten-
sion+
ana age
{years )
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
Sodium <100mg/l
Female
Total
No.
104
121
106
82
63
55
48
579
Rate/100
Population
0.0
3.3
5.7
17.1
22.2
18.2
45.8
13.7
+ Systolic blood press
dee
Sodium >100mg/l
Female
Total
No,.
7
25
24
8
11
3
1
79
ure of
Rate/100
Population
0.0
0.0
8.3
12.5
0.0
33.3
0.0
8.1
at least 16
McHenry
Sodium <100mg/l
Female
Total
No.
40
75
60
73
95
98
40
481
J mm. He
Rate/100
Population
0.0
1.3
15.0
15.1
21.1
29.6
32.5
14.9
j or diastol
Sodium >100mg/l
Female
Total
No.
13
34
28
17
36
39
14
181
Rate/100
Population
0.0
2.9
3.6
5.9
44.4
28.2
28.6
16.2
ic blood
pressure of at least 95 mm.Hg.
* Total population rates are age-adjusted to the total sample size.
95
-------
TABLE 72 AGE-SPECIFIC PREVALENCE RATES OF WHITE MALES 18-75+ YEARS OF AGE
WHO HAVE HAD STROKE DIAGNOSED BY A PHYSICIAN AND ARE EXPOSED TO
VARYING SODIUM CONCENTRATIONS IN THEIR DRINKING WATER: WEST DUNDEE
AND MCHENRY, ILLINOIS, 1976-77
West Dundee McHenry
Stroke
and
age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
Sodium <100mg/l
I
Total
^No.
73
108
77
72
58
28
26
442
tele
Rate/100
Population
0.0
0.0
0.0
0.0
3.4
14.3
19.2
4.0
Sodium >100mg/l
Male
Total
No.
4
13
13
15
9
1
2
57
Rate/100
Population
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Sodium <100mg/l
ME
Total
No.
40
52
49
54
49
94
37
375
tie
Rate/100
Population
2.5
0.0
0.0
1.9
4.1
5.3
5.4
2.0
Sodium >100mg/l
Ma
Total
No.
13
25
24
21
24
34
9
150
lie
Rate/100
Population
0.0
0.0
0.0
0.0
12.5
5.9
11.1
4.0
TABLE 73 AGE-SPECIFIC PREVALENCE RATES OF WHITE FEMALES 18-75+ YEARS OF AGE
WHO HAVE HAD STROKE DIAGNOSED BY A PHYSICIAN AND ARE EXPOSED TO
VARYING SODIUM CONCENTRATIONS IN THEIR DRINKING WATER: WEST DUNDEE
AND McHENRY, ILLINOIS 1976-77
West Dundee McHenry
Stroke
and
age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
Sodium <100mg/l
Female
Total
No.
104
121
106
82
63
55
48
579
Rate/100
Population
0.0
0.0
1.9
1.2
3.2
9.1
4.2
2.6
Sodium >100mg/l
Female
Total
No.
7
25
24
8
11
3
1
79
Rate/100
Population
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Sodium <100mg/l
Female
Total
No.
40
75
60
73
95
98
40
481
Rate/100
Population
0.0
0.0
0.0
1.4
3.2
7.1
10.0
2.5
Sodium >100mg/l
Female
Total
No.
13
34
28
17
36
39
14
181
Rate/100
Population
0.0
0.0
0.0
0.0
5.6
10.3
0.0
3.3
* Total population rates are age-adjusted to the total sample size.
96
-------
TABLE 74
AGE-SPECIFIC PREVALENCE RATES OF WHITE MALES 18-75+ YEARS OF AGE
WHO HAVE HAD KIDNEY DISEASE DIAGNOSED BY A PHYSICIAN AND ARE EX-
POSED TO VARYING SODIUM CONCENTRATIONS IN THEIR DRINKING WATER:
WEST DUNDEE AND McHENRY, ILLINOIS 1976-77
West Dundee
McHenry
Kidney
Disease
and
age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
Sodium <100mg/l
Male
Total
No.
73
108
77
72
58
28
26
442
Rate/ 100
Population
5.5
7.4
3.9
15.3
6.9
7.1
3.8
7-3
Sodium >100mg/l
Male
Total
No.
4
13
13
15
9
1
2
57
Rate/100
Population
0.0
7.7
7.7
6.7
0.0
0.0
0.0
3.9
Sodium <100mg/l
Male
Total
NO.
40
52
49
54
49
94
37
375
Rate/100
Population
2.5
11.5
6.1
11.1
8.2
11.7
13.5
9.2
Sodium >100mg/l
Male
Total
No.
13
25
24
21
24
34
9
150
Rate/100
Population
0.0
4.0
8.3
9.5
16.7
8.8
22 .2
9.2
TABLE 75 AGE-SPECIFIED PREVALENCE RATES OF WHITE. FEMALES 18-75+ YEARS OF AGE
WHO HAVE HAD KIDNEY DISEASE DIAGNOSED BY A PHYSICIAN AND ARE EX-
POSED TO VARYING SODIUM CONCENTRATIONS IN THEIR DRINKING WATER:
WEST DUNDEE AND McHenry, ILLINOIS 1976-77
West Dundee McHenry
Kidney
Disease
and
age
(years)
18-24
25-34
35-44
45-54
55-64
65-74
75+
Total
Pop.*
Sodium <100mg/l
Female
Total
No.
104
121
106
82
63
55
48
579
Rate/100
Population
22.1
21.5
10.4
14.6
12.7
10.9
14.6
15.4
Sodium >100mg/l
Female
Total
NO.
7
25
24
8
11
3
1
79
Rate/ 100
Population
14.3
24.0
4.2
37.5
0.0
0.0
0.0
10.8
Sodium <100mg/l
Female
Total
No.
40
75
60
73
95
98
40
481
Rate/100
Population
5.0
21.3
15.0
20.5
8.4
20.4
10.0
15.6
Sodium >100mg/l
Per
Total
No.
13
34
28
17
36
39
14
181
lale
Rate/100
Population
23.1
5.9
10.7
17.6
11.1
12.8
21.4
12.3
* Total population rates are age-adjusted to the total sample size
97
-------
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Environmental Protection Agency. Springfield, Illinois, 1973.
64. Ronan, R. Simultaneous analysis of liquid samples for medals by in-
ductively coupled argon plasma atomic-emission spectroscopy (ICAP-AES).
United States Environmental Protection Agency, Region V, Central
Regional Laboratory, 1819 West Pershing Road, Chicago, 1975.
65. El-Wady, A., Miller, R. and Carter, M. Automated method for the
determination of total and inorganic mercury in water and wastewater
samples. Analytical Chem., 48 (1):110-116, 1976.
66. Dixon, W.J. and Massey, F.J., Jr. Introduction to Statistical Analysis,
McGraw-Hill Book Co., New York, 1969.
67. National Center for Health Statistics: Persons hospitalized by number
of episodes and days in a year, United States, 1972. Vital and Health
Statistics. Series 10-No. 116. DHEW Publication No. (HRA) 77-1544.
U.S. Government Printing Office, August, 1977.
68. National Center for Health Statistics: Blood pressure of persons
65-74 years of age in the United States. Vital and Health Statistics
Advance Data. DHEW, No. 1, October 18, 1976.
69. Mayer, J. Obesity: Diagnosis. Postgrad. Med., 25:469-475, 1959.
102
-------
70. Water Quality Criteria 1972. National Academy of Science, National
Academy of Engineering. U.S. Government Printing Office, Washington,
D.C., 1974
71. Quality Criteria for Water. U.S. Environmental Protection Agency,
Washington, D.C., July, 1976.
1Q3
-------
APPENDIX A. HOUSEHOLD LISTING AND SURVEY OF MINERALS AND HEALTH
Household Listing
_
1234
Identification
Uuaber
Address:
Street No.
City
State
Zio
Phone:
Please tell me the names of all the persons 18 years old and over living
at hone at this time, beginning with the head of the household? (Enter on line
1 below) Is there anyone else? What is their relationship to him/her?
(Repeat until all persons in household are listed)
PRIMT MAXES IM BLOCK CAPITALS
Line
No.
1
2
3
4
5
6
7
8
9
Last Nar.e
First !Iar.e
Middle Name
or initial
Relation to Head
Head
Date
Completed
Refusal (Pleasf; specify)
Other (Please specify)
104
-------
Survey of Minerals and Health
||| | | | Identification
12345 Number
I would like to ask you some questions about your health.
1. During the past year, that is between
1975 and
, 1976, about how many times have you visited a
doctors office or clinic or had a doctor to your home
because of illness?
time(s)
2.
During the past year, that is between , 1975 and
, 1976, about how many days were you away from
work or unable to carry out your usual activities
because of an illness, disability, or injury?
dayts)
Identification
Number
Interviewer
Number
8,9/
10-12/
105
-------
3.a.Were you a patient in a hospital at any tir.e in the past year?
No
2
b.
Yes
1
What was the total number of days vou have soent in a
hospital during the past year?
day(s)
For what reasons were you hospitalized? (Circle as many
as apply).
Pregnancy 1
Surgery 2
Injury 3
Illness 4
Other 5 (Specify)
13/
14-16/
17/
18/
IV
4. Have you ever had your blood pressure taken?
Yes
1
No
2
DK
9
20/
(For "Mo", Skip to Q. 6)
Now I would like to take a reading of your blood pressure.
(Reading 1. Please record on Q. 32)
106
-------
5.a. Have you ever been told by a doctor that you had high, blood
pressure?
No
2
DK
9
b.
h.
Yes
1
About how many years ago were you first told that
you had high blood pressure?
Have you ever taken high blood pressure medicine
that a doctor prescribed for you?
No
2
DK
9
d.
Yes
1
What was the name of the medicine(s)?
Are you still taking medicine(s) for
high blood pressure?
DK
9
Yes
1
f.
| ME\T SKIP TO Q. 6 I
No
2
How many years ago did you
last take medicine(s) for
high blood pressure?
ye ars
Why did you stop?
Were you pregnant when the doctor first told you that
you had high blood pressure?
No
2
DK
Yes
1
Other than when you were pregnant, have
you ever been told that you had high
blood pressure?
No
DK
9
Yes
1
22,23/
24/
25/
26/
27/
28,29/
30/
31/
32/
107
-------
6.a.Did a doctor ever tell you that you had a heart attack, coronary,
myocardial infarction, coronary throrrbosis or coronary occlusion?
No
2
DK
9
b.
Yes
1
How many years ago was this?
years
33/
34,35/
7.a.Have you ever had severe pain or discomfort in your chest following
exercise or physical exertion?
No
2
b.
Did you see a doctor about it?
No
2
d.
Yes
1
What did he say it was?
36/
37/
Did he give you medicine(s) for it?
No
2
Yes
1
What is the name of the medicine(s)?
38/
39/
40/
41/
108
-------
a. Have you ever had an EKG or electrocardiogram taken?
Nc DK I' es
2 9 i 1
b.
Were you told that it was
normal 1
or
abnormal? 2
9. a. Have you ever been told of any other heart trouble such as
rheumatic fever or a heart murmur?
No DK
2 9
b.
d.
Yes
1
What did the doctor say it was?
How many years ago were you told?
years
Have you ever taken rr.edicine(s) for it?
So DK
2 9
f.
Yes
1
What is the name of medicine(s)?
Are you still taking medicine(s) for
this hear)- trouble?
DK
9
Yes
1
h,
Mo
2
Ho-v r.any years ago did you
last take the medicine(s)?
years
Why did you stop?
42/
43/
44/
45/
46,47/
48/
49/
50/
51/
52,53/
54/
109
-------
10. Have you ever been aware of your heart beating too fast or
skipping beats?
No DK Ves
291
11.a.Have you ever been told by a doctor that you had a stroke?
No
DK
9
b.
Yes
1
How many years ago was this?
years
12.a.Has a doctor ever told you of any trouble with your kidneys?
No DK
2 9
b.
Yes
1
What did he say the trouble was?
13.a.Have you ever been told by a doctor that you have had diabetes
sugar in your urine or high blood sugar?
No
2
DK
9
b.
Yes
1
How many years ago was this?
years
55/
56/
57,58/
59/
60/
61/
62,63/
110
-------
Now I would like to take a second reading of your blood pressure. (Reading 2.
Please record on Q. 32).
14.a.What is your present weight?
pounds
b. Is this your usual weight; that is, is this what you have weighed
most of the time for the last 2 years?
Yes
No
2
What do you weigh most of the time?
pounds
64-66/
67/
68-70/
111
-------
35. a. In the past two years, have you been overweight?
No DK
2 9
b.
Yes
Have you ever been on any special diet?
No
Yes
Did your doctor recommend it?
No
2
d.
Yes
1
Vttiat kind of diet was it?(Circle as many as
apply)
Low salt 1
Low caloric 2
Low sugar 3
Low cholesterol 4
Diabetic 5
Other 6 Specify
Did you take any reducing medicines?
No
f.
Yes
1
What is the name of the medicine(s)?
?]Are you taking them now?
Mo
2
Yes
1
71/
72/
73/
74/
75/
V6/
77/
78/
79/
80/1
Card Number
112
-------
16. a. Have you ever smoked cigarettes?
No
2
b.
Yes
1
Do you now smoke?
No
2
a.
Yes
1
Do you smoke:
Less than 1 pack/day? 1
One pack per day? 2
More than 1 pack/day? 3
What is the total number of years that
you have smoked cigarettes?
years (SKIP TO O. 17)
e. When you did smoke, was it:
Less than 1 pack per day? 1
One pack per day? 2
More than 1 pack per day? 3
f What is the total number of years you have smoked
cigarettes?
years
g. How many years ago did you stop sirokinq?
years
1-S/
Identification
Number
7/
Interviewer Number
8/
9/
10/
11,12/
13/
14,
16/
113
-------
17. a. Have you ever been told of trouble with blood circulation in
your legs?
No
2
b.
Yes
1
Was the trouble varicose veins or some other
problem?
Varicose veins.... 1
other 2 Specify
38. a. Have you ever been told you had any form of cancer?
No
2
b.
Yes
1
What kind(s)?
(Ask Q. 19-21 of Head of Household Only-Otherwise skip to Q. 22)
Now I would like to ask some questions about your home.
19. How many years have you lived in this house(apt.)?
years
20. About how old is the building? years
O.K.
9
21. a. is there a water softening unit for your home water supply?
No
2
DK
9
b.
d.
Yes
1
Is it for:
Hot water only 1
Both hot and cold water? .... 2
O.K. 9
About how often do you add
salt to the softener?
every
nonths
How long have you had the
jsoftening unit in yoar none?
years
18/
19/
20/
21/
22,23/
24-2G/
27/
28/
29,30/
31,32/
114
-------
Now I would like to ask you sone general questions about your background.
22. IF. vhat year were you born?
23. What is the total number of years you toarvft lived in (West Dundee/
McHenry) ? years
24. Row many years of school have you finished?
None 1
Grade School 2
Some High School 3
High School 4
Sone College 5
College Graduate 6
(or more)
33-35/
36,37/
38/
115
-------
25. Are you currently working, either full or part-time?
Yes , full-tire 1
Yes, part-time 2
{ Yes , Housewife 3
Skip to question 28{
{ No, student 4
No, not now employed 5
No, retired or disabled. .. .6
(for "Unemployed" (5) or "Retired or Disabled" (6), ask about last
occupation in Question 27).
26- a. What is (was) your main occupation or job title?
39/
b. What kind of work do (did) you do, that is what
are (were) your duties on this job?
c. In what type of business or industry is (was) this,
that is, what product is (was) made or what service
is (was) given?
40-42/
d. How many years have you been employed at this job?
years
43-4S/
46,47/
27. In what community is your job located?
West Dundee 1
East Dundee 2
HcHenry 3
Other 4 Specify
48/
28. SEX M ? (Do Not Ask!
1 2
49/
116
-------
Now I would like to ask you about your height, take your pulse and
roeasure the thickness of the skin on your arm.
29. How tall are you without shoes on?
feet inches
50-52/
30. Wow, I would like to take your pulse-
Number of beats in 30 seconds X 2
beats/min.
53-S5/
31. Now I would like to measure the thickness
of the skin on your right ana.
Reading 1
Reading 2
56,57/
58,59/
Now I would like to take the last ireasurement of your blood
pressure. (Reading 3. Please record on Q. 32).
117
-------
32. Blood Pressure Readings:
Systolic Diastolic
Reading 1
Reading 2
Reading 3
60-62/
Systolic
63-6S/
Diastolic
66-6S/
Systolic
69-71/
Diastolic
72-74/
Systolic
7S-77/
Diastolic
80/2
Card
Number
118
-------
33, Do you have a personal physician or family doctor?
No
Yes
a. May I have his name, address.
Dr.
First
Middle
Last
City or Town
State
D O.K.
Now I would like to take a sample of your tap water.
Thank you very much for you assistance and cooperation.
Interviewer signature and I.D.#
Dated interview completed
119
-------
APPENDIX B. LETTER TO REFUSALS
s,/»,,;. / I'uht,, HHI/I/I
UNIVERSITY OF1 ILiljINOIS AT THE MEDICAI-i CENTER,. CKICA.OO
January 21, 1977
Recently a representative from tlse University of Illinois School of Public
Health called at your hcire ard was told that you were not able to partici-
pate in a very iropcvtant 1-es.li.h survey at this time. Since there roignt no;
have been time to explain tho importance of your own participation in this
survey, I would like to describe briefly what we have been doing in your
community the last few months.
The purpose of our survey is to evaluate the possible health effects of human
consumption of nacurally occurring minerals found in water supplies. We are,
a]£o, re-evaluatinc the standards that the U. S. Environmental Protection
Agency has set for these minerals.
As you know, the study is being conducted by University of Illinois interviewers.
All interviewers carry credentials from the university as well as a letter of
approval signed by the Mayor of your city. The interviewers ask family aionbcrs,
over IS years of age, questions about their health and measure their blood
pressure. All information is kept strictly confidential! Before leavirg/ a
water sample is taken from the cold water tap in the kitchen for analysis. The
total time for the interview is approximately 30 minutes.
In the next few days, one of our interviewers will telephone you to see if a
convenient time can be made for an interview. Your cooperation would be greatly
appreciated because vithout ycur assistance, we will be unable to evaluate
adequately the impact of water consumption on your health.
Thank you for giving our study further consideration. If you have any questions
or comments, please feel free to call me at (312) 996-8855, or write me at the
University of Illinois School of Public Health, P. 0. Box 6998, Chicago, Illinois
60680.
Sincerely,
Gary R. Brenniman, Ph.D.
Assistant Professor
Environmental Health Sciences
GKBilv
120
-------
APPENDIX C. STANDARD ILLINOIS POPULATION, NUMBER OF PERSON YEARS USED TO
CALCULATE DEATH RATES, AND AGE-SPECIFIC DEATH RATES IN ILLINOIS
Table 76 Standard Illinois Population (April, 1970)
Age
(Years)
0- 4
5-14
15-24
25-44
45-64
65+
Total
Standard Illinois Population (April, 1970)
Males
477,213
1,136,320
903,740
1,298,971
1,124,227
451,365
5,391,836
Females
459,737
1,096,960
950,966
1,353,825
1,218,363
642,289
5,722,140
Table 77 Number Of Person Years, By Acre Groupings And Sex, Used To Calculate
Age-Specific Death Rates In High Barium Communities, City Of DeKalb,
And Low Barium Communities For The Years 1971-75
Age
(Years)
0- 4
5-14
15-24
25-44
45-64
65+
Number of Person Years (1971-75)
High Barium Communities
i Males
6,185
15,145
9,330
16,690
11,415
3,675
Females
5,750
14,400
10,335
17,055
11,715
5,470
City of DeKalb
Males
4,580
8,945
37,245
14,170
8,915
3,340
Females
4,190
8,905
46,635
12,690
10,010
5,120
Low Barium Communities
Males
10,060
24,980
17,605
26,910
24,035
9,515
Females
9,705
24,170
19,720
27,620
26,495
13,710
121
-------
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APPENDIX D. MANTEL-HAENSZEL TEST (59)
When a random sample of disease (hypertension or currently taking blood
pressure medication) and disease-free individuals is classified according to
living in a high barium (HB) versus a low barium (LB) community, the distri-
bution of this classification may be represented as follows:
HB LB TOTAL
With Disease A. B. Nlt
11 i
Disease-Free C. D. Na
Total Mi- Ma,- T-j
i i -1-
Within the above subgroup, the approximate relative risk associated
with the disease may be written as A.D./B.C.. Comparison can be made with
the observed number of diseased persons (A.) living in the HB community and
its expectation under the hypothesis of a relative risk of unity, U(A.) =
HI.MI./T.. The discrepancy between A. and U(A.) can be tested relative to
111 i i 2
its variance which is given by V(A.) = NI.Na.Mi.Ma,/T. (T.-l). Then, the
i 111111 2
corrected chi square with one degree of freedom becomes (| EA. -Eu(A.) | -3j). f
IV(A.). Data from Tables 29 and 18 are used to illustrate how the Mantel-
Haenszel Test (59) can be applied (Table 81) .
125
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TECHNICAL REPORT DATA
(Please read Instructions on the reverse before completing)
1. REPORT NO.
EPA-600/1-79-003
2.
4, TITLE AND SUBTITLE
Health Effects of Human Exposure to Barium in Drinking
Water
6. PERFORMING ORGANIZATION CODE
3. RECIPIENT'S ACCESSION NO.
5. REPORT DATE
January 1979 issuing date
7 AUTHOR(S)
Gary R. Brenniman, W. H. Kojola, P. S. Levy, B. W.
Carnow, T. Namekata and E. C. Breck
8. PERFORMING ORGANIZATION REPORT NO.
9. PERFORMING ORGANIZATION NAME AND ADDRESS
The University of Illinois at the Medical Center
Chicago, Illinois 60612
10. PROGRAM ELEMENT NO.
1CC61A
11. CONTRACT/GRANT NO.
R-8Q3918
12. SPONSORING AGENCY NAME AND ADDRESS
Health Effects Research Laboratory _
Office of Research & Development
U.S. Environmental Protection Agency
Cincinnati, Ohio 45268
Cinn, OH
13. TYPE OF REPORT AND PERIOD COVERED
Final - 8/12/75 to 10/31/78
14. SPONSORING AGENCY CODE
EPA/600/10
15 SUPPLEMENTARY NOTES
16 ABSTRACT
The overall objective of this study was to examine by epidemiologic and supportive
laboratory studies, the human health effects associated with ingestion of barium in
drinking water exceeding the U.S. drinking water standard of 1.0 mg/1.
The incidence of cardiovascular mortality and/or the prevalence of various cardio-
vascular, cerebrovascular and renal diseases was compared between communities with
barium concentrations exceeding the drinking water standard, and communities which
have negligible barium in their drinking water. Mortality rates for cardiovascular
diseases were retrospectively determined for the years 1971-1975. A comparison
between communities with elevated barium levels (>2 mg/1) and communities with low or
no barium (<0.2 mg/1) in their public water supplies did show higher mortality rates
for the exposed population.
The prevalence of various cardiovascular, cerebrovascular and renal diseases in
two communities having similar socioeconomic characteristics and different concentra-
tions of barium in their drinking water (mean barium concentration of 7 mg/1 in water
supply of exposed population as compared to 0.1 mg/1 in the control) was determined
through an epidemiology study. Results of the study revealed significant differences
in blood pressure between the two communities and especially in the male population
exposed to barium when the data were refined to correct for the influence of water
softening, blood pressure medication, hypertension and duration of exposure.
17.
a
KEY WORDS AND DOCUMENT ANALYSIS
DESCRIPTORS
Ingestion (biology)
Barium
Socioeconomic status
Epidemiology
Mortality
Morbidity
Ground water
Potable water
b.IDENTIFIERS/OPEN ENDEDTERMS
Health Effects
Epidemiology Study
c. COS AT I Field/Group
68G
18. DISTRIBUTION STATEMENT
Release to Public
19. SECURITY CLASS (ThisReport)
Unclassified
21. NO. OF PAGES
141
20. SECURITY CLASS (This page)
Un r 1 P .^ Q -f f i o H
22. PRICE
EPA Form 2220-1 (Rev. 4-77)
PREVIOUS EDITION IS OBSOLETE
127
U. 5. GOVERNMENT PRINTING OFFICE 1979 657-060/1574
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