Geographic Patterns of Childhood and Adolescent Germ Cell Tumor Incidence in Georgia and Their Association with Toxic Release Inventory RSEI Scores Open Access

Abstract

Germ cell tumors (GCTs) are a group of neoplasms arising from germ cells. While rare in younger children, GCTs are the most common solid tumor in those aged 15 to 19. The etiology of GCTs is widely unknown. There is a strong hereditary component but rising rates of pediatric GCTs over the past decades indicate the presence of exogenous risk factors. Previous studies suggest associations between environmental chemicals and GCTs. Using Surveillance, Epidemiology, and End Results (SEER) data, we captured 199 cases of GCTs in those aged 0 to 19 in Georgia from 2013-2019. We used EPA Toxic Release Inventory data to investigate RSEI scores, a metric used to quantify the composite health risk associated with a facility’s toxic releases. We aggregated cases and RSEI scores by county, and by cancer registries associated with the facilities and case’s county - Rural Georgia, Greater Georgia, and Atlanta (Metro) registries. Using U.S. Census population data, we found age and sex specific population sizes. Our hypothesis was that registries with counties with higher RSEI scores would have a higher incidence of GCTs. Using Poisson regression, we modeled the association between cancer registry, RSEI score, and incident GCT cases, while controlling for age group and sex, and offset by log(population). We found no statistically significant associations between RSEI scores or cancer registries and incident GCTs. The risk of GCTs in counties in Greater Georgia was 2.02 (0.11, 39.67) times the risk of GCTs in Rural counties (p=0.62). The risk of GCTs in counties in Atlanta (Metro) was 2.04 (0.11, 38.92) times the risk in Rural counties (p=0.63). Finally, a one unit increase in the log of the average cumulative RSEI score for all counties in each of the cancer registries resulted in a 1.23 (0.72, 2.10) times higher risk of GCTs (p=0.46). While these models showed no statistically significant associations between RSEI scores and GCT incidence, we still believe the association between residential proximity to toxic releases and GCTs should be explored. 

Table of Contents

I. Introduction....................................................................................................................... 1

Germ Cell Tumors ................................................................................................................... 1

Toxic Release Facilities and RSEI Scores............................................................................... 2

II. Methods.............................................................................................................................. 4

Data Sources............................................................................................................................ 4

Statistical Analysis................................................................................................................... 6

III. Results ................................................................................................................................ 7

Trends in Germ Cell Tumor Incidence .................................................................................... 7

Trends in RSEI Scores ............................................................................................................. 8

Poisson Models...................................................................................................................... 10

IV. Discussion ........................................................................................................................ 12

V. Conclusion and recommendations ................................................................................ 13

VI. References........................................................................................................................ 14

VII. Appendices....................................................................................................................... 17 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Oncology Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	RSEI EPA Toxic Release Facilities TRI Pediatric cancer SEER Germ cell tumors
Committee Chair / Thesis Advisor	Stefanie Ebelt, Sc.D., Emory University
Committee Members	Ann Mertens, Ph.D., Emory University

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