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The Agency for Toxic Substances and Disease Registry (ATSDR) started the trichloroethylene (TCE) subregistry as part of the National Exposure Registry. The goal of the subregistry is to collect and provide information which will guide ATSDR in exploring whether there may be a link between exposure to TCE and health problems. Information from the first (baseline) interview with subregistry members (registrants) has provided a first step toward this goal. This information has helped in determining what steps should be taken next.

This is the first report about health conditions to the people who are part of the TCE subregistry. This report on the baseline study is a summary of the TCE Baseline Technical Report, which gives the details about the survey methods and results from the first interview (baseline interview) with registrants. The full report is available at locations listed in the cover letter.

Who are the registrants?

Registrants were exposed to TCE through contaminated household water. In the subregistry, there are 4,522 living and 254 deceased registrants. The following is a list of locations and the number of addresses at each that are included in the TCE subregistry.

Michigan .......... 121 addresses

Indiana ............. 320 addresses

Illinois ............... 461 addresses

A site in Pennsylvania was added to the TCE subregistry in 1992 and a site in Arizona will be added this year. The interview data from those sites are not included in this report.

The characteristics of the 4,042 living registrants were:

52% were females
97% were white
         average age was 44 years
24% were under 18 years of age
70% of registrants aged 25 years and older graduated from high
         school
69% were employed full- or part-time
61% were current or ex-smokers

What were the results of the baseline survey?

The health conditions that TCE registrants reported in the first interview were compared with the health conditions reported in a nationwide survey of the general population. The results discussed in this report are limited to white registrants because of the small number of people in other racial groups.

Registrants reported higher rates for some health conditions when compared with the rates seen in the national survey. Table 1 shows the health conditions, by sex and age groups, for which there were higher rates reported. Table 1 also displays the number of cases that would have been expected using the national survey rates.

TCE registrants reported higher rates for the following conditions:

Rashes: Higher rates of "skin rashes, eczema, or skin allergies" were reported for both males and females in all age groups.

Speech Impairment: Higher rates were reported for males and females 9 years of age and younger.

Hearing Impairment: Higher rates were reported for both males and females 9 years of age and younger.

High Blood Pressure: Higher rates were reported for both males and females from 18 through 64 years of age.

Stroke: Higher rates of "the effects of a stroke" were reported for both males and females from 35 through 54 years of age and 65 years of age and older.

Anemia and Blood Disorders: Higher rates were reported for males 9 years of age and younger, 35 through 44 years, and 55 years of age and older, and females aged 18 through 24 and 35 through 54 years of age.

Diabetes: Higher rates were reported for females 18 through 24 and 45 through 54 years of age.

Kidney Disease: Higher rates were reported among females from 55 through 64 years of age.

Urinary Tract Disorders: Higher rates were reported among females in 0 through 9, 18 through 44, and 55 and over age groups. Higher rates were seen in males from 18 through 34 years of age.

Heart Problems: Higher rates were reported for males 9 years of age and younger, 10 through 24 years and over 65 years of age. For females, higher rates were reported for age groups less or equal to 9 years, and 45 through 64 years of age.

Higher rates of cancer were not reported among registrants. However, the rates of all health outcomes, including cancer, can change as time passes and therefore, the comparisons with the national rates may also change.

Does TCE in household water affect health?

Registrants reported a greater number of health problems compared with a national survey of the general U.S. population. The registry data can not be used to determine if TCE 'causes' health problems. These increased rates might be related to TCE exposure. However, other factors might have contributed to these health problems. For example, exposure to chemicals at work and lifestyle factors such as smoking cigarettes and drinking alcohol can affect health. Health conditions can be due to other illnesses. For example, a hearing loss can be related to ear infections.

There are also some technical issues that must be considered when interpreting the TCE subregistry data. The wording for some of the TCE subregistry questions did not exactly match the wording of the national survey questions. This may have caused the rates to differ. It is possible that people who know that they have been exposed may be more aware of their health and seek medical services more often than the general public. In addition, there is very little environmental information. At most subregistry addresses, only one sample was available from the wells to document that exposure to TCE occurred. More information is needed to calculate levels of exposure. ATSDR is going to try to get information that will help address these technical points.

Also, to better understand the health conditions seen in this baseline report, ATSDR needs more detailed health information. ATSDR will contact the people who reported certain health conditions and try to determine the exact type of health condition reported and what other factors, if any, might be related to the conditions. As new information is collected from future surveys, the results will be shared with registrants.

What happens now?

ATSDR will contact by telephone those people who reported certain health conditions. They will be asked to provide more information about their health, and might be asked to release their medical records for review. This new information will be reviewed for the subregistry as a whole; a decision will then be made on what other steps might be needed for health studies. Allregistrants will be informed of these steps.

ATSDR will begin work to try and get the information needed to answer the technical problems. A project is already underway to better define the exposures of the communities on the TCE subregistry.

This summer, registrants will be contacted to update subregistry files. After the interviews this summer, interviews will take place every 2 years. The same questions will be included in the interviews, but there may be some new questions based on the results of the baseline study. The results of the updates will be shared with registrants.

The letter that was enclosed with this report gives the time and place of a community meeting sponsored by ATSDR. In that meeting, these results will be discussed and any questions registrants may have about the report will be answered. The letter also describes where the full TCE Baseline Technical Report can be obtained.

What should the registrants do?

If registrants have any concerns about their health, they should consult their personal doctors or other health care providers. ATSDR also plans to give the health care providers in the area a copy of this report and additional medical information.

For information on this report or the TCE Baseline Technical Report, please contact Dr. Je Anne Burg at (404) 639–6202.

Table 1.—Number of Observed versus Expected Health Conditions

HEALTH CONDITION	SEX	AGE (years)	TOTAL NUMBER OF REGISTRY MEMBERS	NUMBER OF REGISTRY MEMBERS WHO ANSWERED "YES" FOR HEALTH CONDITION (OBSERVED)	NUMBER EXPECTED BASED ON NATIONAL NORMS
Skin Rashes	Male and Female	All Ages	3915	318	248
Speech Impairment	Male	0–9	202	11	5
	Female	0–9	188	6	2
Hearing Impairment	Male	0–9	202	11	5
	Female	0–9	188	5	3
High Blood Pressure	Male	18–24 25–34 35–44 45–54 55–64	218 392 318 197 146	13 38 48 41 52	3 18 28 33 39
	Female	18–24 25–34 35–44 45–54 55–64	235 450 322 192 172	16 27 45 53 65	5 15 27 31 48
Stroke	Male	35–44 45–54 >65	318 197 148	4 2 13	1 1 9
	Female	35–44 45–54 >65	322 192 213	5 6 20	2 1 11
Anemia	Male	0–9 35–44 55–64 >65	202 318 146 148	5 4 5 15	1 1 1 2
	Female	18–24 35–44 45–54	235 322 192	19 16 12	9 8 3
Diabetes	Female	18–24 45–54	235 192	5 15	1 7
Kidney Disease	Female	55–64	172	11	2
Urinary Disorder	Male	18–24 25–34	218 392	4 5	1 1
	Female	0–9 18–24 25–34 35–44 55–64 >65	188 235 450 322 172 213	11 21 20 22 11 14	1 3 4 4 3 5
Heart Condition	Male	0–9 10–17 18–24 >65	202 254 218 148	13 16 12 54	4 4 4 37
	Female	0–9 45–54 55–64	188 192 172	9 27 35	4 13 20