Technical Report No. 11-70

JNIH–ABCC Life Span Study Hiroshima and Nagasaki. Report 5. Mortality and radiation dose, October 1950-September 1966

Beebe GW, Kato H, Land CE

 

Editor’s note:

The following journal articles, based on this ABCC technical report, were published in the scientific literature:
Beebe GW, Kato H, Land CE: Studies of the mortality of A-bomb survivors. 4. Mortality and radiation dose, 1950-1966. Radiat Res 48:613-49, 1971
Beebe GW, Kato H, Land CE: Studies of the mortality of A-bomb survivors. 4. Mortality and radiation dose, 1950-1966. Hiroshima Igaku [J Hiroshima Med Assoc] 26:418-39, 1973 (in Japanese)

 

Summary: Mortality by Cause, Distance, and Dose

The important new finding emerging from this analysis is the increased incidence of cancer (except leukemia) in the 1962-1966 period among those exposed to the greatest amount of radiation in 1945 (180+ rad). For none of the individual sites is the evidence of relationship as strong as it is for all sites combined. It is therefore tentatively concluded that a late, general carcinogenic effect has begun to make itself manifest. It is estimated that incidence may have been increased by about 20% for each 100 rad, for cancers terminating fatally in 1962-1966.

For all natural causes of death except leukemia the discrepancy between observed and expected deaths in the high-dose group in 1962-1966 is somewhat larger than that for malignant neoplasms (except leukemia) alone. The specific numbers are:

 

Editor’s note:

Table can not be rendered.

 

It cannot be definitely concluded that causes of death other than the malignant neoplasms have not also been increased by the radiation received in the high-risk group, but the analysis does not suggest that such is the case. In the eight comparisons that complete the scanning of the spectrum of mortality by cause, two (infective and parasitic diseases; and senility, symptoms, and ill-defined causes) yield deficits in observed deaths, the other six, small increases.

Throughout the 16-year interval the leukemia risk remains remarkably elevated in the group exposed to the greatest amount of radiation, but is clearly on the decline. Approximate incidence for the 4-year periods is 115 deaths per 100,000 per year for 1950-1954, 95 for 1954-1958, 55 for 1958-1962, and 35 for 1962-1966. Among all 432 members of the high-risk group (180+ rad) under age 10 ATB and alive 1 October 1950, 10, or 2.3%, had died of leukemia by 30 September 1966. In addition to the clear-cut leukemogenic effect, but perhaps not altogether independent of it, there is a heightened risk of death from diseases of the blood and blood-forming organs that also appears to be sustained throughout the 16-year period. Hematologic and pathologic reviews of most of the deaths in this class have been accomplished at ABCC in connection with the leukemia detection program. This review has brought to light some cases of leukemia erroneously certified otherwise on the death certificates, but these differences in diagnosis are too few to explain the entire phenomenon. It does appear that the incidence of a variety of hematologic conditions, including aplastic anemia, may also have been increased by the radiation.

Little light has been thrown on the 1950-1954 period beyond that provided by previous analyses. With the passage of time this period can be seen in better perspective, and it is possible that, apart from leukemia, the excess deaths among heavily exposed survivors in 1950-1954 mark the end of the acute effect of the bombs, rather than provide evidence of late effects of radiation. If this were the correct interpretation, it would be anticipated that mortality in the 1946-1950 period would have been even higher, relatively, among the most heavily exposed, than is observed in 1950-1954. From the recently completed report on the 1946 Hiroshima survey it is possible to compare the mortality for 1946-1950 with that for 1950-1954 by distance ATB. Tachikawa and Kato employed many of the same methods of analysis as were used here to compare survivors exposed at varying distances ATB. Thus it is possible to compare age- and sex-standardized mortality ratios for the two time periods, although the samples are by no means the same.

 

Editor’s note:

Table can not be rendered.

 

The O/E ratios for those within 1200 m ATB are high for both sexes in each period, but in the 1946-1950 interval the O/E ratios do not differ significantly by distance for females, and in the 1950-1954 interval it is the males for whom the observed variation in mortality by distance ATB does not achieve statistical significance (P about .10 in the test for a linear increase in mortality with decreasing distance). The excess in total mortality during 1946-1950 is most clearly apparent among older males, and the excess in all natural causes except leukemia during 1950-1954 also derives largely from those aged 50+ ATB.

In the 1946-1950 period information on cause of death is much less complete, and the observed differences among distance groups originate partly in deaths form unknown causes. During 1950-1954 excess mortality may be seen chiefly in malignant neoplasms (except leukemia), diseases of the blood and blood-forming organs, and senility, symptoms, and ill-defined conditions. A tabular summary follows for group IV, both cities and both sexes combined, 1950-1954:

 

Editor’s note:

Table can not be rendered.

 

The relation between mortality during 1950-1954 and distance ATB is not clarified by comparison with the 1946-1950 period. In particular the comparison does not support the notion of an acute effect, initially large after 1945, and gradually diminishing to zero in the mid-1950s. The excess deaths from malignant neoplasms in 1950-1954 are not interpreted as evidence of definite radiation carcinogenesis for three reasons: only Hiroshima females contribute to the excess; the number of deaths is none too large for a discrepancy selected from among hundreds of comparisons; and the excess in 1950-1954 is not sustained, but disappears and does not definitely reappear until the 1962-1966 period. In 1954-1958, in fact, the probability of dying from cancer for subjects in group IV is reliably below that for subjects in group I. Figure 7 provides an age- and time-specific comparison of groups I and IV with respect to the probability of dying from malignant neoplasms (except leukemia), and from all natural causes except malignant neoplasms. Groups I and IV appear to be quite homogeneous in regard to the probability of dying from natural causes other than cancer in each time interval but not from cancer. In Figure 8 the age-specific ratios of cancer deaths (except leukemia) during 1962-1966 per 1000 survivors living 1 October 1962 are plotted for two T65 dose groups, those with 0-9 rad, and those with 40+ rad. Although deaths in the high-dose group are none too large, and the curve somewhat irregular, the suggestion is strong that all survivors, or all under age 60 ATB, suffered some increase in the risk of dying of cancer in this interval. In 1962 those aged 60+ ATB were aged 77+. Whether the increase in relative risk is a decreasing function of age ATB cannot yet be determined from these data. As noted earlier, in dose-specific terms the increase in cancer mortality during 1962-1966 appears to be approximately 20% per 100 rad received. This contrasts with an average increase of more than 600% per 100 rad in the base-line risk of leukemia, averaged over the entire 16-year period. As an estimate, the 20% must be regarded as still very approximate. Although the linear trend is significant at the .02 level, a more certain reading on the existence of the effect must be sought from a larger amount of material accumulated over a longer period of time. Since the effect seems not to have existed much before 1962-1966, even if real it may not continue thereafter at the same level.

 

Editor’s note:

Figures can not be rendered.

 

That deaths from causes other than leukemia and other forms of cancer seem not to have increased, either generally or according to an age- and time-specific pattern (Figure 7), constitutes evidence against the existence of accelerated aging. It remains possible, of course, that the youngest ages ATB will manifest a deviant pattern in this respect in future years. By 1966 those under age 10 ATB were under 32 years of age. For most of the older groups ATB, however, the experience through 1966 should be definitive enough, and all the observed mortality effects seem better explained in terms of more specific relationships between ionizing radiation and individual diseases or groups of diseases. These findings stand in contrast to those of Seltser and Sartwell on U.S. radiologists.

 

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 Tables

1. Percentage of migrants from city among those alive 1 October 1962, Selection I in city ATB
2. Relation between migration status in 1962-1964 & mortality in 1962-1966, Selection I
3. Regrouping of ICD cause of death & control counts for deaths in the total sample & exposed, 1950-1966
4. Deaths/1000/year in 1955 & 1960, all Japan, Hiroshima City, & Nagasaki City
5. Observed deaths by cause, Proper Part of Mortality Sample, 1950-1966, & deaths expected on basis of rates for all Japan
6. Observed/expected deaths, Proper Part of Mortality Sample, 1950-1966 by cause
7. Observed/expected deaths, Proper Part of Mortality Sample, 1950-1966 by age ATB
8. Deaths classified by underlying cause & principal autopsy diagnoses with confirmation & detection rates 1950-1965, JNIH-ABCC Life Span Study
9. Distribution of autopsy diagnoses for deaths in Proper Part of sample 1961-1966, subjects with T65 dose estimates
10. Comparison of T57 (York) & T65 (Auxier) air-dose curves
11. Extended Mortality Sample by total T65 dose
12. Deaths over time, & availability of T65 dose estimates
13. Observed & expected deaths, all causes by total dose, 1950-1966
14. Observed & expected deaths, all causes by distance
15. Observed & expected deaths, all causes, survivors & not in city ATB, 1954-1966, Hiroshima females
16. Observed & expected deaths, all causes by year of death & T65 dose, 1950-1966
17. Observed & expected deaths, all causes by sex, city, & T65 dose, 1950-1966
18. Observed & expected deaths, all causes by year of death & distance, 1950-1966
19. Observed & expected deaths, all causes by sex, city, & distance, 1950-1954
20. Observed & expected deaths, accidents, poisoning, & violence by year of death & T65 dose, 1950-1966
21. Observed & expected deaths, suicide by year of death & T65 dose, 1950-1966
22. Observed & expected deaths, all natural causes ex-leukemia by year of death & T65 dose, 1950-1966
23. Observed & expected deaths, all natural causes ex-leukemia by sex, city, & distance, 1950-1954
24. Observed & expected deaths, all natural causes ex-leukemia by sex, city, & T65 dose, 1962-1966
25. Observed & expected deaths, tuberculosis by year of death & T65 dose, 1950-1966
26. Observed & expected deaths, tuberculosis by sex, city, & T65 dose, 1950-1966
27. Observed & expected deaths, infective & parasitic diseases ex-tuberculosis by year of death & T65 dose, 1950-1966
28. Observed & expected deaths, leukemia by year of death & T65 dose, 1950-1966
29. Observed & expected deaths, all malignant neoplasms ex-leukemia by year of death & T65 dose, 1950-1960
30. Observed & expected deaths, all malignant neoplasms ex-leukemia by sex, city, & distance, 1950-1954
31. Observed & expected deaths, all malignant neoplasms ex-leukemia by sex, city, & T65 dose, 1958-1962
32. Observed & expected deaths, all malignant neoplasms ex-leukemia by sex, city, & T65 dose, 1962-1966
33. Observed & expected deaths, malignant neoplasms of gastrointestinal tract by year of death & T65 dose, 1950-1966
34. Observed & expected deaths, malignant neoplasms of gastrointestinal tract by sex, city, & T65 dose, 1950-1966
35. Observed & expected deaths, malignant neoplasms of gastrointestinal tract by sex, city, & T65 dose, 1962-1966
36. Observed & expected deaths, cancer of stomach by year of death & T65 dose, 1950-1966
37. Observed & expected deaths, cancer of stomach by sex, city, & T65 dose, 1950-1966
38. Observed & expected deaths, cancer of stomach by sex, city, & distance, 1950-1954
39. Observed & expected deaths, cancer of stomach by sex, city, & T65 dose, 1962-1966
40. Observed & expected autopsy diagnoses of stomach cancer by year of death & T65 dose, 1961-1966
41. Observed & expected deaths, cancer of large bowel, liver, & pancreas by T65 dose & site, 1950-1966
42. Observed & expected deaths, cancer of liver & biliary tract by sex, city, & T65 dose, 1950-1966
43. Observed & expected deaths, malignant neoplasms of respiratory system by sex, city, & T65 dose, 1950-1966
44. Observed & expected deaths, malignant neoplasms of respiratory system by year of death & T65 dose, 1950-1966
45. Observed & expected deaths, cancer of bronchus, trachea, & lung by sex, city, & T65 dose, 1950-1966
46. Observed & expected deaths, cancer of bronchus, trachea, & lung by year of death & T65 dose, 1950-1966
47. Observed & expected deaths, cancer of female breast by T65 dose, 1962-1966
48. Observed & expected deaths, cancer of uterus by city & distance, 1950-1966
49. Observed & expected autopsy diagnoses of cancer of uterus by year of death & T65 dose, 1961-1966
50. Observed & expected deaths, cancer of other & unspecified sites by year of death & T65 dose, 1950-1966
51. Observed & expected deaths, cancer of other & unspecified sites by sex, city, & T65 dose, 1950-1966
52. Observed & expected autopsy diagnoses of benign neoplasms & neoplasms of unspecified nature by year of death & T65 dose, 1961-1966
53. Observed & expected autopsy diagnoses of benign neoplasms & neoplasms of unspecified nature by sex, city, & T65 dose, 1961-1966
54. Observed & expected deaths, allergic, endocrine system, metabolic, & nutritional diseases by year of death & T65 dose, 1950-1966
55. Observed & expected deaths, allergic, endocrine system, metabolic, & nutritional diseases by sex, city, & T65 dose, 1950-1966
56. Observed & expected deaths, allergic diseases by year of death & T65 dose, 1950-1966
57. Observed & expected deaths, allergic diseases by sex, city, & T65 dose, 1950-1966
58. Observed & expected deaths, diabetes mellitus by sex, city, & T65 dose, 1950-1966
59. Observed & expected deaths, diabetes mellitus by year of death & T65 dose, 1950-1966
60. Observed & expected deaths, endocrine system, metabolic, & nutritional diseases by sex, city, & T65 dose, 1950-1966
61. Observed & expected deaths, endocrine system, metabolic, & nutritional diseases by year of death & T65 dose, 1950-1966
62. Observed & expected deaths, diseases of blood & blood-forming organs by year of death & T65 dose, 1950-1966
63. Observed & expected deaths, diseases of blood & blood-forming organs by sex, city & T65 dose, 1950-1966
64. Observed deaths from diseases of blood & blood-forming organs by T65 dose & result of hematologic review, 1950-1966
65. Observed & expected autopsy diagnoses of anemia by year of death & T65 dose, 1961-1966
66. Observed & expected autopsy diagnoses of other diseases of blood & blood-forming organs by year of death & T65 dose, 1961-1966
67. Observed & expected deaths, diseases of nervous system & sense organs by year of death & T65 dose, 1950-1966
68. Observed & expected deaths, diseases of nervous system & sense organs by sex, city, & T65 dose, 1950-1966
69. Observed & expected autopsy diagnoses of hemorrhage, embolism, & thrombosis of central nervous system by sex, city, & T65 dose, 1961-1966
70. Observed & expected autopsy diagnoses of hemorrhage, embolism, & thrombosis of central nervous system by year of death & T65 dose, 1961-1966
71. Observed & expected deaths, diseases of circulatory system by year of death & T65 dose, 1950-1966
72. Observed & expected deaths, diseases of circulatory system by sex, city, & T65 dose, 1950-1966
73. Observed & expected deaths, major diseases of circulatory system by sex, city, & T65 dose, 1950-1966
74. Observed & expected autopsy diagnoses of rheumatic fever or rheumatic heart disease by year of death & T65 dose, 1961-1966
75. Observed & expected autopsy diagnoses of endocarditis & myocardial degeneration by year of death & T65 dose, 1961-1966
76. Observed & expected deaths, diseases of respiratory system by sex, city & T65 dose, 1950-1966
77. Observed & expected deaths, diseases of respiratory system by year of death & T65 dose, 1950-1966
78. Observed & expected deaths, disease of digestive system by year of death & T65 dose, 1950-1966
79. Observed & expected deaths, diseases of digestive system by sex, city, & T65 dose, 1950-1966
80. Observed & expected deaths, peptic ulcer & cirrhosis of liver by year of death & T65 dose, 1950-1966
81. Observed & expected deaths, nephritis & nephrosis by sex, city, & T65 dose, 1950-1966
82. Observed & expected deaths, nephritis & nephrosis by year of death & T65 dose, 1950-1966
83. Observed & expected deaths, other diseases of genitourinary system by year of death & T65 dose, 1950-1966
84. Observed & expected deaths, symptoms, senility, & ill-defined conditions by year of death & T65 dose, 1950-1966
85. Observed & expected deaths, symptoms, senility, & ill-defined conditions by sex, city, & T65 dose, 1950-1966
86. Observed & expected deaths, symptoms, senility, & ill-defined conditions by sex, city, & distance, 1950-1954
87. Classification of early entrants by earliest proximity to hypocenter
88. Observed & expected deaths, all causes (exposed, early entrants, & late entrants) by sex & city, 1950-1966
89. Observed & expected deaths, accidents, poisonings, & violence (exposed, early entrants, & late entrants) by sex & city, 1950-1966
90. Observed & expected deaths, suicide (exposed, early entrants, & late entrants) by sex & city, 1950-1966
91. Observed & expected deaths, all natural causes ex-leukemia (exposed, early entrants, & late entrants) by sex & city, 1990-1966
92. Observed & expected deaths, infective & parasitic diseases (exposed, early entrants, & late entrants) by sex & city, 1950-1966
93. Observed & expected deaths, leukemia (exposed, early entrants, & late entrants) by sex & city, 1950-1966
94. Observed & expected deaths, malignant neoplasms ex-leukemia (exposed, early entrants, & late entrants) by sex & city, 1950-1966
95. Observed & expected deaths, various natural causes other than neoplasm (exposed, early entrants, & late entrants) by city, 1950-1966

 

List of Figures

1. Frequency of history of epilation by T65 dose & city
2. Observed/expected deaths from all causes by year, distance, & dose groups
3. Observed/expected deaths from all causes by T65 dose & age ATB, 1950-66
4. Observed/expected deaths from all causes by T65 dose & age ATB, 1950-54
5. Observed/expected deaths from all causes by year, distance, dose groups, & age ATB
6. Observed/expected deaths from leukemia by T65 dose, Hiroshima & Nagasaki, 1951-66
7. Deaths from all causes except malignant neoplasms & all malignant neoplasms except leukemia by year, distance groups I & IV, & age ATB
8. Deaths from malignant neoplasms except leukemia/1000 alive 1 October 1962 by T65 dose & age ATB, 1962-66, both cities and both sexes combined
9. Deaths from all malignant neoplasms except leukemia, distally exposed vs not in city ATB, by age ATB, both cities and both sexes combined
10. Deaths from all natural causes except malignant neoplasms, distally exposed vs not in city ATB, by age ATB, both cities and both sexes combined

 

Appendix Tables A

1. Observed & expected deaths in Selection I exposed 1800+ m in Hiroshima & 2000+ m in Nagasaki compared with Selection II subjects, by city & year of death
2. Relation between mortality status & inclusion in gorup 1 or group 2 at Selection I, 1945 JC cases with acute radiation symptoms
3. Survivors exposed within 2500 m by T65 dose & sample component
4. Observed & expected deaths: All causes (survivors within 2500 m) by sample component, Hiroshima & Nagasaki, 1950-66
5. Observed & expected deaths: All causes (survivors within 2500 m under 10 years of age ATB) by component, Hiroshima & Nagasaki, 1950-66
6. Observed & expected deaths: All causes (survivors within 2500 m under 10 years of age ATB) by component, Hiroshima & Nagasaki, 1950-66
7. Observed & expected deaths: All natural causes ex-leukemia (survivors within 2500 m) by sample component, Hiroshima & Nagasaki, 1950-66
8. Observed & expected deaths: All natural causes ex-leukemia (survivors within 2500 m) by component, sex, & city, 1950-66
9. Observed & expected deaths: Accidents, etc. (survivors within 2500 m) by sample component, Hiroshima & Nagasaki, 1950-66
10. Observed & expected deaths: Accidents, etc. (survivors within 2500 m) by component, sex, & city, 1950-66
11. Definition of basis vectors for analysis of T tables
12. Alternative hypotheses and tests used in the analysis of T tables
13. Definition of basis vectors for analysis of D tables
14. Alternative hypotheses and tests used in the analyses of D tables
15. Definition of basis vectors for E tables
16. Alternative hypotheses and tests used in the analyses of E tables
17. Definition of basis vectors for sample component tables
18. Alternative hypotheses and tests used in the analysis by sample components
19. Deaths from all causes by age ATB, sex, city, & total T65 dose, 1950-66
20. Exposed subjects alive on 1 October 1950 by age ATB, sex, city & total T65 dose
21. Subjects not in city ATB, by age ATB, sex, city, & early entrants classification, alive 1 October 1950 (Nagasaki), 1 October 1954 (Hiroshima)