Technical Report No. 3-86

Adult Health Study Report 6. Results of six examination cycles, 1968-80, Hiroshima and Nagasaki

Sawada H, Kodama K, Shimizu Y, Kato H

 

Editor’s note:

No journal article was published.

 

Summary

The results of the first five examination cycles of the Adult Health Study (AHS), begun in 1958, were reported in 1971. This report presents the findings of the subsequent six cycles (6-11).

Even though more than 20 years have elapsed since this program was begun, a relatively high participation rate is still being maintained. During cycle 11 (1978-1980) the rate was 75% in the group of primary interest (excluding the nonexposed). Participation in Nagasaki has been particularly good (approximately 85%). In 1977, a number of subjects were incorporated into the AHS cohort from the Life Span Study population to supplement the attrition in sample size. The participation rate of the supplemental group was 63%; considerably lower than that of the original sample.

The AHS clinical examination is conducted biennially to determine disease (not limited to disease) prevalence rates. No inquiry is made about deaths occurring between the cycle examinations. Since there has been a remarkable difference in cancer mortality by radiation dose it must be stated that the effects of atomic bomb radiation cannot be adequately assessed through a comparison of cancer prevalence rates alone. Nonetheless, in this study, an association between the prevalence rates of various cancers and radiation has been demonstrated, particularly for cancers with a relatively low lethality rate. In this group are cancers of the thyroid and breast where the association is strong, particularly in the younger age-groups. An association continued to be observed for neoplasms of the lymphatic and hematopoietic tissues, and for all cancers excluding the foregoing, for which a demonstrable association to A-bomb exposure was made at an early stage. These are important findings. Further, analysis of benign tumors suggested an increase in prevalence associated with an increase in radiation dose, a finding which was not observed in the studies of autopsied cases. This finding raises a whole series of questions relating to radiation carcinogenesis. As for other diseases, strong association of increased prevalence with increased radiation dose was observed for various thyroid diseases, anemia, cataract, and calcification of the aorta. As for physical measurements and laboratory tests, relationships to radiation dose were observed concerning hemoglobin, hematocrit, erythrocyte sedimentation rate, and white blood cell count (WBC), in addition to growth and development retardation in the younger survivors as described in a previous report. In general, for many diseases and measurements, the association is stronger for those exposed at younger ages. Furthermore, some effects on the aging process are also suggested by the analysis.

The prevalence of cancer, benign tumors, and most other diseases, in general, is higher in Hiroshima than in Nagasaki, but no intercity difference was observed for breast and thyroid cancers. The findings regarding sex difference were unremarkable and almost the same as have been reported previously.

As for changes over time, an increasing trend in prevalence was observed in such diseases as thyroid cancer, breast cancer, all cancers, thyroid diseases, and cataract, and in such measurements as serum cholesterol and relative body weight. A decreasing trend was observed in infectious diseases such as tuberculosis and anemia. The decreasing trend in WBC observed in the previous cycles was no longer apparent. The decreasing trend in blood pressure suggested in earlier cycles has contrarily shown an increasing trend in the present cycles.

The primary mission per se of the AHS is to elucidate the effects of radiation on man. It is gratifying that the clinical data, even as crudely analyzed as in this report, show associations between radiation dose and subtle changes in biological parameters short of disease as well as disease prevalence associations that justify the original decision to undertake the study. The findings of this analysis suggest that long-term follow-up of the youngest age-group at the time of the bombing will continue to be worthwhile. Analyses of the resulting data undoubtedly will provide important information on the full range of radiation effects on man.

 

Editor’s note:

The following components of this report contain data on communicable disease frequencies, allergies, malignancies, and many other symptoms that may be of interest from a public health standpoint.

 

List of Table

1. Attrition of Adult Health Study sample
2. Number of additional Adult Health Study sample by radiation dose, city, and sex
3. Outcome of contact on additional Adult Health Study sample
4. Frequency of examination among participants at cycle 11
5. Proportion (%) of “too ill to come” among nonexamined by radiation dose
6. Age-sex-adjusted mortality rate (%) among never examined subjects, 1958-76
7. A. City-sex-age adjusted prevalence rate (per 1000) of benign tumor by radiation dose and cycle
   B. City-sex adjusted prevalence rate (per 1000) of benign tumor by radiation dose, cycle and age ATB
8. A. Age-adjusted proportion of all autopsies with benign tumor on autopsy by radiation dose and age ATB, 1950-80
   B. Age-adjusted proportion of all autopsies with benign tumor on autopsy by radiation dose and period, 1950-80
9. Relative risk of benign tumor among autopsy cases by site –LSS sample, 1967-74–
10. Conversion from age ATB to age at examination
11. Secular trend of prevalence rate for malignant neoplasm
12. Secular trend of prevalence rate for other than malignant neoplasm

 

List of figures

1. Sample attrition by cycle and exposure status
2. Sample attrition by cycle and radiation dose
3. Participation rate of exposed group by cycle and city
4. A. Prevalence of diseases of arteries by radiation dose and age ATB at examination cycle 9
   B. Prevalence of diseases of arteries by radiation dose and examination cycle for specific age ATB cohorts
5. A. Mean sedimentation rate by radiation dose and age ATB at examination cycle 9
   B. Mean sedimentation rate by radiation dose and examination cycle for specific age ATB cohorts
6. Secular trends for systolic blood pressure by sex
7. Secular trend for diastolic blood pressure by sex
8. Secular trend for cholesterol by sex
9. Secular trend for relative body weight by sex

 

Appendix Tables A

1. Number of AHS Original Sample by Age, Sex and Radiation Dose
2. Attrition of Sample by Radiation Dose
3. Participation Rate
4. Number of Deaths
5. Number Examined
6. Tuberculosis, All Forms
7. Latent Syphilis
8. Other Syphilis
9. Parasitic Diseases & Other
10. Malignant Neoplasms of Digestive Organs & Peritoneum
11. Malignant Neoplasms of Respiratory System
12. Malignant Neoplasms of Breast & Genitourinary Organ
13. Malignant Neoplasms of Other & Unspecified Sites, Including Thyroid
14. Allergic Disorders
15. Diseases of Thyroid Gland
16. Diabetes Mellitus
17. Avitaminosis & Other Metabolic Diseases
18. Diseases of Blood & Blood Forming Organs
19. Vascular Lesions Affecting Central Nervous System
20. Other Diseases & Conditions of Eye, Other than Inflammatory, Including Cataract
21. Diseases of Ear & Mastoid Process
22. Arteriosclerotic & Degenerative Heart Diseases
23. Other Diseases of Heart
24. Hypertensive Heart Disease
25. Other Hypertensive Heart Diseases
26. Diseases of Arteries
27. Diseases of Veins & Other Diseases of Circulatory System
28. Bronchitis
29. Other Diseases of Respiratory System Excluding Influenza, Pneumonia, Common Cold
30. Diseases of Stomach & Duodenum
31. Other Diseases of Intestines & Peritoneum except Hernia & Appendicitis
32. Diseases of Liver, Gallbladder, & Pancreas
33. Nephritis & Nephrosis
34. Other Diseases of Urinary System
35. Arthritis & Rheumatism, except Rheumatic Fever
36. Osteomyelitis & Other Diseases of Bone & Joint
37. Other Diseases of Musculoskeletal System
38. Height
39. Weight
40. Systolic Blood Pressure
41. Diastolic Blood Pressure
42. Heart Size Transverse Diameter
43. Thoracic Cage Width
44. Heart Trans. Diam./Thor. Cage Width
45. ECG Normal
46. ECG Suggesting Myocardial Ischemia
47. ECG Suggesting Myocardial Infarction
48. Hemoglobin
49. Hematocrit
50. Sedimentation Rate
51. Total White Blood Cell Count
52. Neutrophils Percent
53. Lymphocytes Percent
54. Monocytes Percent
55. Eosinophils Percent
56. Basophils Percent
57. Cholesterol
58. Uric Acid
59. Proteinuria
60. Glycosuria
61. Blood in Stool
62. Parasites in Stool

 

Appendix Tables B

1. Stomach Cancer
2. Lung Cancer
3. Breast Cancer
4. Uterus Cancer
5. Thyroid Cancer
6. Lymphatic & Hematopoietic Cancer
7. Cancer except Lymphatic & Hematopoietic Cancer
8. Benign Neoplasms
9. Incidence of Benign Tumor
10. Uterine Fibroma
11. Benign Neoplasms of Digestive System
12. Lipoma
13. Diseases of Thyroid Gland
14. Simple & Unspecified Goiter
15. Nodular Goiter
16. Thyrotoxicosis with or without Goiter, Congenital & Acquired Hypothyroidism
17. Thyroiditis
18. Cataract
19. Diseases & Conditions of Eye, Other than Inflammatory Diseases, Excluding Cataract
20. Mean Corpuscular Volume (MCV)
21. Mean Corpuscular Hemoglobin (MCH)
22. Mean Corpuscular Hemoglobin Concentration (MCHC)
23. Sedimentation Rate, Excluding Outliers
24. Sedimentation Rate, Geometric Mean
25. Sedimentation Rate, Excluding Anemia, Cancer, & Thyroid Disease