BMJ Open 3:e001847 doi:10.1136/bmjopen-2012-001847
  • Epidemiology
    • Research

Spatial analysis of health effects of large industrial incinerators in England, 1998–2008: a study using matched case–control areas

  1. Peter J Diggle1
  1. 1Faculty of Health and Medicine, Lancaster University, Lancaster, UK
  2. 2Centre for Public Health, Liverpool John Moores University, Liverpool, UK
  1. Correspondence to Nicola F Reeve; n.reeve{at}
  • Received 26 July 2012
  • Revised 5 December 2012
  • Accepted 21 December 2012
  • Published 25 January 2013


Objectives To assess whether residential proximity to industrial incinerators in England is associated with increased risk of cancer incidence and mortality.

Design Retrospective study using matched case–control areas.

Setting Five circular regions of radius 10 km near industrial incinerators in England (case regions) and five matched control regions, 1998–2008.

Participants All cases of diseases of interest within the circular areas.

Primary and secondary outcome measures Counts of childhood cancer incidence (<15 years); childhood leukaemia incidence (<15 years); leukaemia incidence; liver cancer incidence; lung cancer incidence; non-Hodgkin's lymphoma incidence; all-cause mortality; infant mortality (<1 year) and liver cancer mortality.

Results The estimated relative risks for case circles versus control circles for the nine outcomes considered  range from 0.94 to 1.14, and show neither elevated risk in case circles compared to control areas nor elevated risk with proximity to incinerators within case circles.

Conclusions This study applies statistical methods for analysing spatially referenced health outcome data in regions with a hypothesised exposure relative to matched regions with no such exposure. There is no evidence of elevated risk of cancer incidence or mortality in the vicinity of large industrial incinerators in England.

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