PEER NOTES: The Mangano Study Part II

The Nuclear Industry and Health
AN UNEXPECTED MORTALITY INCREASE IN
THE UNITED STATES FOLLOWS ARRIVAL OF THE
RADIOACTIVE PLUME FROM FUKUSHIMA:
IS THERE A CORRELATION?
Joseph J. Mangano and Janette D. Sherman
The multiple nuclear meltdowns at the Fukushima plants beginning on
March 11, 2011, are releasing large amounts of airborne radioactivity that has
spread throughout Japan and to other nations; thus, studies of contamination
and health hazards are merited. In the United States, Fukushima fallout
arrived just six days after the earthquake, tsunami, and meltdowns. Some
samples of radioactivity in precipitation, air, water, and milk, taken by the
U.S. government, showed levels hundreds of times above normal; however,
the small number of samples prohibits any credible analysis of temporal
trends and spatial comparisons. U.S. health officials report weekly deaths by
age in 122 cities, about 25 to 35 percent of the national total. Deaths rose
4.46 percent from 2010 to 2011 in the 14 weeks after the arrival of Japanese
fallout, compared with a 2.34 percent increase in the prior 14 weeks. The
number of infant deaths after Fukushima rose 1.80 percent, compared
with a previous 8.37 percent decrease. Projecting these figures for the entire
United States yields 13,983 total deaths and 822 infant deaths in excess of
the expected. These preliminary data need to be followed up, especially in the
light of similar preliminary U.S. mortality findings for the four months after
Chernobyl fallout arrived in 1986, which approximated final figures.
We recently reported on an unusual rise in infant deaths in the northwestern
United States for the 10-week period following the arrival of the airborne radioactive plume from the meltdowns at the Fukushima plants in northern Japan.
This result suggested that radiation from Japan may have harmed Americans,
thus meriting more research. We noted in the report that the results were
International Journal of Health Services, Volume 42, Number 1, Pages 47–64, 2012
© 2012, Baywood Publishing Co., Inc.
doi.http://dx.doi.org/10.2190/HS.42.1.f
http://baywood.com
47preliminary, and the importance of updating the analysis as more health status
data become available (1).
Shortly after the report was issued, officials from British Columbia, Canada,
proximate to the northwestern United States, announced that 21 residents had
died of sudden infant death syndrome (SIDS) in the first half of 2011, compared
with 16 SIDS deaths in all of the prior year. Moreover, the number of deaths
from SIDS rose from 1 to 10 in the months of March, April, May, and June 2011,
after Fukushima fallout arrived, compared with the same period in 2010 (2).
While officials could not offer any explanation for the abrupt increase, it coincides
with our findings in the Pacific Northwest.
Any comparison of potential effects of radiation exposure must attempt to
examine the dose-response relationship of the exposure of a population. In the
United States, the principal source of dose data (i.e., environmental radiation
levels) is the U.S. Environmental Protection Agency (EPA). Health data are the
responsibility of the U.S. Centers for Disease Control and Prevention (CDC),
which provides weekly reports on mortality in 122 U.S. cities. These are
preliminary data, but are the most useful at a date so soon after an event such
as Fukushima.
The goal of this report is to evaluate any potential changes in U.S. mortality
resulting from exposure to the Fukushima plume, using EPA and CDC data.
BACKGROUND:
POST-CHERNOBYL HEALTH TRENDS
A quarter of a century before the Fukushima disasters, the meltdown at Chernobyl
and the presence of environmental fallout presented a similar challenge for
researchers to assess any adverse health effects. The discussion that began after
the April 26, 1986, meltdown is still very much a current one, with varying
estimates. A recent conference concluded that 9,000 persons worldwide survived
with or died from cancer (3), while a compendium of more than 5,000 research
papers put the excess death toll (from cancer and all other causes) at 985,000 (4).
In the United States, Chernobyl fallout was detected in the environment just
nine days after the meltdown. Gould and Sternglass (5) used EPA measurements of environmental radiation post-Chernobyl (6) and found elevated levels
of radioactivity in air, water, and milk. For example, EPA data indicate that
from May 13 to June 23, 1986, U.S. milk had 5.6 and 3.6 times more iodine-131
and cesium-137 than were recorded in May–June of 1985 (see Appendix Table 1,
p. 60). In some cities, especially those in the harder-hit Pacific Northwest, average
concentrations were as much as 28 times the norms, while some individual
samples were much higher.
Gould and Sternglass (5) also studied preliminary mortality data, to analyze
any potential impact from fallout. Using a 10 percent sample of all U.S. death
certificates, they found that during the four months after Chernobyl (May–August
48 / Mangano and Sherman1986), total deaths in the United States rose 6.0 percent over the similar period
in 1985 (see Appendix Table 2) (7; estimated deaths based on a 10% sample
of death certificates, minus the New England states, for which data were
incomplete at the time).
Eventually, final figures showed an increase of 2.3 percent, which exceeded
the 0.2 percent decline in the first four months of the year (8). The number of
excess deaths, or the difference between the actual and expected death totals,
is 16,573. To date, the cause of this unusual pattern remains unknown, and no
research testing hypotheses for causes other than Chernobyl has been published.
This difference has a very high degree of statistical significance; there is a less
than 1 in 10
9
probability that it occurred by random chance.
The change in deaths for infants was also analyzed. Preliminary data showed
an increase of 3.1 percent in U.S. infant deaths in the first four months after
Chernobyl, 1985 versus 1986. The final increase was 0.1 percent, compared with
a 2.3 percent decline in the four months before Chernobyl. The 1985–1986
differences in infant death rates were –2.9 percent (January–April) and +0.4
percent (May–August). These gaps amounted to excess infant deaths of 306
and 424, and differences were significant at p < 0.08 and p < 0.055.
The stillbirth, neonatal, and prenatal mortality increased in England and
Wales within 11 months after Chernobyl’s initial release (9, 10), and in Germany
(11). In two Ukrainian districts with increased levels of cesium-137 ground
contamination, there was a significant increase in stillbirths (12).
U.S. publications offered evidence that Americans may have suffered harm
from Chernobyl, especially damage to fetuses and infants. Reports covered elevated levels of various radiation-related disorders, including newborn hypothyroidism (13), infant leukemia (14), and thyroid cancer among children (15).
Gould and Sternglass (5) showed that trends using preliminary data were
rough approximations of the final data. Because of the lengthy delay in generating
final statistics—2011 data will probably not be published on the CDC website
until 2014—we believe that analyzing preliminary health data at this time is a
useful exercise that can approximate final mortality patterns and help guide
future research on the effects of fallout from the Fukushima meltdowns.
METHODS
Environmental Radioactivity
The first component of any analysis of potential adverse health effects from
Fukushima fallout in the United States is the doses received by humans. After
March 17, 2011, when the airborne radioactive plume first reached the United
States, the EPA accelerated its program of sampling environmental radioactivity.
Instead of quarterly measures in precipitation, milk, water, and air, samples were
taken weekly, sometimes more frequently. Radioisotope levels in late March and
Increase in U.S. Mortality and Fukushima Fallout / 49early April tended to be higher than typical levels, but declined in April, even
though Fukushima meltdowns and emissions continued. On May 3, the EPA
announced that it would revert to quarterly measurements.
The number of samples and percentage with detectable radioisotope levels
reported by the EPA in March–April 2011 were far fewer than those taken and
reported in the period after Chernobyl in May–June 1986. Reporting for some
of the principal radioisotopes is given in Table 1 (16).
The number of samples for which the EPA was able to detect measurable
concentrations of radioactivity is relatively few. Assuming that the EPA attempted
to measure each of the 10 isotopes in air, precipitation, milk, and drinking water,
only 13.3, 6.2, 2.2, and 2.4 percent, respectively, resulted in detectable levels.
Of the 452 samples with detectable levels, 297 were iodine-131 measurements.
This dataset was much weaker than that reported by the EPA in May–June 1986,
in the aftermath of the Chernobyl meltdown. For example, the EPA reported 2,304
milk samples in the United States, with 2,000 (86.8%) reporting a positive number
for the three isotopes barium-140, cesium-137, and iodine-131 (6). After Fukushima,
there were 670 measurements of milk for 10 isotopes, with just 2.2 percent
reporting a positive numerical value (16). Clearly, the 2011 EPA reports cannot be
used with confidence for any comprehensive assessment of temporal trends and
spatial patterns of U.S. environmental radiation levels originating in Japan.
50 / Mangano and Sherman
Table 1
Concentrations of radioisotopes in the environment, United States:
10 isotopes measured by the EPA, March and April 2011 (after Fukushima)
Number (%) of samples with detectable levels reported
Air
(n = 229)
Precipitation
(n = 157)
Milk
(n = 67)
Drinking water
(n = 153)
Barium-140
Cesium-134
Cesium-136
Cesium-137
Cobalt-60
Iodine-131
Iodine-132
Iodine-133
Tellurium-129
Tellurium-129m
Total all
Total excluding I-131
4.4 (10)
14.8 (34)
2.2 (5)
20.1 (46)
0.0 (0)
77.3 (177)
13.1 (30)
0.4 (1)
0.0 (0)
0.4 (1)
13.3 (304)
6.2 (127)
0.0 (0)
5.7 (9)
0.0 (0)
7.0 (11)
0.0 (0)
49.0 (77)
0.0 (0)
0.0 (0)
0.0 (0)
0.0 (0)
6.2 (97)
1.4 (20)
0.0 (0)
3.0 (2)
0.0 (0)
6.0 (4)
0.0 (0)
13.4 (9)
0.0 (0)
0.0 (0)
0.0 (0)
0.0 (0)
2.2 (15)
1.0 (6)
0.0 (0)
0.7 (1)
0.0 (0)
0.7 (1)
0.0 (0)
22.2 (34)
0.0 (0)
0.0 (0)
0.0 (0)
0.0 (0)
2.4 (36)
0.1 (2)
Source: U.S. Environmental Protection Agency (16).The EPA data cannot be used to assess the amount of time that Fukushima
radiation existed in the U.S. environment, or which areas of the nation received
the highest amount of fallout. Anecdotal samples provide an abridged set of
data. For example, iodine-131 in precipitation reached 242 and 390 picocuries
per liter (pCi/L) in Boise, Idaho, on March 22, hundreds of times greater than
the typical value of about 2.0 pCi/L. The next highest value (200 pCi/L) was
recorded in Kansas City, Kansas, on March 29. The 10 highest values included
diverse locations such as Salt Lake City, Utah (190 pCi/L), Jacksonville, Florida
(150 pCi/L), and Boston, Massachusetts (92 pCi/L). Despite the paucity of data,
it appears that radioactivity from Fukushima reached many, perhaps all, areas
of the United States. Without more specific data, only the United States as a
whole can be used to understand any potential changes in health status.
Health Status
Vital statistics in the United States, including morbidity and mortality, are
typically not made publicly available until at least two years after the event
occurred. Moreover, vital statistics are publicly issued only for entire years, not
portions of years, as would be needed to analyze temporal trends before and
after the Fukushima meltdowns. Obtaining data for portions of years would
be possible only by making special requests to state and local health departments
that maintain and collect data.
The CDC produces weekly statistics on U.S. deaths for each of five age groups
and for all ages combined, and for pneumonia/influenza, as part of the Morbidity
and Mortality Weekly Report. The statistics include 122 U.S. cities with populations over 100,000, representing about 25 to 35 percent of the nation’s deaths.
The number of deaths is reported voluntarily by health officers in these cities, and
represents the place of occurrence of death rather than the place of residence.
A death is counted when the death certificate is filed, not necessarily on the date
of death. Only raw numbers of deaths, and not mortality rates, are given. In
some cities, a week’s total is reported with a “U” (unavailable), although by
2011 this lack of reported information occurred only in a small minority of
participating cities.
While the limitations of the CDC weekly mortality statistics should be understood and considered, so that the data are cautiously interpreted, these limits
should not preclude their use. Each week, about 11,000 total deaths are reported.
The experience of mortality patterns found by Gould and Sternglass (5) using a
10 percent sample of U.S. deaths that approximated final statistics offers further
evidence that the CDC mortality data can be helpful at this still-early date.
In this report, we analyze changes in U.S. deaths in the period after Fukushima
fallout arrived in North America, compared with a similar period for 2010.
Total deaths and deaths of infants under one year, who are most susceptible to
the adverse health effects of exposure to radioactivity, are reported.
Increase in U.S. Mortality and Fukushima Fallout / 51As of this writing, 14 weeks of post-Fukushima data have been reported by
the CDC. All but 3 of the 122 cities in the CDC report submitted actual number
of deaths (vs. “unavailable”) in more than 99 percent of the reporting periods.
This 14-week period includes weeks 12 to 25 of 2011 (March 20 to June 25),
approaching the four-month period in which Gould and Sternglass found an
unexpectedly large increase in deaths after Chernobyl. Here, reported deaths
are compared with weeks 12 to 25 in 2010 (March 21 to June 26). Any 2010–2011
changes are compared with those for the prior 14-week period (December 12,
2009, to March 20, 2010 vs. December 11, 2010, to March 19, 2011: weeks 50
to 52 and 1 to 11).
The 2010–2011 comparison of deaths in weeks 12 to 25 included 119 of
the 122 cities in the CDC report. Excluded were Fort Worth, Texas; New
Orleans, Louisiana; and Phoenix, Arizona; for these cities, deaths in more
than half of the weeks were reported as “unavailable.” The completeness of
reporting for both periods exceeded 99 percent. For the earlier 14-week periods,
only 104 of the 122 cities that reported death figures more than 99 percent of
the time were included. For the cities and weeks excluded from the analysis,
see Appendix Table 3.
Statistical significance between the 2010 and 2011 death trends was calculated
by using the difference between two means. The observed difference was the
actual 2010–2011 change for weeks 12 to 25, and the expected difference was
the 2010–2011 change for the preceding 14 weeks. The formula used for calculating statistical significance is given in Appendix Table 4.
RESULTS
U.S. Total Deaths
During weeks 12 to 25, total deaths in 119 U.S. cities increased from 148,395
(2010) to 155,015 (2011), or 4.46 percent. This was nearly double the 2.34 percent
rise in total deaths (142,006 to 145,324) in 104 cities for the prior 14 weeks,
significant at p < 0.000001 (Table 2). This difference between actual and expected
changes of +2.12 percentage points (+4.46% – 2.34%) translates to 3,286 “excess”
deaths (155,015 × 0.0212) nationwide. Assuming a total of 2,450,000 U.S. deaths
will occur in 2011 (47,115 per week), then 23.5 percent of deaths are reported
(155,015/14 = 11,073, or 23.5% of 47,115). Dividing 3,286 by 23.5 percent
yields a projected 13,983 excess U.S. deaths in weeks 12 to 25 of 2011.
After March 19, 2011, total deaths were higher than a year earlier in 11 of the
14 weeks, with a 7.5 percent or greater increase in four of the weeks. The greatest
rise occurred in weeks 12 to 20, with a 5.37 percent increase (96,900 to 102,108).
In weeks 21 to 25, the increase was a considerably lower 2.74 percent (51,495
to 52,907). Whether this pattern will continue into the future or is temporary is
not yet known.
52 / Mangano and ShermanTable 2
Changes in reported deaths, all ages: weeks 12 to 25 and 14 weeks prior, 2010 versus 2011, 122 U.S. cities
Total deaths Total deaths
Week 2010 2011 No. (%) change Week 2010 2011 No. (%) change
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Total
11,010
11,097
11,075
10,712
10.940
10,549
10,637
10,389
10,491
10,352
9,894
10,781
10,178
10,290
148,395
12,137
11,739
12,052
10,928
10,743
10,826
11,251
11,300
11,132
10,839
9,538
10,770
10,981
10,779
155,015
+1,127
+642
+977
+216
–197
+277
+614
+911
+641
+487
–356
–11
+803
+489
+6,620
(+10.24)
(+5.79)
(+8.82)
(+2.02)
(–1.80)
(+2.63)
(+5.77)
(+8.77)
(+6.11)
(+2.77)
(–3.60)
(–0.10)
(+7.89)
(+4.75)
(+4.46)*
50
51
52
1
2
3
4
5
6
7
8
9
10
11
Total
10,323
7,942
8,288
11,557
11,299
10,110
10,832
10,524
9,877
9,802
10,198
10,586
10,699
9,969
142,006
10,702
8,339
8,194
11,804
10,775
10,689
10,420
10,295
10,700
10,952
10,762
10,779
10,639
10,274
145,324
+379
+397
–94
+247
–524
+579
–412
–229
+823
+1,150
+564
+193
–60
+305
+3,318
(+3.67)
(+5.00)
(–1.13)
(+2.14)
(–4.64)
(+5.73)
(–3.80)
(–2.18)
(+8.33)
(+11.73)
(+5.53)
(+1.82)
(–0.56)
(+3.06)
(+2.34)
Note: For weeks 12 to 25, actual numbers of deaths were available for 1,653 (99.22%) in 2010 and 1,650 (99.04%) in 2011 of the 119 cities for the 14 weeks. For
weeks 50 to 52 and 1 to 11, actual numbers of deaths were available for 1,445 (99.24%) in 2010 and 1,443 (99.11%) in 2011 of the 104 cities for the 14 weeks.
*p < 0.000001
Increase in U.S. Mortality and Fukushima Fallout / 53U.S. Infant Deaths
The CDC weekly report provides reported deaths in the 122 participating cities
for each of five age groups (<1, 1–24, 25–44, 45–64, and over 65). Of special
interest to any analysis of potential health risks of environmental toxins are
the fetus and infant, which are at greater risk than older children or adults. Their
immune systems are immature and less likely to fight off disease; their cells
are dividing very rapidly and are less likely than a damaged adult cell to repair
before mitosis. Thus, we examined trends for deaths of infants under one year
old. The same cities used for total deaths are used here (Table 3). Infant death
numbers are much smaller, accounting for just over 1 percent of total U.S. deaths
in recent years.
Between 2010 and 2011, the total number of infant deaths for weeks 12 to 25
rose 1.80 percent (2,674 to 2,722), compared with a 8.37 percent decline (2,520
to 2,309) in the prior 14-week period. This difference was highly significant
(p < 0.0002). In 8 of 14 weeks after March 19, 2011, an increase occurred from
the year before, compared with just 4 of 14 weeks in the prior 14-week period.
Some weeks had relatively large increases and decreases, because the smaller
number of infant deaths is subject to greater variability.
The 10.17 percentage point difference between actual and expected (+1.80%
and –8.37%) means that 277 of the 2,722 infant deaths (2,772 × 0.1017) are
“excess.” Assuming that 30,000 U.S. infant deaths will occur in 2011 (577 per
week), this means that 33.7 percent of deaths are reported (2,722/14 = 194, or
33.7% of 577). Dividing 277 by 33.7 percent yields a projected 822 excess
infant deaths in the United States in the 14 weeks after March 19, 2011.
Individual Locations
Another means of analyzing trends in mortality is to study geographic area. The
CDC weekly report can be subdivided into either individual cities or regions.
It is difficult to offer an a priori hypothesis on areas with the highest expected
mortality increases after Fukushima fallout arrived, since the EPA data on radioactivity levels are limited. Moreover, voluntary reporting practices in a single
city or area are subject to change over time, potentially skewing trends. The impact
of such changes is less likely to affect patterns in a national group of 122 cities,
since it is more likely that changes that increase or decrease deaths would offset
each other.
Deaths reported from U.S. cities with the largest populations and complete
reporting in weeks 12 to 25 (2010 and 2011) and from the 14 previous week
periods are given in Table 4 (all deaths) and Table 5 (infant deaths). Of the eight
most populated cities, Chicago and Phoenix (3rd and 5th highest population) are
omitted due to incomplete data.
54 / Mangano and ShermanTable 3
Changes in reported infant deaths, age under one year old: weeks 12 to 25 and 14 weeks prior, 2010 versus 2011, 122 U.S. cities
Infant deaths Infant deaths
Week 2010 2011 No. (%) change Week 2010 2011 No. (%) change
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Total
202
182
189
208
186
177
200
172
221
183
173
205
194
182
2,674
201
210
198
163
188
200
196
214
224
196
152
174
191
215
2,722
–1
+28
+9
–45
+2
+23
–4
+42
+3
+13
–21
–31
–3
+33
+48
(–0.50)
(+15.38)
(+4.76)
(–21.63)
(+1.08)
(+12.99)
(–2.00)
(+24.42)
(+1.36)
(+7.10)
(–12.14)
(–15.12)
(–1.55)
(+18.13)
(+1.80)*
50
51
52
1
2
3
4
5
6
7
8
9
10
11
Total
177
150
120
198
193
206
207
177
174
165
191
192
189
181
2,520
202
129
113
158
177
158
148
178
173
188
158
174
165
188
2,309
+25
–21
–7
–40
–16
–48
–59
+1
–1
+23
–33
–18
–24
+7
–211
(+14.12)
(–14.00)
(–5.83)
(–20.20)
(–8.29)
(–23.30)
(–28.50)
(+0.56)
(–0.57)
(+13.94)
(–17.27)
(–9.38)
(–12.70)
(+3.87)
(–8.37)
Note: For weeks 12 to 25, actual numbers of deaths were available for 1,653 (99.22%) in 2010 and 1,650 (99.04%) in 2011 of the 119 cities for the 14 weeks. For
weeks 50 to 52 and 1 to 11, actual numbers of deaths were available for 1,445 (99.24%) in 2010 and 1,443 (99.11%) in 2011 of the 104 cities for the 14 weeks.
*p < 0.0002
Increase in U.S. Mortality and Fukushima Fallout / 55For deaths of all ages, the U.S. 2010–2011 change of +3.56 percent in the
14 weeks after mid-March was well above the +0.19 percent change for the
14-week period before mid-March. This difference between the two changes
of +3.37 percentage points was statistically significant at p < 0.0001.
56 / Mangano and Sherman
Table 5
Changes in reported deaths, age under one year old: weeks 12 to 25, 2010 versus 2011
(vs. 14 weeks prior), most populated U.S. cities
Total deaths No. (%) change, 2010–2011
City (population rank) 2010 2011 Weeks 12–25 Prior 14 weeks
1. New York City
2. Los Angeles
4. Houston
6. Philadelphia
7. San Antonio
8. San Diego
Total
164
74
105
79
60
37
519
163
58
117
93
40
33
504
–1
–16
+12
+14
–20
–4
–15
(–0.61)
(–21.62)
(+11.43)
(+17.22)
(–33.33)
(–10.81)
(–2.89)
+32
–11
–19
–7
–8
+5
–8
(+20.92)
(–14.29)
(–18.63)
(–7.14)
(–14.29)
(+11.11)
(–1.51)
Note: Deaths reported for all weeks and cities except San Antonio (week ending 12/26/2009)
and San Diego (week ending 12/19/2009).
Table 4
Changes in reported deaths, all ages: weeks 12 to 25, 2010 versus 2011
(vs. 14 weeks prior), most populated U.S. cities
Total deaths No. (%) change, 2010–2011
City (population rank) 2010 2011 Weeks 12–25 Prior 14 weeks
1. New York City
2. Los Angeles
4. Houston
6. Philadelphia
7. San Antonio
8. San Diego
Total
13,697
3,440
2,291
3,708
3,489
2,357
28,982
13,779
3,686
2,775
4,044
3,511
2,220
30.015
+82
+246
+484
+336
+22
–137
+1,033
(+0.60)
(+7.15)
(+21.13)
(+9.06)
(+0.63)
(–5.81)
(+3.56)
+1038
+44
–1.649
+207
+222
+199
+61
(+6.99)
(+1.17)
(–45.03)
(+5.42)
(+6.32)
(+9.74)
(+0.19)
Note: Deaths reported for all weeks and cities except San Antonio (week ending 12/26/2009)
and San Diego (week ending 12/19/2009).DISCUSSION
The Fukushima meltdowns, and the introduction of radioactivity across the
globe, indicate that accurate measurements are needed on subsequent changes in
environmental radioactivity and in health status. In the United States, there have
been limitations in both measures. Radioactivity samples in precipitation, air,
water, and milk were sporadically reported by the Environmental Protection
Agency. Many measurements failed to produce detectable levels, and on May 3,
2011, the agency reverted to its policy of making only quarterly measurements.
Some elevated concentrations were found to be up to several hundred times the
norm soon after the arrival of the Fukushima fallout, but no meaningful temporal
trends and spatial patterns can be discerned from these data.
Few aggregate data on health status are available until several years after a
death or specific diagnosis. Immediately after Fukushima, the only nationwide
health status data available in the United States were weekly deaths by age
reported by 122 U.S. cities (about 25% to 35% of all U.S. deaths), as reported
by the Centers for Disease Control and Prevention. In the 14 weeks after the
Fukushima fallout arrived in the United States, total deaths reported were
4.46 percent above the same period in 2010; in the 14 weeks before Fukushima,
the increase from the prior year was just 2.34 percent. The gap in changes for
infant deaths (+1.80% in the latter 14 weeks, –8.37% for the earlier 14 weeks)
was even larger. Estimated “excess” deaths for the entire United States were
projected to be 13,983 total deaths and 822 infant deaths.
Patterns of deaths among persons of all ages strongly reflect patterns among
the elderly, who account for over two-thirds of all deaths. For the older population,
explanations for excess deaths must be considered after exposure to higher
levels of radioactive fallout. If cancer in some patients becomes active again,
it may mean they already have cells carrying all but one of the three to four
requisite mutations to express cancer. Exposure to radiation (or a toxic chemical)
can provide the one final mutation to reactivate a quiescent tumor (17). Also
vulnerable are those elderly with depressed immune status, made worse by
exposure to radiation.
The CDC weekly mortality data have limitations. They represent only a 25
to 35 percent sample of all deaths, which may or may not accurately represent
the entire nation. Deaths are reported voluntarily and thus are subject to variations
from city to city and for unusual circumstances in a week or period (e.g., totals
during the Christmas holiday season appear to be much lower). Weekly totals
are sometimes reported as unavailable and so cannot be used in any analysis.
The deaths reported are by city of occurrence, whereas all final statistics are
by residence at time of death. Deaths are categorized when the death certificate is filed, not necessarily the date of death. Finally, the CDC weekly reports
provide raw numbers of deaths, not the more useful mortality rates, as populations or numbers of births are not given.
Increase in U.S. Mortality and Fukushima Fallout / 57Nonetheless, 25 to 35 percent of the United States is not a small sample,
representing all large cities and many smaller ones in all regions of the nation.
When extended periods are used, the numbers become larger and more
meaningful, because any variations increasing or decreasing death counts are
more likely to balance each other out. The total of 155,015 U.S. deaths in the
14-week period after Fukushima, 2,722 of which are infant deaths, represents a
large database that is meaningful in a preliminary analysis of potential Fukushima
effects. Not to use them would mean a two- or three-year absence of any health
status data, until final figures are made public.
The statistically significant difference in increased number of reported deaths
(total and infant) for the 14-week period after Fukushima has an added dimension because of similar findings for the four months immediately after the
Chernobyl meltdown in 1986, using a 10 percent sample of U.S. deaths. The
post-Chernobyl increases, based on preliminary death data, were roughly comparable to the increases calculated from final death data (see Appendix Table 2).
The preliminary versus final 1985–1986 change for the period May–August in
total deaths was within 3.7 percentage points (+6.0% vs. +2.3%), and the count
of infant deaths was within 3.0 percentage points (+3.1% vs. +0.1%). Thus, it is
unlikely that, for Fukushima, final death counts would show results markedly
different from the finding that more Americans, especially infants, died than
expected in the 14-week period following arrival of the Fukushima fallout.
The 14-week excess death projections after mid-March 2011 (13,983 total,
822 infant) are relatively similar to actual excesses in May–August 1986 (16,573
total, 306 infant).
Recent assessments have suggested that the amount of radioactivity released
from Fukushima equals or exceeds that released from Chernobyl. Given the
continuing emission of radioisotopes from the melted reactors, the high density
of population around the plant, and the close proximity to food sources, we can
expect that morbidity and mortality will be high in Japan. The relative homogeneity of the Japanese population will allow for comparison of health consequences for people living in areas with lesser and greater levels of contamination,
as has been done in areas affected by Chernobyl (4).
Adverse health effects may also be expected in the United States, even though
exposures have been far below those in Japan. Low-dose radiation exposure,
previously assumed to be harmless, has been linked with elevated disease rates
in children born to women who underwent pelvic X-rays while pregnant (18),
Americans exposed to atomic bomb fallout (19), nuclear plant workers (20),
and, for leukemia, children exposed to very low doses after Chernobyl (21).
In addition to physical diseases is loss of cognitive ability in adolescents following low-dose ionizing radiation in utero (22).
The human fetus and infant are especially radiosensitive, given their rapid
cell growth and cell division, as well as their small size that results in a proportionately larger dose. These exposures include X-ray, alpha, beta, and gamma
58 / Mangano and Shermanradiation. Depending on the time of in utero radiation exposure, the result can be
expressed as spontaneous abortion, premature birth, low birth weight, stillbirth,
infant death, congenital malformations, and brain damage.
While this report concentrates on effects to humans, all life is sensitive to
nuclear radiation exposure, including plants, fungi, insects spiders, birds, fish,
and other animals (23). The best-studied group near Chernobyl (birds) shows
a 50 percent decrease in species richness and a 66 percent drop in abundance in
the most contaminated areas, compared with normal background in the same
neighborhood (24).
More importantly, the findings reported here, plus the disease patterns that
developed after Chernobyl, indicate that public health personnel can anticipate
and plan to put in place diagnostic and treatment procedures. Given the continued high levels of radioactive iodine, it is predicted that the incidence of
thyroid disease, including thyroid insufficiency in newborns and thyroid cancer
in children and adults, will increase (4, 25).
The health effects of exposure to radioactivity from the Fukushima meltdowns,
both in Japan and around the world, will take a long time to fully assess. The
paucity of data from the U.S. EPA is unfortunate and will hamper future studies.
A quarter of a century after the Chernobyl disaster, and more than 60 years after
the bombings of Hiroshima and Nagasaki, compilations of health casualties
are still being updated. It is critical that research should proceed with all due
haste, as answers are essential to early diagnosis and treatment for exposed
people, particularly children and the very young.
REFERENCES
1. Sherman, J. D., and Mangano, J. Is the dramatic increase in baby deaths in the U.S.
a result of Fukushima fallout? Counterpunch, June 10–12, 2011. www.counterpunch.
org/sherman06102011.html (accessed August 4, 2011).
2. Fong, P. Sudden infant deaths on rise in B.C. Toronto Star, July 6, 2011. www.the
star.com/news/canada/article/1020924-sudden-infant-deaths-on-rise-in-b-c (accessed
August 4, 2011).
3. International Atomic Energy Agency. The Chernobyl Legacy: Health, Environment
and Socio-Economic Impact and Recommendations to the Governments of Belarus,
the Russian Federation, and Ukraine, 2nd Rev. Ed. Vienna, 2006. www.iaea.org/
publications/booklets/Chernnobyl/Chernobyl.pdf (accessed August 1, 2011).
4. Yablokov, A. V., Nesterenko, V. B., and Nesterenko, A. V. Chernobyl: Consequences
of the Catastrophe for People and the Environment. New York Academy of Sciences,
New York, 2009.
5. Gould, J. M., and Sternglass, E. J. Significant U.S. Mortality Increases after the
Chernobyl Accident. Paper presented at Symposium on the Effects of Low Level
Radiation in Humans, Institute of Radiation Biology, University of Munich, February
27, 1988.
6. Office of Radiation Programs. Environmental Radiation Data, quarterly vols. U.S.
Environmental Protection Agency, Montgomery AL, 1985 and 1986.
Increase in U.S. Mortality and Fukushima Fallout / 597. National Center for Health Statistics. Monthly Vital Statistics Reports, monthly vols.
U.S. Department of Health and Human Services, Montgomery, AL, 1985–1987.
8. National Center for Health Statistics. Vital Statistics of the United States, final
totals of U.S. deaths, annual vols. U.S. Department of Health and Human Services,
Montgomery, AL, June 1986.
9. Bentham, G. Chernobyl fallout and prenatal mortality in England and Wales. Soc.
Sci. Med. 33(4):429–434, 1991.
10. Busby, C. C. Wings of Death: Nuclear Contamination and Human Health. Green
Audit Books, Aberystwyth, UK, 1995.
11. Korblein, A., and Kuchenoff, H. Perinatal mortality in Germany following the
Chernobyl accident. Rad. Env. Biophys. 36(1):3–7, 1997.
60 / Mangano and Sherman
Appendix Table 1
Iodine-131 and cesium-137 concentrations in U.S. milk, spring 1985 versus spring 1986
Date
Stations/
measurements Average Times vs. 1985
Iodine-131 concentrations
May 1 to June 30, 1985
May 13 to June 23, 1986
May 13 to June 23, 1986
Boise, ID
Spokane, WA
Helena, MT
Rapid City, SD
Seattle, WA
Salt Lake City, UT
Portland, OR
Cesium-137 concentrations
May 1 to June 30, 1985
May 13 to June 23, 1986
May 13 to June 23, 1986
Seattle, WA
Spokane, WA
Helena, MT
Boise, ID
Portland, OR
55
68
1
1
1
1
1
1
1
55
68
1
1
1
1
1
103
563
8
9
10
10
9
10
7
103
563
9
9
10
8
7
2.53
14.15
71.00
56.44
33.30
31.90
30.67
29.70
24.00
2.63
9.47
39.33
29.44
22.50
21.38
21.14

5.6
28.1
22.3
13.2
12.6
12.1
11.7
9.5

3.6
15.0
11.2
8.6
8.2
8.0
Sources: Office of Radiation Programs (6), Vols. 42 and 46.
Note: Averages are in picocuries of iodine-131 and cesium-137 per liter of pasteurized milk.
I-131 has a half-life of 8.05 days; Cs-137 has a half-life of 30 years.12. Kulakov, V. I., Sokur, A. L., and Volobuev, A. L. Female reproductive function in
areas affected by radiation after the Chernobyl power station accident. Env. Health
Perspect. 101:117–123, 1993.
13. Mangano, J. Chernobyl and hypothyroidism. Lancet 347:1482–1483, 1996.
14. Mangano, J. Childhood leukaemia in US may have risen due to fallout from Chernobyl.
BMJ 314:1200, 1997.
15. Reid, W., and Mangano, J. Thyroid cancer in the United States since the accident
at Chernobyl. BMJ 311:511, 1995.
16. U.S. Environmental Protection Agency. Radnet Laboratory Data: Japanese Nuclear
Emergency—Radiation Monitoring Home. www.epa.gov/japan2011/rert/radnetsampling-data.html#precip (accessed August 3, 2011).
17. Ide, C. Personal communication, e-mail, July 28, 2011.
18. Stewart, A., Webb, J., and Hewitt, D. A survey of childhood malignancies. BMJ
1:1495–1508, 1958.
19. Institute of Medicine, Committee on Thyroid Screening Related to I-131
Exposure, and National Research Council, Committee on Exposure of the American
People from the Nevada Atomic Bomb Tests. Exposure of the American People to
Iodine-131 from Nevada Nuclear-Bomb Tests. National Academy Press, Washington,
DC, 1999.
Increase in U.S. Mortality and Fukushima Fallout / 61
Appendix Table 2
Change in total and infant deaths, January–April and May–August, 1985–1986
1985 1986 % change
Infant deaths, final
January–April
May–August
Infant deaths per 100,000, final
January–April
May–August
Total deaths, final
January–April
May–August
May–August 1985 and 1986, preliminary
and final reported deaths
Total deaths, preliminary
Total deaths, final
Infant deaths, preliminary
Infant deaths, final
13,473
12,788
1,123.55
985.36
737,963
657,311
65,377
657,311
1,201
12,788
13,169
12,800
1,091.49
989.56
736,418
672,569
69,271
672,569
1,239
12,800
–2.3%
+0.1%
–2.9%
+0.4%
–0.2%
+2.3%
+6.0%
+2.3%
+3.1%
+0.1%62 / Mangano and Sherman
Appendix Table 3
Cities and weeks missing from mortality analysis
(Morbidity and Mortality Weekly Report indicated a “U” for unavailable)
Weeks 12–25
The analysis includes 119 cities (all 122 in the CDC report except Fort Worth, Texas;
New Orleans, Louisiana; and Phoenix, Arizona). Of the 119 cities in the analysis, the
following weeks had no reported data (“U” for unavailable), by week ending.
2010
3/27
3/27
3/27
4/3
4/10
4/10
4/17
4/17
5/15
5/22
5/22
5/29
6/19
El Paso, Texas
Somerville, Massachusetts
Washington, DC
St. Louis, Missouri
St. Louis, Missouri
San Jose, California
San Jose, California
San Jose, California
Detroit, Michigan
Long Beach, California
San Jose, California
Jersey City, New Jersey
San Francisco, California
2011
3/26
4/2
4/2
4/2
4/2
4/9
4/9
4/9
4/16
4/16
4/16
4/23
5/7
6/11
6/18
6/25
Worcester, Massachusetts
Duluth, Minnesota
Minneapolis, Minnesota
San Francisco, California
St. Paul, Minnesota
Duluth, Minnesota
Minneapolis, Minnesota
St. Paul, Minnesota
Duluth, Minnesota
Minneapolis, Minnesota
St. Paul, Minnesota
Tucson, Arizona
Charlotte, North Carolina
Paterson, New Jersey
Baton Rouge, Louisiana
Shreveport, Louisiana
13/1,666 = 0.78% missing
1,653/1,666 = 99.22% reported
16/1,666 = 0.96% missing
1,650/1,666 = 99.04% reported
Weeks 50 (prior year)–11
The analysis includes 104 cities (all 122 in the CDC report except Baton Rouge,
Louisiana; Bridgeport, Connecticut; Camden, New Jersey; Charlotte, North Carolina;
Chicago, Illinois; Cincinnati, Ohio; Detroit, Michigan; Fort Worth, Texas; Miami,
Florida; New Orleans, Louisiana; Pasadena, California; Peoria, Illinois; Phoenix,
Arizona; Pittsburgh, Pennsylvania; Rochester, New York; Trenton, New Jersey;
Washington, DC; and Wichita, Kansas). Of the 104 cities in the analysis, the following
weeks had no reported data (“U” for unavailable), by week ending.
2010
12/19
12/26
12/26
12/26
San Diego, California
Berkeley, California
El Paso, Texas
Milwaukee, Wisconsin
2011
12/18
12/18
12/18
12/18
Jersey City, New Jersey
Lansing, Michigan
Paterson, New Jersey
Seattle, WashingtonIncrease in U.S. Mortality and Fukushima Fallout / 63
Appendix Table 3 (Cont’d.)
2010
12/26
12/26
1/2
1/2
1/9
1/30
2/6
2/6
2/13
(cont’d.)
Newark, New Jersey
San Antonio, Texas
Fort Wayne, Indiana
Jersey City, New Jersey
Cleveland, Ohio
Columbus, Ohio
Kansas City, Missouri
Seattle, Washington
Jersey City, New Jersey
2011
12/25
12/25
1/8
1/8
1/22
2/19
2/19
(cont’d.)
Houston, Texas
Seattle, Washington
Columbus, Ohio
Somerville, Massachusetts
New Haven, Connecticut
Columbus, Ohio
Paterson, New Jersey
13/1,456 = 0.89% missing
1,442/1,456 = 99.11% reported
11/1,456 = 0.78% missing
1,445/1,456 = 99.22% reported
Appendix Table 4
Calculation of significance of differences in 2010 and 2011 deaths
For example, in Table 2, the number of deaths rose 4.46%, from 148,395 to 155,015,
from weeks 12–25 in 2010 versus 2011. This compared with a 2.34% increase from the
prior 14-week periods. The significance of difference between the two means (+2.34%
vs. +4.46%) was calculated using a t-test.
The formula (O – E)/SQRT (mean1
2
+ mean2
2
) was used, assuming
O = observed increase (1.0446)
E = expected increase (1.0234)
N1
= number of deaths for weeks 12–25, 2011
N2
= number of deaths for weeks 50–11, 2011
Mean1 = 1/(SQRT N1
) × O = 1/(SQRT 155,015) × 1.0446 = 0.002653
Mean2 = 1/(SQRT N2
) × E = 1/(SQRT 148,395) × 1.0234 = 0.002657
The computations yield 0.0212/0.0037148, or a z-score of 5.71, which converts to a
p value of < 0.000001 in any basic statistics table, meaning there is less than a 1 in
1,000,000 chance that the difference occurred due to random chance.20. Alvarez, R. The Risks of Making Nuclear Weapons: A Review of the Health
and Mortality Experience of U.S. Department of Energy Workers. Government
Accountability Project, Washington, DC, 2000.
21. Busby, C. C. Very low dose fetal exposure to Chernobyl contamination resulted
in increases in infant leukemia in Europe and raises questions about current radiation risk models. Int. J. Environ. Res. Public Health 6, 1-x manuscripts, 2009,
doi: 103390/ijerph60x000x.
22. Heiervang, K. S., et al. Effect of low dose ionizing radiation exposure in utero
on cognitive function in adolescence. Scand. J. Psychol., doi: 10.1111/j,1467-9450
2010.00814.x.
23. Moller, A. P., and Mousseau, T. A. Reduced abundance of insects and spiders linked
to radiation at Chernobyl 20 years after the accident. R. Soc. Biol. Lett., 2009.
http://royalsocietypublishing.org.
24. Mousseau, T. A., and Moller, A. P. Landscape portrait: A look at the impacts of radioactive contamination on Chernobyl’s wildlife. Bull. Atomic Sci. 67(2):38–46, 2011.
25. Sherman, J. D. Life’s Delicate Balance: Causes and Prevention of Breast Cancer,
pp. 57–66, 234–235. Taylor and Francis, New York, 2000.
Direct reprint requests to:
Joseph J. Mangano
716 Simpson Avenue
Ocean City, NJ 08226
odiejoe@aol.com
64 / Mangano and Sherman

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