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Council for Tobacco Research

[Regarding Polio and Tuberculosis As Predisposing Factor in Lung Cancer]

Date: 31 May 1966
Length: 361 pages
CTRMN002943-CTRMN003303
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25 Sep 1995
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Ctrmn00000667-6967

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Little, C.C., Tirc
Macdonald, E.J., M.D. Anderson Hospital And Tumor Inst
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118
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LETTER
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003
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rnq30a00

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1 !k - / .. ~. 1.. - THE UNIVERSITY OF TEXAS • M. D. ANDF RSON HOSPITAL Vf; AND TUMOR JNSTJTl1 TEXAS MEDICAL CEti'TER Mql5iUr1 25 .. r . Dr. Clarence Cook Little Tobacco Industry Research Committee 150 East 42 nd Strest~• . - New York 17, 2y'ew York Dear Dr. Little: May 31, 1966 • THIS DOCUP,1ENt SUBIECT. t0 198~ t~ ;,-pj;;E;,11NATI0M OP,D.-R ; !N R_ OGERS ;,f~p D_UKE CASES. In reply to your telephone request the following information is in my files either already coded or pending coding. Through August of 1965, we had 58, 593 register ed patients at the Ander son 1-iospit.al. ` For each of these we have a 200 Item code sheet filled out upon discharge and kept current with additional follow-up. I call this the anticipatory cod.e because it anticipates 80% of a11 requests of the clinicians. Enclosed is a copy of the basic-data through 1961. . ,•. I have already off the computer, an analysis of the meaning of the changing classification of causes of death. Expect a monograph on this before the end of the year. Many unexpected dividends are coming in from this. - cancer incidence figures for the entire state of Nevada for five years, 1959-1963. Here we have a large Basque population, (unusual blood type group) and a large Mormon population. I set -up the plan and am directing the analysis. We have, in addition, 140, 000+ abstracts from 45 hospitale. Two complete counties are among them, Travis where Austin is located and El Paso. The reports on these give true incidence for Latin Americans and Negroes, as we11 as Anglo Ame ricans. Also from our office sobn - through the Fleischrnan Cancer Center in Reno, Nevada, will come true •_ , ~~~~~ ~`"~~'~ ~.~t~~2943
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01 A -~ THIS DOCUMENT SUBIECT TO AUG. nj, 1985 NON•DiSSE~1IP;ATiON GFDFR IN RG~Eic_ h„D DUKE Cn,,:S, Have coded and tabulated special study data on practically every site of cancer. We are now at work on a rehabilitation program which is promis- ing since we are coding social service data not hitherto available. -Our department of social service beats any I have ever:• seen. They really take care of the patients. ,` • -1~ Rapport with the Houston Department ci Health makes it possible to have almost any kind of study done there. The popula.tion of metropolitan Houston is 1.3 million. Until Sabin, we were an endemic area of polio. There is a lot of tuberculosis here among the Latin Americans. It is dif:icult to ever get a job again, once you have a history of tuberculosis, not only here, but everywhere. So education doesn't do much good. The wage earners work until they drop. History of tuberculosis is given in the pre- 1941 books, e, g. , Ewing's Tumors, as the principal predisposing factor in lung cancer. These are our major sources of information. ' Sincerely, - P441 r u. ~.7.~f Eleanor J. M donald " Epidemiologist - EJN:: j1 CTR 5022 `~~~~R HN 002944
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Jua. 3, 1966 . • THIS DOCUMENT SUBJECT TO AUG. 19$5 NON •DiSSEN11iikTION ORD--- IN RJ,iEP~, n:,v u:Jh:E CA.iE.S. ,- I '. ;V:7 miss L11san! d. Ka,cdG0.1d , • ! ~,. . . 6723 . btTi•.net Drili'e $041itOG, Z'fSi,t. 77M ;. •~~~ t ' .. Dsar 3ti.s s I~a~ns,l~d! J,~t' 'l. snd tbst ve s+sy l.e1 t1~W to, tonsult yoa m stich a~ttt.~.rs h~n (`~ s a~r u tb ri ti tb V t d i d t ti d ' .rs r. s camss o ..i 1 7!J{i2 Cf a~ al ~l g f~ p,1D~+ • . , 1. # , •, , • ; " ,. . : •. ` . ~ t 1 ;. 1 •. . j % r ' t~ ls t l tt ~ id ' q ya o at ~ Ta sa tia at n~ r~ ars aa .9 -f•"• tbdrt aa atauns.l r*tainrs' in the a.ount orf 410,000 is szt,isisrt.aay •', iI ~'- to rw sa3 w aacloa" oaa cD.cac to wat' ordar ia thst smocat !cr "` the rtsr ecmasacin6 Jtm 1', 1966: Siace w caasider rm au ' ind.ysadent coatrictor aar" not an .vlap", ve srv s.Yi~ po ' tritnbolRtngs !ar tsx ar aocial aecuritj y=,po.a, a.lthossgh the `»tasnsr sayotmrt .riu at coarsa b. :.rport.d at the .md of the 1.ar.to the Iat4s'ail B.rrs=u bsrrie.m Tom 10990 . ~ Ve lOa trsit pt*sure. . .1 . i8• A •i . .,.; . t, Y ,'. WI~, t sY tsr`.1.,. i larvard ~•• toaaassociatian vith you vith ° Ver7 truly Taas 0 , CT;R ~ 0~3 ! C T R1. N H ~'~ ~~' S. 1 WE- *;'
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THIS DOCUMENT SUBIECT• TO AUG. 20, 19$5 ~,,,h J1~~:r,1iNATIGN ORDER IN ROGERS AND DUKE CASES. 2.-,4s: Me-•.=.,^- J. ::Pacd ~^l• 67,23 IL-i:ro A0,:.r,z^=, ^:*--n s 77e25 . d.?1;~-y„e1 t'^t Yv: h..~^= M,.~=d to rS;•c L.^ Lft:rice e..3 cOL.":., a1 = L.:rtec-S to c--.d th--t S.~ L'^y f Ccl a"ma to c.^.a^...^.Lt YC'1 Cm LLC~' ^;~ta3~ .r h~ t'.i- to d='i--Z t~h$ S•CLT t8 .t'..."' ~• ~"'+AC. L:'C ....~. ~.C'. "t of .•`.,_ ~~f•rCa11` in ~~~-CjV~rJ ~ G.^.v:.i...CsJ`~ to yra r.!4 ke c_^? =s o^ ch=c`: to yc= c=..w ia ti:--t tc= £:r.es %e corsic~e:- , u •.r ~c~ ccaw-sctx nr..: ror an ~? o, ~c, w c.-~ : ~~ r.o '_L-~;s fcr tr:c o: t'r.2 tr'".:".::." ti'ill C? cCt=LQ b-- at tL--- C:-A of tJ 5:.= to tse L-tc•-•.al fccsxv_..•• S;~-ics = Fa ` 10;9. fc locy to cr.= ascxs 3.tica %.-ith y-ci with r7Cet Ve.:•? t..n:?;,• v. T. Ec, t F=c•stivn `imct=- T+'=?:c*- c-1 . V- . . CTR 5024 , C~4R #1H ~'•~O2946
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THE UNIVERSITY OF TEXAS .X M. D. ANDE RSON HOSPITAL AND TUMOR INSTITUTE TEXAS )d_°DICAL CET.'TER HOUSTO2: 77021 January 16, 1967 TN1S D%'T'ENT SURIECr T• _ Ir/ nVUCR~ n.J UJnC Ln„e,, Mr. W. T. Hoyt Executive Director ' The Council for Tobacco Research - U. S. A. 633 Third Avenue New York, N. Y. 10017 Dear Mr. Hoyt: - Under separate cover we are returning to you the two booklets on smoking that you loaned us. We found the information very helpful and thank you for the use of the books. < << < ~~~ ~ cdonaid Epide:niologia t E?M:as C T R C `f R N N 002 ~4.,~'
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, TNIS DOCUMENT SUBJECT TO AUu. CO. 1985 ;%„~1• Di,;~E.,inATIG~; u2C;R Ih RvGEri,> h.iU UudE plia Ll,eaa~r J. Xaadoar.l4 8pid-iologiat . . K. D. Aadar son 8otpital an! S'mor Znatitute Te zaa )Scdi c al Centar ~~ ?!~T 1, 1967 r ~ ; Bouaton a9, Tezaa ~7'/ D1S,~ . .~ . De ar F.Le aaoT s I do not kao++ vhetber rou aare seen the attacbGd paper o2' Aot but, in aLQ event, t}]OSlgbt you ab o3l.d . Af•te r Jvu have hed a cha.nce to loor at . it, any iagz•tasions that Tou could reflect t2rougb to us would De sost acpp.reciated. . ;. . Witb all beat vi:bet, , , .. i , , , Sincerely, iT7a : e.Y att. EztcutiTe Director X. S. Hoyt ~ . . , , ., , , - , .: . . C T R t~ I ~R N~`~ 0~8~'. ~:~~'~° ~
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, , Y 1 t . / f }J fs , i 4 , ,I 1~ • . '1 i.nQSaQ ?iiisZ er 3cdaaal ; r . . . 6723 Bertner Drire Baustoa, Zraxa.s 77025 ' !Denr Y1as Krscdanald: I ' .'S r ; ~ f , . X , Attacbed Y+cxi wi11 tinir cbecr 13853 cover ~' an dllaLta1 ='etaSDCr StiGC tOr 4. yoair 'eananlting services for tLe Te e r ea®encin "g ~e I 1967:/la in th t , .e paa, w conaidc: 'yron an' inriapee&ent coati-JYctor aad xiot an enploYre; tberefore,' k ue naldi~ ao .rit.hholdings for tax or s oci al se curity purpoa es .. The retainer e>xrun t vill, oS course, be reparted rt tbe end ot t.be y,ear t' the Ia'teraal Rrreuve Servic ~ ~ ~ ~ 7orsa i ~199 • f 1 Kith a11 bett xiahaa .a : . ' 8ineerel,y, .~ . . , . . 1 , W. 2 . Sayt ; Ene cut ive Di.re c tor , ~..~,. f J1;l / 1 ~ .. c . ' : ..: r i I.'fi }r 1 S~l~+ '' yy i1 J c~ ! .. 1 l N:H:ek att.' , , . J ,.j. ~ , , June 7, 1967 ~..... ~,_. .,,~~ THIS DOCUMENT §UBIECT' TO AUG. 20, : 1985 NGti• DiGS_ ,'1NAT(0N ORDER IN ROGERS hr\0 DUkZ CASES. '. i .\, . .~ ~ Ue I ~`f C~.'~~`I , .,. < . C T R 502~7 ' ;t
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• .i r Juze 7, 1967 TNIS DOCUMENT SUBJECT T0 AUC. 20. 19$5 N;;ti•DISSE!,','iATION ORDER c IN , .: (; .' y ' } t 1 ,. i r k.ias Llaannr )IaCdon.1,d . 0 6723 baTtr*r Ia-ire ' , BOlittClls 7`aZa•a . T7Q25 De..r xi s s Xi,:.caoo.a.la : . ' ' Attacb,.d 'raa Vill ti.ni cbecY 13$53 coveripE an anaual rstainer fee for jucir coasulting ar•rrices for tb. rt ar comwnc ing hme 1.9 1967. /ls in tbe p ai t) c ons i.d ar 7w an S aQrpe ndea t contra ctoar affi not an 1'; scpl.c7s.I tbertlore, .re ar* sss)dag ao vithDoldi.nrgi for tax Qr s oci al a c cusi ty pu.rpos e s. The retaincr emouat rrill s of car.-se , be repor{..ed at the aad of tba yesr to t.be Zsrteraal Rrreaue 6erricw aa ?ozm 1199. t t .. ~ . . . ' ~ ' With al.l best visDes, r X'".'H : eY att. - r ~`•a1 , .. 2 , I ~ . , , X. :`. Bayt , , Bxecutiv. Dirertar ri , r .. ~ s , t r CTR siacerel,y, , ~ ( c c i ~ ~+ ', } Le j ~`.0 2 ~ ~`
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. i , June ~ . ~ .~ )iiss Elee.aor Kncdonald 6723 Bertner Brive Houston, Texas 77025 f Dear }'.iss Kecdonald: s , r. .. • Aa *I mentioned pleai• excuee us for not ~ , , . . . .. . ,.r. TNIS DOCUMEFrT SUBIECT TO AUG. ~~j, IN ROGER~ A„ J DUK,'- (,AS:,,. 27, 1968 oa the phone this afternoon,' having sent your check before. 1'on vill find attached check f5339 co"rlh8 s•n anann; rete.iner fee for yovr coasulting serric.s fo: tb,e ys ar ccme n c iag June 1, 1968. A s in the pas t, vs coniider Tou an independent contxactor an3 not an erploTee; therefore, ve are nn.king no vithDoldings far tax or social security pzrposes. Tbe retainer amount vi11, of cota'se, be reported at the end of the Tsar to the Znter•aa1 Revenue Serrice on Forz J199. , , . , ..., , -. With a11 best visbes, 81nce:-e l,jr, -., KTH:eY att. it . T. Hoyt Lxecutivre Bir.ctor r CTR . r l , t i . , 1 C T RN N 1-1
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~ ~~-^;~M.1t7 Octobe: 18, 1968 ~ ' Y1sa Elennor Xncdonald 6723 Sertner Drive . Bautton, Texas .77025 ~ • i . De as N.i a a N.ncdonrld r ThaaY rou inery mucb for rour iatere s t in ~ ~ ~•i. t . , . . ~ , +, 1 t .• S CTR dnd coments 00 the nattrial Vhich I r.centl,y sent you. We chall look torvard to sM idena or anal,yaes that roa .'. r.r,T aah* of this naterici in the tutnre. 7ocr cooperntion hss b.en nost helpful. •. •, t . . J • . . . . i: . . Y:th Yi.ad regarda ~ ~ • . , Sincerei,q, ..~~ TNIS DOCUMENT SUBIECT TO•A'Ju, fJ, 1985 ., Clarence C. Littls; 8c. Scientific Director t . t . ... ....,.+1 ~ 50~0 t . . t , ,
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THIS DOCUMENT SUBJECT TO AUG. fJ, 1Sa5 tjU~j•DWE'.:;NATION ~ June 12, 1969 IN ROGEr: h,,U Gjr.E (,~~LS,~• ~:/ . " SI a e Lle nnor Me c doaald 672j bartxr IIrive ; + ,• ~• Aouston, Texas 77025 Deer Y1e.!?{acdonald: • e: v ce on a ernr ora, Reveaoe 9y . course, be rtpoe ae en oe year toe itdt thdf th th ? i S * t l ~1 I 000.00, covering .n auzaual retainer fee enount of a10 Yon vill fi.nd attached check W51 in the # , ~. I Ir for your consulting .ervicea for ttie year eac=enci•nb .'.June 1, 1969.`• 'A•$ in the paat, ve coasidar yon an !{'~ independent cantracto.: and not an eapleyes; therafore, .•e ere t`nking' no xit::.`.oldinga for tax or social : ' !f ': ;~• e cur i ty ptiupo i . t. Tte re t ai ne r =onnt rill i of ~ .t ncere.ly~ J W.T.Rvyt ~ Exe c ut i ve Dire ctar , 1 • ~ . .• , , r J, r, • CTR 5 0 3 1 , ;. , , ,:. ' ~~~~ ~~ ~
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THE UNIVERSITY OF TEXAS M. D. A?:DERSON HOSPITAL AND TUMOR I2.'STIME AT HOUSTON Tezu Medual Centtr Hoaatoc, Tena 710:s June 17, 1969 TNIS DOCUTAENT SUBIECT TO AUG. 20, IS8~ NJI~-D SS;~,t h;,TIO'O~; c3 IN R,iZq Mr. W. T. Hoyt Executive Director T'ne Council for Tobacco Research 633 Third Avenue New York, New York 10017 Dear Mr. Hoyt: Yous cl~eck for consulting services was received yesterday. Sincere good wishes, ~ ~A ~ Eleanor J. Macd~,ald Epider.zioiogist ~.':._:k-7
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~ .t 4 June 2, 1970 . .s! ~..' ~. ~ . Kiss El.anor J. t4aodonald 6723 Bertner Drive Houston, Texas 77025 Dear Kiss Kecdonalds You will in the $10,000.00, coverinc an annual retainer fee consult,ing sarvices for the year ooe.oanclnq THIS DOCUMENT SUBIECT TO AUG. tii. 1985 NON•DISSEtdiNATION ORC_a .. • IN RuCER; AnD QUYE CAS:S. i ). As in the past, we conaider you an independent oontractor and not an •a>playe.i thar.fore, ve are making no vithholdings. for tax or social security purposes. The retainer aaot:nt find att.ac'sed che dc vill, of course, be reported at the end Internal Revenue Service on Torm f199. • `. . Kith all best wishes, Sinoerely, s. W. T. Hoyt Executive Cirector KTH , s:k att. C T R of the year to the 5n33
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. ..., ;+ - '' . r . ~~.. , July 9, 1971 THIS DOCUMENT SUBJECT T0 AU6. n~, 1955 1i.,iv-D(S~Eh:(NnilOi ORDE~ 1N ROGER~ AhD D` CASES. .. M1ea Eleanor J. Macdonald . . 6723 Serts»r Drive - ; Houston, Texas 77025 • ~ Dear rlss xacdonaldc , l You vill find attadied check in the amount of $10,000.00, covering an annual rrtainar fee for your consulting services for the year coc=oencing Jctne 1, 1971. Aa in the past, ve consider you an independent contractor and not an armloyeei therefore, wa are naking no wit?Lholdings for tax or social security purposes: The retainer a7oount will, of course, be reported at the end of the year to the Internal x,avanu. Servioe on ?orn f199. . ~ . . • . . Mi th a11 bes t wi ahes , .. ' Sincerely, W. T. Hoyt Lzecutlce Vice President K^.'H:tk att. 11 CTR Sn;T4 ~ C T F-11 0 122 C ~ ~ :-
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THE UNIVERSITY OF TEXAS M. D. ANDERSON HOSPITAI AND TUMOR INSTITUTE Teut Wee-cut Ctnttr Houston, T.us 77C25 July 13, 1971 Mr. W. T. Hoyt Executive Vice President The Council For Tobacco Research 110 East 59th Street - New York, N. Y. 10022 Dear Mr. Hoyt: THIS DOCUMENT SUBJECT T0 ;;. 2 198' h'JhDiSjc','IPIhTION Or?;;;~ lh RS qti D k~g Cna:S. „ Thank-you very much. The standby eonsult.ation fee arrived July 12th. Very truly yours, ~ (G>71 /-'. l l ( <cf'61r~C1 Eleanor J. cdonald Epidemiologist EJM:a.m CTR 5035 .L.:: .. `02,
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THIS DOCUMENT SUBJECT TO 1985 NON-DoEmINATIOk,' IN ROGER S h,iD DUKE THE UNIVERSITY OF TEXAS M. D. ANDERSON HOSPITAI AND TUMOR INSTITl/-E Teii 4e0'cal Cenler Mouslon, Teul August 20, 1971 Robert C. Hockett, Ph. D. Associate Scientific Director The Cour.cil for Tobacco Researc : 110 East 59th Street - New York, New York 10022 Dear Dr. Hockett: 77c25 This is a rather severe critique, the kind I hate. to give. I sympathize with the authors. Perhaps they became aware as they went along that this costly and time consuming endeavor was giving no valid results. If they had presented their tables and described their dilemma this vvou.ld have been a very useful document - an effort that failed to make the computer analyze rather than to serve as a tool. However, on a precarious data and analytic base, they have drawn some firm and unwarranted conclusions. There is no basis for any conclusions in this study. You asked where it should be reviewed. In any statistical journal it will be a_•inihilated.. Irn a psychology or social science journal, its faults could conceivably be overlooked. In the Journal of the A.-n er ican Public Health Association, its fallacies might or might not be recognized. I wonder what 1`'.arv:n Kastenbaurn would think of it. Probably the same as I did. Sincerely,' ~ ea.zor J, cdonald Epidemiolo st EJM:kr Enclosure CTR 5036 y
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-nY _ .~~. July 5, 1972 ~ ., :y'~.4 ~;1. . t ' i.Y'N:'. . ; ' ~ `k.~.1:'' ~ . Y.:ss Eleanor J. ~lacdonald 6723 Bertner Drive1' :' Itouston, Texas', 77025 ~..,1.c.: . f Denr %1 acdonald3 iss 2+ Int.e:-nal Revenue Service on Porm #199. - for t+ix or social security purposes. The retainer amount will, of course, be reported at the end of the year to the. , .,. ~. f You .rill find attached check 111243 in the amouAt of $10,000.00, covering an annunl retainer fee for your " consultin9 services for the year cor.roencing June 1, 1972. As in the past, ve oonsider you an independent contractor . and nct an ec-ployee)' 'therefore, we are rutkina no ait~-hold:ngs with K:N:e.k att. Lxecvtive Vice President '`. 3 all best vishes, Sincerely, W. T. Hoyt ' J . TNIS DOCUMENT SUBJECT TO ALIG. jti1, ' 1985 ND~S f.. IN RvG:r,~ hffU Lur, ,. C T R f . ., 5n37
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~ THIS DOCUMENT SUBJECT TO AUG. ?J, 1985 NON-DISSE;,1ir„T10;, IN ROGERS hnu THE LINIVERSlTY OF TEXAS AT HOUSTON M. D. ANDERSON HOSPITAL AND TUMOR INSTITUTE T.as Y.tiut Cenu+ Houston, T.aas T7C25 . July 25, 1972 Mr. Tom Hoyt - . Executive Vice President Counci] for Tobacco Ite.earcb • U.S.A. 110 East 59th Street, ~ New York, New York 10022 . - .. ` .. • Dear Mr. Hoyt: • The fee for twelve montb's consultation has received. Thank you very much. Sincerely, EJM:kr Eleanor J. 2v~acdonald Epidemiologist been ~ i G~ CG'.~ !/! ~, (l ~L C T R C ~~a F"~k
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July 3, 1973 Miss Lleanor J. Hacdonald 6723 8artner Drivs Hou3ton, Texas 77025 Dear M.isa Macdonaldi 1N(S DOCUM£KT SUBIECT TO AJG. Ki, 1985 AJ,,-DlSSE,•11NATID,ti ORDER IN RDG:i, AnD DUK: C:,S:S. .. M . _ . .. You vill find attached check #12283 in t2he amba=t of 510,000.00, covering an annual retainer fee for your oonsulting services for the year coamenciTq June 1, 1973. Aa in t~e past, we consider you an independent contractor and not an esaloyeet therefore, we are saking ao withhold.ings for tax or eocial security purposes. The retainer arotmt will, of cou_-se, be reported at the end of the year to the Internal Ravenue Service on torm 11099.- hith all bes: vishes, Sincerely, W. T. Hoyt ti7 Executive Yice Preaident .' X^.'H e e k CTR 5 03;i ~ ' 0
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TNIS DOCU?aENT SURIECT TO AUG. 20. ORDER -, !N ROGERS AND DUKE CASES. THE UNIVERSITY OF TEXAS AT HOUSTON M. D. ANDERSON HOSPITAL AND TUMOR INSTITUTE T.ut Yb,ul Crnln Moutton, Tsul 7)025 August 14, 1973 Mr. Torn Hoyt Executive Vice President Council for Tobacco Reaearch 110 Eaet 59th Street New York, New York 10022 Dear Mr. Hoyt: The annual retainer fee for consultation services waa received while I was in Europe attending two scientific meetings. Thank you very much. 0 rJ:.::kr Sincerely, Eleanor J. M.acdonald Epidem.iologist , CTR 5040 D~'~~'~ ~
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C i TFi1S DOCUMENT SUBIECT TO AUG. ~. 1985 NON DISS:/;;~~ilJN IN ROGEr•,~ n.,u Dut„ Ch~:J. June 7, 1974 Kiss Eleanor J. `tacdonald 6723 Bertner Drive Hou.aton, Tezaa 77025 Deaz Y1sa Macdonald: M / You will find att.ached check 413179 in the aaount of $10,000.00, coverinq a.n annual reta•iner fee for your consulting se wices for the year coa®encing June 1. 1974. Xs in the pa_/st, we consider you an independent contract.,or and not an e^.nloyeet therefore, we are saak,ing no withholdings for tax or social aecuuity pu•rpoaes. The retainer amount will, of cou,-•se, be r•epor•ted at the end of the year to the Znternal Revenue Service on Forrl 01099. With all best wishes, Sincerely, 4 W. T. P.oyt P-cecutive Vice President k':N:ek att. , C1R a-09i 002-a'-163"
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A<V -j W-Im W-I~ THE LINIVERSITY OF TEXAS SYSTEM CANCER CENTER n,.. m.ab.i o.fto., No,Kwn, r.... »oil June 11, 1974 TH(S DOCUMENT SUBJECT TO AUG. `l0, . 1DOJ ~iiJiV ~ISSEtii~rATlv i CP. ~=r~ IN ROGERS ANG DUKE Cf,S:.S New York, N. Y. 10022 Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Research-USA, Inc. 110 East 59th Street 1975 arrived today. Thank you very much, Dear Mr. Hoyt: ~ ' . T •.• . . ~ . . . . . The check for consulting services through May, Sincerely, . 6W10 l . /l1,~(-a l7ja'' vi E'leanor J. jacdonald Epidemiologist EJl.::eh CTR '-') 04 ti M D ANDLRSOh'NJSI:,.tCN.JTUMORD.'S'TNTT ARoirs .mlAiA:bilit.nceCc"tn UfTRAMURA1 IROGR.iMS DMSION Owcelory Cernei!•l.en.6cal /tinnrnemi C.1Lbntror Str/ur S*bri.nau ~ [ny,ro.a,,;nii.ISciAEr lnt LII.'rv[.RS(rYCdNUJt FOllh'DAnON 7L Mlmo~ M.y/." ~R1- ~~~ ~~1 ~~~ ~~~~~~~~~~
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June 19, 1975 ,,. . Miss Eleanor J. ttacdonald 6723 Bertner Drive TFtIS DOCUME'rT SUBIECT TO AUG. 1985 tIJ(V•JiJS:.%1INA710N IH R.~GEr~ Ai~O DUh•,E w,SiS .. Hou.toc, Texas 77v95 Dear Miss ltaodonald: Toa vill find attached check /14181 in tae +moant of i10,000.00, coverinq an annnal r~et•ainer fee for yonr ooasnltinq sez-.ioss for the year oceamencinq J=,e 1, 1975. As in the past, we conaider you an independent ormtract,or and not an e•aploy.ei tbcrefor., we are nukino no vithAold.inqs for tax or social security purposes. :'tie retainer amount will, of oonrse, be reported at the end of the year to the Znternal Revenue Service on Torm t1099. . :°~ ~ t { 1 With all De•st visbes,, ~ 1 i1 1 Sincerely, I W. T. Hoyt Executive Vice President 1rrH : ek . / att. CTP ;") 0-?3 C-)
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C. I THE UNIVERSITY OF TEXAS SYSTEM `} CANCER CENTER TYa.. A/.lf..l C.wtw Aor.fe% Tyaw M?1 Jur,e 23, 1975 Mr. W. T.. Eoyt Executive Vice President The Council for Tobacco Research-USA, Inc. 110 East 59th Street • New York, New York 10022 Deax Mr. Hoyt: ~ The retainer fee just arrived, , very much. EJM:rv , '~ ~-- . . . . t. -•THIS-0bCUtiO7 SAECT TO AUG. -n , 1985 . IN ROG~R AhO Djh;; ~A„i~. r M ~ C 1 R Z-1() 44- M D M.'DUISOI.' HOSPITAL .t~D'UMOR D.'ST:TUTT Mw+.n! RiA..il'1.ev. Gwin CXTRAMUR.ti 1ROGRtiMS DMS1Oh' Owc.loty C..+c+7•l.evl~ca7/tinwi+eW C.1LMn+e.. Sn4n 3sl.ue..r [Wyn...ne.1 Ssancr Ii.! ID.TVCRSfT1' CANC[R fOUh'DAT1OA' 77v Mlmo. Mryro. C' ~~s ,
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THIS DOCUMENT SUBJECT TO AUG. ?t1. 1995 NJti•DISSPA1NATI0N ',)RD;; IN ROGERS F%.ND DsK,: ~ASE-S June 7, 1976 Kiss Pleanor J. Macdonald 6723 Bertner Drive Houstoa, Texas 77025 ~'. the year to t-he Internal Revenue Service on Forw #1099. You vill find att.adia•d check f 15186 in the anou::t of 510,000.00, covezinq an annual retainer fee for your consulting services for the year coaaencing Jume 1, ~ 1976. As in the past, ve oonsider you an independent oontrector and not an e=ployee r therefore, we are ssaking no withholdings for tax or social security purposes. The ret.a:ner s•anunt will, of course, be reported at the end of Den.r rlss Mecdonaldr ~,. .. ••~ . ' tiit2ti all best visAes,' ' ~. .. .4 ; . •.', Sincerely, . W. T. Hoyt Executive Vice Preside.zt , `'~"~ ~" ~.1 ~. `~~-h~11 4 ~` ~ `~ a
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,... r / .%-:\ \. Imp-jo-or-.. k ' i ., THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER 71...11.alo.I Qrnt.- Howecr1, T.,.. 1)0l{ June 21, 1976 Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Research-USA, 110 East 59th Street New York, New York 10022 The retainer fee has arrived, very much. -- , Dear Mr. Hoyt: Inc. 0 : ,, • -. . ... f .... THIS DOCUMENT SUBJECT T0 AUG. tU. 19UEhJ~~D;S~;';;ti~TiQ'; IN ROGEr',S AtD D'uKE Ch;c;. for which I thank you Sincerely, ~l ~GGIl/Z Eleanor J. Macdonald Professor of Epidemiology EJM: rv CTR 5041,.- 1.S D t'.'DlISOI.' HOSP T l: A~'D TUMJR C.'S77TJ'F Annti.+! 1GAa1ili,dno. Cr+tcl IX'futMUlU:1Rni.MMC DM5/0N Owcoloty CoWRnl•/,o.u/+c.'l,unrvnoti Ca!!.b»hw Sw[us U1.NLRSRI GVdC[R iDU).'DA770n' TAc MlMon M.y/fn Sa bua.m . _ . .,.._, _ . ..... .., [.vr.nent.ul Scx*rr L*k lmr' I R V11 f y.J~ ld• 2.a/'
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER Ttis~ Yrd1o.1 dnr.+ Horaon• T.a.. 1)OJ~ ` ~ November 11, 1976 Eleanor J. Macdonald Professor of Epidemiology - -- - ,.- -'r- ; ® RA1'ERIPLEASr. CORRECT RECORDS 9..nMcF« r.f.+s p814507590 ~r..m.t.a. o.,,t . • ~. ~ 2011 .-~ . . . _.- ; " Sincerely, SEND THIS PORTION TO YOUR PAYER hy.e N.ee aaa Ada.er ELEANOR J MCDONALD 6723 BERTNER DR HOUSTON 13-2671498 THE COUNCIL FOR TOB RES USA INC 110 East 59th Street New York, New York 10022 Mr. Tom Hoyt Executive Vice President Council for Tobacco Research - USA, Dear Tom: TH1S D0C1iMFKLV/fCr TO AllGJ ~ : • 1985 N5y-DlSSfr1:hATIOri OaOER • ~_ Ifi ROGER ~ AhD UK~ C~Sw~ Inc. I received this from the Internal Revenue Service with instructions to mail to you. EJM:rv Enclosure ---.---------------- 11 076 1/74 / 1 50ao9 iZA r F.r. Fa.e 1099-MISC MISCELLANEOUS INCOME ` ~. . . . . : F . F.r Tai Yrr E.i.d r ® • .Co..miun Idarg"fift ... L.mr f rwar rrur, •E/c a, wc R SOCYMr) NYmblr ~ Lnrrvcxsrn cAr,tcR roui.vAnOr.• - nu Ans..:r,* DEC. 31s 1975 P.ya waetru trw,P r nu 7, R. !0 '~~crw e •U~G ~o u sYarJj 7e-~ a..c 7 To.i 0 TX 77025 CTF~ 5047 J C `€~R N-H
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER Ttisa. 1d.dtcel GnM Howufow• hsar 110)0 Mr. W. T. Hoyt .' " . . Executive Vice President The Council for Tobacco Research-USA, Inc. 110 East 59th Street New York, N. Y. 10022 Dear Tom: _ . .'. lK O,OER' E't`D D CAS: This is to acknowledge with appreciation the receipt of the consultation retainer fee for the coming year. - I just returned today frorri the Maxwell Associates Seminar, which I enjoyed immensely. Raven Press is publishing my first book this fall, and prob~bly the second on environmental fac- tors. It is`fthis volume'tlatwe prove statistically that the "Not stated wether primary or secondary lung" is different from primary lung cancer.. The third is a text to go with the tables in the first volume, which needs more work and writing. I appre- ciate the continuing support of the Council which has made these three docurrpnts possible. r Sincerely, ~l(affn/ Eleanor J. Macdonald Professor of Epidemiology EJM:eh M D rtNDERSOti HOSP1T.tL .4.\'D TUMOR LA'ST7TLTE )Zr%+abi! iarion Genrt. EXTR..WURAL PROGR.tMS D/ t?5/0.\' Oncololy Cancil.8.c•nrd caf lnrnwno•v CoQa6orrriw Srvdiri Srbcru o.u En.nronrnenra! Sci.nce Par1 U.'.7VERSITY GSNCER FOU.\'D.1TlO.\' T1+e Andercon Ma7fai. C T R 504S THIS DOCUM,ENT SUBJECT TO AUC. 20' 198~.Nui~•DISSEdIhh110ti OnU=~ a June 9, 1977 ~; -I- ~s ~~`~~`41 t'.. ~+~~~°~~~~~~
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June 27, 1978 i- ~.y,~' _. ,fKss Eleanor 6723 Bertner . ~ J. Eiacdonald Drive . . ~ . ~ J Houston, Texas 7702S . .'. . ,.Y ~,. ;, Dear Miss ?tacdonald: THIS DOCUMENT SUB!ECT TO AUG. 26, 1955 hjr •D1SSE,.~iNM1iCr, C ;;,,R IN RDGERS AnD DUKE CASE.S. .• You will find attached check #17316 in the anotmt of $10,000.00, covering an annual retainer fee for your consulting . '% services for the year comencing June 1, 1977. As in the past, we consider you an independent contractor and not an ee^;loyee; '' therefore, we are making no withhold.ings for tax or social security .~ purposes. The retainer aaount will, of course,be reported at the ., -~:' '. end of the year to the Internal Revenue Service on Form .*1099. . t:ith all best wishes. a . .1 ~ s Sincerely, W. T. Ilovt Executive Vice President K1?f:ek att. CTR 5049
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:"0 ( June 4, 1979 Ifith~all best wishes. I 1 • ' . .. .• - 'i •r'I . Hiss Eleanor J. Macdonald s•' 6723 Be-• t D ive ; .,;_ ner . . r t ' Houston, Texas 7702S ! , d fi h Y ona : esr H ss ac ir - •• ' - D i H d ld '1 ' - 1' ,. Revenue Service on Fora 11099. THIS DOCUMEN'T SUElECT TO AUG. 20, 1985 OnDER IN ROGERS DUKE U."E'c. attac n ed check f18259 in the amount ou will of $10,000.00, covering an *an.nu.al retainer fee for your consulting services for the year coaeencing June 1, 1979. . As in tho p&st, we consider you an independent contractor and not an erployee; therefore, we are naking no withholdings for tax or social security purposes. The retainer amount rrill,' of course, be reported at the end of the year to the Internal . Sincerely, W. T, Hoyt Executive t'ice President , `. h't}?:ek att . ___ C T R 5 05 0 , , r .~" a 0 .2A
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER T4nu Afn/leal amt.. I/owrow, r.++u 77025 June 6, 1979 Mr. W. T. Hoyt Executive Vice President Council for Tobacco Research U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dear Tom: TNIS DOCUMENT SUBI"CT TO AUG. `t.:). 1985 1i3N:DiSSE~;'+ATICN Or2D;r IN ROGERS AnD D';r.E The retainer fee for consulting services was received today, and I ar, very appreciative of your continued support. Book II is now scheduled for June 29th by Academic Press. It will cost $16.00, a better price than the $45.00 for the first book. We are hard at work on the third, which will be interesting reading with fewer tables. Si ncerely yours , Eleanor J. Macdonald Professor of Epidemiology Department of Epide.miology EJN.: ve . CTR 5051 M D ct.ti'DL).SO.ti NOSPl7ct: AND TUMOR A'STTTL'rL A+.ci.+/ /Gn.bJi1.nc, Crnit+ [XTRAMUR.t_ PROGR.USS D(1'lSIOI.' O.relory Co.r. M•l.o.v4c.I lpur, r.noti C.fLb..nx SwL,a S.bsr.env F~.o.,.cwial Si.rwc( P.•k U>.TYIRSffT C.L' : [R POULDA77Oh' ?a. Aw/r+v, ALy(.n 'L-.,' T R' N H ~ C)
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<_ I ~ Jtaye 4, 1980 miaa E1awar J. YA5c.iarusld 6723 Bc^._-tzv.-- Drive Baustm, Texaa 77025 r ~ , Daz+-- Miss t•Sandcrold : THIS DOCUMENT SUBIECT TO ArJG. 2(1, 1955 L).S5'-'„in';,11DN' C:...;n IFi RuGiK~ „trli DUKE CtiSia, Yau will find att,a=-rad dvck W158 in the w=mt. of $10,000.00, coverizg &n azsmial re}.,ainer fee for ycts oonsulting services for the year amamw.4M Jme 1, 1980. As in the pnst, ve oonaider }ou m indeperdentt cxnt=nctar an3 mt an emplaycie l thrwsef cse , ve are rak.ir,g r,o vithholdinga f crr tax or socfal aecurity pu.^poses. Z-e z e}„ai.ner a=unt wil], of oaxrse, be r+afxa.-ted 'at the end of the year bo the Inte:rnl Pwvm~ Service rn Fc= #1099. . With all best wiRhes. Simce.-ely, - W. T. Flc~t Fxec,:tilve l'j,oe President h'lf:: e}: r att. C T R - - ,,,-v. 505•N' ~ R ~°~ ~°~ ~'~ ~` ~:'. `~)~'' ~.~ R~x 4
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~ © THIS DOCUF-',NT SUBIECT TO C,;lG. 20, l:,o15 Nv,i -DI S.)=.Jj,i %,iION OR:,:n ) ' IN ROGERS AND UK CASES, I 'lne University of "tZ,,xas System Cancer Center M. D. Mderson Hospiul and Tumor Irutitute Tuas AScdxcal C.cnrcr • 6723 Bertncr AYrnue • Haaron. Te:n 77030 Mr. W. T. Hoyt The Council for Tobacco Research U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dear Tom: June 12, 1980 ntri,;.. y cvacv. Pr"Mn~+, Thank you for your retainer fee for consulting service for the coming year. It arrived yesterday and is much appreciated. Sincerely, l (Cl1lC~~i Eleanor J. Macdonald Professor Emeritus of Epidemiology Department of Cancer Prevention EJMrew CTR CT F12" N N CC) 2
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. TNIS DOCUMEh'T SUBIECT T0 AUG. 20, IN ROGERS AND DUKE GAS;;. I Miaa riamn= J. Haodaald . 9C. T. Hc,yt_ President 6723 Bertraer Drive - Fbusttn, 2exis 77025 :~.. , . De= M.SBS Yftodanald s, , , A . ' Yoc1 v311 t1nd ttthafied cbe* t20113 in the amomt ot $10, 000. 00,. ovvering an -m1 retaines fea tnr yocs ocxoultinq eesvicas for the pear ca=en=jng Jum 1, 1981. Ae in t21e pns L, ve o0.rai.At~ }cx1 an l'--i:.=-EStk,.~-rt =itractor and tot an ecployaet tbeme._ci^o, We are msScing nrm rrithtntdirqs for tax or *oCi.al cecvocit}' purp»s~. 1he retallrr_r t¢aDUrt, will, of oaurse, be z+epnrtad at the end of the year m the Inte=al Aewenie Se,rvioe aa ftaxa f1099. wth ull best wist~s . WMVIP at-..ae-ainnt, -hr* 5, 1981 ,~ J / /2 --~----, ;'.
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7HIS DOCUMEKT SUBrECT TO AUG. 20, 19iJ i.ORDE..R in tiiiu CUKE CtiSES, Jms 2, 19ffi Y.iag P.low= J. H%03oczld 6723 Beirtn»r Trivs - EbUston, Tmcas T102S Dasr Misg 2i~a1d: - _ YaU ViLl tind ~t4 Med ctxdc 121170 in ths a== tlf 510, 004. 04, ooaeri.nq sa a=al z+ctLinar ten fw y= cacssultinq serviam far the year a=eccinq Jtma 1, 1982. xs in the past, we cpraidts pvu au S.ndepenlec:t oontnmct= " ricrt an emplayee i Uiezuf=e, we are making m fc¢ Laac ts aoC:jal DeCL=ity purpoOM. 'Jkie zeL~iz~ax aeaotat vil.l, oa! ooursa, be ztp=tod at tbo ead of the year to t}it Mnte=Al Aevemae 8eivsoe aa lbaa #1099. With aU bast wishes. W. T. )9vyt oatat3r, t CTR 0' 0 ;,~_ cl-I' R1-1 ~`•4 0 ~ 2 ~~ ;'' `./
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2107 University Boulevard Houston Texas. June 14,1982 77030 THIS DOCUMENT SUBIE;,T TO 1985 K"v~~ DiSS; IN ROGERS AND DUft, W,Thomas Hoyt,President. The Council For Tobacco Research-U.S.A.,Inc. 110 East 59th Street New York,New York 10022 Dear Mr.Hoyt: Thank YOU for the consultation fee Friday June 11th. The which arrived lastleasa t one of which I am association is a p very proud. Sincerely Professor of idemiology /W/ -. .:1 ~.. . .l'. .f -., CTR
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... ._._. : TNIS DOCUMENT SUBIECT TO.AUG. 20. 1985 NOn-DISS: ,~jr,„iI,;, C• . IN ROGEP,S AND DJKE 1A," • .•. _ Jme 29, M3 y, 1 V .. , .. . ~'~ - . I lCiss L'lr~ez~ J. ?3wd=ald 2107 UniYE!r'8ity BOR11tYA21d $0[titmi 'hPXlts ' TIOM As Sn the pnst. Ma amcider you aa Srdepmunt ccatractor , ma >= aad mt aa a.play+seq therefcace, ve src mScing m xit2~ ill t i Tb consultimg sszvic+es fx the yew commercirg J=A 1, 1983. 2cxi will firA atthc3r..3 c.'nrk"4 22368 in the a=mt of 510,044.00, cvverSnxl an uuasnl *etxtner fee far yrxs ' Dea7c ?diss macdncald! _; . e zt a s~or v . !cr tsz or .= ial smasity purposes• Ga-66-1.~ 6, of mssa, be repaz.'Ged st the end of the pear to tbd Sstternal Revaxm Setvioe aa ?= 11099. ? With s1.1 bsat xisbes. ,='-~ . - Sinx.-ely. W. :~. Bvyt • . ~~.• • . ~ CTR I,- •V~ '~ ~ CI~ti VIN DO
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THIS DOCUM,EN1 S(fplrr; .., A _ 1985 hOh-DlSS~r~t ~' INAlfu,j ---` _ }~ 1H ROGERS AI~iO ~1 C,({SES, : June1, 1984 ~1 1f3u tfind RttdC~ OITL' CfiEK* in the e+ccxa:t of ;S, GC0.00, oaruring an ttmrsna.l retainer fee far your-aomsultir~g servicm for the ye--r ==ftlcinq Jux 1, 1984. As in the pest, we coraid'°r S'm an 4 erdent cr emd mt an arploymel theraf=., we are mn}dag rjo wittr- baldirrgs foc tax cc .acial ae+cursty p=poees. The rebminer +~moca~ will, of ao.aae, be zr=ta3 at the .od of tfia p.ar to the Zaternel Pzvemle Se-"vioe as lba9 11099. . • - .. f; • (brdi.a]1y, R. r. C.erttmbrch E ' ~i~. ' NH 00296~~
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Y7i~rs` &~4~OtT T}(IS DOCUMENT SUBJECT TO AUG 2is. -- .2 >O7 9-=,2& T7G,YO IN RUuEicS i,,D DUKE June 24,1984 Mr.Robert F.Gertenbach,President The Council For Tobacco Research -U.S.A.,Inc. 900 Third Avenue,New York,N.Y. 10022 Dear Mr.Gertenbach: Thank you for my retainer for consulting services in the amount of $5,000.00. It has been a very pleasant association and one which I have-enjoyed. Will you extend my best wishes to Tom Hoyt. ld Enclosed is reprint of paper that came out in book December 1983. Have gone through 100 requests for reprints all over the world. The most interesting froc teacher at U.C.L.A. who gave a copy to each of the students in his graduate epidemiology class. E.J.M. . .. _.~. ~ ,~-. / 1 C T R 5059 , ~x ~. CIT ~ti 11 f-1 0 ~1-i
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wwiO~•wopd wwi A N C C1o~ r[ rbsnr d H.C.Ce~7k R..mh.a.N..YortC 19i3 I Present Direction iri the Epidemiology of Lung Cancer ` Eleanor J.~Macdonald Dqoarnmrnr af Cmticer Prrvr,tlion, T 3K UA?wrriry g' Tcmr Syrum Cance. Cenu.• X. D. Andesson Hospual ad T~r lnrcwa. Hounon, Tc= 77030 R?% Coosid~entiom of the cpidemioloYy of cancer of the lung must start w'ith an awastacss of t>,c prucnt state of knowlcdge in many brancbcs of >scientific eadeavoc. The huge investmcnt of cancer funds in basic resemb in all the acicaces, e:pcc~ially in the last 35 years, has brought abovt a trruca tuliution of the complexity and intcrrelatioostips of the factors that contribute to the etiology of this dasetu.. The wroTic of these acientists msy be likcned to tbat of the artisans in the Middle Agcs who artve a.rlole life of effort to perfect one cornice of a beautiful edifice and • crosidernd the rane well spent. Our scientific am~^s, by ezplaining the mechanism of one fragmcnt af-r another of genct;c, biocbcmical, somatic, behaviocil, envi- tvnmcntal, epidcmiological, 4utritional, and carciuogen-related information, arc bui.lding gradually the whole mvcnue which upon completion wi.ll teveal for ou: ase the m~ms involved in the genesis of each of the cooditions grouped andc• the term 'Cancc>'. _ ~'- MCTDEtV CE '. . Knowledge of the population-baxd incidence of cancer is the baseline for mca- uu•ing the siu of the problem. Ovrr time, incidence dats enables a study of tzrads, which in turo trovidu clues to ttx popula6ons at risk and the factors involved. The World }iealtb Organiution (WHO) his gathered together several yearly av- enges of incidcncc dua from 69 population segments around the world (3). Among ma1u, the varianon in age-adjusted lung cancct incidence raus is from a high of 86.6 per 100.000 in Liverpool to a low of 13.3 per 100,000 in Bombay; among females, the varianoo is from 11.9 in Liverpool to 1.9 pc 100,000 in Hungary. Among wb.ite males, the age-adiustcd lung canctr incidcncc rates as percentages of tatal csnccr incidence account for over ooe-fourth in every region in England, Scothnd, Finland, and ttx Gaman Dcroocruic Republic. Rues for white females in the same regions fall in the came patiern (Table 1). ln Tcztc. an intensivc, carefully oontrolle>i study (26), covering 23 concccvtive yein, e*1miwd the canccr incidence in~a population of 4 million, in otx-di.rd of the sute, comprising 56 contiguous oounties and ttuoe major ethnic groups. Ever)n known sourze of records was covcrcd• including dermatologists' offices, clinics, I , a ~ . E. 7- ., C T R 5Ut;0. ~ ~4~' N~`~°~ ~~~~~~~~~2
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TAt1LE 1. AxHwnea of btal cwnoa and Mp cincwr br 23 counMe.. Q9 popAaAbn prvuqw h E Cortd4rta, a,^srp+ annwr act7+»Md nMS pe. 100.000 .' Total c.nc.. CancYw of Rr Iunp M.t. Femete Mele F..n.1e Lunq cenoew es perterrteqe A4e- ApF Aoe- Ao- od totet cenc•e. Lanhvde No. .d?ushd No. .dhfsleE No. .*»t.A No. .d(vet.d (deqr"ee) oesM rat1N fyeM rate. CeM. Wee ca.N r.tes MeM Femrh I i Ceucaslens extel±t Spenlsh-/umeme0 /Vnerict Unhed Steten HR..eN-Ceucesien `' 10-22 643 2tS5.1 8015 :: 235.4 • . 131 : 43.5 34 10.2 163 4.3 Texss-Harllnqen 20 ' 1.048 459.3 ., . 355 ~ •354 tS 1 131 36 3 27 6 8 7 9 1 9 Texee-Len.Oo , 1 : 27-20 479 • 491.0 . . 379 ° 380.9 `~ 3e . 37.4 e" . 0.5 . 7.e . 1.7 Texes-Snn Anfa,lo 29-30 15.22e ' 349.7 6.063 ._ 295.2 : 718 409 134 e.3 11.7 2.1 Texes-Hous,pn 30 7.616 362.0 e,22e 322.2 1.150 54.4 235 9.3 150 2 9 Texee•EI i'eso 31-32 1.200 3309 1.269 300.2 95 283 25 ea e E 2.1 TexesCorpuq C1x1et! 27-28 3,547 577.6 3.015 442.9 298 48.5 58 E 9 8.4 2 0 NeveAs 35-42 3,72t! 2369 3.325 '~ 23A.5 '• 441 27.5 87 6.3 11.8 2 e CeNlpnle-AtsmeA. 38 5.573 254.1 E,090 220.0 ~ 1,032 47.e 190 7.4 1e e 3 3 Cpx,ectlR!t 41-42 12.229 257.e 11.935 I! 220.0 ~ , 2.0e2 44.0 423 7.E 17.1 3.5 Cenede New &untrwklc 45-48 1.725 275.5 1,700 r 2tla.5 15e 27.0 24 4.2 9.8 1.5 OuebeC 45-62 19.924 209.3 20,724 .d 19e.2 2,667 2e.7 443 4.3 13.7 2.2 Newtaxidtend 46-60 2.148 205.2 1.1907 ~ 2072 182 23.5 24 3.1 8.9 1.5 AJbwle 49-00 E,008 . 225.6 , • 5,524 '.: 222.2 702 25.0 105 4.1 11.4 1 S MenNobe • '. 49-60 e,357 291,1 • 5,8d3 !, 261.1 92e 42.2 1" 7.3 iso 2.e Seekatdwwsn : ~ . 49-80 e.042 ` 330.3 5XI0 295.9 e42 2e.7 . 99 5 0 8 7 1 7 AM@ , . . . h•dl.-Domber 18-19 5.052. 139.5 3,551 131.1 , 504 13.3 ~ 3.7 . 0.5 2.8 Isr.wl M Jews 30-33 12.193 190,6 13.194 1N.e r 1,705 20.4 5" 8.7 14.0 4 6 Jews bom In IueW 30-33 8130 1386 902 •' 144.7 55 17.3 2E 7.0 12.5 4.e f4 )
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,Jowe txwn In Ahke nr Aale 30-33 2,e45 14e.7 2,50.1 12e.3 430 22.7 11e e.1 153 48 .Mwe born In Europe or Art+Mtca 30 33 e,4ee 203.7 9.729 22S 0 1,300 29.6 440 .fr.e 14.5 44 NonJewt 30-3J 795 132.2 430 70.7 134 24.e 1e 3.1 1ee 44 4 Eurocw Yupn.l.vi. • Rbv+.4. 45-46 e,070 204.1 e,e46 1050 1,637 3e e 23A 4.4 189 27 ta<rnants•Oen.t req" 4S 1,420 17e.0 1,44e 151.e 209 249 36 35 14.1 2 3 F1ur'OerY Crnmty Ve9 48-47 1,599 174.7 1,e0e 157.9 21e 22.e 5e S 1 13.1 34 S7nbolce-S?slmin 47-48 2.092 142.2 1,9s3 1152 212 14.3 34 1.9 10.1 1.e MLko1C 48 715 175.1 7B8 15e.4 113 2e.4 29 5.6 162 3.5 R ) Polend Fnr nwwl .fww• 9 e09 65.2 1 129 2e 2 e29 131.1 ZS J.O 7DY 29 W.r•.w,rrllv 18J 2 2119 7 572 4e v 891 2a 3 IW 0.• n.o 4.1 l'...•n,..-M,. .n.1 n~.hYt , SI0 49-SO 3. 151 a . , 1z2.2 654 27.9 9,592 11O a.v To V 32 K.~,...~-..r.r~ 4950 I ,238 138.3 5.03e 1222 919 294 iio z.i [i.v 22 (3ew.nen DeMnnaet/c nmxrtft (Of)n) 50-54 74,71z1 211.7 ee.572 1900 17,e17 48.8 2.2J0 4.3 23.1 2.3 EnqlenA ' wrq' -"r^ ' ' 4nR l C r ++ ` ~~ * $a,e,-.reelem reqlon ,s-52 ~ 2o.e49 24s.1 '~ / toe o 21,oe4 : 15.059 i eo.3 953 ,, e.7 24.e 4.4 oRforA replon 51-52 io.777 . 234.2 1 10,317 ,,17s.e 2,920 e3.1 ' 57s o.e 2159 se ShertMid rngkxr 52-53 26.573 ' 227.4 25,496 -i e2.e 7,5e2 d1.1 1,17e e.5 28.2 4.e I Enptard and Wsle.- ~h,e+nod reqk~n 52-54 19,e55 ..288.7 1e,53e 199.9 5se2 ee.e 1,109 11.e 30.0 'S.9 Enqt~ne-armhiphem ~+ 53 30.31e 254.5 28.571 ' 19A 3 e,977 73.3 1.254 e.4 2e.e 4.3 i Derxnerk 55-57 33,112 221.1 35,e42 223.3 4,e00 31.4' e0e s.r 14.2 2.3 Sooltmnd 55-e 1 28,791 231.5 27.e1e 1738 e,440 67.0 1,551 9.9 769 5.7 Swrxlen 55-69 45.5e2 199.4 4e,tee 203.2 4,3e3 19.2 1.142 4.4 9.e 2.2 Nor~~ 57-71 13.763 174.e 14,023 164.9 1,283 15.5 279 3.1 9.4 1.9 utbe~n 57-71 e,397 207.1 e,9se • 1et e 761 252 1ee 4.2 12.2 2.3 Rurel 57-71 7.306 153.7 7.057 151.2 479 10.5 111 2.2 e.e 1.5 Flnlnne e0-70 21,591 259.7 .21,247 1e2.e 5.900 70 0 5J0 4.4 27.0 2.4 Ah1rA South Ahic.-CMe Prv~4noe-wMMe 33 2,012 371.2 1,934 276.7 237 44.r 37 6.3' 12.0 1.9 Oceente New Zedand-Evroperr+ 34-47 16,734 242.1 14.201 21b.0 . 2,965 45.1 42e e.1 16.6 3.1 I ' UT ,
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TABLE 1. (oornMved) i Total cnr.per C.no.+ d tf~. Mq. Male FemaN Mate F.mab etthrde A No adw qe- sted No Aqe- .dfvsted o d?uet~ed o d~ted Luq ev+cer n Deroents9e d lotet ar+cer (deqroos) . cnsea ra , . tes • cn+ef • ret" . caeee rate$ . taee1 ratet Mel. Femnb I Btedc Amerk,y UnNed Statr» Texee-San Antonlo 9-30 07 25 1 427 ' 77.9 , 5 4.5 0 .0 36 22 Texeg-Nouston 30 1.425 26 8.4 1.802 277.0 245 44,5 46 6.1 166 29 Texes-Corpve Cfrtetf 27•28 123 24 8.2 159 278.6 ' 30 60.2 5 6.9 24.3 3 2 Celltanle-Alemede 38 545 25 1.1 552 • 195.7 106 43.6 22 9.0 17.4 4.6 Jameke•Kkqeton and Sz Andrew 7•1e 713 21 2.3 1,079. • 200.2 e3 24.6 • 35 7.5 11.6 3.7 Africa Nlpafa-Ibndan 7-8 707 7 15.7 , 716 104.8 12 1.2 8 1.0 1.e 1.0 ~ ~ MpAeele-Bvtewtyo 20 450 • 30 49 132 . 370.4 59 47.1 2 4.7 15.4 1.3 South AMc. Natel•Afrlcen 29-31 682 20 6.9 50e 162.6 18;1 41.2 25 102 19.7 6.3 Natel-IndIen 29-31 220 12 9.1 276 168.3 30 20.0 4 3.3 • 15.5 1.8 I Cwp. Prpvhrc. . ' I Coloree 33 726 21 7.0 777 164.5 129 42.f)• 1t 4.2' 19.7 2.6 BerMu 33 199 23 2.0 91 ' 156 0 19 2e.9• 2 4.9• 11.e 3.1 CP
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.f Sarces: G+ncwr hcib4w+oe k+ FM1w CmAierNs (3); Texas det. (t9e2-A8. wvrld amderd). Mecda+MA. E. J.. prohe.a wnerlhts ol epldemlobpy, Depertrrwrtt of Cer+ce. Preventlon• The Unlveroky o( Texas Syetem Cence. Ce.4er, M.D. Mderson 1loeqltai.nd Twnp MS1hft,lbveton, Texm. , 1 Sr,er4s,-vwrwx,wn nR,wtre • 1 I;t,krrta..Cev 3.4 1•8'M 2459 2.441 2803 107 17.5 31 -3.d 7.1 1.5 PwAo RCo 17-18 e,100 205.0 5.457 180.1 392 13.e 149 5.0 e e 2 8 thMtee state. Tern-F1a,11rqerr 2e e19 210.5 1,107 26e.4 10e 28.e 31 7.6 43.3 2.9 Te.ee-Lerndo 27-29 , 384 1932 552 2409 42 21.7 ?~ 9.e 11.2 4.1 Teree-Cortxrf ChrisC 27-28 527 229.4 740 292.8 87 31.! 24 11.1 13 e 3.9 Te.ee-Sen Iurta4b 29-30 1,257 1851 1•814 238.3 135 20.8 49 ee 11.1 2.9 Te*ae-F/ovitan 30 2(S3 2144 371 209.4 29 23.8 12 12.3 11.1 4 e Tex.s-EI Pe," 31-32 404 180.3 702 248.1 45 22.8 27 10.7 12.2 4.3 Or1en1pb1 Arr.erlce lM1eE Steh"-HRwwll Hewenen 8-20 76 13.8 82 64.8 2 70.3 e 2.3 24 4 Chkiege 18 20 205 207.0 193 228.3 27 27.2 13 18.7 13.1 7.3 FI1I,*io t8-20 325 131.0 9N 180.9 43 17.1 8 17.4 13.1 9 8 Jeperwme 18-20 1.0m 207.e 795 too.e 123 28.3 37 7.e 12.7 • 4.7 AWS „ .,. ` -r ,. Ckey.m. PTefec"v 35 1•e70 • 189.3 1471 1 14s.4 .: 140;~ isa ss l 6.2 ` e.1 3 e M1rng1 Prefecttwe 37-39 = 4,082 .199.0 3.e23 142.8 ' 321 is.e . 151 f 6.0 8.0 4.2 I oCesnla Nea zeelend-Mea1 3447 512 259.3 6e0 278.e 124 70.1 e0 37.7 27.0 13 e 'roa h,nr oomper". l ~ ~ ,. . . .' , I .C
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6 EPIDEMlOLOGY OF LUNG CANCEIt laboratories, and group mediul practictt. Because of the unusual complctcnas and a.xuracy of the data, they arc being cited as a microcosm of the cancer ez- pcricncu in developed sutrs and oountrics: these data represent varied degrou of urban dcasip•, industrial complexet, large seapotls, rura) agricultural communities, and a)utudes and cliautes ranging from the temperate to the tropical, as wcU as Ecnuic and sex differencei. During this period of 23 oonsecvuvc ycars, thut was a tocal of 9,551 canoers of the lung, of which 7,655 wrrc in ma1u, and 1,696 were in femala. The lung cancw rates for the entire period and for the lut 5 years per 100,000 population in thc tix rsgions arc given in Table 2, by ethnic group and sex. The agc-adjusled rate for the six oombinod rsgions for males was 47.6 per 100,000. By TA81.E 2- c.no.w od s» .rap: nc.nD.w or cxs.t ana up.aD1ua,.o rjais.nn" rad.w p.. 1Q1•OUO• itr l.pioro ih Taxts,• 1Dit--1A66 Whlt. 14orwtA& nrnam.d W1,h1 fbonatihe wrnurrd ToW ma*s n%alft RNI" /ilRlil" 1M111e3 - %+T1a1ei pOQlYiL50f1 f,Y t~y bf1~ - 104A-1f66 6•099 T61 972 1,162 144 390 . 9,551 1944-1066 37.278 33.802 18.332 6.306 5.839 7•t134 18.7'G2 1 D62-1066 53.626 48 .936 29.118 O.OJ•1 8.077 10 586 26.81X! El Paso - 104t-1966 255 4 117 65 4' 72 517 1044-•1Gb6 26.037 8.974 20.344 5.761 7.755 10201 14.783 1DE2-ita86 33.449 17242 26.717 6.817 8.483 12.875 18.717 San Mttir.o 1t?ta-1M6 1,782 155 321 347 25 tte 2,748 19u-19k16 30.706 29.072 15A87 5158 4.006 5.630 15.258 196,2-10K 47.438 40.855 24.BS4 7.339 5.897 8.123 22.578 lar.0o iDN-1098 130 2 118 25 0 56 331 1W4-1D66 42.662 26.058 19289 8401 .000 7.614 16.84b 1962-1966 41.391 .000 26.325 7.123 .000 11.823 20.195 1944-1966 336 2 195 66 2 62 663 1Pat-1966 2b 688 8.687 17.077 5 464 13.298 5.567 13.BR2 1D62-1W 42 563 .000 34.801 7.563 45.057 p.6•l5 22.307 UrPRA Ormt 1444-1966 725 59 138 112 17 60 1,101 1ci4t-1fl66 38767 38 597 20470 5.555 10.057 8.110 19.903 10f.2-1D6Fi 56 417 68.Q4b 37.966 6.73.4 10.8J7 13.104 30.1V Houvzn %, .. 1P"-ff65 2,671 56.2 E3 547 96 32 • 4.191 1ta44-1D66 46.231 36.063 26.624 7.676 6.995 12.85A 24.5?9 1062-1964 63,060 50.689 26.714 10.626 G.452 14.980 32.88•4 • 1060 ttan0a id. ~' Frpm A~aaaor~a~d and H.as:a (26). ~ . 7 i, :r. a2 - .. . :~•. .- r ': •: vr CTR 50 f ~ ~~F-14. Hull
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EPIDENIOLOGY OF LUNG CALVCER 7 ahnic grocrpa, the rate per 100,000 for white males aas 53.6, for ooowhite malu, 48.9, and for Spanish-surnamed males. 29.1.'Rx rate per 100,000 for.vhite females .ras 9.0, for nionwhite females, 9.0, and for Sp+.nich-surnamed fcmales, 10.3. In all rrgions, the ratio between w-hite and nonwhite males and females was approz- imatd,v 6 to 1. and bctween Spanish-strrnaroed males and females, apFmozimttely 3 to 1. The ctb s ethnic and tLgionil diffcreoccs ue evident from dcse ratea. The ratrs for Spaaiah-aunamod females were ceariy double those for white feznales in El Psso and Lxcdo, and were also higher in evcry oti-t region. Tbe coovcrse was true for Spaa.i4-suroamed maks aad white males in the same regions. ~ MORTALM Public bcahL measures in the Unitad Staocs have curxssively evolved a popu- luioo that in 1980 is healthy beyond winat anyone would have imagined 50 ycan ago. The mortaliry rue from all causes in die United Scatu, in the most troctnt availabk yur, 1977, .ras 8.9 per 1.000, an all-timc low. The ezpetud life span has risen from 59.7 years in 1930 to 72.5 ycars in 1975 (for males, 68.7 years, for females, 76.5 yesrs) (45). Morulity from the gsutest killers, the cardiovascular diseases, has dropped. Half of all pcople who develop cancer are over 65 at the' Cme of diagnosis. and more tnan 10% of the total U. S. population is over 6S- morz than 23 million individuals. So there is a large number of people in the age grovps in .rdich caflccr-asccptibles arc clustered. A stead,v increa-u in the total cancer mortality rate has been observed. Despite all these potcntial rusotss for a massive inmr.isc in cancrr, total cancer, when adjustod for age, ha_s increased only 2.5% in the 10-year period frvm 1968 through 1977, a very modest increase in pcrcentige poisTts, although it is large in num.bcss. This reflects the results of cancer programs in producing an increase in survivals, an increase in pcrson-to-person educition bex-w-ecn conccrned pbysicians and patients, and improvcment in t.ech- niques for early diagnosis and trutzaeni as well as supportive care. Age-adjusuad morulity rates for many kinds of cancc: ue either ttabilizi.ng or declining. The two exceptions art the ratcs for cancer of the digestive system and cancer of the rrspiratory system. The separation of tnu cancer of the rsspiratory syztrm from othcr ncspintary conditions is demoasvatcd in Fig. 1, which relates tbe advent of new• antibiotics to the drop in communicable respir:tot•y disease moruliq•. The gradual increase of rcported lung cancer is inversely relue.d to the drop in competing respiratory risks. S" The su,ady docrease in mortalirv from tuberculosis has been almost exactly re- Pla,,:,cd by the incTtue in lung unccr. Wong (51) h rpothesizad that if people wete susceptible to both tuberculosis and lung canccr, the deaths at eulier ages from tuberculosis would result in fewer deaths from lung canocr. But nrxcssful trcatment has prevented much of the mortality from tuberculosis, aitb a conscquent increase in lung canctz mortality. The association bezwecn desc two causes of deub is illusv-uod in a audy by Ipsen (17), in wtich be obscrved that mspiratoty cancer occurred 5.3 times awrc often amoog those who had died of tuberculosis and that .. ~~..i • - -r . / C T R CTRI IIN
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8 100 EPIDEMIOLOGY OF LUNG CAIv'CER a N a E [ . I-I: l~e ~ ; [ ! G • t I a..., I I .w,.n s.... s .-.. t.+..+..r , ~ ._-. r...~ .r rr.,. r~.... M Lr~rM.n bw ~\ 1 1934 1040 1045 1050 Y. ar 1655 1959 fiG. 1. A4,xtaJ ty hom rrsWratory dusaasas by dates of nvobuction ol an<fnsooca. tuberculosis occurrcd 3.8 times more often among those who b.ad died of respiratory cancer than among the general population. - UndcrsuDding the dynamics of change in the mortality rates for lung cancer among meo and women can be aidcd by examining the rate of change over time in the death rates. This was done by approzimating the first derivative of the empirical tiane function by a"moving slope, a linear slope calculated for consecutive overlappinj time intervals of fize.d length" (49). Analysis of the moving slope for the death sates from cancer of the bronchus, trachea, and lung from 1950 to 1975 showed ar entirely different paturn for white males than for white females, as illustrated in Fig. 2. The moving slopc for white male mortality indicates that until ,1964 ttrcrs was a gradually decrtasing trend in the rate of increase, but that the rates acttktated sharply in the early 1960s and have been in a steady declinc since then. For females, the corresponding graph shows a slowly increasing rate of increase aratil the late 1950s, when a sharp and steady acceleration began wbich lasted until almost 1970. Then a slight deccleration occurred, followed by a much more gradual acceleration than in the previous rise. A 4Qyeat intcrest in cancer mortality data culminated in a comprehensive study (50) published in 1979 on the rclationship of environmental and ethnic factors to tfic tnoruLty for each site of canccr for every sute and region of the United States. A large aumbtr of factors, data for which were availabk for every state, .vere studied in depth, individually and in combinat,ion, to asctnain their influenoe on the geographic patterns of cancer of each site. In order to carry out a systematic a4ysis prvviding comparabilip• across cancer sites, a pool of 12 variables was CTR 5pb^, C 1z~'
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EPIDEMIOLOGY OF LUNG CALVCER 9 2.40 1.80 120 .60 • VMt /Uw. • ftW 1~M1 , f. . 0~ y~~_ t y f _ t 5 1950 11955 1960 ~~ 10E5 1970 1 75 RG. L Rr.-ysar mannq siooe ot r+soaratory uncs' rr>autr,r axv+. th+tt.d Stats. 1D50- 1075 Vwiason n trw rata ot ntJUSe (aDsauta rw.'ti) par 100,000 uass0 on ratss ap.-adruttad. b 1970 U.S p.rWtabOn. chosen foc the derivation of the geographic models for eacb type of cancer mortaliry m the United States. The variables tttprescated were smoking, consumption of dificrtnt kiads of a)cobolic beverages, ethnic background, pollution, income, tem- penrur,c, :ad prrcipitstionielevatioo. lflformatioo on industrial etnployment risks .vas not avai7ablc. The mak mortality models for cancer of the tracbea, broncbLLs, and lung, specified as peimary, iadicate only one highly tignificant factor besides incomc (INCM), and that is the stroogly positive effect of tempcrarure (TEMP), a characteristic shared onlr• by the correspooding female mortality models and by the skin cancer morulity modds for botb sexes. Pollutioo (POLLUT) also enters as a significant fartnr, but only when INCM is not in the model, indicating a possible interchange between tbe two effects. This appcus to be even more the use in the models for the aaspecified categon•, whc:e an uainterpr>:table negative POLLUT effect ahcrnates with a ncgirive INCM efTecz. The correlation betwern these two vari.able5 is Oot targe (.407), but the variuion that they have in common could n:present rpxificall;• those state diflcrtnces that pmduce the varying quality in mcdical diagnosis and records. t Procipttsaoa'elevatioo (PRFI.FY), a strong positive effect in most of the cancer mortality models, is notably weak in the models for primarv lung cancer in males, and it does taot even enter the female morulity models for this canccr cuegory. A few of the wnsumptioo and ethnic fa.-tors enter these models positively but .rcak)): ciFur.rtrs (CIGS), aine, and Scandinavian ethnicity (SCAN). It is clcc that the variable pools do rtot contain tall the factors needed to explain sufficiently the variation in lung cancer since only 44.26% is accounted for by the / . C T R ~0 41; -S-, _ ~'~~' h ~"'~t1l '~'r,~CW1
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OF wpG cOCER ' wgc el t carw e EP1D~'S lunS°S ~ byQc°°~' ~ ,r.ites ~ O •LM ~hOun ~,ls a~T s T1~ ' ~ b1c~i`~ to nugc ho oS ~ `r~sisnoc~ sn ~ . ~,.~~~ _ . ~~'~ pro4°w°° °,,nt ta uQ ~ ~y ~Cµ, C~~ ~otuC in tDU~ i~ y ~~ ~g wc W° pyp,cs dv~ ~isooo• ~ . ~1O 411•'[t+osc ~ ~oDSbiQ ~~ wWds ot ~BQhi tio o~ g c,utica t~ ~~usuly ~~trA tl'u ~ a~as a~ D$t"ttw u,d t!K P; a~,n tvl~ ~~ 42!~~ b't~a, ~~°~,be ~ t~ ot t~ ~nt ~~°g ~ sad a~ c~ooau t° ~wolo~g+c~~. M,ny ot ~ hu b toc ~ cvc° sc'~ oon u •IM b~ ~ t}u sti t ~ ur d . id~ d~ ~'o1nn8 tt~ t`~ ot cmQl ~t ~sn ~ oc ~C .+oc~Q on tt'°uld ~ pO°s ~~se rt oomQe o tion>11 f ~ ` l f ~ ~ p ~1 s~ ~ vidc ~ ~ u 8 D . , . ~ i ~ ~ ~s c c R~~io~ ot ~nu, s"gB ~olo~c t'ct ~~t°c ~ Doll (3)~ wi~ . ~ ~ `r'r° u ~ a`~' ot n~1OCot ~~ ~ ~ o ~w ~ - s~ i°'1°ritY ° ~ ~ , c _ t ot ~~ in Qc c~gnicion ~~n w"~ Qcoducx' ~n' is o° ~t ooct c*na~ . - ~usiDg c~'~~K cona'b`~ w ob,nous. ~~ ~. .-id~C ti~. oD ~~e~ _.: . idme, ~ t0 ~~ ~ u+vironWC ~ vcto o°n ~ ~DBooo cvccY _ ~ ~ ~ S~~u,ly ~sO ~ ahich ~ ~Ui1.1t a ~ ~m~t ~ r. ot ~'ons', oD ~e ~vcry ~ - . ~ b°\ fc°m Qlcn~B~'ts ssnon$ °~ Whom a t° °~nh~srd. ~o °oc 01 °°t~le~ J ~. .l c~c ° t f ' ' cn tcls~ t° ~ ' ~i~lfic•~ n~F o~inoBc . P coun~`l ~ ~ act~4~°O~' sdOQ~ ~ of s M ~T c.D bc o~ lsbos.t on as ~' c tctspo yw o[ ot cu' surc w~~'usb.n P°Uuo~'ti~~can ~lsnonshiQ nicul p~vnth exQQ ously ~P"'~ ~rch.rcQo ~ eVen gsr•~ ~htionshiQs 4 Sci ~O u7wto ~Msis~vc, sftu tur~T ~;.idtna dcna (4~' ~W cAnfua`cd *' ~c 8 ~d lu t~ unl 8 w'cct u'wss dooc' ahl ot 1~°g ~xwss u,lung ~~iv~on c~~~ ~kin8 ~e ~01og5' t121 1~ bc~ n bentoP~~,~,~~eutton toc c'g ~~csni f~ct°c ~~e cstly tcQ°~T~soc. ~st~t ~ bct"' n s~„~": 1t is ~ siBD ~~int. g v,'ctc s5 lung csn . hdd w'~ t 1Waon ~tsc' si~~ ~sc ci~~~ 0,o~~ S~ ~~ fot ~ mo~tin~ . tsn ~,t ~ ~Q°s~ ss ~ c~Qos~ ~~ rthovc ~tot sc°ok~• ~T ~oth~ ~bcst ~ ~t ~b ~u ~~ ~,it ta T~SR,oYets t ~~gcD ~ ~ . ~ e oD a wccc `~ ~~ dosvi~ 1~ tM i~ ~~ po01 siO`'c ~pn~ ~ s ot ~,Qh*s ''vblc ~~ d' u's St ~u ~ n d~ a u u' .n~ ~~bs . t n ~ ~ ~Y oB bt tt lv .tilass~ n~ n°dnt COn~ol ot u ova t},c if ` P~nve to u` s~` a0 ..~p OD ` tOTQm,c m" bts 1'. ~~C OWo ~°m tcsP°nsc bioloZ~c-I~ C T R
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EPIDEMIOLOGY OF LUNG CMICER 11 mrlustriaJ cavironment, the change in tbe last 100 yean to a nw-artificial man- soa,de eevironrncnt. through the introduction of new physical and chemical ageats (pesticides, plastics, berbicides, artificial eolots, food additives, among others), hu been too fast to allow a natural defensc mcchanism to develop. Wbereu this pacration has the advanuges of longeviry, leisure, and control of communicable d7seases, it also bas, as a by-product of matttial progress, ttse new type of be;hh b.azj~d mpt•e.seatad by expocurc to chernieal and pbysical age.ats posscssing earcia- ograic properties. , An esumate by tbe Eavironmental Ptotertioo Aaenry (EPA) tfut 60,000 ebem- ixls are in oQmmmrial use and that new ones are being introduced at tbe rau of 1.000 a year may be a modest estimate. Many of these ehemials have been rttopizcd as arcinogenic, and some have been bannod. Because it takes so long to idcntify arrinogens, and because the lstcat pesiod to arcisogeacsit after ex- pos= often is co long, many people wbo have been exposed to arrinogeas wW drrelop anecr before these ehetnicals are rscognizod as arrinogeas. 'Ihat mtny eficmials become carcinogeaic only in aombinatioo with otbcr ebetnicals ealarges dbe pool of agents to be studied. Many chemicals that in ttscmulves a1t only .+etkly carcinogenic are p-uent in such large quantities in our eaviroament that their total . eanczr-producing effect may be grcater than ttut of laown suong carcinogens (2). Most laowa carcinogenic agents were fitst identified by clinical physicians ex- tmiaing buas.as who had been subjected to oa.-upatiotsal expostue. Notable ex- ampla of this arc provided by Percival Pou (15), wbo in 1775 ideatifiod ehimney- swerps' uncer. Cntich and Johnson (7), who identified angiosarcorma in vinyl ehlocide wockers; and Rebn (40), who'ideatified bladdcr atuYr in aasli.ne dye w-ori<rrs. Often the specific ause-and-efTe: relationship has been obscvred by the boog latent pesiod between biological insult and onset of diu.ase and because until roccntly it war aot realized that the exposzue does not have to be continuous. The tremeadous variety of taz.ic and carcinogenic airborne ebemical.s produced b7 modrrn sociey and released into our indoor and outdoor environment, in our bomes and in oar workplaces, places a heavy burden on each of us pbysially from repeated and cumulative exposures. 1- , Rascarch taward identification of carcinogetu is more effertive and pottntialha,ort productrvc i>i cootroUed populatiotss in the workplace tban in studies of thc ,gcncra] populaaoo. In such studies it is rtcogniuC that the phyeical requirements of good bultb at the timc of first employment, followed by regular bealth checkups, make the work for..e hultttier than the population u large. Ttse employed popul.atioo may be coosidr;,~i a"bcalthy survivor" group. In eantrtst, the general population includcs latgc numbers of indi.iduals unemployed bccaux of sickness, disabilit; , or previous occupational injury or discase, as weU as the iastiartionalitcd population. As a result, in such studies the expez-tcd cancer rate derived from the general populatioo for a particular type of unccr will be higb, which tends to lessen the difference between the observed rates in industry and the expcctod rates. This dilutes the true magnitude of the wori;-nlated risk. . ! ~ . ' 1 .t. S . ~~~~~~ DO
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12 EPIDEMIOLOGY Of LUNG CANCER t-,ovcnvnenul and nongovcrnmcnul organiutions are at ..ork trying to dttcrmine the in~ risk for each suspc;-ted carcinogen, together .rith its impa.^t on tbe ' indusuiaJ population and on society as a whole. 7?ThC undetiying objcctive is to institute rtxuurcs for prcvcntion and control. The Occupatiotul Safety and Hcaltb ~ Adminisvation (OSHA) bas ofTicially listed 17 carcinogens, 6 of which ire eDo- bPical fa„^tocs in the induction of lung cancer (28). These are asbestos fibers, coky oven emissions. 3,3'-dichlorobcn:idi.ne (and its saJu), vinyl cl!sloride, cblocomethyl me.thyl ether (Ch4.ZE), and bis-cAlaromcthyl ether (BCME). 7be lntunariotul Ageacy for Reseanch on Canocr (IARC) of the WHO has published a aeries of mooograpbs (18) on industrial carcinogcns, in the summary of whicb nine are listcd as cart:inogenic for lung canccr. arseaic and certain arsenic oompounds, asbest.os. BCt.')E and CMME, chromium and oertin chromium compounds, undecground mining of hematite. mustard gas, nickel refining. soots, tars, mincral oils, and vinyl cblocidc. The 1ARC also lisu 12 ocha cAcmiuls as suspected lung cancw cascin- , ogeas: .xyloaitrile, beryllium and certain bcryllium compounds. cadmium and ccrtLin cadmium oompounds. dimethyl sttUates, epicblorobydrin, btmatite (fexric oxide), bcxachlorocyclohexane, it:oniazid, Ietd and ccrtain lead compounds, nickel and aztain nickel compounds, 2,3,7,8-tetracAlorodibenzo-pdiotin, and vinylidene ctiloridc. - In a recent cornmuniution, rccvaluatioo by Kang, Wantc, and Carra (20) of the dau previously interprctcd as supporting noncarcinogeniciry of lead in humans showed a significant exccss of moruliry hom two categories of canccr, digestive and trspiratory, among workers exposed to lud. Cancer of the rospirztary system in lud-s.tneltcr workcrs and battery-plant workers was detnonsvatr.d to be statis- tically significant regardless of the type of sutistical analysis ernploycd. The tnag- nitude of the risk among the lud-cxposed workers in the study by Cooper and Gaffcy may still be underestimated, bccausc the latency period for 59% of the uncl= workers and 36% of the battcry-plant wori<cn was less ttun 20 years. The LAftC has issued two avuts for rcsurch into the identification of carcinogeruc risks by epidemiologic means: (a) failure to analyu data by latea-y categorics prtsumtbly wil] ruult in a dilution of findings in studies of any diseasc characterized by long latency; (b) such studies must emphasize the rKr.A for use of appropriate epidcmiologic methodology and statistical analysis and for full prrsentation of data in a format that pcrmits an assessment of latency. loaizing radiation has long been recognize.d as a carcinogen for cancer of the lung and even other sitcs (15). The Joachimsthal and Schneeberg mincz in Europc and unaium miners of the United Sutes have demonstrated on a large sulc the exocss lung cancer risk. . Tbc carcinogenic potential of chemicals extends to the neighborhood surrounding an ia&srry as well as the workplace itself. Examples of this include bcryllium, caal-car fumes, asbestos, isopropol oi.l, ionizing radiation, and arsenic (copper • t:mcltrrs). • A rzccat publiution by Hoover and Fraurncni (14) showed that in a county by ooanry morulity study of the gencral population of the United States there was a CtR 5071 • / t
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EPIDEMIOLOGY OF LUNG CM'CER 13 10% excess of cancer of the lung, liver, and bladder among tnales in the 139 counties wbcre the chemical industry is most highly concentrated. The authors state that if this excess is due to oacupationaJ exposure, then the risk of tbese cancers would be two to three times the risk for the general population. This study suggests fresh leadi to cbcmical expasure that may be carcinogenic and states that of paniculu note arc ekvucd risks of lung canccr, in counties producing pharmaceutical prrp- aruions, soaps and detergents, paints, inorganic pigments, and tyntbeac rubber. In the evaluacoa of epidemiologic dita relativc to the effects of czpouue to indusvial avriaogeru. results are more acetpubte when the comparisons by dif- fcrent lengt>ss o( exposure are made using cohorts of exposed workers and control cohorts in the same indusvy_ and in ot}e-r industriex oot exposed to the ctreinogen being casd;od, but for the same age groups and years of observation. Tber= arc li.rnitations to esrimarion of risk wben ctudies of industri.al hazards compare the morbidiry and raorulity of the gcncral population with that of the industrial pop- ulataon. The differing l.areot periods between internal exposure " onset of cancer for differcnt ca.rcinogens make intcrpretarion more difficult. The cohort ttudy (48) of workers exposed to vinyl chloride demonstratzs the importance of considering duration of ezposure. When a comparison was made berwern the risk for a cohort of workers with 10 yean of exposure and the risk for• a cohort of workers with 15 years of exposure. the excess risk of eacb cite-specific canccr .ras incrrascd. Althougb it was angiosarcoma of the liver, occurring in a cluster of surgical patients, that brought the danger of vinyl chloride to public ancntion, it .ras found that the respiratory system, the brain, and the bcmatopoietic rysum also experienced increased risk among exposed workers. Vinyl chloride also causes chromosomaJ abe:rations in rnale workers and an excess of miscarriages in their wives. fi - lnvesoaarions of cancer in the rubber industry have emphasizcd the complexity of the epidemiologic aspects in the rccognition of occupational cancers, not only in the rubber industry but in evm industry. Because different chemicals arc intro- ducc.d at dibcrent tirocs by companies engaged in the manufacture and processing of various products, this results in the appearance of biological effects during diffc:-cnt periods of time. The detection of cancer risk is enhanced by studying cohorts of employees in a departmental comparison, with periods of obsrrvatioo of 20 to 30 ye.ars or morc. For ezamplc, all deaths from lung canccr in a curing dcpz^.rncat wcre from a cohon of employees ovcr 30 years of age (31). F-xposurc eo all typcs of commercia' asbestos fibers results in a high incidence of lung caactr in humans, oot only in the workplace but also in the neighborhood of asbcstas fa:-tories and in asbestos mines, as well as among persons living with asbcstvs .rorkcrs. ' / One of rhe important Icads found by Fraumeni et al., in their U.S. counry-by- count`• said.' (1,9) suggests exploration of the shipbuilding industry, in which asbestos aord other shipyard exposures occurring during wartimc employment ac- counted for part of the exccss lung cancer mortality reported later in crrtain coastal areas of tbc United States. k, f ~
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oF LUNG ~`cdctt+or ~1D~1o~ cu\-s1Y 04~ a\\ ~gt ~Uv~ tbY\ ctt+crt w-s °°+t a~ t. 14 •k ot \unt tp ot aposutc gwock ~°a'` p+8~bc __~ ).~, (79 ot tung ~utn p\%aag ot ~ccN ~ 3b ~ Y telsto ~ pg r-a' ~ adt ~ be h°m ~ ~,~,esc is sn ~ng tt~~ ot '~~s~ng long ~` cl ot`~ 'wtj0 ~~ (s~'ccuYT13 s~ ~ Q+~ o_ us ot g ~ is NB~ ~ ~ c~c •~~tc ~' 60 ~ (n'o1\o~4 4°a~"" . Csp~ ot tun8 ~d ~ o tt c•-~'"~4~, cxy~~d ~vr 1~ p~ lung ,~ st*',dc~5~s' ~t c~'a cyo~t ~ ~ c(( ~~ cXY"" . cYcl sci't•ui' ~d ~ny ` ot luag ~. b5 n` a,d o~ ~ong °'o~~ ot tung ~ * bi8of (~tn~~ ~ wfs c~p°~ \ ~ m*d" ~~in7"1'tio° s~ b~vc \p°g b~ V~o~~ bY t+d00 ~~ow~n • bcrtjdn pt ot cX ~t ~is ~ndlna' tres is ~u~ sct~ ~ ~it~ogeo ~c ~t ~'c ~ o(1~f~d is ss ~ ~\al• ~'ct cu ' \ung I9~• ~ (ot e'c t~~ ~c ~~ ~ hom t aon ~ b~1 , s ~dy . ~ c~'t ~,~p css ot ~.~,c %+~t bs~ b*XO ~(~sncuso gccs~Y x urc tc8" ~~tc. ~~, t)v ~oe 10 ~bl~sh % binolo~s ot c p°s\0 Y~ss Q9cc~~ ~~D" b~n cw~'ss ~ v+lt. tc~, 1 Y~ Kom'.fl to ~~ b~r %oogcO~c 6~ kc. ar'd jes% ~ t cft ticu ot tiqu`~ n8 ~ 1 ~ g~ c ~yl be t ot °o tat - °~c.d\Y otunog mp 1o u' d`c ~y~`ct the bbt`iUtu 0 ~ lung csc`~ be 2 85 u~ 9onsh'pe cXp°s`~ to h uenIs is ~~t a,4°S~ cs•posry ~cngs ot w~ s dosc~ct{\ -='b c ~ivcb o g~ttt~ tt'O N 1i ~ o cp~~a'`ou ~~c ~Ye n~ ~'S ~snc '~' % ~r•ecs ~ ~,cc nt ;utno~ aum\aoVe 60 o, (ot wo~ ~u,ogc~~ ~2tq 91• ~ng ~t, CATN ~ I u ~~ns~ble (oc 0 cj' :.ct n N"-cs ~~,.~ ~~ o n p~nc ot bl\wot iry' to \u°g d It h ur~-~um ort' ~n ~oxlde u'~~,et Wb~ss~~ p by seon a c ~'°~ l3N Ln~i~o~ ot ~s~ ~\~cc ~ ~ i221 o~ mc ~dis ~t ~og ~ot ti'gh ~M s -~`ong \d ro~ bt ~ ~du~s 1r~+6 o( ~o \ung ~' ~fD b 4 tA \2 ~ Of ~'b`~' ,,a risk ~ ~ po4`~~'00~ cx (o~ as a` o~, ~~ d~e snc~"o(_ cxF"' cnc \un6 +u~ c c~p° • It~k ot ~gcns ~1det°pO~ Fo1low.upoon ot csssu'o `~1sT so ~. ~no11N c-TC ~~ (351 ct~\trfi~s ~n ~'u ~,c\tat u' ~ ~ ons vc. ~c sbo xpu-s' ,Aotc ~^ cn~ ocs ss~" is itnp~' a~'ng ,t ~cc \cvc\s ~ coo ~nmuN .be chi\(a tswt` stss rs~s~ntly ti~6 vr~ 4~cu\-t ~cc ieY6~ ic.'~`c Irv- t,c lc 1i'nng ~yngct cb'\~ st~o t~nd in pcpD ~tb `1 gc, ponsticp ~o C T R 5073 `a) 0 e~e .,.` C++'~ `_~
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EPIDEMIOLOGY OF LUNG CM/CER 15 T1x pan played in lung aucinogenesis by the petrocbernical industries is not yet oompletely documented, but the county-by-county study of Mason and McKay (3d) gives some thought-provoking leads by pinpointing counties witb high incidences of lung cancer in ttiosc areas with great petrochemictl ezposure. Half the pctro- chctnical industry of the United States is locace.d in Houston, Texas, aad most of the plants are on the Houston Ship CLannel. A ctudy (25) was made in Houston of age-adjustod mortality sucs for each cauu of death for a 34yw period whicb ' grouped the data by the census tracu surrounding tfie 15 a,'u-pollutioo sampling uatiotu. It revealed high motulity from lang caaccr, b,eart diseases, aad all otber respiratory di.ceascs from the ship channel in the soutbeast to the northwest in the pathway of the w•inds prevailing 1 I months of the ysar. In the 4st 15 years of the study. dcaths from ttspiratory cancrr aad odex rupiratory diacases and beart dis- eascs had doubkd, wbereu tbe 34-year rates outside this pab.vay tud remained rtlatively stable. A similar finding was reported by Clcmtncscn (6) in Ftsdcricia, an indusvia] town in Denmark. Tbesc epidcmiologic findings are suggutive of the multipk fa..^toa underlying the etiology of lung canocr. Prcliminary epidemiologic atudies in Virginia, Maryla.nd, North and South Car- olina. Gcorgia, and Tezas were performed by Hitchcock (13) in which oomparisons wcre made between lung cancer morulity rata in counties graded for trrbaaization, - employment in higher-risk industries, and turrogate meuures of natural biogenic sulfide production. The surrvgate mcasures wcrc mean aanual precipitation. drain- age, and landfotm feuures. Her field studies in ult ma.zbcs and otba coasul sites confirmed tbat hydrogen sulfide produced by bacteria in flood iodimeats is npidly convencd in the atnwspherc to Rspuable paroculate sulfate. She cuggestr:d that the hip,h rates of lung cancer among oil- and gas-field workers in Tezu and Louisiana a.re related to tuch sulfate production and that otber tnining a.nd manufacturing operations that involve releasc of this gas may also carry the added pulmonary huird. an anothcr study (46), ttre authors rt:lattd rtspiruory cancer to wetlands ruidcncy in Louisiana. ~, Tbese studies may explain the strength of the pruipitationlelevation factor in the models of the geognphic distribution of cancrr in the United States (50). Even attcr correccior, for most of the factors that come und--r the urban umbrella, areas of high p:ccipitation and low elevation were found to h,ave high rates for almost evern type of cancer moruliry•, including the respiratnry group, and a7eas of low prectpitation and high elevaition experienced very low cancer mortality. Thc rrsponsc to potentially carcinogenic i,ndustria) iasulu varies in individuals, not only in tenmc of genetic tnakeup but pcb.aps mosL imporunt in terms of general nutriuonal and basic health and environmental background. A study of cancer among rnigrants has been a very productive form of research. In the pm, the focus on tsiip-aats wu on individuals from foreign camtries. ?.iancuso et al. (32) found differences among migrants from differcnt paru of the United States. An important considcration in the dcvelopment of cancer among mignnt3 is their bacl;ground, esprcially among blacks, of general malnutntion and relatcd discases as a ttsult of dccades of poverty, with associated physiological impairments affecting the sus- ~ a . CTR 5074 , J C - ~~
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16 EP1DEMlOLOGY OF LUNG CM'CER ceptibility and adapubiliry of the i.ndividuil in subsequent years of life. 'Rse direct bcaring on canocr devclopment of malnutrition in combination with subsequent eavironmcotal factors is virtually an utxxplored area. TThc migruu sxudy.rithin the United States stvealed that the high incidence of lung cancer among blscks in Ohio was unong migxant blacks. Ohio-bom blacks had the samc lung canccr death tttts .a Ohio-born whites. The indications an dat this was related to tbe fact thu the migrant bla:.ks who were born in the south and mignted to Ohio were employed in tbe 1ow'cv jobs with the greatest indusvial exposures. An int=dng further potrati.al txudy (28) may show a reverse migration of blacks caused by major employment dislocations in nonhern citiu. Ofu.a blacks who spend their working lives in ttr indurtzial north return to their original communities in drc south. 7be long latent paiod between exposure aad onset of lung canoer meins thu in timc tbere will be an upward duth rate in tfx southern eommsmities to whicfi t3sese exposed workers have rCauned. lt would be a major contribution to our tmdGSUnding of cancer development to establish a mechanism for idendfying and following tfiese workers so that the prior work-industry exporure oould be propezly documented for subscquent evaluation of the future lung cancer patterns in tbese areas of the south. •_ •- A sclatively recent avenue of rLSCarch is opening up because of awareness of the pan played in lung cancer by indoor air pollution. In our own study (27) in El Paso an attempt was rnade to determine why Mexican-Aroeriun women had an incidence of lung eancer twice as high as that for other white women in the same community. About 609E of both the Mexiun-Amcrican women and other white women smoked eigartues, so this was not the mijor ausative factor. El Paso has had a totil regisvy sirKx 1950 cooperated in by all the medical profession. Enterviews with the women with eincar and their relatives were earried out prospectively. Eacb patient was asked for her thoughts as to what m.ight have caused her disease. They all mentioned the arlling environment when heating braziers were usrd in the airtight adobe houses in which they had all spent at Ieast 20 yean, and this was found to be a significant euuative factor. Analysis of wall scnpings of tbe Mexican-Aaurican women's houses demonstrated the presence of benzopyrcne and DDT. No unusital radiation kvels were detected. . .,., ' Because of a recent review of the current status of a number of studies (10,43) on the subject, insights into the extent of indoor pollution and its sources ut coming into focs. Because peoplc spend an estimated 70% of their time in their homes, this may be an important eonsideration. A demonstration energy-saving botrse built in Mount Airy, Maryland, was described as a`veritable fortress against the loss of energy." When the conservation-minded designe*s studied the results of their airtight bouse, they found that without the drafts of outside fresh air typical of most bomcs the indoor air went bad. High concentntions of foruuldebyde gas were found, as was 100 times the rutural background level of radioactivity. Tbese pol- lutaats originated in the home itself. Forrnaldehyde, a bonding agent in foam iatuluion and in furniture made of plywood and particle board, and a common ~I.ngTOdicnt of adhesives in c.upeting, escapcs into the inside air. . t C i~ c_rT C.,s' •dr
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EPIDEMIOLOGY OF LUNG CM'CER 17 The most alanrting pollutant discovered in these studies is radon, a radioactive gas. Radon'r: charged dccay products cling to dust particles that often lodge in the lungs and result in short-range radiation. ln regions of the country with luge deposits of radioactive minerals. indoor levels of radon can become high. Auuming that most Amcriun horncs contain severa) tirnes the uormal radiation backgratnd, as ttu limited data suggest, the Lawr:ncc Berkeley researchers (10) have ettiautcd that this might be ttsponsible for tbouunds of lung cancu ases per yeaz. The EPA his wggcsud that if vcntilation in all U. S. bomcs were cut in half, the ixreasod uposurc to racbn alone migbt increase lung cinccr cases by as mucb as 20,000 M Year• The National Academy of Scieoca has rocogniud the imporunct of indoor air pollution in the development of cancer and other biological effecu. Rectntly, the WHO rocomrnaidcd that governments that reduce 4cntilatioo roquircments in the interest of enerry conservation be mindful of the impact on de qualiry of air that vri.ll result (10). . V GE\-ET7CS a The expanding knowledge of genetics and its relationships to disease processes • gives rise to ideas that are "speculative, but represent reasonable extensions of our knowledge of genetics and lung disease" (21). An individual is born witb his own immutable set of genes. Tbc interaction of the individual genotypes witb factors in the environment, in the diet, and in individual behavior determine the bealth or illncss of thc individua]. Different sets of genes condition an individual to different responses to environmcntal factors. When limits of tolerance are reacbed, i.llness ruults. It follows naturally that sets of gcnes differ from person to person. Tbe limits of tokrmce to environ.mcntai insults also differ. Genetic factors are characterized as pndoninantly single-gene factors or mu]- tigenic, due to one or more genes acting together. The search of clinicsl geneticists for euscept.ibks in the popula:ion with eingle-gene disorders or inborn errors in mcubolism ba3 been divertcd to the more productive rntdy of hcrrditary factors predisposing individuals to common disorders. The aim is prevention. Single-gene disorders are rarely uuses of disease. in lung cancer the etiology of the disebse seerns to be a trsult of a eombination of enviroamental and genetT factors. These evvironroental factors have been set forth broadly as pathogens (bacteria and vi- ruses), irritants, polJutants (eigaren.e smoke and coal dusts), drugs, and nutrition. ln the more prevaknt histDlogicaJ npc of lung cancer, squamous eell, as in most human diseiscs, pathological hctr.rogenciry sxms to underlie important influetxes, arid liale evidence exists fo: inherited influences. ln the tam types of lung uncer Nstology, the relationship is more apparent , between grneoc facton and onset of diseax. Mulvihill (37), in 50 rrported eases, listed cckroderma or progressive systemic sclerosis as a forcrunner of alveolar etll adenocarcinotna of the lung, with the unusual ra.tio of 7 females to I male, w-herras the ratio in ickroderma is usually 3:1. Also rcpotud is a dirtct rrl.a.tiosuhip between 1 . , 507 G C T R C ~~~ ~~•1 0 +~~'~~~~`
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.; , 18 EPIDEMIOLOGY DF LUNG CANCER t,he level of thc enzyme aryl hydrocarbon hydroxylase ard the induction of lung canccr and fibrocystic pulmonary dysplasia. Geneticitts arc rocognizing hereditary traits or syndrornet in families w~ch pre- dispcKe to criuin types of cancer. Mulvihill (36) states tdsat the clinician who diagrtoscu the canocr, but not the syndrome of which it is a snanifestation, makl s _an inaomplete diagnosis. • The geaciic and hereditary factas ttut are coming into focus give a means of aaoeaing persons at high sisk. with the anticipation of interrupcing the process and prrveating the development of cancu. As of 1980, the multicuge or two-saage theory of carcinogeaesis, initiation and proruotion, is the working hypothcsis of many scieatists (5). flucidatioo of the toles of DNA damage and repair mochanisrtu in the carcinogeaic pcocas,and of the relationship of tbe wide range of individual genetic variations to carcinogenic suvxpdbility has broadened the base for oootinuing the explorttion of this complex subjoct. An important avenue of Veat potential involves attcmpts to idcatify and exploit agents capable of inhibiting oe rcvcning the biological mechanism involved in initiation and promotion of carcinogerxsis. The increasing sociological impact of envvonmental carcinogens is clearly sbown in national and international incidence and mortality studies. It appears that most canctirs arc initiated by external agents. Intrinsic to that observation is the idea that cancer may be a preventable disea_se. The difficulry of translating this to a real.iry lies oot only in i,adividual responsibility for health protcction but also in a mote areful awarcnus and regularion of the by- pcoducts of our technological development. NUIRIENTS AND A,*%Tih'UTRIEhTS Tbcrt is a coovcrgence of scientific interest in 1980 oo the relationship between nutrition and discue. In a recent article, Dubos (8) observed that many people in the Wesiern world, especially the United States, arc intensely worried about their nutritio.d sutus, flot Dccusarily because they a.m suffering from malnutrition but because bey are eonstantly hearing and reading about the dangers of bad dius and of food oonurninased with additives and other eherniuls. Any departure from a bypotbctical "idul natural diet" is publicized by the tnedia, thus contribuang to the prrvalcot social neuroses about the genera) state of the world. Dubos goes on to say sbut if s,ome, and perhaps many of us, an: in a state of malnutrition it is bc:.auu our dietary rcgirncn is ill-adapted to modem conditions: "It would be avrprising if the nutritionai rcgimcns designed for the old ways of life were the right ones for the conditions prrvailing in today's wheel-borne, well-heated, air- ~ eooditio.cd societies." A rclatively oew departure in nutritional research is the swdy of individus) diffcrences in nutritionil rcquirements. Tbe scientific evidenoe is . inarariasg ehat a diet suitable for one individual may be dangerously deficient for anothet. Dubos rrporu as an example of the trend in this type of rssearcb, a recent :~'trcudy of 19 bealthy men in which an almost fivefold diffucnce'was found in their . CT R S077 ~' r~ S ~h ~~ ~4~ ~~ S..r~ eJ 2 ,.,. .r' ~ ' ~ '
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EPIDEMlO1AGY OF LUNG CANCER 19 daily requirrmetts for calcium (from 220 to 1,018 mg). and twofold to sevenfold differcnccs in tbcir necds for the various essential amino acids tlut maintain nitrogen balance. Fxaasinatiotss of many poQulation groups under widely different cirrum- uinccs have deroonstratcd that the nutritional nocds of an individual undetgo pro- found changes as a result of adaputions to rboruges or abundance of certain m.iuieats. Basic laborawry• ttsearch is coctinuing in pbysiological, biocbemial, ceIlular, aad molecular a.ac. The time is at hand to idcntify individual dietary roquusmcnts, ukimg into aacvaat the different genetic, somatic, bebavioral, and eavironmtaul siiuariotu of individu.als (11). In expert pands, assays for tract tstioaal oonteau can provide a ruisfactory method of determining the balance or imbalance existing in a given iaaividual. Mineral rebalancing by nutsitional or pbtrmacologictl ma- nipuLtions aboall increase the well-bcing of the individual by balancing his prrsonal equation and may prove to afiect the probability of a favora.ble prognocis, even in early clinially observable stages in tbe malignant progression. Deliucatioc of the epidemiology of anxx of the lung etnphasizes again that awareness of tLe w•bole person, his work history and his environment, not only his canar, must be considered to effect improvement in the present picture. In an adcquan detailed history, carefully elicitod from the paticnt in the clinician's office, covering the entire lifetime work experience. family medical bistory. and residential and other usual envirortrtxnts, may lie the clues to identifica5on of tbe causes of lutcg a.na,•r. As in the El Paso lung cancer txudy, the patients dctns.elves give the moct i,mporunt clues, but they must be listened to and encouraged by careful qucstioaing. Mi.ni.mum-fotm registry data, although it allows a hcad count, defeats the epidemiologist by its omicsions in the search for etiological clues. A retrogressive stcp was taken roantly when the laiown primary lung cancer deatbs wTre combined with lung cancer deat]ls not specified as primuy or secoodarv in the InterIIabOda: Cla.SSlflcatJon of D1stLSGS, 1965 revision (19). Scientific evaluation has shown tbcac two categories to be clearly different (50). Epidemiolvgisu must work toward uncnding the official reporting of lung cancer by separating lcstological types, bccause diffc.rrnt ceU types often have different nuural histories and causes. i It is in th bes-: interest of science to take a comprehensive approach and to avoid the fatal fixnd id:.a in considering tbe epidemiology, etiology, and eventual pn- vention of lung cancer. Obviously there an causative factors or combinatiotu of factors that sc*nce has not yet pinpointed. As we strive for objectivity in the face of nurocrous pressures, we might consider the wry comment of one of our cootem- pon7• pailosoFic:s that "the great tragedy of science is the slaying of a bcautiful bypatbcsis by an ugly fa.n" (16) and, after disappointments, go on with courage to try again. ~ It is vital ti;r: research continue in an unbiased, open-minded atmosphtre wich a broad pexspc=vc as a basis, so that potential or proved environmental, noncn- vironrnentil, social, and economic carcinogenic factors wi11 fall into their proper ! T R 50?S t ~~e' R NH 0012000
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20 EPIDEMIOLOGY OF LUNG CANCER placa for the eventual solution of the lung cancer problem. It Quy be (tuJ action by the upcoming healch-constious generation will lead us to reslize that t•ticre are tnr<ny tarcinogen-producing luxuries to which we have become accustorxd and wittwut wGich we can learn to live. Epidemiologists must continue to work closely with clinicians and scieotists from evrry field and maintain an essential objectivity in the comrnon goal, the pttveotioo and ooatml of lung canca. REFERENCFS I. 1Slot, w. J., aod Fr.umeai, J. F., Jr. ( I919): SWdus of respiruory amca ie h4h rick oommrm}oa. J. Occv. Nee.. 21;276-271. 2. t'..emeroe, E.. snd P.ulietS, L. (19?9): C.nrrr a%d Vuaiwln C. Lixu Paulinj laainnc ot Sc~eaa .od Medectiee, Menb Partc, Calif.; Diicibvtod by W. W. Nonm, 1k,r Yortt. 3. Doil, R., Muir. C., taed Watcrltousc. J., rdtuon (1970) Cancer l.c:dtwcr /n Frw CoRriwrwrt, Va'. Jl. Duaibured for UICC by Sfriatc-Vcrtag, I:ew Yort. 4. Ccm., B W. (1971) TThe '1cbu+ f.aar aM hral csnar. C+proat smolanj or air poUuom7 Ewrirw. HrahA tenptcr., 22.17-21. S. CSart, R. L. (1979) lnaotr+xuoo to the 3191 ancual ry=pOCiuro oa fuadamcntaJ caDa rescrocL. !n Carrswtertir ldts+(frcarion anG MecAanuftj oJ A.cuon, edrued by A. C. Gnffin tod C. R. Shrw, pp. 1-2. Revcn Prcu, /+ew Yort. 6. Clrmnacc. 1. (1977). Is lunf c.nc« wociated .mb air potluuoo' A ule of r.ro row-ni. Hwuno ae,d Fndcruu. Acu IarAol A(tc.obtol. Srawd /AI /Shippl. 2611, S:Sbb4. 1. Cpeecb, J. L., and Jottnwo. M, N(197t). Anjrowcnma ot tL.er io the manuf.cmc of polYvinyl &bridc. J. Otcrp. MsQ., 16:150. 1. Dubot, R. (19i0). Nutrwand ambijuitiex Hanral Hrnory, 19.14-21. 9. Fs.umeai, 1. F., Jr. (1979) Epidenuolo=icaJ uud,es of canm. la. Carcurotnu /[trv>finanon and YecAarun.u of Acnion, edtted by A. C. Grtffin and C. R. SE+w, pp. 51-63. Rivea P+cu, New YoA /o. Gold, M(1960) lndoor a'u pollutioo Sc.rnce. K1.3d-33. 11. Gon, G. B(1978) Dra .nd ouonuoo m arti-er uuwton Nrrnrion a&d Coxr, !S-3. 12. Hamnwnd, C. E, Srlttoff, 1.1., and Sctdman, H. (1979). A.abcuoK uposurs, cijarcnt cmokicj .nd Itath ruu ARn N.Y. AcaC Sci., 33-0A 73J90 13. Hx-ice! , D R (1911) LunJ cancer, .u)ands .nd hydro:co sulfide. tn Trnrr Srbrwwcti in F-"voM+rrua! Hra1rA, XlV, edtud by D. Hemphill, pp 43-50 Uoivmtry of Musoun, Columbu 14. Hov.cr, R.. and Fraumrni, J. F., )r. (1975) C+ocer mon+Jtry ic U.S. oounou with chcmiul wd.axs Ejqruon Rtr., 9:196-2D7. IS. Firrper, W. C. (1966) Occvpanosa/ aid Eavi,owaunw! Cawcrre oJtlu Rrrprraory Synun. Re• cnv Rrrult.; &n Cancn ReirarcA. lYo. !. SpruEer•Vtrtat, New Yortc. 16 Hoiley. T. H(Il79) Btojeoects and a"encrti PrtttdcotiaJ.ddreu, 1170, Bntith Ascociatioo for the Adv.nocment of Science In Ducowiri. Bto)ofrcal and Geololua'. Collecrtd E.isoyr. Val 8. D Appleroc. New Yori . 17. lp.ca, 1(1966) TTr eptderniolory of luoj carar to Rtauon to pulmonary tubcrcvJost4 Special Lacarrc, Uavcniry of Ptauylvanta. 19, lntaurocaJ Ajency (or Rrvtarcb oo Canacr (1979). Erolrorto+t oJ t)re Carciwottraic RuJ oJ Chr.ucaL to Hro.mnr IARC Masod.ap)u. Voti 1-20. Srpp1. 1. WtC, Lyooa. 19. Vt?tO (19d7). Inirrnarta+sat Ctarrrficarwn of Durafri. VoiL I and 2. 196,5 rcvisioc. WNO. Gmeva 20 U;a.j. H K., Infante, P. F., and Cam. I S (1980) Occup.cional kad riposurs and caxer. Srwwcr, 207:935-936 % 21. Kuauac, H. H(1976) A tcocticitt'c view of lunt duurt Aat. Rrv. Rrrpv. Du., 113:261- 266. I'.. Lsc, A. M., tnd Frwrrroi, J. F., Jr. (1969) Anentc vd recpiruory cancc in man An ooau- pnonal audy. J. Narl Cawct.lRn., 42:I04S-1052. 23. L-.R A..JoGn.m,W.M.,Watmc,J.1:..Arcbc:.V.E,vd°-=--__-a^m,G.(1976) C),obpc obaovuioot and canocr incidet.a (oUowwj CRposurt to BCME. Ann N.Y. Acad. Sci., 271:71- • 0 CTP C ~ ~T ~~~ N F4 -) 01,30,10 1
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i j EPIDEMIOLOGY OF LUNG C.tNCER 21 24 Lloyt. J W. (1971). Lcng•serm monaltry RWy of aeelworkcn. V. Respiruory cancrr in ooke ptant .c.tm. J. Ocrrp. Med.. 13:53-68 • 23 M.cdoruld. E J. (1976): D¢rrwrraphtc varuuon in cuxrr m rtlaoon so LrAuaoia) and ennrsx+.* menul mfluence. ERnron HraAh Prnnrcr., 17:153-166. 26 Macdonald. E J.. and Heuuc. E. B. ((971). Epidrmtdo=r ol, CancYr in Terar: hridrnte Analysrd . by Typw. ErMic Gro.rp ad Grojrap)ur l.ocanon. R.ven Prcu. ?:er Yort. 27. Macdonald. E.1.. Lschcossein, H.. Nooner. D.. Fior). D.. 9r'Itetrom. S.. and Oro, 1. (1973). E-0.dcavob8rc faaors sn hin8 carscer amoot women in El Puo Cotimry. Tcus. 19At-69. J. Ars. Mrd. Woon. Asroc.. 2l:4S9-W. 28. Mu+cvao. T. F. (19?91: Ca.csr .n rAr Wortplacr: Aa Oxndr~.-. Ptooaedm8s of a temiaar for .ewi mudu oo loa ia lbe .crtplatt: Is ehcn aa oocepatrooal diacau epidrrtuc' Sepa. 13-14. 1979. U.S. Dcparvnros of Laboc. C>tiarp.tiona) Safcry .rsd Ficalrh Admmm.ooo. CsicaBo. 29. Marscvio. T. F. (197s): Consi6er.c,on of ehromivm u an iodumia) eKi,eoFen. In Proc.edinjl 01, tAr /.rrn.miaoal CatYrm.cr on Hoa.7 Msal, tr{ the Eirv+rwsnsrnr. Torasto. oaurio. Omoett. 1975. py. 313-356. 30 Mannno. T. F. (19'601: Moru)ity wsdy of Eeryllium iaduavy vaScm' oonqnoooal hmj eancw. Eawon. Rrr.. 21c4i-S5. 31. Mancvso, T. F. (1976) Probkrru .nd prnpoopvc m epidemiolosiul m+Qy of occ~cpanooal pealh Wuds m the rvbba irsdusay. ERvwn. Hralrh Prnpen.. 17:21-30. ~ 32 Mancvso. T. F.. Cbuhcr. E 1., aad Macdonald. E.1. (197)l: Mtpwoo and cancc mnru)iry e.pcnence A audv of eanvt tod .ousr,an born nao.+bitr Osio reudeau. Trarr Srbnanrei in Est.+ron HtaLh.. 6 49-56. 33. Mason. T. J., Fmmcni, 1. F.. 1r., aad McKay, F. W. (1972): L'rvtium mil) ailiats aad carstcr moruhry in Color.do. J. HaL Cancn Insr., 49:661-664. 34. Mason. T. J., and McK.y. F. W. (1974). L'S. Ca1 crr Afo+ralln b~ Co.rnry: 1D30-1959. DHEIA' publseauoe oo. (K1Ht 74..615. U.S, Govemrncot Pnnnej Office. Wasbintsoo. D.C. 35. Milham• S.. Jr.. and Svooj. T. (1974). Human srseau eipoturc in rsianoo so a coppr caselscr. ER.+ron. Rcu.. 7:176-182. 36 Mulvihill. 1.1. (1975): Cooreruul ard jrnuic dt.ease In: Ptriou m Hijh RuF of Canrtr. An Approarh to Cascr Enolor and Cortirrot, edited by 1. F. Fraurneni, Jr.. pp. 3-35. Anbcrruc Preu. Ne. Yort. 37. Muavihill. 1. J. (1976) Genr,;c f.csors in pulmorsry eeoplasrru. Etnh Defecu. If99-I I1. 38. Ne)son. N. (19'76) TLc esbroetlxrs-ouupauau.' earaaojens: A tummuy of taDoruory and ep,dcmlolory studies. Atsn N.Y. Acad. Sri., 571:81-90. 39 Rsdmoo. C. K.. Csocco. A.. L1oyd. 1. W.. and RuC. H a'. (1972): LooB•tum moruliry crudy of aalrortrn VI. Mortaltry trcxn euJtjrunt eeoQlums arssonj coice wea w•oeicas. J. Ocnp. Mrd.. 14:621-629 aQ Rrtsn. L(1906) Uber BLaxncrtrmkvn8cn dte Anilrnarbcltero Yrr'r.. Duch. Ger. Ciur.. 35313- 314. 41. DHIPA' (1979) Srnokin` and Health. A Rrpon oI the St+rlron Genera! DREW publstatioa no (PHS) 79-50066 L'. S. Gorernmcnt PnnnnE OH'ice. R'ashsnEsor,. D. C. 4:. Sserlinj. T. D(19801 Srrwttnj. occup.uon ard rtspsratory dtsease. Presented C tbe A,mersc.an Lunl /uwcuuon Occvpanorsal Health Tut Fcrcz MeeunB. Cka.*ue-• Flonda (in prrsr). 43 Stcrltn8. T. D., and Kob.rut,:. D. M(1977) Expos:uc to polluunu sn encloeeC'Lvusj tp.ces ' Enhron. Rrr . 13.1-35 4s Sterling. T D.. and a.'eusk.am. 1. J. (1976) Srooktnt char._-tensucs by type of employmeat 1. Occup Med . 18.743-754. 45. U.S Bwcau of the Crnsus (1978) Sta+iiural Abrrra-r oJ the Unurd Stc+u, 1978. ed. 99. R'asb• . mEson. D C. 46 Voon. A K'.. Jolwson. W. D.. Strtile. S H.. and RochsctsilC. H(1978): Re4tionslup bcnveen respuvon canccr and .eslands rniocrscy in Louisuai Arrh. Errvvon. HrakA. 33a24-129. s 4', W'ajooc. J K. Arcfrr. V. E.. Lurdm. F. E..1r.. Hoiadry. D A.. and L1oyd.1. R'. (19f5): Radsmon as the uuu of lunj eancer arrsoaj uranium msoen A'. Enr! J. Med.. 273:18I-188. 48 R'aEorser.l. K., snd lofanse. P. F. (1977) Vtnyl eAlori6c: A ease for tbe ose of 4borasory bauuy in the rtjul.torN eontrol prvicedurs In Onrinu o/ Hw.un Cancrr, edited by H H Hurt. J. D. M'auor., and ). A w'umun, pp 179%-1805. Cold Spnnj Harbor Labocuory, Kcr Yort. C T R 50rS0 ~ ~r ` ~°~~ `~ '..~ 0 "0 C) 21
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22 EPIDEA!lOLDGY OF LUNG CANCER 49. Wellutjwo. D. G(19{0): Tum chu.-uKt of U.S. kmF cancer manaliry. ln Tw Srnti Awdy,u. eCiied by O. D. A.ndawn W M R. Paryman. pp 617-631. Norch•HoIWd Pub)uhinj Co.. Amaerdam. 50 . Wellusfion. D. G.. Nudonald. E. ).. ud wbtf. P. F. (1979): Cawcfr ilorsa)uy: Ew+vwnmnua! .wd EUw;r facwa. Ara6cmic Prcu. Pk+ Yort 51. Wooj. O. (1977): A wmpaial-n+l er,odeJ Wod oo the 4fe ublt prmCurc )o ep.6emioiojic.l SaWus. Jwr. J. Epde.uoJ.. 6:133-159. . I 0 C T R 5081 cr€'R, HH 0011,~~`.~C)"i
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: I//l1 %/! f/i : ://// o/!/-l .... ~ M...M o•...a M...r ® •w/ br../ llp.wnt ..~.~..~:r..~~~~..~. w~. ~ Ax ~ ~ ~ . . -~ . - I/!1,p/l! ... .r...... - .~..~...+.. . • .._. . .~• -. :f: 0 ~ ., • ., r/f 8 , \ ,.` -~- . ,: .- . . . ~r. . . j~.r.r-, ..tw •.r...• ~ •.Ytw © .r. .u..~ ...._ I --...r.J ..r. Ir~Y~/.K ~w' ~~1~ ' NV.w M.It.a MV1M •t~•.trt C1R 5086 ...tw ••awa .
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-?.~-'D TH1S DOCUMENT SUBIECT T0 AUG. 20, 1985 Nuil -O,SSE.AinAfION ORDER IN ROGERS AiW DUKE CqSLS~ THE UNIVERSITY OF TEXAS M. D. ANDERSON HOSPITAL AND TUMOR INSTITUTE Te.,s Yea.ul C.nt.r Nowsan• T,ras T1025 May 7, 1970 Dr. Clarence C. Little Scientific Director The Council for Tobacco Research 633 Third Avenue New York, New York 10017 Dear Dr. Little: Enclosed are some observations on the changing mortality rates from respiratory diseases. Because of chang+.ng c:assi.fications it was necessary to gather the material from origina.l sources. Since some of your statisticians may wish to make further use of the material I have Xeroxed the worksheets giving the basic data - deaths by age, by year, explaiaing unavoidable discrepancies; and exactly describing where we obtained each bit of information. Since rely, ( (Gf~si /~/d , i, Cj ~ Eleanor J. Ma+Edonald Epidemiologist EJM:kr Enclosures CTR 5087 CONFIDENTIAL: M1NNESOTA TODACCO LITIGATION -e C T D 0 '3 0 0 Si
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I DU ; t ,. , =r_. - THIS 1985 h.,;i~:~; IN Rvut,••, u.;r,E GhAS. Observations on Mortality from Respiratory Diseases 1930 - 1965 . .`~ In response to your request for a checic on G'.?lia_-n's suggestion Lhat reported lung cancer rnortality is subject to so zaany d_'agnost:c vagaries over time, that a reduction of 2a'e or 5%% is probably a reiaimal correction factor, some figuring was done. Deaths from lung cancer, Internat3onal List 160-164, from 1930-1965, have been age-adjusted using the 1950 United States population as staadard'. Deaths from chronic respirato.ry disease have also been age-adjusteci with the 1950 population as st.andard. Included in this category are *;e fol- low', ng: (008) tuberculosis of the respiratory system, (241) asthma, (501, ' 502) chronic and unqualified bronchitis, (518, 521) empye:::a and abscess of lung, (527) pulmonary collapse, emphysema without mention of bronchit_'s aad ot,~:er diseases of the lung and plural cavity. Two per cent of the chronic respiratory deaths in the age groups 40 and over were added to t:e lung cancer deat;zs and these f.gures were age - adjusted to see what a possible 25 error of under d?agnosis would make i. t<ne trend. Only the categories listed above were included although earlier c:ass?- fications grouped some other categories. Acute bronchitis, for example, was removed from category 106 (1944-1948) so that only cl:ronic and un- qualilied bronchitis was used. The graph shows the age-adjusted mortality rates by year a^.d a?so show•s Y:e year of discovery and use of t.%%e drugs which have been l:.fesav--.g in treat:-mg respiratory disease. ~ T:e response by cure or pailiat:on of non= CTR 5088 CONFIDENTIAL: M1NN@SOTA TOBACCO LiTIGATION
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7HIS DOCIItAENT SUBJECT TO AUG. 20, 1985 t.,,.,'LLSSEMIriAfIGN ORDER IN RJGER.) AiiD DUKE (:ASES Page 2 malignant diseases of the respiratory system to drugs, frequently was t;je , :. . differential that estabLshed a respiratory disease as cancer. Therefore, with even a one year lag, the drop of the one should be aCcompanied by a rise in the other and this has happened. The steep decline in deat~-j rates from chronic respiratory disease corresponds to the introducton and use of new therapeutic drugs to tce point in 1954 where the death rate for chronic respiratory disease is equal to t;.at for lung cancer. From 1955 through 1965 the death rate fror:: chronic respiratory disease see:na to have atabilized, shows only atna_'1 fluctua: ons from year to year, although it may be star t:ng a gradual increase agarn. The introduction of the respiratory disease fighting drugs provided in addition a further diagnostic tool for detecting lung cancer. Some cases thought to be lung cancer were found when treated with the mycins to be other respiratory illnesses. Some cases, thought to have been chronic respiratory were found to be caacer w'hen C-iey failed to respond to ant'_bio- tics. The curing of respiratary illnesses in the m!dd:e age years, has left a larger population at risk to develop lung cancer, a disease of the later years. The increase of the lung cancer death rate is gradual a-nd steady, however, and shows no great fluctuations. The change in the rubrics which•are used to ciassify causes of deat;. caused great confusion in studies over time. A drastic change for exarr.ple, as in 1939, when Hodg}c:n's disease was listed with mumps, and out of the cancer category, is one case of which there are many. In order to remove possibl,e inconsistencies, the Tobacco Council CTR 5OS9 CONFIDENTIAL MINNESOTA TOBACCO LITIGATION
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TN-IS DOCI""ENT SUBJECT T0 AUG. 2Q, 1983 1,. ,. „..,E.AiNATfON ORDER Page 3 IN RujcKj Ar%D DUKE CASES, made' a grant to the Houston City Health Depar t.-nent which enabled recoding according to the rubrics of 1967, all death cer ti-ficatt s fr om 1940 in that city, and created a body of valid dati. The deaths for each cause were age- adjusted to the 1950 population of the United States, for Lat.ns, other Cauca- sians, and Negroes, for each year. A series of reports is being prepared on these data, several of which have been presented at national sc?entl..fic meetings. The accompanying graph shows the gradual decline in deat~-,s from all causes. It alao shows mor:.ality curves from 1940 through 1967 for heart, cancer, and st.: oke. The actl:al graphed a nnual adjusted incidence rates are sho".%M for total respiratory d:sease a.nd for the principal cause of resoiratory deaths, for influenza and pneuraon.ia, for tuberculosis, for asthma, and for re spiratory cancer. The years of the iatroduc: on to general use of the principal anti- biotics are shodmn, as Is the population involved in 1940, 1950, amd 1960. Ti:e calculated trends over t~r.:e frora 1940 to 1967 show a^ average annual decre- ment of -4. 657 per 100, 000 population for total respiratory disease; of -2. 628 for pneurnonia and influenza; of -2. 027 for tuber culosis; and of -0. 320 for asthma. For respiratory cancer there is an annual average increase of +0. 897 per 100, 000 population a year. In Houston, the rising mor tality rate for respiratory cancer crossed the dec'_iaa'g rate for tuberculosis in 1951, t~:e year of the introduction of izoniazid. From then the tveerculosis drop was precioitous, the reflection of the influence of each successive antibiotic is c?ear?y apparent in this chart. It is freely admitted by those CTR 50(10 C'DNrID_'N"ilAL: MINNESOTA TOBACCO LITIOATION - C ~R ~~'~ 1`"~ ~``~ ~ ~'~ ~ 01,22
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T}NIS DOr""ruT Su?lECT TO QUG. 20, Ih ROGt~zi h,iD DUKE . Page 4 involved, t;-,at elimination of an oqerly:ng '..r.fectqn enabled a di~.<erent:a? d.iagnosis. . Also, apparent from t;ie sa_^ze year, 1951, an erratic, but qta;e ' clearly, an increase in mortality from pnet..^:zonia and influenza er.:erges; as does an i.ncreaee in mort.ality from total cancer in 1954, tot.al heart rsortality from 1954, and in astama from 1959. C T R Z") 0 9 1 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION
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.- - ~- ------- -- ~ _ _ -- -- =--~----; ~ - - rY - ~-- _ _---_ - _ y- -- ~ • --,µ - - ~ - --- - t= -~ ~ ~'- ~ - V ~~ a~ECr ro Auc. - ~,-"EMINAT/0N ..~...,.., ~~ AND DUKE CASES. CONFIDENTIAL: MINNESOTA TOBACCO LITIOATION .. ......~_.~.. ,... ----_ . ._.._. _ --- . . . _ _. .,. _ ._.._ -_ _.. . _. ....~.. ..... .... -- ~= ~; ~^~.... -'-T---~-~----~.-.T ~ . . .. . . . . .' . . L~ _. ~ t ro -~.f- ~+: J d ,~i-„•~ -- t =- .:r_= .. ~ . 1 . . ~ ~ .. .. '! ~ ~ r-r ; .-~i..~...+ ~~ „~ ....... .,, .. ~....J~....'1_.a.. -'- C1R 5092 ~;ti [i t`f 14
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. . . - - ..-,_ ----~-r., ~ ;---~- ; r-----------Y---f--- C:- L-- __~-- - -t----:_- _._ .F,.~.._~..... Z-1 -:y.'.-I r--'----y---- i...-.... .. CONFIDENT/AL: MINNESOTA TOBACCO LITIGATION - . - -- - - ~ ~ -~ -- --- ~- --- i/..~~_ 0 I~ Is ..:r-, i-.r '' _ IN OGER~ hi+U DUKE Lna'" I .. ~- zz:zzz= ' 1~ ~;,".j ~' 1=d u ~---
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_ , . w - L f _ ~ : .. I . . 1 _ ,1•.r •,r r 6,:/ r:-4 ~c :._6. . - r- 1 - c "' ~ _ r 1 : J 91 5ii r k I .~ 1 .h = L7 _ _-c _ :.. • F- ---; ~ .. . Ir^_.I'r_a_vJ'_l,F-''ti - 'F _ i.-.4+ eb ! Nrr: ,r _r - i'1 Z 1 I •- - I I'~ I~r: I L'~i. : - 1-.:-0!. -1 • ,~' r. ! l_'~ G_:= ° 14 : , : .._ :: .._ ... . , ~. . . , L,_ .. T, ::. ..;.__y ^ W_ ! J , Z ' . ~ . I . . : _ .._ I.:i. :.. ~ !..~1~'.. L....~-...~!.... !...:. . . .... . .___. , CONFIDENT/AL: MINNESOTA TOBACCO LITIGATION ?~.. ~ . .. .... . - .....:.-..,:., ~~~ NuK•D.SSE'.;;iaATlb4' ... •.. LK.UGERJ AIrU UuKE ~.r..•w a r ~ `.. >ti ~ p o 0 ''~----- i I I ! -,r-~ ---1- ?lm:IH r I----.Y--.- ! ...l:: ; ;! ! 1-_-_--. ' I I n.. -r ! -rji i riillu' u ~ Lr: r;L 77 ~ I I ~ q ~d u !y i t IGu!'.• _~I ~..~ f n~'; l' I IN ~'~o ~0 ~ G
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~153~ r, ,~1 G ,SElrINATION GRGEr )4RuGW AND D_qU CASES. ~ 1 , © , ® f , i ~ ` S~IT d,41 0 v ye 1 C--;l CONFIDENTIAL: MINNESOTA c ~ Ir R .~'I``',~ ~.~ +~~ ~ 01 .rv 1 TOBACCO LITIGATION
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f.~,v.r,rs ~ounry r~..~ T,r~,ry S~uoy ~ `-- - -_ _ - _ _ -- '. --- -- - . ~ . T 7 - \ Y L ' _ - 0 7 S ~-.d...r.,~.,..w.c..yi (.e. _ --on...wso CONFIDENTIAL: MINNESOTA TOBACCO LITIOATION c T_ J 0 0 1 a
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fJ,y,d.oAct ~ou n-y ~1ar~stc iTy SC. /1.i~ES if:G.vCy <~Ib) c t ..-1S0~ I'IVi1•G~SJCI ~'IM vnu.n y IN RJJEk~ RrvO = CASES, s - - 0 ~ ~ - ~ ~ - ; ~ s ~ ~ J 1 ' ` - I 3 ` k • C . t kj ,/,/ t „( S t/ C .n CONAIDENTIAL: MINNESOTA (~` 9~ C"~ TOBACCO LITIGATION t-~ ~-+r
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~ - --L----- . . . . 1 . • 7 It ® • -- ~ - ~ r A ~ . ~~ . ~ - C4 ~ ~ ~ • a © ® CO TOB CCO LIT OIATION MINNESOTA ~..,r ~~x { v a~' { f -,P ,~s t~ ~, lrR
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l J ~ ~ ~ ~~. 1{/h I~.JF ~pJt~S/Etl I /o.~1N[ /! y /~~NlfS Vr~ 0 0 0 0 0 0 Y UUCUnIt:Nr SUBJECT TO AUG. 20, 1985 10 •DISSEMINATION 0!(DER- IN RJ,^,ERS AND DUKE CASES. • 0 0 I J
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~ ~ .a~.. 0 2 1 r 0 i ...1.,1 . Y IIIIIIGIIIII ~ ' y u 0 9 11.111 11-1 yIa1.N (:fl, ~ri /ao~oAD 0 i 8 0 • • J • • T}{i~ ())CUMENT SURIECI u AUG. zu. 1985 NON•DiSSEMINATI~N ORDER IN ROGERS AND DUKE CASES. • • ~ I Idlll
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ITy Srs~.o~ % .C.PW yWX 1-7•vs..Es P. I ~ ~ ~ ll4aaNJJ1~ 7 ~ Z V - - .. ~ N ~ Z W ~ U 0 ~ W N ~ z C~, Z - ~ ~ O = ^Y~ -\ O c e ~ . C ~ . =y • • a sca+s - i a -~ ~ I I 1 I ' 1 ' ~ 1 ' ~ . s 7 • m s! 0 a CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION
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17) .,,,,e ~ MD. ~ .a~.. rrR ~.~....,,...,.,..,..., _ .1 • • ~JP.' Oco, O . 0 0 1C 0 I 0 0 ~ 0 THr -JOCUMENT SU(31fICT)1'0 AUC. 20, 1985 NON•DISSEMINATION ORDER IN RJGERS AND DUKE CASES. $ r r • • • d • ~ m I 0 ~ 0 0 it.
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, ~ 9 +.r..1 .J.r. y w 8 ~ 11 1~ 2"I•,ENT SUf~I[CT 0 AUG. 20, , ....,, . . ...........•. .•~.. ...... f ) I..u. ..y.u-~1.,.,R•. r.. • `- ' ' lyha tl„N•DISSEMINA110N ORDER ROGERS AND DUKE CASES rr.t~ ioo a~o al 0
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fJ'.~,r..~is <c+u ff~1.V, ~ 0 ct: d N /R C S .. Z' ~ W O Z 0 z s d N ce W C.~ O ~ Z C ~ry ~Jv.r~s,%c iTy Snro LS ~LQDOF.~ ~/~~> L. L C io !1 .r• CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION
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.N y '..,'s! a 7 N N- 0 C T R Y • 0 .... ,•. .. ..., .• ~ • ' . ... . . ~.~:, ~ •. . „...~, f/l~ /~o lu S/FU . ~~ .0 ' 'r"... «M TNiy i?pCUMEifT SUIIlEC1 )0 AUG. 20, ; 1 ( »5 NON DISSEMINA110N ORDER loo o/o I!l ROGERS AND DUKE CASES. % ~N I Y Y • • • J • • Z rrrmrrmtitrmmer7TnTTItTtilTi1i1A1IiiAf(il11QI4i 1A1111f1iRiliiliffi 1 I, P" I RWl I ~ ¢Innm ,
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, .. r..r r r ..••..' r..vi :.rr..•.'... .. ....-.r Ctl. ,~~.. ~ ~ F.- Y Y . a J • • a 1NPS G1()IMENT SUDIECT /fUYUG. 20, 'I !') I 1985 N0N-DISSEMINATION ORDER rl IN ROGERS AND DUKE CASES. ' t - Y L • a J •_ 0
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1985 NON•DISSE!dINF.TlJN ORD,R i ,z g ,l, y .2 « S 70', /$2 ~ c o 14 '7a S5/ 1: sG . s~ 9 S9a ds- ,~0 // f ?~.~ ~ 5~ ~ y /~ G S~ P /-?s/- .~-2 .21 99 /9S~r .-. ;= 'S ~ ~s( '~ /ss7 .3:. p/- 7cS /3G / -: ", -110 99 F=7 /f , ,:;-4 '7 o ~ i~`l•=GcJr.c :: ~~ r IN ROGERS AfiD D'JKE CnSES. r C1R 5107 /70 I ~ 3S 413 /7 P I G •3 9 1? o .,z o I17 • V- Z 6 ' a/ / 9 V -7 ~s• -2 ~a ~z ,5.3 - y G a ~ ~C ,2 ? ~ 7- ~ 7 .2 .f .•, ~ 1:A7`lOTv 0 0 "'ti..,q k .i
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TO AU~~ THIS DOCUMENT SUBIECT tA1NATI0N ORDE3 .- 1gSS NON DISSE IN ROGEP.S htiD DUKE CASEi ~ ~. ... • - . 4 G-/G jz / ~ ~ ' c Go-G y 7C~ /C7AL /Sr o 9~ SP :~909 ' •xP 7 3 9, sy/-3 ~i ?7 .f/ /0 5/ 96 7 /t 6 / ~ /L,2 3ss 9 , J/ 60 3177 ..:3 ;.L .9. /.2 v 9 t/7. : ~ 19 6~ ~4 /S J 57 -1 3, « •t ?o 7 t'O ~ . ~. / J,97 4 ~. Soo ~; 3-2 / y 3 y7 79 /0 9 s~ i.x. /,79:. ~! '707 ?,oF3 /{~/G~ /: y7 J~ S~ 0/tie .% c/6 ~/ 9G 9 S ad /7 3 / c . S7z '/3`f !~ ~/ , ~ ,. 7 +/,i7o '7a~ l3 ys /9so /9 ~9 s/o s9 ds' v ; ~ 9 eta ~6co G, s 7 ~~7/V . 3 3 //9 '14 7 c,:/c 9,9 17 `I/63 : ~- ~ 6.GC~ F v C7 ~ gJ7 l ~3G s~ s~a -'c7 9 , . > . ~ 99 9,13~ 7,/l ~ 9, 9 3-. 7 27, G:7~- //G SiG , 9/ y 6S/ ~7y7 -Z 85" G 33 1, G9/ f,-7 S8 p %c 9y ~o~ , 9 PG 9GS ', 3cP F d/7 •3S s y /~ >1 -7t , -' 11'9 qv_r . f /9c o ~ / -1o -27 .7 v .27 P7 8'/ 7 ~.: ^ y 7 9,9/€ S .J , 9; 'c~ © ~L P -9 Py . 79c cs'8 14C, 9y" /. /ap= - 7 43 ~~ 8: P- ^ y, .2 9 -Z- 97 /W, ~1 15 =o p17 y~ b~ /~oys /7 as :~ yQ /F 7 s ~ y d ' c /9 y 7J 7 . l: t,j v~ cA. ~4= L V ~ ./.' . .- 2 P~ a:y~ l V ' - CTR 510~; CONFIDENTIAL: MIhNESOTA TOBACCO LI7l0ATI0N 3 ~ ~, 13 ( "'~
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© ° ~sl _z/c s3 z 97~ 9~f . -7 y-) rf6 / ! ~~ ~f r9S/ 5-- r/ /! o`s ~ ~%-% /I ' /.f! // .J/J //.37: THIS DOCUMENT SUBJECT TO AUG. 70, 1985 NON•DISSEW NATIO"1 IN ROGERS D;:r:E .,'.,Ll. , /: 07.3 /^' , , ~.,' .... CTR 510~1 CONFJDLNTIAL: MINNESOTA TOBACCO LITIGATION "4
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:-'!S DOCUMENT SUBJECT TO AUG. 20, 1985 NOh•DISSEMINATION ORDER IN ROGERS AND DUKE CASES. A~.:~s~~-t .- • - . ..~ -4`-i /<r, t ~ _ , . ;, . ;,..~ , SL -~ ~ J C T R J r 5110 CONFIDENTIAL: MINNElUT'A ~ t r4 4~ ~ TOBACCO LITIOATIOH ~ ~~ ~~h fltq 1 `3 ~
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TNfS .DOCUMENT SUC;E^T " "; 2'., IN OGERS AND UKE CASES. i 9P2 f C~-9~ : _J/ .. ~ /'::~ 'f- =y-,/^ ( '~~'--r.J tf- ~6Z:7",- L /^L = 9 7 /ca />7G ~ 9 ~ 1 /• / C T R 5- 111 CONFIDENTIAL: MINN@8MA TOBACCO LIT/OA710N C-~ti~; h~ti;h NFI 003033
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TH/S DOCUMENT SUBIECT T- 1985 NOIi•DISSEir,INnT{Uh VPD;R 1N RO^E /- CLl,..L d, 7 ~ . .~%-..iJ - ZL-.' ,~----- r GG CTR CONFIDENTIAL: M1KNE9QITA TOBACCO LITI(iA-npN CTRt~ R ~~ ~'~ ~~ I~°~ ~.~ .~ ~.~ ~ i~.: ~ ?S AND D` CAiEa
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_ -- _ . .•7-.rr 1 - - ........ -. THIS DOCUMENT SUBIECT TO AUG. 7C. 1985 NON•DISSEI,iIt,nTlDi~ IN R`RS AND DuKE c.,._ ~ q/ e- - ~ ~- v~I /.- . sa ~ ./ 9 5/ ~, ~ . - , e C/ - O~- - \ \ r.- i/47 = C-_ i _.. ~~.• . r -Z. C T R 511~ L/ CONPIDBNTIAL: MINNESOTA 7rU e ~ cco~ r `~~~~.h e~cco LiTtc+~1~nN t- i i t b r L. ...+
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55 -7 THIS DOCUMENT SUBJECT TO AUG. 20. 1985 NON•DISSEtr~INATION ORDER IN GERS AND DUKE CAS S, ,,, 9 , - ,"- `; ~- /; 11 ~~r - L,~ '7 l ? s~ , ~o -- ; c ~ ~ `1 ~ J ~ C T R 5114 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION r' -4 ~~0ti'~~~ ~~ M ~y ^ t~~ ~f~~~~E~
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TNfS DOCUfdENT ~ (/ 1s6D N SUBIE„T TO AUG. vir•DISSE~dINAT10N 0,?~; IN AND UKE CAS:S. cJ I /. e~- ? d, A. L~/'.!r•~: c<<, i- c' T •C. .~.~; l~~.Gc/ -~GGt/ ell ` ~L 4, C! c( Qu~ i'7~ rGl4 7r 3 - 4 j,,, ~/,GCL ~ ltG.lGL L~. l' C C~ n[ ~ ~ Q~~G/~ pL ~/~ ' ~~~tf-l «G~~ .r tlf0/.t /.( CTR 5115 CONF/DENTIAL: MINNESOTA__ TOBACCO LITIOATION ~~ [~~~'~ ~`~t''I ~.~+.~~~~3';~
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~ ~ '^' . !l. f 111.6::,- lyG~ iviD{S$",;if~ni iGN GnDER IN ROGERS AND DUKE CASES eZ se•;c~C r,.Cft~A ~/J?c?:.o y /leyou~?; (~Ga/ n !/ . ~/ • / / / J 6" / . .ri/ - 9iG ~ /% O~=C: fc~ • ~tat O~C:~LaICc, ~ ~ ~ ~~G i~~ox[ tu..r/ ~i•.,: cc../Vo ~ tr.~ -~o~ s/ A2Ci --., . CT,R 511c CONF/D:;NhAL: Is:INNBSUTA T08ACCO LITIGATION cl sR rim ~"..~03036
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--- - - ~. _- -•~~ Tr ~,,,i~.~EIIJ S ---------------------- ---------- _~_-- - -_-~_ - . __ _ -_ ._ :.. _ -• .-~ =:~-r..i__ _ _:.c _i'.i. .. __':.. I• .,.:r ...;~e C• rt- •r'==•--- V •••. ~ •K.••1~ M~- M~l• ~.._.... ii:•,•:~~~ .:;. ,t... ~- ~- - _ ~ , ~-i . L lL L 1~ 1, - ". - '• - • ~1 - r- L - I. ... . -_ . • _ _ , T..- _ . u.. L hs ,.,.a o c T ~ , . , . - : .. - .^ - .. . _ ~ ...~~ ~ii .~:a rs~~.' a. :, .•i. - - - rac 't-'_ari . . .: - . . . I . • _ ; --~ . - _ -L. - __ - , ~.r,•• i, ,. _ , n---z _ ^ :'.' .1 ' ~ + --•~`.":_~.r- ~-_ • , .1 , y. T,,.• ~ .-c.•r~hir ~.i r •' '• ;~n1 i _ ] V:, JL-=j '~ _ ,. I r __~f ~r~t= ~~. ~_.., •__ , :.. : r - 1 . - i'- - ~~: _ i~~ 1 _ , .'><':~ .: ~• .~- y, _ -L r .-_ • . - !i3. ..c~ _ n u:.. ..n . L. _t• _c i _., ' •- - , - _ _ _ __~ - _ . --. -" - '. r' . . ~= - • _ _ - _ : t== _ _ - - - --- ~ - .... -_ - -'- - - " _ = _ - - ::_-i ~ -- _'c_ .__--•'~-= = ~ _ _ - - _ _ ~ ~_---- _ _ - -...-- .• ..: . . -- . _ -- .. . . .., : . . . _ '_ ~; .- ~t.:.. . . 1:. . ' - - .Ir .! - .._ -~ _ _ ---.---_ . _'J~.;~f~:J: lr _-• _ - - _ - -=- - _ _:_. . _:~. _.: .~:-. .' :-.z - - - = _~-_ i=a~-^ _ - •-__ - _ _-- _ _-- - _ - r_ -1 - _ _ -- --__ - - .(; -.L- -r- - _ - -^. - 1 ~ -y#---•. - - _ . i - •-a~:-_ ---a-_----- ~- -_ -- - - - ~--_- ~ ~---- . - -----__--' , _ _? -_-__'_ , .__ _ _._.:_~ ' _. . .' .--•~._~._-_' - - - _ -- _ _ c ' ~ 1 =~'.'_..- _T... __t-- - _- V ~~- iv A '^ N ~-• ~.- ~- .•1 ~ "L~-1 L.:: ! 1 -~I .;i: i.: : _ ...,__::.;.:;_ •_: :,.:.::-:,i.: _.. - .-. _ ~- -••' .; ? ~N n\ ~ - - ' . ~!•( . CON'r1DENTtAL: MINNESOTA TOBACCO LITIGATION rri ----_--~-_ ;-L _..~~..',.. AND 1ASES J . ir.. ~. ...: : '. 1 -. ~ 6~~ ~' ~ ~ ~~ ..) 0 3 .~ `~ t:.:~ 1,4 1'I. it - - - - - ; - UBIECTJO !V0, 20, •~~•~-^•:•• yalrUN •DISSEM;NATIpy ORDER •r«~~•• IN &GGEP
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lE~i TO AUG. 2Q, THIS DOCUMEH~~ MS NON DISSa1~NATKO ~S~~ Ih _RO~~ AND D- , ~ ~ ...~_..q.. n 0 Z ..cr.•,., 7ry._ aP_ae..., R.. fr'rir p., i.. .r. ® =;= -:;: - FEi ---1-.--`-.a - _ .J ~ ~._.....•.,_r;~._.n - _.. . ~ ~----~--•-r- -- -'---J~ - ---- -- --- _.-:---~--~~---_: . . . . . .... t ~. . . . . .... . . . . .... C T R 5, 11s CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION ` .I- h ~~"I `~w,~ ~~ ~~ :~; 040
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'17 I Ili` +1 II~ WI . . • 1 1 1 , I ~It , } { ; ~~II { I ;. Il~lr*, S{{{I'1 i { I I ~ ~. , I!i D ,. sll~ t I . I .,- i illlflltli Gti THIS DOCf/MENT SUfITECT TO AUG. 20, 1435 NON•DISSEh11NATI0N ORDER 1M ftOGERS AND DUKE CASES. ss I I r ..... ~,..... ,........~~ .....-.ti. . . -~ i.wt l.r~./..ly . •..... y i {V111II11tt . ~r.~~..7J •.+la.r./~
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THIS DOCUMENT SUBJECT TO AiT'~ 2li, 1985 NON•DISSEMINATION ORZI IN ROGERS AND DUKE CASEi L'. S. Total Population Age-AcjusteC Mort.ality ?.ztes 1930-1965 yez: Ch ro n.i c ~e.pir atory Diseases =teapiratory Caacer _-~etpiratory Cancer + 25o 1930 75.08 3.95 4.84 1931 71. 10 4.05 4. 88 1932 65.54 4.45 5.21 193-3 64. 4 6 4. 72 5.46 1~?= 61.53 5.11 5.82 1?=5 5.66 6. 34 1936 60.62 6. 10 6.78 1)37 57.90 6.43 7.08 1933 52. 47 6.96 7. 55 1939 50.73 7.28 7.87 1940 49. 58 7. 88 8.46 1941 47.69 8.26 8. 82 1942 45. 84 8.63 9. 17 1943 45. 35 9.04 9. 58 1944 43. 25 9.51 10.04 1945 40. 69 10. 17 10.67 1946 38.60 10.97 11.46 1947 36. 65 12.23 12. 71 194 3 33. 36 13. 12 13.57 19_; 9 • 30.52 13.22 13. 65 1950 26. 54 14.08 14. -17 1951 26.24 14. 59 14.99 195% 22. 27 15.41 15.76 1953 19.44 16. 35 16. 67 1954 17. 24 16.73 17.02 1955 16.61 17.73 13. 01 1956 16. 60 18.68 18. 97 1957 17. 34 19.25 19.56 1958 15. 59 19.72 20.00 195; 15. 33 20. 4 1 20.68 1960 16. 01 21. 23 21. 52 1961 15. 38 22. 12 22.40 1962 16. 14 22.96 23.25 , 1963 17. 59 23. 69 24.01 1964 16. 83 24. 36 24. 67 1965 17. 97 25.47 25. 61 CTR 512 0 CONFIDENTIAL: MINNESOTA TOBACCO LtT1GAT10N L"~IR h N`,4i 00"-~J04.~~
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THIS DOCUMENT SUBIECT TO AUG. ?;, I;i~ ;,~N DISSEt11NAT10N ORD~ iN ROGERS AND DUKE CrISES. `/!`15 / J . l++ck wwca: C - w ' , .-~-a-SS Ga-G y % 7 ~r/u i/ 33 37 SP :7 9•1 J6 7 / /.3.2 /4, / .?~cy •'<f 3e 7 s 3 9 .+c, c 9.~/~ ~ra'cr , ./ ~ J/ _ bo .. 38S /,S7D 5,177 .J / 1 d ,rs ~9 ~ r . . .~xf ~ 3,1 ~ • ^ ^ /4 dG 3, 9P.~ l,y 76 .1, 3S/ ti s S r 7: /Sw _ Soo y3 y 7 ; ~~ s3 ' s /c9 y7:. 41%07 e; 9 ' o 3 , s/ 7 . ~ s • S,/9G J- 7 a d _ , Y / 7 ? ~~ ys 4(.2 /~ s 6 ya /ov'9 /GO ~ ' ,S7,z 11,17 ~/39 J, Odo o /70 ~ 7/S- , .. , /1, 97c~ I~.I /`; /9S0 ?9 39 ~ ds Sa9 ~.ad3 J? 6,310 1, ?,f 7 S a63 .t9 /oG S.t~ G.LCS' 8,G ^ 7 , r s-17 o ~ ?o y9 S.~o .~~7~ ~, ,ZO3 9 » / 'S : 9~ v ~-• ... 9S S: z 9,P31 , 7, 9, 9 -- ' , . - r ~7, L~7, " , 9i j ~ LS/ iC,e .! F 7, 7y'7 ~ /~ ~ ,>7 : % wf • Js. 2S 9y pL 63.a Go.t 7p .r ~ 09l , 3cP //,4~ ~.G^? G'/7 a 76 p,aa ~ o ` 9^ /. - p/97, : .fj /7 ~~ 7d 7,j~ ~ ,1 =q i 9 3sr" /9GO lo JU P7 7 3,Gy~ , y,9/8 3 7 ~/ 17 ?7 ~~ 7Sy /oS yG CS.- Py 790 OS/~ 1 /o 9y+~ 4/ :7 /~ n~2 ~ 6 3 /P l3 P~ FS7 s:~ Q -~- , 7 // .:o ~ y P~.7 , /? QSG /71 aS ;"' 7 S// cr /9 ~%3G / /7,7J 7. ~, C.: : 04 LY.CJrc.- ~ J ~' • ? ^ t~: .?.' S7 /70 ' ~SC // aS q t .i.' ~? S G~? / '7l GY1 L ~ 7 ' ' 7 fy / ~ . . . ~ a -/ .a -~ . 7 9G a ~~2 CTR ~~21 CONFIDENTIAL: MINNESOTA TOBACCO LIT/GATION ~``~~ .~ o 3 ~ i ~- ~
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I 'O•3- /S-C.~ 3/ q 9a3 977 cj-3 :z,,S'65/ s1 Y3 c/J.2 7/3 L:S -2 SSl /~~l .z/7v9 THIS DOCUMENI SUBJECi 1U F'uv: Nt, 1995 NON-DISSEMINA110N ORDER IN ROGERS AhD DUKE CA~ii .S9G3 y 'P,jS j.33 u 9 ~s F- 0.S3 />SS / 95;1 fs 4.z _ 97 7 c~~ ~ ~;</ ,~DyLv / ooS ,3o G .z73 / .z~y~S/ f9?.2 ~ ~sa ~ ?sl ~ /,e1S / t'9...' / ,2, o d o 1 V 3v --S- Yp 6~ (, SGO ~.17 :~ IS~ / ' lPd ,3~ / , 7a.d 7 I%C S 79~ ~ I Ir 7 /s/ L' / 9:~5 ~~ z9~ , J~ ?c/ ~ 9 s 9f7 ' / teo 1 -2 /9lc 770 q/3?1 ; /~SIL ~/S9! f fJ A;soS s 99:.j /o ~37 ~ ` /o's~; /o ytc7 io7cL ,,.-. // ) SS .~, 3 I y' ~~~G 39 Sl ~- /o / ;3cy ly~! ./ , ~c/9 ieP,~r / /4D1 .~, I v 4I ~ .l:i S/ d.7, G L L /~ =K s -:7 y/ ~ ~ P "°7 /.3 i.S.~ , / f d fl/ a 7S f / ! 7 _ 4 . . 7~ p ti? J, 7 .. 1{/b~ ~`lqG7 it o1/ ,l .27o ss~/ /i C L ~r Ir I ~,' 1?~c , /G, 6r10 /-~' G.jL J , 4c-G9 X ~c- - //e •d 2 ~,, / e, 3-Ao ~t~ t~ w1 .3 ; ~ 7e I 7 S 9 4 /77 . _ . 8 11,•G .2q9~ t /r,?; JKoo ~90 ~'73 / 7~ 7S1 ~. j'o f '=7 ?/P~ iSS- , . ~ I?fS ~S.fa ~ p 2 aA f 1 3 G~» 1 17. 4.1 .. i i~ . , . %- ~ ~ ya v J~S_<s ././ ~ , ~, -7a :/ 7 // 7 7i /~ j, ~'7G C T R CONFlDENTIAL: [dIP:NESO]/ TOBACCO LITIGATION 512*2 C.I- 1"1 003044 ~'~
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. 0 0 e_q /e_iq ~.o-1q ... ,~ 39. ~o _ /-7 . v- A - THIS DOCUMENT SUBJECT TO AUG. ;% . 1985 NON•DISSEIrSINATION ORDE; G /N RC,GER.3 f,.6 DUKE CASES. ~o-SlO •~o-r 7" /doS /~90 ~~~ s=7> ;' k 53.2 /~S3 /.J3D Y7S ~ °T/ 6l, t 43S /1,7.3 •'96> /os7 3 /.2 ~ p2o7L /.2 SSI 4 ,'s~~ G.:". /31 K . 7, 7. ~~ n.l. .~o.2 ~G-7 7 .t-2tY ' / %~'r ? lG/ laY9 s=~9S- i ,z~~o~ r 7oI CtR 5123 .CONFIDENT[AL: MINNESOTA "',TOBACCO LITIGATION
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~ cr c 0 ~ U W ~ ..I E ~ I-) co ~ 1 9 c_cE•_ Q CtL~~,) /; 5/~ /OG c C ~ i 4 :; G - i 9 3 2 r-~~ : -:. r_ , /.- .~, i . :r C T R CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION c°f, ~~ HN 00304:6
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THIS DOCUMEN7 SUg1EC7 TO AJG. ?0 ]985 NOh•DISSEhlINti110N ORDER IN R~GER:; ANO D~E C: /,v a-/- ;90?2 I / y: 0 -/G-z o S,% ~~4 41, e2 w _ .y~~' .- /~ j i~ 7 C = 9 -7 Ca.~ I ({/L'~..~C/~. / {I t ~ i lllli y(? / "76 r OrL r~j -([. i • ~ / ... y' ..~ . // CTR ;12-0 , CONFIDENTIAL: M.INNESOTA ''F' TOBACCO LITIGATION P-4 rI F4( ~`~ 4
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! i& -) - / & ~z i THIS DOCUMENT SUBJECT TO AUC. 20, 1985 NON-DISSEPdINATION ORDER iN ROGERS AND DUKE CASES. L ~ZC, ,~ ~, C/ G• • , - 7 C T R 512G COT08 CCOAUT CJATIONOTA LTR HN 003046
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THIS DOCUMENT SUBJECT 10 AUG. pp, 1985 NON • DlSSEIdINAT10N OROER IN ROGERS AND DUKE CASES, / ~ i / I C___ ..--- i , r Ci L-oo, ~ %- a r ~ ~4 C~ll '71 . ~ i .~~~' CTR 5 127 CONFIDENTlA'L: 'h71NNES(JTh TOBACCO LITIGATION E , ~s ,„ il, fi, 4I 003049
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S )GO-i(; ~ 16 c - IG ~/ J (_ -,(~ (o_<~ I(, :~-I c%4 ',t 9 -S`: ~ ^ ~ ai .J TFilS DOCUMENT SUBJECT TO AUG. ?`J, 1985 NDN-DISSEMINATION ORDER JN 0~ GERS AND DUKE CASES. J ,r.' CTR 512S 4! 7 ~ / ~; ~ o- (LJi[ i CONFIDENTIAL: MINNESOTA TOBACCO LITIGATIO ~' ~"a i t"'~ "~" ~i;~ ~~~;,# 003050 N
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~~ • ~. a-~ 1985 NON•DISSEIdiNATIOh^ORD~R- IN ROGERS AND DUKE CASES. , CG/-6lP 07%•- IG:, itc•4-lo o i _ C~lG~~:tiG lc q / ,r: 7 .~, /.2- 6-t-[ Q 4Z-i:.`. ,17G- y j.t i J , , - Z•- e2! ',LL ' ~ ~~ . ~ c G.l G~cc L`~ ~rG.•Gl.7s .. z~~ 1~:~,xlJ G v . l r c c: :~.. j J 29 ~CON~'lbEtJ`TIAL:•b:1tvN~S 1~`T?+ TOBACCO LITIGATION L-LClC~1C.C Q i~./ LC/.:cL lL.ZLs: ~ ~ ; SL •. 4~ &, G f cL eL G•, ~, ~.~~ CC. l~C..~/~y
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: ~ tl t.c.v THIS DOCUMENT SUBJECT TO AUG. ?0, 1985 NON•DISSEMINATION ORDER IN R;,;,ERS AND DUKE CASES. G`LC-/l7c CtLL~c.jG /fta~ !',Gt~Gall'. ~xs 7p ~ ~f1 ~ Cliz C T R C'ONNIDENTUL: MINNESOTA T08ACC0 LITIGATION N t•1 0 0 3 0 lJ .c.G ~.-l" % (~'iC<<! f G„z c ~ lhf~ t! s~~'LliY s!t Gt.cL ,/~ S' G:Lrr G~-icc sr
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F 0 t TWIS DOCUMENT SUBIECT TO AUG. 20, 1985 NON-DISSEtdINATION ORDER JN ROGERS AND DUKE CASES. THE UNIVERSITY OF TEXAS M. D. ANDERSON HOSPITAL AND TU'MOR INSTITUTE Teeas Yea,csl Cente, Houston. Teass 77025 May 8, 1970 -, W. T. Hoyt, Exe cutive Dire ctor The Council for Tobacco Research 110 East 59th Street New York, New York 10022 Dear ToTn: The day a.'ter you called I went to see Bill Alban. I showed him my i:r.:r.ense computer outpu.t on the dat.a and had him send h'.s three head statistical workers over here to my office to atart a series of reports of deaths from each cause by the three etr.r.ic groups. I have age-soec'sic, age-adjusteas and crude rates for each of these for each sex, for Latins, Negroes, aad Anglos, and for toti:s in each ethnic group and grand totals. Carl Erhardt, formerly Head of Statistics and Records of the New York City Health Department, prepared reports like these in Connecticut before as- au**++*+g the New York Department directorship, when he was Assistant Director of VitaI Statistics in Connecticut. After he left, Bill 1-1aenszei published them under h'-s own n.ame, and probably got his Washington job as a result. T"nis will be good basic data and wonderful use of the materia:. I have all the respiratory causes of death computed separa:.e:y a.nd toget':er by year. Enclosed is sorze of the output to give you an idea. I wrote to Arnerican Statisticia.n aL'ertizg them to this project and they are going to publish my comments in the near future. Enclosed is a copy of a paper from the data on my tapP- which was read in San Francisco and has been acepted for publication in the Texas Journal of Biology and Medicine. I worked on the suggestions of Dr. Little that 23'0 or 5% off the lung cancer rates would alter the picture. It didn't work out very dra_-natically because the earlier data is sota what unreliable. It does show that there may be some improvement in diagnosis as tiine goes by. I will send it with the work- sheets, giving the original numbers in caie some one there wishes to make further use of the material. I am sending a graph usi.: g Houston data, related to the years famous antibiotics were introduced. It makes a dramatic graph which you might find useful and one which accounts for rno st of the switc : in causes of death. One graph is of the United States as a whole, the other of Houston. On the Houston graph you will note inclusions of cur rent inter e st, CTR 5I31 bm \e.=e S.w3
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THIS DOCUMENT SUBJECT T0 AUG. 20. 1985 NON-DISSEIMiNA1I0N ORDER IN ROGERS AND DUKE CASES. W. T. Hoyt Page 2 i, e. , heart, cancer, and stroke. Then I give total respirator; disease. Under this I give the major inclusions in the total respiratory category; i.e., (1) influenza and pneumonia, (2) tuberculosis, (3) the respiratory cancer category, and (4) asthrna. Influenza and pneumonia sta-ted-up again from their low in 1950. It's interesting that the first supposed breakthrough in productlon of lung cancer in animals from cigarettes is by the ubiquitous Auerbach, the only pathologist who claims to identify "in situ" cancer in assorted lungs, who claims never to have known of a case of lung cancer in a non- smoker (notwithstanding David Karaofsky or Godias Drolet - famous Head Statistician of the American Tuberculosis Association for 40 years, who never srnoked anything in his life - both of whom had primary lung cancer). The method of spr:nging their results is reminiscent of Ivy and Krebiozen; to a specially invited group of reporters and science writers, with specia: stage effects. ~ In 1956, the first week in June, the Third National Cancer Conference was held in Detroit. It followed by a few days, the Ewing Meeting at the Me:^o- rial. Auerbach presented his findings on serial sections of lungs at the Ewing Meeting. He was asked by Dr. Fred Stewart, Pathologist of the Memorial, if he ever had seen any multiple foci of lung cancer in the sa_:.e person. Auerbach said he had not. Then Fred Stewart drew a diagra.rr:at:c sketch of the bronchi and lungs, showing the area that would be reached by cigarette smoke, and siid quite obviously there would be multiple foc: of cancer in smokers or else cigarette sznoke had nothing to do a:th caa- cer induction. Dr. Stewart,said he never had seen multiple pri.maries i-n lung either. Well, at the Third National Cancer Conference, at a cocktail party given by Pat McGrady, attended by 40 or 50 people including Dr. Little, Auerbach called for a press conference, so Pat invited him up. In great excitement he said he had the final proof. That ex.arniMation of his specimens showed multiple foci of cancer. Then he held up the sketch of Stewart and demon- strated. One visiting pathologist from Turkey immediately challenged hi:r, reminded him that a few days before he had never seen one instance of multiple cancer foci in one lung and had so publicly reported before many of those present at the cocktail party who had also been at the Ewing Lecture. How then had he reversed himself on the same source data? Auerbach said he had resectioned and restudied the material. The other pathologist asked him if he had used soft or fixed tissue. Auerbach said "soft". The ot=e r pathologist then said that Auerbach undoubtedly was seeing different parts r 7 p 51362) C) C).
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I THIS DOCUMENT SUBJECT TO AUG. 20, 1985 NQh•DISSE.e.INATION ORDER IN ROGERS AND DUKE CASE& W. T. Hoyt Page 3 of the same tumor. Auerbach had no answer for that and left. At the t_---e none of the science writers carri••d the story, nor did Pat McGrady. Dr. Little will probably remember the incident. It certainly caused some excitement at the gathering. I just this morning saw the full page account of the letter exchange on Auerbach's claims and thiac it is very thought provoking. The brain washing has been going on so long without challenge it will only be "the quiet silent majority" who will really fice the facts. At the Anderson, Walter Burdette of the Surgeon General's Committee, now Associate Director of Research here and high committee man of the Cancer Society, and Clark Griffin, American Cancer Society Lite Fellow in Biocheraistry and also a Mormon, are both pressur'.ng to get the Inst:- tution on record favoring the "theory". At the time of the International Cancer Congress, the Andersou is giving an award for the best suggestion for a TV commercial on smoking a.nd lung cancer. It was to be presented by Tony Curtis, head of the "I quit smok'4.g" group. Now that he has been arrested in London and fin~ed for smoking marihuana, they have to f:.nd - someone else. Dr. Jack Healey, a smoker himself is the one who has to make the decision. Dr. Howe, Head of Med?cine, Dr. Wh,ite, Head of Surgery, Dr. Healey, Head of Rehabilitstion and Plann.ing, Joe Boyd, Vice President in Charge of Adrnin.istr ation, and Dr. Haas, Head of Biology are all cigarette smokers. :t is certiinly a long s.nd unscienti`ic story. The end w•?i be when the true cause of Cancer is really found, probably. Have you ever thought of hava.ng.a study done on the major statr'sCcal papers such as was done on the K:_nsey Re-port. Siyce rely, 1~%'J t Eleanor .i. Macdonid Epidemiologist Z JM :kr 'nclosure s CTR 5133 C ' f ~~ NN
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. W. T. ;oyt P.S.. THIS DOCUMENT Su6lEC1 1- AJU• 4U, 19~: ORDER IN RO-,,ERS AhD DUKE CASES. Page 4 F?as anyone in your group given an}C thought to asking the Americaz Statistical Association to appoiat a committee to evaluate the methodology in the Hamrnond and other studies since the economy rnd welfare of several states and of a major industry are at stake becau-se of these reports? Brownlee dSd a fine brief review in the Jouznsl of the American Statistica: Assocation. The American ~ta~stical Association appointed a committee to advise the hational Research Council Committee for Research, in problems of sex, and came up with a det.iiled 330 page critique. The Kinsey Reports used the same methods of non-random sampling, that these others have used. You could obta.in a cooy of the report from the American Statistical Association. The analogies are exact. It was pretty clever of the group responsible for the ao- pointrnent of the Surgeon General's Report Committee to have Coc.hran on their Comrnittee since he headed the highly criticai committee on the Kinsey Report. Carl Hopkins now of U. C. L. A. wrote the critique of the Kinsey Report among females (enclosed).- z-?is line (marked) on Page 188 tells the story. Incidentally, Dr. Hopkins is Cbairman of the Faculty of the School of ?.ablic Health, and is a:so directing the California Center for Heaith Services Research, Los Angeles 90024, CaIiforaia. C T R .5134 ~ ~~ ~ti NN 0,0305G)
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! STATISTICAL PROBLEMS OF THE KItiSEY REPORT on Sexual Behavior in the Ht:.man NTale A Report of the American Statistical Association Committee to Advise the Nationel Research Council Committee for Research in Problems of Sex s: W7a.LIJ.x c. COCHxA., s"l. Je,uL, Eoph+w cuc.nrity cMc:.maFk> TBEDERICS 3SOSTELLEP., Scnard Cn:wr~y JOHN W. TIIEEY, Princaon L'n:..*.ity witb th..ea.taao. o! W. O. JtNnxa. DRiarvrity eJ T.nn.ra.. PublialKd by Tb. American sc.tirticaa Asaociation 1108 16th St., h'orthwest Waahiatton 6, D.C. 1454 i I ( _I/ I , CTR 5135 ~`I~`~ () .~ ~
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I I From A Critique oi Kinsey's "Sexual Behavior in the Human Female" I ARTS AND LETTERS Ca<t. E. Horcrxs, Psi.D. , tOlT1AND, O•1ltGON tba Uwivnsity oj Oreaow Melital Scboo! Srare: Brn+vror iw !be Nrrnan Ft*jtit. By the Stafi of the Institute for Sex Researeh. lndians L'nivcrsity: Alfred C. Kinsry; Vardeil B. Porn- erov: Clyde E. Martin and Paul H. Gebisard, Aescarch Atsoeiatcs. 142 psges, lff illusera- uons and 179 tabies. Price $1.00. V. B. Saun- ders Compiny, Philadelpnia. 1953. tortoa's NOTt: See aiso Virwi aw! Rcv/tsvs, p.,tr : !II oj tbtt jorrTnel. as :orcign observcrs' opinc, love and sex I are nation.al probiems in Ameriea, almost anv rcadcr of Tbt Frniile is likely to find considetabie material of interest. If one of Kinscy's assertions is true, most of us, partie- ui:r:v in the "upper" social and edueational icvc;s, =avc had a very limited range of per- son•i exocricnce in sexual beh:vior, and our cui:;:rc recuires us to bciieve that the normal r2r.;- :s :c nny ratc quite limited. We tnere- ior; nrc ii:cly to agrcc entnusiastieally witn a:cv oi tine things Kinscy reports beeause ticv are ..•ithin the range of our eultural ex- pcc::tions or our own expericnee. And we mav tend indignantly to reject as uncrue or maiicious those facu or assertions that go be- vo-•c os:r r:ngc of tolerance. Scicntisu, on the other hand, are expeeted to acc-pt or rcicct propositions not according to tricir pcrsonal expcrience or cultural ex- pcc:ations, but according to standard tcju oi evidence which seientisu have found gener- ailr trustworthy. Scientisu will .rish, there- forc, to examine the evidence for and against tne stated propositions and determine thus v~at confidence or er<dence may be placed n ticm. SInce what Kinsey says is already stenerallv Rnoo•r.. t; is review will dcal primarily with tne evidcnce for what he says. T!x Frmalr is many things. It prcxnti: (a) c:a on rc:~orted oreatm exoerience of 1940 r-.rranaitrr referred to as The Frmiir, by K. nscv. women rather thoroughly analyzed and sum- marized; plus (b) auertions and gener:iiz2- tions based on several thousand otiser women for whom data are not given; plus (c) user- tions and generaiizacions said to be based on "special research studies" and on "exhaustive study of the literature," pius (d) five specia: chapters summarizing what is now knowrn about the anatomy, physiology, psychological factors, neural mechanisms and hormonai factors of sexuai raponse and orgum, in both male and femaie. Only (a) can be evaluated in terms of evidence prexnted in the book, and it is to this original eontribution that we .+ill direct attention. Since The Fcuialr com- piemenu The Male (Kinsey, et al., Sexual 3rhavio•r in tbr Nns+ian Male, 1948) and Kinsey himself m:kes frequent eomparisons, it is weil to view tne cvidcnee in the iisit of tac c-iriicr book. Scicnasts, while welcoming the fortnrignt, ene~.;etie attack by Kinsey in a nearly virgin ficid of inquirv, gcnc::iiy found much fauit with his mcs;sods and tech- nie,ua as reported in Tbr Male. Extended crit- icisms were made" in the sincere hope that they would lead to improvement in subse- qucnt volumes. We will kesp these in mind in our examination of The Femair. 7tiC P0.oDLPM Kinsey's stated ambition in the ficld of scx studies in the human is to learn all he can in 29 yesrs. Like any good investigztor, he hic laid out a program of selected problems he wishes to work on, and has chosen par:icular obser.ations to make and variables to meu- ure. His omission of this or that problem, aporoach, or variable is thus not a basis for vaiid criticism, but an opportunity for coi- lateral investigation. For exampie, no direct mention is made of "love," "atfec:ion" or ":eproduetion." i nere is some specui:tive gencraii7.ing on the value oi sexual ex~cr:- ence (Kinsev thinks it may be good [p. $37) ), but 6rir is no mention of its uscfui- arv C T R 513G ~ur ~'~ INH ~`~0%30~%.5811
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sn /C++r/. r-:. - N...•.. w.J.J 3_o.a G-K..-,~~, I t , ncu for reproduction. Procrcation is men- covered in thc survey, :i:iiough Xjr.scv -, s~ tioncd only in rcfercnce to historic rc' ;ious some bcneruons (p. )GG) c.)wc posc;,;,- Icgitimations of costus (p. 366). It furthcr cffects oi increased know;ccgc o: coc:r:cco. sccrns to thu reviewer quite erroncoLs to crit- tion on premarital coitus. \o rn),s:c:', c: iciu Kinscy's report under the rubric' of physiological parametcrs, suc.) as cvcn. sociology, pssychology, anthropology, mce.i- state ot health, height-..rcight r:tio, :nc so cine, or even zoology, aithough Kinsry cer- forth, of the subjccu other than sex, aec an;, uinly makes excursions into all these fseids. race are obaincd. Tnis omiuion oi cours; It sccros best to fit into the rubric of l.uman limits the usefulness of the data, out, :;:ir., physiology, as "the scientific study of tnc the investigator cannot rcail,v bc functioning of the normal human orgahi_rn." for choosing the variables that sccrn As Kinscy frequently emphasiw, the social cant to him. Much more wii; neec to o; aspeeu of sexual behavior are secondary and known before anyone can judge accur:teiy ineidenul to his present approach, the study the relative significance of the many variaaic, of the sexual functioning of tne individual possibie to study. organism. . Since the human femaie is often "a:ouscc" Thus his objective in Tbr Frnrale is "t.o without oreasm, it was necessary to mc:surc determine what American females do sexu- "arousal" expericnce as ..•cil ss org:sm. aily" ("how they behave" in T/x Malr). Tne +ey aswu tisat obtaining dat: or, inciccnce fundamental variable selected for observation of nonorgasm arousal .+u a:airiy ccpcacao':; is the orgasm. Again, it may be objeeted that operation, but that it was very dir:icuit to orgasm is not the most important c only get eostsistent daa on i:equene;: oi su:a t'tsing in sex. It is somewhat like studying arousal. It is too euy. howevcr, to im:e;ne peopie's eating habits without mentioning that, for instance, a.+oman vho iias nevcr nutrition, metabolism, and so forth. Kinscy, experienced orgascn :nibat cor.s:a.r „ despite thu obvioua disadvantage, haa never- arousal an orgasm. One must recair, s=.c theiess chosen the orgasm to measure as an doubt as to whct;.cr womcn rePo:tin6 inaez of xx behavior which can be fairly sii" are actually reporting t: c s:e:e c.cn:. consistently defined and observed. ~ ne bur- Likc.rise one could challensc Kinscy's unsu?- den seems to be on the critic to propose a poned assertion tiat "orgasm is a cis:ist: :.,, bettet index. specific phenomenon Nhich is usuaiiy as icen- THE ODSEAVAT7ONS tUtubie in the femae as iG the maie" (p. 45/. In The Frnsalt, as in Tbr Male, orgasm is In Tbc Frnialr riinscy hns und::::iccn c=.- eiassifsed into six different forms of "outiec:" ob)ectives of dc:ermining nor oniv it- masturbation; noeturnai sex drams; netero- maics do, out also oi drtcrr,ining: sexual petting to elimax; heterrnexuai eoir.:s; factors m:v account for ::;ci: ;,:::;:ns o: sc;: homosexual eontaet; and a n i m a I eontac:. beh:vio:; (b) how ticsr s;x :z, c:.cnccs :., Kinsey gives no evidence of his claim that ail aifectec thcir iives; :nd (cj so:::i s.:- other forms of outlet are of negligible si;ni:i- nificance the:c r-.::v oc i: ::cn :*.e a: oc- eance, but it seems plausible. havior. Kinsey's eriginal d::a provice cv:denc: For neh of tnex outlets he determines ac- bc:ring only on wnat fcmaics do, or s:}, cumulative incidence to a given age, current do. Some weak circumst:ntiai evide::cc ae::- active incidence, frequency of activity, num- inS on (a) might p o s s i b 1 y be ber of years involved, techniques used, various from the data, but most oi a•=:: tnc ux..: information about the partners in sociosexual has to o i f c r on (b) and (c; is in :.-.c eontaeu, some information on motivations nature of specuiativc sociai anc incivic.::: and attitudes, sources of sex knowledge, and piychoio;y, cultural :nthropniuy~• :nc so forth. By incidence he means having ever, ology. One might .+isn that Kinsey, a up to the given age, experienced the item. By rate zooiogist, had reir:incc from r::-n: --- frequeney he means number of times the itr.n tions in these fields ouuide nis spe;;i:c .ras experienced in s given time intervai. - tcncy. Yet n iorcctui, thou;:~t:ui anc A conspicuous omission in the interview man can perhaps be exeused for havin; some scisiduia is data on medical histnrv. Preg- thoughts about data as highiy ci;ar;,cc a naneia are mentioned only as incidental to these he is collecting. His icrtiie s?ccuiations dreama, extramarital and premarital coitus: might be treated as hypochces ot i;stcrest to contraception in eoitus was evidently not sociologists, anthropoiobisu, poii:Ac:i scien- CTR 5137
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,.F~ S_0A G.-ll..-110H Kr...r. l.r:. - i{..:r.. 37• ~ tisu. ct al. Many of these hypotheses aevn conversation about a taboo subject; cstrcnciy plausiblc, some are .;,parently sup- (b) determine respondent's socioculturai ported by close dcductive rworsing. Perhaps aub-group so that the appropriate colloquul a fcw are scientific hypotheses in the srcnse language may bc seletted for phrasing the ~ tn,: we can think of opcri ional experimcnts questions; ;.. 'i-.-'.sding obscrvational " c-P,_rimenu") by (c) explain the project's mcchanics for ~ ! vh ' i;i thry could be tested. msuring saiery of all coniidcncu voucns:fed; ! Kinsey makes many generalizatiolt such u (d) overcome resistances to particular tiat rrsponsiveneu in marriagc is correlated quations; riti carly coital expericnce (or u it early (c) uk 300 to $00 questions; marriage that causes t}se apparent eorrda- (f) check the coded raponse record for tion?) for which he gives co evidence that cocnpleteness and consistenry; and can be checked. Rather than attacking the (g) return to clcar up errors or inconsis- man for having ideas outside his field of cocn- ccncies. pctcncy, and rather than futilely debating All tnis is done in 90 to 120 minutes, or at thc merits or the social consequences of his best 0.4 minutes per question. The incerview obiter dicta, it would seem the chariuble and technic is thus highly directive, and is further fruitfui thing to regard rt+e*n as interesting, charactenzea by: suggestive speculations, and hope that his (a) Great specd. cx:mplc will encourage other •+ot,cers to en- (b) Leading qucstions. The burden of dc- ter this field and test some of these by- ni2l is plactd on the subject. "We assumc tnat pociaes everyone has engaged in every typc of activi- a'e will now rrturn to the mnc of fiinsey's ty," and uk such questions as "when did you contribucion-che survey of sexual cxperience lut masturbate?" of United States women. Having limited his (c) Varied piu-asing of questions accord- probicm and defined specif-ic categories for ing to sociocultural sub-group membership of obsrvation, Kinsey's genenl method is tuo- respondrnt. (While writing convincingiy of nornic. He observn a large number of indi- the necessity for doing this, Kinsey is silent vicuals and obtains frequency distributions about bow to do it, about the exact phrasings ci occurrence of various characteristics or used, and about the kinds and amounts of cvc^u, such u orgasm. Kinsey claims this influence t.hat this selection may have on the rnr:.~od ss his own invention, but in view of responses.) Many physicians might, nevcr:ru- ics videspread use in zoology, genetics, biolo- less, profit by a thoughtful reading of his ; r, anthropology and sociology, it would rem:rks on sexual vocabuiarics (p. f 9f: ). Ice-n that Kinscy's invention is merely quan- (d) Truth c:hecks. Like many beginners in :;ts:ive-an old method applied on a very the experience of interviewing pco?ic, %insev iarec scale. serms to be more concerned about the possi- Tnc method of observing his selected .ari- biliry of calculated untruth (lies, deceit, a+iil- ,f' sc;a is indirect. Kinscy ob.ervcs not orgaams ful misleading) than about that of un,ncen- in the human female but verbal behavior of tional misunderstanding and semantic con- ` :err.aic subjccu. He is fully aware of this fusion. Thus he claims to control the trutn ~ ~cakneu, feels it is the best available approxi- of the responscs by looking the respondent ~ rna;;on to direct obse.-vation (p. f70). Even squarely in the eye, firing the questions in 1 i; one is ready to accept orgasm as a valid rapid succeuion, exposing the lies of tjrie re- inde: of sexual behavior, there rcmaiw the spondent, and asking special leading qucs- i iurther question of the validity of the verbal tions ind interlocking quucions (entrap- I raoonscs as an index of actual bchavior. . ment). 1 The method of observing the verbal be- r.euAsit.rn' Arrn vALtOtrr ~' ':av;or is a lengthy personal interview guided Three methodologieal questions must be 1 bv a standard coded eheek list of queationsL asked of this u of any interview method: ti .nacyrvie.~ is of course conducted only by 1. RcliiGility. Can the obtained resporue 1 "nc ince nacy and a feW of his highly trained as- be duplicated? t sx:atcs. T he singic interview is usually eom- 2. Trrcth. Does the respondent bciin~r sne ;.c;e and sc:t-sufficien;. This means that at a is giving a correct representauon? • s:nsic sictine he man3ga to: 3. V.fidity. Does the verbal ruponsc as (a) establish rappor, necusary for ready, recorded by the interviewer bear a reasor.:bie C T R 5138 C F, Ht•I ~'.013
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i I . I s.. C.wW. L-4 - K.-.. e corrupondcnce with the physical event it purports to rcpresent? Ordinarily in behavioral research we regard (2) as an inevitable intervening variable and indude its error in (1) and (3), for if rclia- bility and validity are satisfied we nerd not be concerned vith the truth question. On the other hand, no amount of satisfaction of tis: trutis requirement .rill necessarily auurc va- lidity. Kinsey appears confused on this quei- tion when he cites hu truth checks as evidence of validiry. What he fails to appreciate is that controls on truthfulnexs ws ensure corres- pondence only between reapoose and rtspon- delst's belief, not necasariiy between raponse and actual evcnts. Kirssry has made extensive analyses of his data in both Tbe Mslt and The Frfuslr to test their reliability, or rcpeatabiliry, and ordin- arily one would be inclined to accept the in- vatigator's appraisal at face value. But Kinsey displays such remarkable naivete about the statistical tec:nniquc he is using that the read- er must be wary indeed. For example, he states that "it is a prime weakness of statistical aver• agrs that they suggest a regulariry in the occurrG'sce of activities which do not actually occur •itis any rc, larity" (p. 420). If so, why use a statistic that docs not idequacciy describe the observations? There arc statistics for describing irregularly occurring events. Again, he concludes that "such petting sccros to have increascd ... although we do not have sufficient data to utabiish this point statisti- cally" (p. 426). It is fair to ask how eise Kinsey thinks such a point could be estabiish- ed. On extramarital petting he did not at first gveu ita high prevalence, and so got schcduia on oniy the last 1090 married females of his sample. But he says, "the accumulative inci- dences of all these activities would undoubt- edly have proved to be higher if our data had been more compiete" (p. 427). Does this mean that the lut 1090 sampled were syste- matically different from the rest of the um- ple? If so what does this do to the observ:- tions taken across the entire sample of 5940? In view of ruch evidencez of misunderstand- ing of basic toois of sutistical analysis (de- spite the usutance of top-flight statistical consuitanu), we must inquire cioseiy into ICinsry's uairru of rtliabwry and validity. ' Analysis of the interlocking questions iho+s gvod agreernent, but this is to be ct- pected because corrrctions and justifying of the reaponsn arc done in the incer.ic+rs.. Re- , W-J.d S.O.a G.M...,l'., taku arc cone on : suDSampic o: cLX atter a two-ycar Interval to test rc;>e:;:p,;,;y (p. 68-7f). Some of thcsc arc donc same intcrvic.+cr, some vicii : r ii •'crcnt onc. T ne tables presented show simiiar resu'.u ir,c:. pcndcntly of intervicwcr. The rcc:KC snt;r. views on thc average not oniy rcpc:;cd information of the first intcrvicp• but :cL:c to it, indicating a certain amount of unccr. reporting on the first interview. S,ncc ;,., losl customs and attitudcs conccrnir,; s;s bchavior require tisat Kinscy's dc;raccors :c more concerned about possiolc ovcrrcPortin; than about undcrrcporting, iCinscy is p:c::;- vith his rciiauiiity tests. Viewed as : scscn;.f:; experiment, however, obscrvaUon biu is a,s• quieting, rceardless of the direction. ic snourc .also be said that he h:s rctaice, or rc;i:c;': data, on only a small numucr ( i:-• fcr,.::~ of his totai sampic, and thcrc is no rc:scn :c bclievc that the rciiaoiiity oi tiiuc resPo:,c• ents is typic:i of thc entire sar npic. Could similar d:ta be ciicitcC bY ton othcr than Kinscy's immcai:;c oro,:.- Sincc he docs not dcscribc the dcc.iisci ;c= he docs the intc:vscwing, this is di::icuit co test. He has, howcvcr, comp:rcd 'nis with thosc of many othcr studics wiscrc t;;c'• touch thc same c:tr;orics of infon;s.tion. :r.: they show a fair dc;rcc of a6rcc -mcn:. 3os:' .ras aCie to reproduce Kinscy's inciccr.ccs t:. masturbation, homosexualit,v and inccrcours< in a study of scx bchavior of coiic,c r..:;c (Table I). u hiie this apparcntiy contur..s t ablt i Rc-er„~t r,r Cam M„A a;,.,~,: t;-ol,..- Art NO1{.Vn KlYl-• Ross ...i 91 9A.5 Kirucy 21.0 i980 92.0 28.f S5.. Kinsey's incidcnccs, it rcfutes his con;cr,:wrr that face-to-face in:crvie.+s are ncccss:-. since thc Ross studv vu made vit:- :aor.: • mous, written qucstionnaires! Surgeons, obstetricians and gyneco:ots:c need not De confus:d ii Ainsey's tinc,^,;s various inudcnces differ from their o•.--n o:• servations on t.ticir patients. As w::i ~ shown later, it is impos.sioie to s:y jus: group of femalcs Kir.sey's sampic rc?res:r•:: and t'tse sampling representtd in a surgcon's practice is even more an unknown. rcii:o : s In a still more rigorous test of Nicnw,s he compares the testimony of two to the same act. Paired comparisons of rcpo.a C1R 513J C -f-R VIN 00 ~061
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:s 0 s s s I wJ/ s.OJ r:-H--1 W tU..We L-L - 1aw:+. 1a1 by spouses show good agreement on moet ,t,-ms, although Kirucy acknowledges that such conformancc might bc due to ssome cummunality conscious or unconsuous of d'u- tortion of reporu by spouses (p. 71). Un- psircd comparisons of males and females gen- craliy would thus give a stronger test of sdit,v. Sinu every act of marital and prt- montal heterosexual penis-vagina coitus by Jciinition includes exactly one male and one fcmalc, the overall average frcquency of msics and femala (not mates) in coitus snouid bc equal. In Table 6 Kinsey shows this crucial comparison for marital coitus. Dcs?ite some statistically significant depart- ura from conformance (e.g., median frc- 5ucnc,v per week, age 21 to 25, 2.5 rc- ported by fcmales, 2.) by malcs) Kinsey sums this test as showing "remarkabie" :Srccmcnt. His criterion of what agreement re should ex,xct in such an experiment is only implicd in his conclusion that "evidently the conscitution of t h e married female aample r.ouiv parallels that of the married male s:mplc; and there would seem to be consider- :bie validity in the repiies received from fe- maia and males" (p. 7S). It should be noted tn3t Kinsey is here not really testing •alidiry, bu; oni~- reiiability. This exoeriment merely tcsas vhcthcr males and females in our culture viii produce the same verbal patterns in re- sponsc to certain cucstions conccrning fra riucncy of coitus. This cxpcrimcnt does not rc3iiv test wiir,hrr the conformsnce is due to actusi coincidence of the underlying physical tYcnts or merely to a communality within a cuiturc-arca of socially approved answers to crrtain questions. Tne same ambiguities obtain for his com- Parison of conformance in prcmarical coital frequency (Table 7). Here the conformance is bad (though Kinsey does not call it "re- m3ricabiv" bad). Females consistently report Ihs premarital coitus than males. Kinsey dis- cusses nine possiblc sources of this discrepancy and concludes that "It is probable . . . that differenca in the representativenas of the fcmale and male samples, and the probability that the females have covered up some ponion ef their premarital eoitus, are the two factors tinst are chiefly involved" (p. 10). If so, this tst vouid seem to impugn both the reliabiiity anc the walidity of Kinsey's data. ,Vemory certainly plays an important role In the production of Kinscy's data, and it is unfortunate that he has not undertaken va- lidity studies to test the reliability of memory as a function of time, and for various sub- jecu, and so forth. In his statistical compila- cions he gives equal weight to a report of numbcr of mucurbatioru pcr week occurring 40 years ago with a report of evcnu that took place last week. The reliability and truth teau at best uti- mate only the consistency in verbal behavior, giving no clue to degree of c,srrespondencc with acrual events. Criticism of this Meaicncss in Tbr Malr forced Kinsey to face the prob- lem of validity in TGr Female. He gives only one test of actual validity, i.e., correspondence bctween the recorded data and what actuallv happened. He compares the ruulu of his recall - verbal pattern - recording operation with other studies of the same event made by direct physical observation of. a sample of presumed similar people. The evenu com- pared and the resulu ahovn in his Table S may be summarized: Mean age of appeinnce of: Pubic hair-tigrremcnt not good Brea.st development-sgrecment ambiguous Merutruatiors--sgreement satisfactory Compietion of hciahc Srowth-agrecmect sat- istactory This tat,is at bat ambiguous, and one cannot sately assume that even this good agreement .rould obtain on the many other events studied. Most readers will test the vaiidity by agrcc- ment between Kinscy's findings and their o•rn experience, observations and bclicfs. While this is generally a poor test of validity, in a few instances it does seem thu common belicfs must be rather close to the truth. I: scerru highly likciy, for instance, that the incidence of coitus in marital couples is close to 100 per cent. The fact that Kinuy's mar- ricd subjecu report about 100 per cent inci- dcnce of marital coitus is a tcst, of soru, of validity. It of course still does not exclude the possibiiity that local customs «quire mar- ricd women, .vit.h high probability, to say that thcy have coitus. In concluding this discussion of reliability and validity one can sympathiZC with Kinsrv for the extreme difficulties he faces in o:>- taining valid data, but such appreciation of the difficulties in obtaining good data should not blind us to the weaKnesses of the data obtained. CTR 5140 C `t~ ~~ I "~ ~"°~ '.~ 0 ~ () 6 ~`
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ttq K,..a•. ) .L - H..:,.. WJ.i S.O.L s , THE SAMPLiNG PstODLt:)•t T•ne next major quution is the scieccion of a sample of sublccu for observation. Kinsey's taxonomic method requires that: (1) he ob- t2in a large and varied enough sampic of the human female to get a good idea of the range of varietie:s of bchavior to be found; next (2) he needs a rcprcfrutalivc sampic of the human female from which he may estimate the dis- tribution of various charactcristics of sexual behavior (ag., incidenccs and frequencies of orgasm, and so foreh) t}sat can be usily measured or counted. Tnis stacutical dcscrip- uon of the behavior of the human female would then be rounded out by (3) intcnsive study of relationships and dynamics within typical (u defined by the second step) indi- viduals. The Male and The Femalc represent Kinsey's first attempu at the first and second steps. He has not yet entered the third phax, but eannot bt criticized for waiting for a solid grasp on (1) and (2) before piunging into the still more complicated details. Tne first objective-wide but not neces- sarily representative sampling to find the range of possible variations-has eer t3inly becn accomplished, at least for the contempo- rary United States femaie. The second objec- tlre requires a prodigious taSk of survey sampling. In survey sampling it is often near- ly impossible to obtain a strictiy represcnta- tive (i.e., random) sampie out of the desired population and out of each segment of cne population that may be of interat.' The usual compromise is to survey some sampic that is . accessibie, taking speeial care to record many other parimetcrs than the one under study so that it may be determined ex post facto what population the s;ample did come from, if not the originally desired one. Stacistical expKrts' felt that in Tlx Male Kinsey let go the first horn of this dilemma without gain- ing a sound grasp on the second. In Thc Male he tried, by making various age, edueation and ochcr awkward adjustmcnts, to extend the findings of his sampie to the United Staccs male population. In Tnr Fn+ialc he has heeded the advice of the statisticians and avoided re- peating the fiaseo. Tne planning and collect- ing of the data were done several years ago, rithout the aid of mode.rn methods of survey tampling then avaiiable, so that the most his consulting stitistieians could do was to sensi- dze him to the weaknesses in the data, with- out being able to eiiminate them cx post facto. Kinsr7• states (p. 57) that in the report on th, human fcma;e "ec~c:ai:za o:.s :rc ,C str:-ted to the par;icuiar samp;cs we ; had availabic." This is a scvc:c the u•cfulneis of his frndines. or, Kinacy docs not, however, :ci•,c:c to t;;s restraint against cxtension and ~ascr:iica;io-., and neither will his readers. T hc rcaccr r.,u,; then etaminc the sampling prosrar,i so as :o dc:;d^ how far ixynnd cisctc par;.; ::,r s:cs. ples i: is safc to extend the specific iir,dir-s. Tisc mcthod of obtaining subjcc3, aa;.;; much useless verbiage (p. 24-3 1 ) on tiinsc,-'s part, is essentiaiiv voiuntec:. Hc ;ec:ures ;o ; grou-, on tnc aims and procedures or n u sur- vey, and then asks for voluntccr suD;C.:SS iG order to avoid :ae obvious biu of :c:ni;;:-,e an occasion;i or "ur.usuai" voiun;ce: such a group, he is:s piac«i great e-;=.as or, getting :00 per eent p:::icipation oy While elimin:ting one form of a:s, :~.a u-. a% •idabiy ineroduees another. He cecs ~y. press soiici:acion of a group's parc:ri,:aor, c.. less a promising proporcion show :nic:a', o,;;' ingness. So he is sti;; get;inp m:iniy rr,,.; who have above averase wiilincness to •„ interviewed bv Kinsev. Sci;; anocac: ;c,nc , biu is bound to occur in intact groups. ?.s sons in organized groups (ciassrooa,s, c;uc;• churches, prisons, and so forth) presum:u,)• have more in common cisan people :: rancon:, and so in interviewing 100 persons oi ar, n::r.. :...., intact group one does not ;c: as degrees of frecdom• or amount ni ir,cc?cr.o- ent information, as in intcrv,cw,n; : ;_.. mr:::o:;sn. s dom persons. Anc snnic group may well imi,osc dircc: rcccr:cc:ons or. :... kind of cxpencncc tisc inoividueis :.. :,R: : to have. 1Y'ouic onc cxpcct to :~-- ample, the same incid;ncc or nomos:xu:; pcricncc in 100 iemaics, 20 years o;c. t:RCr. :: random as in an intact group o: Jv e:::s living together in a sorority house? i n,sc other biues that are undoubtediv ;,.,• Kinscy's data may or may not serious.y imn::r gencraiization. Ic is rcSrcr::bic ti.:: nor; provision was noc madc in his or,gin:: ~::rvcY plans for study of the sampling proccsc. for example, ;vcre the refusers? :iow cic differ from the volunteers? V'hat were varieti« of mocivation of voiunc.c: and how did these affect the resuia? T nac and many other questions cannot be ar.swcr. ed, because Kinscy's method eheeics wc:c not built into the experiment plan. : he c::,cics he cites were devised ex post facto anc rn:i, c:;• miss the point. Intact group sampiin6 oocs C T R 5141 ~4f ~ N~~ ~~.~ ~~~~ ~
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i I ,rJ 1 s-o. G.. LW.s 0b/ st. W. s...-i. - sMpirr tY.3 not remove the volunteer bias. The take- rctake and spouse comparisoru check th: ~ron- sistcncy of the rapunses, not the represcnca- tivcness of the sample. Kinsey emphasizrs as es•idcnce for the validity of his data th+t all ;:ic-jiations were done twice. This, r: similar cncciu on arithmetic, is standard prc.:edure in ail statutical work, and quite inti'cvart t. tix question of what tise sample represents. Since the human female is a many-facetcd pncnomrnon, Kinsey was naturally interested in determining whether his basic observation, «ported orgasm, wu in any way associated w1tis various other varlables such as age, race, rciision, education, and so forth, according to which the female of the speciei can be conveniently suudivided. Hence, he divided nis sample of human females accog ding to: marital status 3 age at report 18 age of adolescence S education level S occuoational level 4 parcna' occupation 4 rural or urban 2 religion _ . 3 religious adherence 3 categones categories categories categories categories catcgories categories categories c.ategoric A complete cross-tabulation of the data ci:ssified on all thae variabla would result in : nine-dimension tabic containing 388,800 cci;s, or entries. T hc race-cuiture (eleven categories) and the geographic (f0 cate- ;orics) variabies have bcen omittcd from his taoics in Tbr Fe~nale, but would add more 6un 200 million cells if included. By the Kinscv taxonomic method, a proper srudy of this species would thus rcquirc a rcprrscn- rahtr sample of several casa out of each of tncse many cells or subgroups. As Kinscy points out, however, many of the cells are k'npcy-e.g., there are no 15 year old wid- o-cd college - graduate practicing physicians iiving in rural areas of Oregon and adhering strondlv to the Jewish faith. Kinsev's tabled data (Tabla 1, 2) crou-tabulate cach of the major variables with age separately, giving the frcquencies found in 592 of the )88,800 postible cells. This is quite enough for ani•+er- nS a great number of interesting quations suci as: does sexual activity vary with age? viti occupation level? with religious adhcr- encc?, and so forth. Bocausc of the uncertainty of the overall umpling plan, however, we cannot be certain that the proportion of females in tne various cells of the observed samplc arc at all the ume as in the.popuiation of Amcrican wom- en, let alone of the human female. So the hypotheses we can test a.re laroely limited to ccll-to-cell questions. Kinsey uses the cell data to gct around the fundamental qucstion of the rrprexntativeness of his sampling. He un say that if he does not have a rcpresenta- tive proporrjoi, of a particular subgroup (cell) in his sarnplc, he i,as at least a sample o/ that subgroup, and we can gene:alizc from the sample to that cntire subgroup. This is what lse does throughout the book, when he shows the experience of women of diiicrcnt occupational, educational, religious, and so forth, backgrounds. The difficulty he:e is that the sampling bugaboo follows him even to this level. Is his sampie of 2 S year old 'nigh- school graduate stenographers from rural areas with Protestant reiigion actually rcpre- sentative of all women with that particuiar combination of atcributes? Tne:e is nothing in Kinscy's sampling process that guarantees representativeness and much (e.g., the voiun- tecr aspect) to make it doubtful. SIZE OF THL SAMPLE The question of sample size, which fruit- lcssly occupicd considerable of Kinsey's atten- tion in The Male, has bccn dropped from direct considcration in Tbc Frrnaic. In T bc Frwulc he correctly rccognizes that the im- portant question is not overall sampic size, but size of sample in each of thc 55: ceils tabuiated. Assuming random sampiing, the smallat sample that could give an estimate of central tendency (mean) and v:riancc (dispersion) in each of these cells would be two. Kinsey's total number is more than adc- • quate to satisfy minimum requiremcnts. Yet in many instanccs he makes statements such as "there is a sizable but stiil inadecuatc sam- ple of females who had been widowed, sepa- rated or divorced" (p. 34). Now the number that he calls inadcquate is 785 cases, and Kinsey is not clear as to whether t/u inade- quacy u due to needs for greater precision, or to insufficient volunteen to fill all the $92/3 cells for this marital category, or to failure to get a balanced probability sample over 211 the subdivisions of widowcd, sepa- rated or divorced females. This latter typc of bias is suggested by his statcmcnt (p. 31) that "the ... younger and older groups arc inadequately represented in the samplc." I-Ic CTR 5142 I C 1_R L-A ~'~ 6 i:
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I , I 1N WJ., givCS, however, no indication of wRat could coMPOsR10st or 7%tC sn.m^:•' be considered adequate representation. Actual composition nf tnc s:r,: . c I:. Tnc main considcration in his sampic sizc Ft,ua/r is largely women of :ii;,n scnoo:. c•. ' problem would seem to bc: (1) How accurate lese and postgraduate lcvcis, f:o r uroar, or precise need his estimates (e..g., of average communities. Kinscy does not m:KC any o,:cc: marital coital frequency) be? (2) What to comparison of his sampie with tnc L:nitec do about the Oolind of data from different Stntcs population, but says (p. 36) t: at age periods of the ume respondent-<.e., in eraiizations reached . . . are lcast ii. cciy to ix Tbr Ma/c he counted tise ten five-ynr periods applicable" to: ~ in the historv of a 50 vnr old male as ten Ages over S0-(hu sample inciuces 276 independent cascs. (3) `6G'hat to do about the of these) dutter s•,ampling-the inlact groups, from L,ow levels of cducation-(179 gramm:r irutirucdons, clubs, frsternitia, and so forth. school, 1014 high school) In Tbt Fetirsa/t be amply omits discussion Ci/idowed, divorced and separaed-(71;'; of the prrcision problem. The second consid- Catholia-(727) cration he has taken care of by not pooling Devout Jcws-(108 ) the data. He now uses simple uninflated Labor occupations-( s43; ~ ogivea for the various obxrvations by succes- Rural foik-(401 ) sive age groups, and puts the proper sample Southwcstern '.initcd Scatcs, ?ac:i c\cr:=,. sizt on each uble. The problem remains of wcst-(900 wut of Sc. Louis iine e:. weighting the memory factor. clusivc of California, •+nic ri i;:c e:S;. Tne cluster sampling pcnisu and Kin%cv An idca of how unrcprescnt::ivc :nc .vritcs at length trying to support its usc. Hc samplc is of the Unitcd States fcrr•,aic onnu:: s acknowlcdecs the advice of statisticians that tion can be obtained from tnc t:0i- o`n ;:-; a representative probability (i.a, stratified 32 that shows 55.6 per cent of nis sarnpic oi nndom) umplc is the bcst procedure "when- m'lcge level, 19.8 per cent of g::cu:ce sc=,oo. ever the cost of such sampling is commensu- level, 90 per cent urb:n, 59 pcr ccnt i,ici rate with the function it may serve." Kinsev white collar (professionai anti man:gc.-n;) states that he has nrrcrthclcu "deliberately acupations. chosen not to use a probabiliry sample nt<esLx-ATtox (p. 25), giving numerous reasoru, not sup- As for the presentatiun of rauits. `ur ported with evidence, such u the anticioated Crnralr is some imorovcmcnt over high refusal rates on lone individuals not Tzbiu I and 2 show the tota; sam?ic bro. k c-, part of a group, and the need to get the eo- down by age againsc esci of th: oc:~c: ooeration of the respondent. Tne choice of ables observec. 't is cic.r no0.• r.. icr••z 0 cluster sampling, because of the eorreiation are covered, though this is con s;c :n :.. within such 8rouos, m;res it imoossibie to . tezt by Kinsev s st:tcmcnt ::....: so-): e3timate the precision of nl. data• for we have more females fi(;urc irn m:n•: of tlt: "non,::• little idea of what the effective samole size tisticai" gcncralizz tionst but a•crc no; In- is, i.e.. how many eisentially independent ob- eluded in the "statisticai e:ic i~t.or.s." servatioru he has. Tne tables scattered th:ougn tic oook arc , t'.inser's apolos;y for all the uneertaint;e" confusing because few sisow• tnc same tot:;d and biasa introdueed bv his umniins: pr^- T'n,s is becausc for sontic individu:.:s t.ir -• eedures is summarized in his arertion that ticular quation was inappiic:oic. tnc ociu~rr "better statistical dau on the incidences nf uncertain, the question not asKCd. nr re:usc the various types of xsual activity mir}:t It is unfortunate tnat thesc nonresDnn4s -r= ~s.e been obtained .rith random samplinc not coded and entered in ti,e t:bics w c:•:: but we would not have arrived at our presenr the totali would baiance. At least in tnis ~c- understandine of the other. nonstatisticat there are only a fcw tables (c.c.. ~:-=:t ^r•' oroblems whieh we have eon~idered of rnual in Tabie 21 in which the totoi is •;rrarrr t:.:-• importanee in the present studv" (p. 27). the 5940 of the sample (due to muitioic a• Thr. aotseara to be an admission that he olsce. eupations). more confidence in authority. ooinion. irn- A new denarture in Thr Fr,„air ic a pression and intuiti,,n (the "nonstati%tieal at the end nf cach major cnapecr summ:n-n-, probiems") than in data. the generalizations about tnc fc:r.al: :n~ CoT'• C T R 5143 M•1 DO-- ~")E70tj
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ra. 1 vJ/1_OJ C...wtr-~w Ki...r'. L~.L - M..1a.. 1l3 I psring them vith the findings for the male. p. 213 is so spare as to heading that the readcr Tncse tables arc a welcome addition, giving must study attentively to get the meaning. :o;. ~ interesting and useful comparisoru, and using rrrrurwETwTtox :;n rough statistics to avoid spurious precision. As to interpretation of results, a great ;c; { vut, (a) they often generalize scrou the many of the "interpretations" and comments r,tire sampie of funaics, which means they on significance of this or that finding are cn- 1 really apply only, if at all, to white, non- beyond the range of methodological criticism be I crson, upper-class, college graduate, urban because they ate expressed s.s dcrived con- ' lemaies born since 1900 and willing to give clusions vithout presentation of evidence or _,0 ~ eistorics; (b) some indication of the standard the mcthod of derivation. t errors or statistical siFnificance of these dif- Concluding the section on the survev of ~ .., •..,-. ~. .. .r. _. ------ -- --- -o ... p...,,. ~..r... ... .. ... .. -, ~ standard objcctive tests of significance he is a summary of "the record of individual 1 at ti:at any v t to su i v d i h i bi f d " h i " d i h gg e no .ve a e tr ar at e r ta cs o at: uys on presente n t c diftcrence . . . is significant unless such a Kinsey notes that (p. 539 ff.): I conclusion seems warrantcd by . . . direct in- 1. The variation in sexual behavior of fc- ~ terpretation of the data" (p. f2)]; and (c) males is much greater than their anatomical ' hc includes in thexe summaries some dogmatic variation. Tney vary widely as to incidencu t dicta on physiologic, psychologic and social and frequencies of response, intensitv of re- tn• ' "signiiicance" of the data that go far beyond sponse, physical versus psychoiogica sources cx' ~ the evidence in the data, as when, for ex- of arousal, types of psychologic stimulation, ~ :mple, he asserts that masturbation in both age at first erotic response, age at first orgasm, scxes "may increasc efficiency," and in fe- continuity of response, aging ef:ecu and maln "contributes tc hiAher rate of orgasm sources of outlet. ,cc 1 in marriage" (p. 175). His data in no way 2. Females in general show greater varia- : o; , te•st these hypotheses. (d) Numerous gmeral- tion than do males. ,a,! 1 izatioru about the nature and behavior of the 3. Most individuals have lit-.le idea of thc ;;;, ~ human female are made on the basis of plau- range of variation, and hence have difficulty ;) 1 stbic but untated phylogenetic rtasoning understanding the bchavior of othen. ;' from direct observations made on other mam- 4. It follows from (21) and (3) that fe- i T,ais. L•xtramaritai coitus, for instance, is seen males arc less liicciv to undcrstand or have r to n:vc its "origin" in the bchavior patte•ns itmpathy for one another than maies. MIcn of lower mammals (p. 411-412) and the and women will not "learn to get along bct- cn i fencraiizatinn is made to the human specics ter" r+ich one another until thc,v "undentand tnat "not all of the human problems are cul- each ocher as they are and noc as thcy hope turol dcvelopmenta or the product of partic- or imagine thcm to bc" (p. 567). F uisr philosophies" (p. 412). He then prcaches 5. No two females have cxactly the same 000 I that "these mammalian heritages, human combination of all the variables scudied. ! m2les and females must acccpt, or rise above 6. "We have never found any individual tncm if thev intend to control their patterns who was a composite of all of the averaqes on , of sexual behavior" (p. 412). However safe all of the aspeen of sexual raponse and overt irc J snd plausibie these extensions from one sne- activirv which we have analyzed in the pres- ;-t. ( cies to another mav appear, the history of ent volume. This is the most import:nt f:ct experimental physiology certainly teaches us which we can report on the scxual histories yr ~ to be cautious about aceeptint such extn- of.the females who have contributed to the ooiattons without experimental trial in the present study" (p. 543). human. Proposition (1) sounds plauiibie, and its ar The graphs and eharts in Tbr Frru.lr art first part secrtss to be well supported by the OIK ~ numerous (179 major and many minor), data. But he does not show us hii data on •nn4 Well drawn, indexed and listed. They refer to anaromical variation and doos noc show the n I dsta sourccs and on the whole are simple and sratistiu that test which variotion is ereatcr. :ctiblc. although the editing of their tirles Proooaition (2) seems to hold rrue fnr the ' snd hcadints is sometimes eonfusine. For variables he measurp, but atain he dou not !.);c 1 -~ample, Table I refers to mean ate in rlse show how he compares the two variances, cx- .ing i n-:d;ng, but the explanatory text (p. 10) eept by direct impressio,,. His evidence tor ~ rc:ers to median age; the dream table' on (3) is a table (p. 67S) showing that females i CTR 5144 ~z ~ c~ f ~~ti ~~~•~ DO ~ te~ #~~ b-
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i , fM r,..s . s....~ - w...,,. tend to discover masturbation for themselves, whereas men are more likely to hear about muturbation from verbal or printcd sources or obscrvation. Thcsc rather spare data he dcvciops into the generalization that "maia' are much more inclined and females much less inclined to discuss sexual matten with othcr persons" (p. 67f). On the other hand he states frequently in Tbe Mate and implies in Tbr Fcrnalr (p. 538) that malcs .vith the exception of clinicians do not know of the variation in male behavior, and charactcristi- cally misunderstand deviations frorn their own bc.havior. Thex two arguments appc:r to be at crosa-purposes, and in any casc not derived from the data presented. Further, he has not presented any data at 211 tending to establish his (again plausible) proposition that it is necessary ftx one to have experienced a particular varicty of behavior to "under- stand" it. Proposition (4) follows oniy if (2) and (3) hold. Propositions (5) and (6) seem piausible but his data do not show them. If the unique patternings of thcse many vari- abies by the individual subjectl are indeed "the most important fact," then possioiy fiinsey has made a major tactical error in dissecting the individuals and tabulating them according to these separate dissected variabics as if tney were quite independent. He might better have devoted his analysis to a dcscrip- tion of the pall:rrsu or co+nbina[iour of the many variaola found in his subjccu. Kinsey probabiy necd not be as discoura;ed as he sounds when he says "the difficuity lies in tne fact that one has to deai with averagel in order to compare the most charac:eristic aspects of two d.iffcrent groups, but such avcra¢es do not adequateiy rnpnasizc tne individual variation which is the most per- sistcnt reality in human sexual behavior ..." (p. J38). Nis data show averages adequately, and show individual variation adccuatel•v. Thc difficulty lies in the fact that he nras to show averages and individual variation in pa/lrrur or combinations of the many vari. abics, as veil as in the variables taken singlv. Innumerable interesting generalizations are sug;ested by the presented data (sub)'cc: to the limitations of validity already men- tioned). A rmall ssclection: 1. The human female is born w-ith the nervous equipment for sexual responsc, out only a few (iess than 10 per cent) respond besore adolescence.. 2. Prevalence of masturbation in icmaies w~.r s_oL is iower thar. i-i nuics, on,v ::)ou: o: -•- ~.. cent having :vn h:c cxpc:.c ncc. 3. `4uturbati~n in the icmaic tcacs to cc. come a permanent adult pr:::icc, the male it is a pa aino piicnomcnor. c: :. adolescence. The icmaic incidencc :s on:v :; per cent by age 15 and continucs :o i;scrc:sc to middle age, whereas in the m:ic i: ,s x: pcr cent by ave 1' and decrcascs a.,:- trt teens. 4. .VSasturbatio+, accocnts sor tcn pr- ccc: of total sexuai out"t .f marricd ..-omcn. i; has relatively high ~revaicnce in co::;;: Froups, is depressed by rciioious :c :•,c-cricz. tcchniquc is mainiy manual, vagina; :nsc;s t.ions of peniiorm oujcc:s bcin; unco-.r-o- exccpt in male fant:sy. Ait ;ouSi .:nt:sv s infrequent in female masturcztion, so:nc t.- r-xr cent of fcmalc masturo::ors :rc :c;c •, achicvc org:fm -Dy :cntasy aione. 5. Most of thc sexua; responscs come ;a::r in life in fm..cs tn--n in ,,.:ics, :re :nor; variaulc• and have les: rciarion to :cv:: oi cducation. . 6. iiomosexu:i contacu ioiiop . pattern in the femalc from tiha in t:,c ra..,. ; nc incidcncc is considcr:isiy icss male, homosexual promisraity is ., .,. ,,, femaic, and there is iess vuil: and dis:?--rov: associated with femaic homoscxuai 7. Thc incidcncc of coitus in 700 per cent. Orgasm in m:rit:l coit;u, ever, is evidently lcarncd ovcr :hc vc:: s. :.1 tnc first year of m.rria;c oniv 75 ?c. o{ fcm:ics ex? cricnccd coit:i or;um, wr:ic os .,-,c cwen:ictii ycar somc 90 rc. ing org:sm. intcrest in coicus crecu with years or r,s:rriagc ior is :.::s r.r...- Iv - result or aging?1, :nc is ;css ....-_ .. social and education:i f:cto:s than Lrn t-.: maic. Nude sleeping and c01:u1 ic•evic increasing for tnc fcm:ic from 3cncra:;cn :o generation, and variety ot coitai ?osicions :cccpted is liiceR•isc inc:casin~. 8. Femaics respond much less to psvc=.l; stirnuii than do m:ics. (There :re s:vcr :: :. bles on this, such as rupons, to >ccinc ^ic:ures of oppositc, or samc ac>;. :nd a, so-:r.. It is not clear, ho•+evcr, wi;c:: cr tnc<c ca:: are from the 5940 fcmaies or somc oc:,c • source). THE SLTPLEME\TARY rT:FO0.MA--0N' T ot Frrnair, in addition to tnc rc~ort:n; and interpretation of t'ne surv.`v c.ita :.a grea: accretions of discussions oi ir_ci cua• tions, academic frecdom, sex educ.t,oa, ^rsc• CTR 5145 I i C R H N
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} , w..; ..! ItiOi G_M.r.1%14 Ki../6 I- - M~ 11R 71 0 0 ,c I c tical marital and premarital problems, social conuol of sex behavior, and the "aignifi- cance" of all thcse and many other things. 'n:rc is a.+eaith of footnote material and dis.-ussion based on "supplementary informa- tion" obtained from: histories not tabulated; personal obscrvations in taverns, dance halls, and so forth; recorded calcndars, diaria, cor- m;>onocncc; erctic fiction; scrapbooks and pnotographic collections; "a r t" materials: Sr:ffiu; misccllancous collected erotic and sacomasochiscic material; community obscr- v_c;ons; clinical studies by physicians, sociolo- es:s, antllropologists, and so forth; zoolosical stud;es of mammais; and study of the huge coi;ection of 1f,0)8 volumes assernbied in the Ins:i:utc for Sex Rescarch. Unfortunatel) K;nse,v docs not in these diseussiorss make a proper distinction between tested and un- trsted hypothcsa, between well-dnwn facts :nc impressions. Since he does not present his ev;ccnce thcse excurs;oru cannot be considered ;e.--:anc to his scientific reports, and ean be trc:ed only with an urgent caveat emptor. ;aere are five chapters which attempt in. : seneral way to collate and summarize for -c :;tcratc layman Kinsey's i.deas of what is inovn about the anatomy, physiology, psy- cio:oev, neural meehanisms, and hormonal ..c:ors in sexual response. There is a very ully edited 47 page b;bl;ography of items rcierrcd to in footnota and text, which does r,oc purport to be a general bibliography on iunan sexual behavior, but nevertheias af- :orea a very interesting and fairly complete cntroduction to the literature. A detailed in- dcx includes practically everything mentioned ;n tinc book from abdominal muscles in sexual rrs>onse to Zuni Indians. The casual reader is oerhaps bcst advised to sean the index for c::cs is to where to dip into this compendium. Inc medical, surgical or psychiatric elini- c:an perusing this volume will find numerous r.ssages of extraordinary interest and ehal- :cn;c. Kinsey deals at length with the ques- tion of capacicy for orgasm, tends to relate it to nrly experience of masturbation, petting of coitus. Assuming that the correlations are =t ;ood as K;nscy thinks between early or- ;=s-, ex;>cr;cnee and m a r i t a I orgasm, his s:uc;es in no way establish a casual reiation- s' p. it could casily be that fcmala who are constitut;onally responsive, for that very rea- svn iave sexual experience early, late and al- Kinscy Kinscy acknowledges this possibiliry of u-cctis•c :actors, yet makes the statement that "It is doubtful ii any type of therapy has ever becn as effective as early expcrience in orgasm, in rcducicg the incidences of unrc- sponsiveaess in marital coitu.s and in increas- ing the frequencies of response to orgasm in that coitus" (p. 38f). Despite the severe doubts one must h:ve about the validity of Kinscy's bisic data and the representativeness of his sample, it is plain to sec in this s u r v e y the contribution to knowledge to accrue from general study of a total population group (i n c I u d i n g the healthy, normal subjccta). With all its dif:i- cultiu, this remains the principal mcti:od of avoiding the Scylla of observation of :oo fcw individuals to get an accurate idca of the range of variability and the Charybdis of obsci •-eing large _but highly selecccd s:r :pies such as most clinicians encounter. Sex behavior being an important part of the overall func- tioning of the human, it would appear essen- tial for the physician to have basic knowledge about the range of variability, the general limits of euentially "normal" bchavior, and some criteria for significant or pathoioSical deviation from the range of normal values. Critiu who ssert that Kinsey is trying to tubstltute statistical ranges for morality or natural law ser.tl to be basing the obice:ion on belief that appropriate or normal bchavior ean be deduced from assumed tcicoiogy oi the organism; e.g., any sexual behav;or that does not serve the function of procreation is abnormai, or per verse. This leads to ci:ssifsc:- tion of contraception, homosexual contacts, masturbatior., enjoyment of coitus, pecting, and so forth, as abnormal or perverse because they do not serve the assumed ourpose. Ex- amination of s u e h teleological arguments, however, usually leads back to a cultural arc;- fact rathet than to experimental evidence. Tnere are some who feel that modern medical education shares the general cultural attituoe of reticence about sex and that physicians as a eonsequenu tend to share the local folklore about sex rather than bcin; equippcd witi seientifie knowledge.' If this is true it can be hoped that the stimulus given by Kinsey to research in sexual behavior will eventually provide material of sufficient scientific merit for inclusion in medical education. SUbtMA>~Y In summarizing, it must be aeknowledAcd that Kinsey's persistence, courage and col,iss.Al industry have succeeded in making the •'irsc C T R 5146 E.: ~f R VIV•1 ~'~ O%'-1-~~ ~"~ E)
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V 1 + lA! K....r'. l.r+. - M...w major brcak-throush since Freud and Ellis in tnc curtain of ignorance about sexuai mactcrs in thu country. Vi/c must agree with George W. Corner, Cnairman of the Committcr foi Research in Problems of Sex, that "thc current report makes a notable contribution of fact in replacement of ignorance and of inadcquatciy verified surmise" (p. viii). In view, howcver, of the overriding importance of the subject and the tremendous effort that has gone into 6e collection of data, it is extremely regret- table tnat so many faulu in the planning of the data collection require almost paranoid caution in use of the survey data. Tnc basic weaknesses in the data may be summariud: (a) Trse validity question. However plausi- ble ti3e rrnslu may seem, the study provida no robust test of correspondence bctwcen the recorded verbal raponsu and actual behavior and physiology. (b) T'nc reliability question. Evidently the method of making obscrvations is fairly re- liable (repeatable) for simple incidence data, less good for frequency data and data de- pending on long-range memory. (c) i ne sampling question. Despite high numbers of cases and fine breakdown bv agc, educational, marital status, and so for,is, the umpling process leaves us quite unable to cx- tend the findings to individuals outside ti3e accual study, that is to make generalizations. Because of the integrity of the invatisators one can rely on the n.+ numbcn, but cannot with asscssable risk extend the pcrcen:agcs. .Qne can safciv conclude that there were in the United St:ta at least 54 femaies who in a certain situation would tell a Kinsey inter- viewer that they can masturbate to orc_sm by fantasy alone. But to infer from Tabie 37 that two per cent of all United States fe- mala who masturbate do so by fantary aione .rouid be extremely huirdotu. eonelusioo a svetinet critique of Sezsca! Bebrviw ix tbt Nssnun Fnrsslc migl3t consist in a rewrite of tnc :•;ic, w11%ic.^. i\.nscv n, acknowledges is misic:cing l; • 4~ ~•. ,. snoulc bc: Vsrbal Bci~asv~:r of S9•J Sdaecs Urban Fcrualcs %l''/xj Havc Gorrr :o Co/lcgc and L:7crc Williuo [o i1c iu:rrvrn~,•; Alron! Tbcir Pfrsoual Scz :':xprrscures. J / * AnDrN oUM Since this review went to prus can Statistical Association has p u b i r s;, c; (J.AS.A., 45:264, 1953, 673-716) :nc rc. port of an expert commit:cc a?;>oir,:cc :-. 1950 to review tie statiscic:i mcmocs uscc in The Malc. After seeing this very thorough rc;>or;, present reviewer .+isncs only tn:t he hac aecr. more emphatic in stating that ti3c wc:icncu;s of i{inscy's study are sn:rco by ocner uuc,a in this field. The Committee comparcd the nir.scy wor., with sex studics or nine ocncr m.sjcr tors and concluded tna: in resprc: to :ii major criteria (intcrvicwin;, mc:i:oc cr,ccr.s. sampling, analysis, intcrprc:ation; tne wi~ cv scudy u as good or definitciy superior. ACR\OW l.Lt3G\tENTS ine writer anteiuiiy acKnowiccSu rnc cr.- coungemcnt and cnr3cism oi Jr. C:ri G. in connection witn tne prcpar:cion oi tnis rnar,u- script, particuisriy with respec; to :i3c cec:s,o-. co limit ti3c discussion iar;civ to thc scc;,or. c: ~tisc book that reports Kinscy•s ori;,+n:i invcst:;s. tionl and findinss: and :ssumcs iuii respons+o, for the views pracnteo nercir.. RL: L nLNGS l. a< Reun. d< Sain, R.: Atun+¢ Mon,n.r. iH. ?4,. 1f+s. .. CaiILL. W. A.: . An1- Sf.,Jbci. A.MC.. •.:.1 i.<c<merr• 1f.)• .13..1.. . 3. Heob,. A. ii.. .nd L+meart. n. :).: A- lo.:7ss.>•c.. )„n.. :s.s. M.: :,7,ene" b.il.. 1. Geiannn. J. .nd Puler., N.: ~. ?rycne:.. :1.3.r.3c:. If.l. 4 R..a, R. T.: J. Aeno<+e.i k Socul ?rrcna.• .t... Occ..crc sl1C 71s-7, 1. 7. Dorn• H. F.: Mn J. Pi. }{aitA. U:c. J.nc Ifr;. cr7.M. s. E.kenal, Laaca, s:ctJl. Arni So, U.r, 7... CTR 5147 , + ~x6I9~' ~`~~``~ ~~~ti ~
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THIS DOCUMENT SUBJECT TO AUG'2G, 1985 NON•DISSEMINATION ORDER /N R,, q,Q DUKE CASES. THE UNIVERSITY OF TEXAS M. D. ANDERSON HOSPITAL AND TUMOR INSTITUTE T..as Y.qicai CMtH Movsta+, T.us T702S June 19, 1970 Mr. W. T. Hoyt Executive Director Council for Tobacco Research 110 East 59th Street New York, New York 10022 Dear Tom: Thank you very much for yoursrand5yconsultation fee. Enclosed are the corrected graphs for you and Dr. Little. You may use them any way you like. I listed the components of total respiratory so it would be clear that asthma, bronchitis, tuberculosis and resoiratory .cancer were included as well as emphysema and bronchitis, and that the separate rates are included in the total rates. The rates for the last two conditions are too small to consider separately. This makes quite a case for improved classification. After going down with the introduction of antibiotics, influenza and pneumonia are now going the same route as reported respiratory cancer mortality. The so called Hong Kong flu in 1968, gave that death rate another jump, so it is on the general ascendant course. My work on the longer document continues. I have all the mortality data on hand and will make a report with Bill Alban in the next two or three weeks. I have my other file of cases completely processed for Negroes, but not quite complete for Latins and Anglos. That is, they are coded and punched, but need to be checked for duplicates. Wben I have the printout of the 40, 000 plus cases in Houston, and compare them with the 200, 000 plus deaths from all causes, I will first check thek162, 163 classifications and see what the facts were. I have been asked to put this article in the Inter- national Journal of Cancer. The awareness that 23 years of total popula- tion base cancer cases in Houston are available and may be checked against total deaths from all causes in Houston has caused a great deal of anticipa- tion. At the Tenth International Cancer Congress in Houston, I had a steady stream of visitors in Epidemiology; the only meetings I was able to attend , CtR 5148• ICONFIDENTIAL: MINNESO'IA "',TOBACCO LITlOATION C c >' r'.''4 ~~ti ~.~ 0 ,~ :! ~"~
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THIS DOCUIdEA'i SUBIECT TG AUG ?0, 1985 NUN-D(SSE,r,1NATICN IN ROGERS AND DUKE CA;,;. w. T. Hoyt Page 2 were the two in which I was a par ticipant. I showed them my data for Negroes. It is interesting that in the early period, cancers of the pros- tate and stomach were the leading cause among Negroes. As the N4Bro cornmuaity became more a.ffluent for the last seven or eight years (163) not stated whether primary or secondary lung cancer became first, as it had been among whites for socne years. your grant has made possible a wealth of material. Conzbined with can- cer incidence data there is enough here for a couple of books. This letter is by way of a progress report. Sincer ely, /, C~JJ((// ~(// '.'~. UI'f ~ Eleanor J. M donald Epidezniologist -J:rf:kr Enclosure c1R 514s CONAIDENTIAL: MINNESOTA C T f~ ~"~ ~ / °~ 'eF~+ '~ ~ TOBACCO LITIOATION ~' 4 t..R ~ •
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, aACE/SEx - NE(.a0 MAIE ) Af.E SpECI 11C af~PIRA/Onr R~TES ~FR-1CO,ooo nr CAI/Si ~NO AAC[/SEx EOR T(11A1 RES~IPATORY O~ATHS CAU9E TuDERCUlOSiS -3MAl1GNANT IIEOOIASM SUDCIASS 162 SUDCUSS 163 ~ INEIUENlA • PNEUMONI>t _ ORONC111 T IS u EMOI/YSEMA (, ASTIIMA n All UTIIER 11)TAL AGE 0-9 10-19 70-79 30-39 4.53 0. 40-49 50-59 - 60-69 70• IOTAI 1.1e 14.2) 11.64 _ l6.93 0.- 155.69 16.C•0 7.1e 0. 0. 0. 0. 0. 0. 0. 0. 25.08 0. 0. 0. 7.1e 0. 0. s3.ss 50.15 36.23 0. 7.1e 14.73 4.53 0. 0. 66.93 75.23 155.69 0. 0. 0. 0. 0. 0. 21.57 2e.46 0. 3.43 ~ 0. cl. 0. 0. 0. 0. - 13.39 y -25.09 51.89 __35.70 e6.93 ^- 50.15 ` 103.79 79.39 2e1.12 T 1S3.6R 26.46 40.16 1SG.43 207.58 30.05 300.90 674.62 3. 4 3--- 17.14 04.136 N 0
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[,Li:rl" .. Sr.Ct/ IC -1,•i;[x RfSrIRATORy R4l[S rER t0C.00) 11Y tAt1N nAiE -- t•;Int RESrIRA10RY f)EAT1l5 C At19E C 4u$E eim RI1C,f /Sc X( f/R 1954 _- 0-9 10-19 20-29 30-39 AGE --40_t9_- SO-59 _ ` 60_69~ TO• y__f01t1 EUr.(RCUt11SIS 13.4e 0. 0. 31.70 _ 52.99 __141.44 - NALIGNANf NEOrtASM 0. 0. _^ _ 52.99 10.72 SURCIraSS 162 0. 0. o..- `- SI/BCLASS 163 ` 0. 0. 0. 0. 52.99 10. 72 I4rtv[N2A ~ rNEUMONIA- ` 40.44 0. 0. `_. 0. 0. - 0. - RR0NC1/I t t.S 0 . 0. 0' - 0. -~- 0. EMP/IYSEMA 0. 0. -- - 0. 0. 0. 0. ASE/IMA . 0. 0. 0.. 0. 0. All UtItER 13.4e 0. o, 0. 0. 10.12 tptAl 6T.39 0. 31.10 105.99 2R1.e9 127.39 0. 2 ~- 0. --2e0.11 0 ` ` 0' R.A6 -Je2.17 __ 0. 25.9T 0. ,0._ 0, 0. 0. 0. 0. 0. 2eo.tt , 509.5% 560.22 / I 1 i i f
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~r CeiiSE Ai+o iisCE%3Ex fna id5~ rt~ t~.A/Uar a~tES P ER 1bC000 ..~a0 NelE-- I,t ~[s~tant0ar CAV9E o€ Af~~I 10-19 20-29_ 0-9- ----- _ -- AGE )0'j9 -_40-49 59-SO _-60-69_ _70• TOTAL s. 79 e 13 • zo 76 7e er 1)2.se 13.25 --- - 1.93 •1.51 114.l1 244.53 241.05 )T.4) 0- 16.1~ )0.)9 6e.91 10e.47 11.92 1.9) 2S.)7 70.91 150.4e 10e.47 21.e6 0. 6.92 27.O1 62.70 120.5) 12.92 - 1.9) 4.61 0.1) 1 )1.35 4e.11 S.]1 . . - - -- -- - 0. 2.)1 0. 0. 0. 0.33 --- 0. - 0, 1.1e 50.16 )6.16 ).97 -- l.9) - 11.5) 20.76 - ... 112.e6 741.05 - 1e.22 ~ - - -,- • 11.57 - e0.71 - 19S.aS Se9. )Il e19_57 u, tn 91.42 _-OK t~/11taCUtOSiS __ - YAl IGNANT NE.VOIASM o. o. 0• -- ---- 0. - ~. SUeClASS SUflCIASS 16)_ INf lUEN1A • PNEUMONIA- . y totAt- V rr v t 0. 0. o. 2 15 0. 0. 0. 2.15 _ 10.74 - 1.5) 0. 0~ 0. -0'----- - 0_ 0• -- 4.60 4.e6 ._ 0. --- - ~ - - ------- - 4 . e 6 4.30 16.e7_-- - ------ - ~- - 1 h ~l 1`, l 1Y1~ _ t - - ~t- I L l - . ` r-.-. .,_,. r - •; --- - - ~'' o - 0 - ; ---- --- ' ' a -0~ --- {. o ~-~- o m T i 1 1
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TNIS DDCUMENT SUBIE T TD AUG. 20, ~ t I N R0GER; A rID DJKE t ti ~~t iCJUSTED CaF.C 1t1Uua DEA1N RATE S t'ER 1~,000 BY CkJSE ct\C ReCEIS Ex LlP:G SEGOND (163-1t31 . tC ElS E~x - ~AT IN FE!tALE } t E1 p CR UOE ADJUSTED ! tyc0 t;. U. tCC 1 C. C. tc42 0. C. 141 3 6.57 18.60 - _ - - 1 tti44 0. 0. Ica; 0. 0. t«b E.73 7.90 ;. to47 t. E 5 7. 87 - _ j 1«P C. C. 1',c9 0. C. _ _ tUS; 6.42 5.74 t'+ `.1 0. • 0. _ 1 IS:2 1C.40 2C.54 !'+S 3 0. C. 14,4 0. C. , I555 0. C. 1556 3.76 7.43 1~t7 C. 0. t I {:ti 3.31 9.47 tS',9 ?.12 E.78 t : :bC 0. G. lr tl 2.80 7.69 1!;t1 2.66 7.23 ;St? 2, 54 4.64 r :40~ 5.70 23.19 1vf.s .c.64 13.1C 1~6t 13.36 32.4C I:b7 4.29 8.33 S . CTR ,COA'FiDENTIAL: MINNESOTA X TOBACCO LITIGATION
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THIS DOCUMENT SUBJECT TO AUG. 20, 1985 NDh•DISSEIdINA1I0N ORDER J I ,N t 1 I 1F<- - y: _~ AG: ADJUST ED CARC INDr,a CEA'1H RO TE S NE ~t-1~,J00 3Y CA,1 S E ViD P eCE/S EX L su~E - LUNG-PRIMARY ( 1t2-1t21 1:,A 1E/SEX - LATIN FEMALE YEeR CRUDE ADJUSIED IS~C C. 0. 1v41 C. 0. 1042 C. 0. i 1S4 3 0. c. 1944 e. c. i ; 15 : 2 0. c. - -- Iq5 3 c. 0. lv;Z E. 13.54 ~ 1555 0. 0. C. C. IS:1 C. 0. 1 1~=° C. C. 1°=S 3.12 6.15 1St~ 2. S5 8. C8 ---- "- ~ :ot 1 5.60 15.41 1CC2 0. 0. - 5.C8 12.CS 1 1St4 C. 0. - 2. 32 6.14 ; t ~ee [. 23 5. 85 - - "- - 1) b 1 0. C. CTR 0. 0. C. 0. C. 0. - 0. C. _. 0. C. 6.42 15.10 0. 0. R^ U AttR_Pj!~L-LASS.-._ . 51~4 CONFIDENTIAL: MIhNESOTA TOBACCO LITIGATION LIT~~,h HN 01, f^~ 2-3~~ e ~ 6
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THIS DOCUMENT SUBJECT TO AUG. 20, _ 1985 NON• DISSE,AINATION ORDEg - IN ROGERS AND DUKE CASES. i ~ - ~ACE AUJUSTEI` CAHC1 NU.`A Ot•~ Qa TE S P>+R 100. 0~ J t3Y Ct.J - SE rtiC ReCE/S Ex : CAUSE - LUNG SECUND 11t3-163) ~ -aaCE/ SEx - NEGRO FEMALE ~ ~ i ~ YEAR CRUOE ADJlS1ED _ '1 1940 G. C. 1 1941 2.05 4.34 ; - Iq4 1 . S4 . 5 ' 19ti? C. 0. ± "1944 1.74 2.75 ! 1945 0. C. - - --- --- ~ 1546 6.34 7.15 1547 6. C6 7.36 ; --1948 - S.al ~.SS _ _ ~ 19A9 2.79 3.76 1950 1.34 1.24 i 1551 _ 2 . ! 2 4.36 ~ 15`.2 1. 18 2. C4 1953 2.24 3.46 _ ' 1954 1.06 1.1C ~ 1955 4.03 6.39 ~ 1956 1.92 2.34 ' 1957 2. 7 5 3.92 ~ 4 1558 1.75 2.45 19~9 4. 2C 6. 81 1960 4. 4 5.90 1561 2.33 3.23 _ 19E2 E.73 E.55 1563 4.33 5.55 19614 3.48 5.31 19t5 2.02 2.55 _ _- 1966 5.21 7.29 ! IQ67 3.79 5.58 ~ S i L C T R 51 CONFIDENT/AL: MINNESOTA •;~ TOBACCO LITIGATION ,r•) 0 r~ C) 7`11
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THIS DOCUthEnII Suo,t:.i r.. •_,;, 1985 NON•DISSEtdINAT1UN ORDER ^ 1N RAND DUKE CASES, r t sCt aCJUSI ED CAP 1hOrie DEa 1ri RaT~~E K 100,000 E Y CaJSE en0 ReCUS Ex ' CaUSE - LtxvG-Pkl"AKY t162-1t2) ~ceLE/SEX - ANGLO FEMALE l'- r YEdR CPUDE aDJI;SIEt) i 194C 0.73 0.68 l 1S'.1 C. 67 C. S4 ,42 62 0 --- - `~-- 15 . C.SS -- t 1943 C. C. IStiti 0.53 0.45 -- - 154~ C. 0. ~ 1S4t C.41 0.65 1Sti7 C.44 0.52 154E c . C. - 1 1545 0.40 C.55 ` -- 1950 1. 14 1.36 - 15',1 1.45 1.71 j 1552 0.35 C.4C -- 1S'.3 1.00 1.24 1954 1.52 2.25 - ) 1555 1.24 1.44 1S;t 1.79 2. C!> --- '•S57 1.44 1.62 1 1S 5? • 2. 06 3.34 - IS5S 1. 61 1.66 ISt0 2.E1 2.82 -- - - --- 1 196 1 ? .79 4.C8 - - ISt2 3.19 3.53 -- ~ 1St3_ 3.33 3.65 19t4 4.t6 5.13 _ ~ - - - _ IS65 3. 60 3.91 ' 1Ybb .S 2. 1 - , - - --.•--.._ _ _ S 1967 3.42 3.56 1 I i -t CTR 51 -0t; CONFJUL•IiTJAL: M)NNESOTA TOBACCO LITIGATION ~~ `~` ~ph 11H 0- ,r") 3 ,~',~ ) `,r ~"'~
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THIS DOCUMENT SUBJECT TO AUG. 20, 1985 N0N • DISSE!AINATIOh OrUER f e I 3 ~CJUSIED AK 1N)y4 DEM Ra1~S v=-`.11~OU,000 BY Cla1SE ~<hC RtC=_/SEX Ctu~E _ LUNG SECOND ( 1E3-1E3) 1C t/S E X ANGLU FEMALE ~.-J .. ~ ,, -- 1':445.87 7.78 ;C:5 1.00 1.'32 _ 1:4b 3.25 3.81 • ;c4 1 ' 2.66 3.13 Iti~tl 2.1 .6C rtAR CRUDE AUJLSIED locC` 0.73 0.53 ltic l 2.68 2. e5 ---- --~ lcc2 3.09 3.76 --'- ;~<3 4.58 5.27 - 1 2.53 2. 68 t''t2 3.15 3.46 - !'~f3 4.C5 4.3C _ 4.40 4.58 ~ l~~s 5.E3 5.53 _ ~ .48 5.75 14tf 7.69 e.C7 1%45 4.38 5.57 _ 11050 3.C3 3.75 1'•51 3. 63 4.20 ;5:2 ~.48 4.42 11; t) 3 2.34 2. e2 1.6 1. 8C 5.25 6.10 _ I +:E 2.C8 2.29 1'$ :7 3.45 3. E5 1ti5H 3.61 3.46 ll:=q 2.50 3. 46 1'),,0 4. 17 4.62 - i CTR 515r CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION C 1, Rh llitq 0030:' ,9
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THIS DOCUMENT SUBJECT TO AUC,. --_- --- ------- ~'- ~.--19° R _ GEKS At, D DUKE CASES. ~ Ii G It ~UM4 DE41H R~TES ~ ~ 1GO,JGJ-EY :Ct aC,1USi ED Cn~ •~. C:JSE an0 R4CE/S Ex ~utSE - LUNG-PRIMARY (1t2-1t2) - i ctCE%SEx - NEGRO FEMALE rtaK CPUOE 4DJUSIED 1940 C. C # . 1S41 2.05 2. CC IS42 0. C. " 15c3 C. C. 1944 C. 0. 15~5 C. C. 1946 1. 59 2.4C 1547 0. C. i 15ar 0. 0, I44 9 1.39 1.13 1950 2. 68 2.46 -` 1q51 1.2t 2.18 )S`.2 1.18 1.66 1Sb 3 2.24 2.54 1554 2.12 2.92 j 1y55 1.01 1.7C • 1y56 C.St 1.3C 1S5_7 11 e3 2. 5s ISSE C.88 _ 1.47 - ly=~ 1.68 2. t1 1S6C C. 2:1 C . S4 - i 15E 1_ C. 78 C. 91 1SE2 C.75 C.99 1St3 C. 72 C. Sy )yb~ C.70 C. E5 15E5 * 1.35 2.21 i I " tt C.65 C. E5 - •r. -. • ----- -- - 1067 2.52 3.55 t i r CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION CTR 515b
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- ?,t IL, THtS DOCUMENT SUBJECT TO AUG. 20, 1SE,5 NON•DISSEMtNATION ORDER Ih ROGERS AND DUKE CASES. THE LINIVERSITY OF TEXAS M. D. ANDERSON HO`•PITAL AND TUMOR IIhSTiTUTE Teus Meo-ui CeAter. Mouston, Te.es July 3, 1970 W. T. Hoyt, Executivt Director The Council for Tobac:o Research 110 East 59th Street • New York, New York 10022 Dear ToTn: 77025 Here is the general.rerort of the work done and the progress that has been made to date in the study for which a grant was made to the Houston Health Dep<rtment. It is more an acknowledgement of a great opportunity, the results of which are in the process of realization than a finalstatement of accomplishment. This is the introductior to the indepth studies which vvill follow. Thark you for making tds possible. Sincerely, Eleanor J. Macdonald Epidezniologis t EJ?a:kr Enclosur e 1 CTR 5151q ..J , CONFIDENTIAL: i+S}NNFSOTA TOBACCO LITIGATIOK CT, HH ~°~ 0 ti ~ D ~".. 1,
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_. THIS DOCUMENT SUBJECT TO AUG. 20, " 1985 trUN•DISSE411NATION ORDER IN R,,-t?( , h„U DUKE CASES. To: The Council for Tobacco Research July 1, 1970 i rom: Eleanor J. Macdonald Epidemiologist Subject: Mortality Study in Houston fr ora 1940-1967, Enabled by a four year Council Grant. In July 1966, a grant was made by the Council for Tobacco Research, to the City Health Department in Houston to enable recoding of all the deaths from arl causes in Houston according to the VII International Classification of Diseases with interim U. S. Vital Statistics Depar--n.e n; decisions, as of 1966. Included in the new code for this study was a place for &.e rubric ~ as it was originally coded, as well as a special space for asthma, br on- critis or emphysema, whenever they were mentioned. Census tracts for the entir e period were coded as they wer e spec~°ied '..n 1966-6 7, al- though many revisions had occur red since 1940, so that as :a- as was possible consistericy and usability was estab:isaed. The 203,000 pius individual punch car ds accruing from : t: :s pr oje ct were made available to the Deoar =ment of --Epidemiology of the L'aiver sity of ; exas M. D. Ander son Hospital and Tu.-nor Institute fr om 1940 thr oLgh 1967. These were edited and checked for consistency and for consecutive cor_:pleteness. Corrections were made, ar.d a printout was obtaiaec fr or:: the computer. The staJf of the Department of Epidemiology then rechecked ,: e entire file and coded the Latin A,:.erica=. surnames according to t:^.e definitior.s of the U. S. Bureau of the Census. These entries were t hen CTR 5100 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION C T R' ~ ~~ ~ ~~ C) 0 3 Cy B2
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THIS DOCUMENT SUBIECT TO AUG. ?D, 1985 NUh-DISSEtdiNATION ORDERpage 2 !N RJCER,) AnD DUKE CF,SES, repunched, the tape was corrected, and was ready for statistical appli- ---eations.-- - PTogra..^zi_verre-wr.itten under the auspices of Epidemiology for figuring age-adjusted and age-specific rates. On the central computer ZBM 7094, the age-adjusted (to the United States 1950 population) and age-specific rates were figured for each individual cause of death for each of the years. A'-specialroutput--was prepared on all the r espiratory disease, both separately and combined by sex, ethnic groups, and totals. Trends were figured to deinonstrate changes over time. In April, 1970, a total alphabetic prir..tout of all the data coded was obtained. Regional Medica? Pr ogra_-n - Su; vey of Texas Concurrently Conducted, 12/66-6/69 In 1966, with Regional Medical Progra.-n funds, the Depart::ct of = pideraiology obtained abstr acts of every lmown ca.ncer in aouston, from a?1 hospitals, c?i.a.ics, and laboratories. liouston has as st:h-groups, with approxir: ately 250, 000 of each, both Negroes and Latins. The age-adjusted incidence rates in Fiouston for cancer morbidity among Iregroes is now available from 1944-1966. The codiag of the other two ethnic groups is finished, but the checldng for duplicates (i.'e. admissions to more than one hospital, or abstracts from pathologists' laboratories as well as hospitals) ren-iains to be done. To prepare the deck for statistical hand- 1_ng, the first admission has to be identified and coded as the master car d, , CTR 5161 CONFIDENTIAL: MINNESOTA ' TOBACCO LITIGATION rif`I (~ ~'~ ~ r .~ ~~ 1
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TNIS DOCUMENT SURIECT TO AUG. 20, 1985 NOh-DiSSEir,iNATiOv ORDER IN ROGERS AND DiJKE (:ASES. ~ Page 3 to eliminate duplication, and the entire deck has to be eyeball checked w•ith the listing of deaths. We are handicapped by shortage of help for this phase, but are working on it. From the 74 coV.nties in the state, including Harris (Houston), for which we have complete coverage for 23 years,we have 335, 000 accessions for approximately 250, 00U indi- viduals. The Regional Medical Program funds were discontinued Ju:y 1, 1969, while the collection phase was in progress, and before the data reduction phase was under way. Absorption of these two huge data sources, mortality of Houston, 203, 000, and the survey morbidity, 250, 000, has taxed our sta« and slowed anticipated production. The presence of the morbidity and mortality data together, horno- geneously processed, gives a data base from which the following or e- sently sought but still unknown basic facts will be derived as rapidly as pos sible. I. A 23-year accuracy of the death record study as to site of can- cer. Hos: ital ab stracts, and/ or pathological proof of type of can cer will be matched with reported cause of death. This should clear up the present con fusion about the accuracy of the 162 and 163 rubrics, as well as the size of under or over reportins. II. The recoding from 1940 to 1967, according to tT:e VII Interna- tional Classification as well as the original coding from previous Inter- natior.al -ists with different rubrics aa show what iafluence changir.g classifica:'.or.s 'r.as on reported causes of death. IIi. The r:,or:a?ity tr end,over nearly thsee decades of heart, ca.n- CTR 0-162 CONFIDENTIAL; haNNESO'TA 'TOBACCO LI?l0A?/ON g~,# ~4 f ~~ ~~ ~ 084
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THIS DOCUMENT SUBIEC7 TC' AUG. ?^,,, 1685 IH OGEkS hnD Page 4 cer of every site, s.nd of str oke, of all respiratory diseases, of diabetes and other chronic diseases, as well as of accidents, etc. will'be on the firm foundation of a consistent coding pattern. IV. Important knowledge to be obtained from this compilation of d.ata will be the relationship of the staggering increase in air pollution in the last 15 years to the reported causes of deaths. The cases and deaths in Houston are census tracted. Study will be made of appr oximately ten different population areas i-:. 'r.ouston, co :z- bining census tracts into areas to give firm and adequate population bases of similarly exposed people to see what e°~ect sir::ple residence has on reported causes of death. For cancer, the sarae approach x•:11 be used to deterr.:ine the influence of environ.:.entai factors. V. A study of daily particulate sample a.-id benzine air sar.plizg with r espiratory deaths has been set up with our biocher.:ist. It is to be noted that i:n the July, 1970, issue of : nviro.^.:nenta? Science and Tech- nology, Dr. Tho:nas A. 1-iodgson, Jr. of Cornell Medical Co'.':ege in a study of deaths in New York City from November, 1962 to \:ay, 1965, a study, incidentally using the same techniques and data that we pla nned for Houstor., slight or moderate in:r eases in concentrations of air pol- lution during a month can be expecte,a.d to result in increased mortality from heart disease and respiratory Ziseasea arnounting to several hundred deaths. An :ncrease of one ,...it in the average daily concentration of par tic•.1ate matter during a month results in arn incr ease of r::or e than 13 deaths each day fr or.: respiratory a:,.d hear t diseases for the third c1~ 5i6 1 ~ CONFIDENTIAL: M(NNESOTA T09ACC0 L!T(OATION 011 0
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THIS DOCUMENT SUBIECT T0 AUG. 20, 1985 HON•DISSEI,1INAilUF1 OhuER Page 5 1N BU-~RS AN D DUKE CA$ES, month following. An average of two units from month to month in New York or in Houston, is not unusual, which would meaa an increase in the daily aver age of 26. 7 deaths. That figur e would represent an 18% increase over the average 150 heart and respiratory deaths pe: day. Hodgson studied the effects of ezvir oamental factors such as particulate matter and suLur dioxide in the air, and temperature, on mortality rates. He observed that temperature influences mortality independent of air pol- lution by causing stress upon the body when it is very hot or very cold. Our planned study was also adding daily pollen counts for September and October, which often run into the thousands in Houston. These mort.ality data have been shared w:th Robert Roberts, Ph. J. , of the University of Texas Graduate School of Public Health, an ecologist, who has done factor analysis by eth nic group of the deaths gr ouped in five general categories: 1) infectious diseases; 2) degenerative diseases; 3) social diseases; 4) maternal diseases; and 5) ir..fant mor ta;ity (see attached). There is a concept held among ecologists of wh.om Roberts is one, that diseases of one kind are common in pri-m-itive populations, but that as communities emerge into more sophisticated societies, the types of diseases tend to change. The e:ner ging societies have high i nfaat mor- tality rates, high maternal and ir.fectious disease rates, while the mat-.:r e society is weighted with mortality from the degenr.rative and social diseases. These are generally today's expressior.s for vary:_ng stages of public heaita awareness and, contr ol. Roberts has read several reports C T R 5164 CONFIDENTIAL: MINNESOTA ` TOBACCO WTIOATION CT 1 ~4V 1-1 t;,J ~''~ 0 ~ ~'~ B 6
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. TtiIS DOCUMENT SU~IECT TO AUG. 20, 1985 how•DISSEMINAZION ORDE~ ~'age 6 IN ROGERS AND UKE CASLS~ on these data, and published two. Alban is preparing a series on changing r.norta.lity in Houston starting with tuberculosis and the separate respiratory diseases and continuing th..-ough the 35 major causes of death (see attached). It is import.ant at this time to produce the data on respiratozy diseases because of the extreme current agitation in Houston over air poliuti on. Accor:,olish,-nents to Date Are: 1. The collection, coding, editing, and printout of the nzo-tality data from 1950-1967. 2. The calculation of age-sper.fic and age-adjusted mortality rates by each yea-r by males, females, and total population, and by males, females and total population in each of the th,-ee etli.-iic groups, of every cause of death. Tables have been prepared of rates of r epira- tory diseases when they are secondary causes of death. 3. Dr. Alban has con t:.n ued with the coding of the nno rtality r ecords since the Department of Epidemiology closed the books on new additions in December 1967, and began processing, and has them for 1968 and 1969. Epidemiology has not sought these two years which would corn- plete three decades, because there has not been extra personnel and not enough existing personnel to add this time consuming effort of checking, edit4_ng, coding and repunchi_-:g the Latin American surnames, together with the magnetic taping of the final product. CTR 5165 .CONFIDENTIAL: MINNESOTA TOBACCO L1Tt0ATlON ~"~ 0"30~", 1-1:'
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THIS DOCUMENT SUBJECT TO AUG. 20, 1 1985 Nvrt-DISSEMINATfON OP,DER PaBe 7 IN RDGERS AhD . DUKE CASES, Dr. Alban has also looked up and placed street addresses on the , oriYinal code cards, for the establishment of a base for clustez studies of individual diseases. A cluster has been done already in Houston for leukemia, but has not bee.n attempted yet for respiratory cancer or asthma, bronchitis or emphysema. He has made maps pinpointing the deaths to show the relationship of residence to volume of respiratory disease. The Mortality Picture in Houston for Respiratory and Other Diseases Referred to in the Cu_-r ent Su: veys Into Pur ported Tobacco Related Etiology of Disease In 1940 with a poouiation of 384, 514, Houston was the 21st largest city in the United States; in 1950, with a population of 596, 163, the 14t: ; in 1960, with a population of 938, 219, the 7th; and in 1970, with a poaL- lation of 1, 212, 967, the 6th largest city. Du.-~.g t~~s sa.-ae period o_` time, the Houston medical Center, has come into being. Bu~~t on 134 acres of land, it is composed of 22 institut?ons interested - programs c_ education, r esea: ch ir. medical and allied sciences, and treat-nent o: " patients. Every branch of medicine is represented. In 1944, the year the M. D. .4zderson Hospital and Tumor Instit7.:te received its first patient, in teazporary quarters pending the construction of its own building, a• h?ch was occupied .n'1`Sar ch, 1954, according to a su:vey of hospitalized cancer patients in Houston, over 80°,"0 of the pat:ents treated for cancer -. I-iouste:: general hospitals were residents of r'o-.:s::.-.. By 1950, t::s h.ac dropped to 50°,'0, showi^.g how i:-:zr.:ed:ate was the r eceg- ..ition of the ~ous;on ar ea medica: center .: the care of cancer patients, CTR 516 G ~TOBACCO LIT OIATtON TA ( f - I s ~ ~~1 t ' ~ ~..R 0 ~ S~ ~~ ` L
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THIS DOCUMEKT SUB/ECT TO AUG. 20,_ 1585 NON•DISSEtdIi~AT10N ORDER Page 8 IN ROGERS AND DUKE CASES, even though t.his figure does not include any but the Houston residents -..from, the ca.ncer hospital. It has been obstrved previously, that when _..-_auacer-.or any other specialty hospital comes to a community, people ._ _seeldng help for cancer or the other entity come to the institution-s and .physicians' offices seekiag help for the clinical entity in the same co-n- munity with the speciality hospital, in ever increasing numbers. . This .has occurred in Houston. As urban density has increased in Houston, total cancer and diseases of the cir culatory system have increased. In their higher incidence ?:. the earlier years of this study, and their lower incidence in the later . years, tuberculosis, in.:ectious and parasitic diseases excluding tube: - cuiosis and influenza, diseases of the respiratory system excluding i: fluenza and asthma, influenza itself, and diseases of the cigestive system are positive:y and sig_-ifica n'.:y r elated to one anothe r(p %. 05 at leas t). This means that when one of these rates is a:gh so are the others ar.d when one is low, so are the others. Diseases of the digestive syste:-i s^.?'ted during the period from a positive relationship to all the other diseases mentioned above, except caycer and heart disease, to a negative rela- tionship, and from a positive r elations: ip with cancer and heart to a negative one. When the breakdown of the diseases included in the tera: 't'.igestive system:' was studied, it was fou.nd that the large increases over the period were i-i u?cers of the stoz:ach or duodenu.:., diseases o: the pancreas excluding diabetes, diseases of the eso_oh.agus and cirrhosis 0 ,CONFIDBN7IAL: MINNESOtA ~ T09ACCO LITIGATION C T R 5167 ~~ ` ~ CT 0 03 0
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THIS DOCUMENT SUBIECT TO AUG. 20, 1985 NuN-DISSEMINATION ORDER Page 9 IH ROGERS AND DUKE CASES. of the liver with alcohol. The large decreases were in appendicitis, hernia and intestinal obstruction, stnd diseases of the buccal civ:ty, - In the earlier period, 1940-1950, a11 these ethnic groups had a similar total cancer death rate relationship between males and females, but in the later period the males had higher rates. In buccal cavity and pharynx, males had higher rates than females and rates were higher among non-Latin Wh?tes in the earlier period. An increase in Negro male rates occurred in the later years. Male deaths for cancer of the esophagus were five ti.^.:es the female rate, and the Negro male r ate was nearly twi ce the rate for the Whites. Death rates for cancer of the stomach for males were generally about twice those for females. Negroes had higher rates than either White group, though the Latin rates were higher for the Latins than for the non-Latin Whites. The Negro rates are now declini:.g. Cancer of the i.x~testines except rectti:.:n had slightly higher rates aznong females and non-Lati n White females had higher rates than Latin s or Negroes. In cancer of the pancreas, the highest rates were for Negro males, with Latin males and females next. In primary eancer of the liver and biliary passages, non-Latin White females had higher rates than males. Among the other groups the rates wer e about even. In the unspecified liver cancer group, males in all racial groups had _ C1R 51tiS CONFIDENTIAL: MINNESOTA ,r ~' ~' TOBACCO LITIGATION ,,~ ~~ 1,~ 4~ t'^'~ 5~~
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THIS DOCUMENT SUBJECT TO AUG. 20, 1985 NON•D;SSE'/1NATIUN Ur,,;;R Page 10 IN ROGERS AnD DUKE Cti,E.S, higher rates. Slopes ar e negative, however, showing a decrease in mortality '.n this category. In cancer of the la.rynx, the male death rates are approximately five times those of females, In Houston, the nc:n-Latin Vhite males and the Negro males have run a fairly similar course in laryngeal cancer, with the Negro rates slightly higher. The Negro rates peaked in 1960 and have declined in the last seven years. The Latin males had no deaths from cancer of the larynx for 15 of the 28 year s of the study, while for 9 years their rates were higher than the non-Latin White rnales, or the - Negro males. Since 1958, there has been a decli.ne in the rates. A.mong females, there were many years with no repor tec deaths from cancer of the lary:x. In the last 10 years, there have been deaths reported, and the rates in t.hree of the 10 years have bee:n h:ghest for Negro fe:na_'es. For car.cer of the 1•:-.g in Houston a.._.--cr.s :-iales, the category, 163, unspecified whether prir5ary or secondary; has higher rates than primar}• lung so specified in the t.h: ee ethnic g= oups, and ther e is an erratic rise in t.hese death rates. Until 1953, the non-Lati.n White males had consis- te :,ly higher death rates than either Latin or Negro males. Since then the Latin and Negr o rate,s have crossed back a nd forth, sometimes higher, sometimes lower than the non-Latin White :_sa?es, For pri-mary lung cance r, tae r ate s are remarkably cios e t'_-r oughout. Azrior.g fe:nales the unspecified waetlier primary or secrrdary lung 1 CTR 5169 CONFIDENTIAL: MINNESOTA ~ ~ TOBACCO L[TIOATION C ~I ~ f ti 1-1 0 0 3 -
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THIS DOCUMENT SUBJECT TO AUG. 20, ' 1985 Noir • JiSSE~dINATION ORDER IN ^ kS AND pIL9 Cr1SES, page 11 rates are highest among Latin femaies in 14 of-the 28 years. Both Negro and non-Latin White fezaale priaary lung cancer rates are leveling off in the last few years. ~ -T e o •er reepiratorydds eases ar e~~:xed• :`n ULe:r•dec:i.ne•'and ascent. -E'tnphysema martiTity tts-higher'smong-matea: •-Amoag-males,-tae lowest --- Worta.lityzms sre-~tvag-the i.a'..~ Y~~tes,--Che-:a:ddte-zates-a._soag the non-Latin R'h.ites, and the highest among tiegroes. The trend :r. all t:-ee groups is dowr. Among fe::za!es, the trend of the death rates for empay- se:na is rising for the Latins. The rates are low, however seldo:3 reac:.ing 2 per 100, 000. Deaths from asthma for males and fer.:ales are declining precipitously for Latins a.nd Ir'on-Lat.in Whites, and more gradually for tieg:oes. The decline of tuberculosis -_- f-iouston since the middle 1950's is spectacular. The rates are now approac^._i..g one another in each et .n^-:c gr oup and sex. Tuberculosis, as a reporte_ cause of dea'.:, has prac- tically disappeared in age group u_der 20. The rates for La:ir. males were extremely high, and for Latin females were also excessive. Con- trol measures and educat:on have effected the greatest irnprove::~e nt i:n t.he Latin and Negro groups. The death rates for influenza and pnex..--aonia dropped with the intr o- d;:ction of antibiotics, but since 1954 have witnessed an irregular incr ease. ti:ale death rates were slightly higher than the fe:nale's for a11 eths.ic groups, anc Negro rates higher than those of the other eth~-c groups. Death rates for males were h.•~,vher tha^ the rates for females in CTR 51~~0 .CONFIDENTIAL: MINNESOTA ~` ~ TOBACCO LITIGATION L' 4f ~;' N
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THIS DOCUMENT SUBJECT T0 AUG. 4 1985 NON•DISSE~dMATION 0„~cR Page IN ROGERS AtiU DUKE CASE$ cancer of the bladder. The r ates are practically stable for non-Latin 12 White males. The Negro male pattern for.cancer of the bladder is very similar to the non-Latin White male pattern. For White Latin males the picture ia more erratic, some years have no lasy-_x deaths and aome have rates that peak above both Negroes and non-Latin Whites. The trend is irreQular, but declining for females in all th.ree ethnic groups. Graphs have been prepared shocving for Anglo males and fernales the rates by year for cancers of the bladder, k:d.ney, lung, primary and secondary, and stomach. Primary and secondary lung a.^zor.g males have approached =e another since 1957, interestingly enough the yenr the neu- International was i ntr oduced, a1t.:ough all of these r ecords have been recoded since 1966. These two categories had an errat'cally different course until that time. Cancer of the stor: ach f: or.: the most serious cause of death hzs declined to the level of cancer of the bladder. Cancer of the bladder and cancer of the kidney are parallel, with kidney rates lower t:a.n bladder rates, but both fairly stable since 1947. For females, the sazne picture maintains except that the rates for cancers of the bladder and the kidney are dec?ining. Conclusions This is a very brief outlin e of the obse:ved trends of mortality rates over time. The ethnic dLfier ences in merta?ity are pla:ned to be the sub ject cf upco^-ii ng scientific repo: ts. The ex;raorc:r.a: y oppo: tur.° ty to t2is invaluable data source CIP 5171 CONFIDENTIAL: MINNESOTA ~'' ,~, ~ '§ TOBACCO LITIGATION C T ~„ti ~ ~~ ~'~ (~ i,~ ~ .rP f 3
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THIS DOCUMENT SUBJECT T0 AUG. 20, ` 1985 NJN • DISStr~WNATION ORDER Pag e 13 IN ROGERS AND DUKE CASES was made possible through grants from the Council for Tobacco Researc :. The uses of this source beyond these outlined above, will be cohtinuous for years to corne. Copies of the forthcorning studies wi11 be sent as rapidly as they are published. C T R 517- 2 CONFIDENTIAL: M(NNESOT A R ~~ ~ ~-~ r ~ TOBACCO LIT10AT10 ~ ~ ~ ~ ~ {N
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~~ f . - . .~ .. r. '.. SOCIAL STATUS, ETKNIC STATUS, ANp UR9AN MORTALITY: AN ECOLCGICAL ANALYSIS• Robert E. Roberts, Ph.D. •• George n•. Mc3ee, M.A. • E1ear,or J. Macdonald, A.B. •. Houstcn, T•exas July, 1969 •PreYare'' for presentat'_on at the annual mee-~~~ of r the ~.,~e^:ca^ 5ocic:oj:ca: Asscc:at:or, Sa' i:azc --•~a 1-y ! :s:c, Ca!_:c:..?a Se; te-.~e- , SE7. _ , CTR [CQNFIDENTIAL: MINNESOTA rTODACCO 4ITIOATION (),I ~'.~ ~~~ ~.~
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•• The University of Texas School of Public Health, Houston, Texas. • Texas Research Institute of Mental Sciences, Hous:on, Texas. ++ The Unive:s'_ty cf Texas M.D. Anderson Hospital and Tt:-.c: Institute, Houston, Texas. r :CONFIDENTtAL: MINNESOTA "-,TOBACCO LITIGATION ~1 7 4 ` NFI 00" 096 CT
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Historically, research has deWor.strated the existence of an inverse relationship between socioecono^ic status and nortality.I In recent years, however, there has been less agreeaent relating to the existence and nature of socioeconomic mortality differer.tials. A r.u.ber of recent studies have reported that the traditional inverse relationship continues to be pronounced,2 while the findings of other research efforts indicate that the generality of this finding tsay be open to question.3 As Stockwell has pointed out, this conflicting evide,ce may reflect actual differences between the various populations studied, cr, it mav reflect the results of different methodological procedures.` Nis ow~o research indicates that dif:erent neasures of socioeconcm:c s.atus car, influence results considerably. But it is also interesting that regarc- less of the nethodology involved, the overall relationshi:~s he observec between mortality and socioeconomic status reeiained inverse. In fact, the great bulk of evidence indicates in general that Stockwell's findings are valid. There are still socioeconomic differences in norta:ity, and the overall relationship is negative, e.g., the higher the socioeconoc:c status, the lower the mortality. 1 CONFIDENTIAL: MINNESOTA " TOHACCO LITIGATION C T R Z-) l i5 ~ ':~' 00,30
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/l,e basic assu.-p:ion underlyinQ such s:udies of social class ard . t:e information on ,,lity is that sociocultural environment profoundly influences life ,Ionces. Measures of socioeconocic status in general are a gross Of describing an individual's or a frour's life style, and conse- .•ily the conditions of living which must be coped with in order to lu studies of social class and mortality, two principal approaches , 1,een used. In one, dea:hs are classified by socioecor.c-ic s:a:us ..,Jing to so©e characteristic of the individual decedent hirself. •. is usually accomplished by using the aajor occupatiorn of the deceased, :jphic area such as a county, city, or census tract, and then measures -:o=e, education, occupation and other variables of a sccioeconowic -_ a:e used to rank the area in ter:rs of its socioecorc=ic status .:e to other such areas.6 Of these ,„.;:roaches, the ia::er or lical approacti has received a great dea: cf attent'-cr.. 77here are -il; two reasons for the pcp;:lar_ty .,. --*-e ecological a.,roach. :;ted on the death record.s The other approach assib:,s dea:::s to a occupation as recorz~ed on death cer:._.ca:es .riously inaccurate and, in addition, yields only one variable '• to class. Second, a great deal nore social and econc=:c data •ilable for ecological units such as counties and census trac:s. -)ther hand, the weakness of the ecological study is that it ~s Yeneraliza:ions relating to individual social s:tu.ations and 'v. 2 CTP 5I ^t G CONFIDLNTIAL: MINNESO'1 a TOBACCO LITIGATION C`;~ ~~~e }~ ~;,( 0030S S
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The procedure adopted for the present study is the ecological aethod. The focus is upon eomparative mortality experiences between eensus tracts which have been scored, relative to one another, in terms •of their socioeconomic status. In the past such studies have demon- strated a n=ber of inadequacies: (1) the concept of social class has been conceived and measured in much too sic,;listic terWs (Ellis and Stockwell represent notable exceptions); (2) in comparisor.s of death rates by social class of census tracts, arb'-trary cutting peints have beer, used to set up the class groupings (a:l have used this technique); (3) the majority of ecological studies have dealt little with the i=por- tant factor of ethnic status and, more i.pe:tantly, the interactien of social'status and eti:nic status has-been virtually ignored; and (4) analyses of mortality have tended to be limited to overall mortality, to a single cause of death (heart disease), or to gross categories of diseases (suc:: as chronic diseases). The pur-pose of this paper is to exYicr e the : e:aticr.s :i? bet.een social class and mortality in an ecological perspective, and at the sa.:.e time, address these issues of simplistic measures of social class, interaction of ethnic status and social status, and limited focus or. mortality. To this end arn atte_:rt is made (1) to develop and a; ply a theoretically rigorous co=yesite measure of the social statts or socio- economic rank of census tracts, (2) to deve:ep and apply an exhaustive, logical typology of mortality, by cause of,death, and (3) to analyze the relationship between social stat.:s ra,.k ,.. :ens::s tracts and rates of ' 3 C1R 5 1'(/ ,CONFIDENTIAL: MINNESOTA _`,TOBACCO LITIGATION 01 ~~ `fc .~' ~"'~ ~ ~~
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various types of nortality, taking into consideration the influences of ethnic atatus. H.-ootheses The analysis atte:rp:s to answer two questions: (1) How is social class of census tracts related to differential rates and types of death? (2) To what extent can rates of death from differing causes be predicted on the basis of the social setting in which they occur? In an atte--pt to gain some understanding of the social class/nortality phenomenon, seven general hypotheses are developed, subject to e_:;irical verification. These hypotheses are: 1. Social class of an area is inversely related to rates of death from infectious diseases. 2. Social class of an area is not related to rates of death from degenerative diseases. 3. Social class of an area is inversely related to rates of death froc social causes. 4. Social c:ass cf an area is inversely related to rates of death from diseases of infancy. S. Social class of an area is inversely relatec to rates of death frow diseases of Waternity or child-bearing. 6. Social class of an area is unrelated to rates of death from senility and other ill-defined causes. 7. Social class of a+n area is inversely related to rates of death fro: all causes (total aortality). 4 C T R 51i5 .CONFIDENTIAL: MINNES07A ~ ~°~ ~~ ",%,TOfACCO L1T1GAT10N ~ . -fs R r I U-4 COC)"
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_ MethodQlogy The city selected for study - Houston, Texas - was chosen because of its size, its ethnic diversity and its range of socioecononic conditions. In 1960 the greater Houston death registration area contained 154 census tracts with"a•total en~-^~erated population of 1,057,941. Three major -sZhnlc-Yroup~ ^~~te 1 iThL~' o.pula'.! fln : hnQ10-A-e-1t~0,t~C71 NeYro-llmericans (22.6 percent), and Mexican-Anericans (6.4 percent). Me~ian•-fa-~::7- rnc~oe-:angedi-from f~r,:59-to-~~~10c-pc~ear-,--ui;.'. an overall median of 55,793. All cases of aor;ality for the calendar years 1959, 1960 and 1961 Ys:.p- obu:ned..':oa. th4 Hous:on hea::a depart=er.t, and coded onto punch cards by age, sex, ethnicity, census tract of residence, and case of death. To coWpe:u ate for the usual lack of a holistic perspective in analyses of mortality, a typology recently developed and arp:ied at the international level by Hillery, L:dtke and h'eisbuch was used.7 Fo11ow:ng their procedure, deaths were categcri:ed emploving a seve-:?oid class?:-- eation of mortali;y: infectious, degenerative, socia'_,• .nfa-.:, ma:e^:.a:, other ill-de:_ned eaues, and tctal dea:^s. T: e basis _.,. the codes was the 1955 revision of the International tlass:r:ca:ion of Diseases.8 Three-year (1959-60-61) average age-adjusted rates were eomputed for each of these seven categories of mortality using the indirect me:hod.9 The standard pcpulation used was the ..,tal Houston population in 1960. •Social deaths are de_°:ned here as traffic accident:, et::er accidents, s:...ides, anc ho-...ides. 5 CTR ~1/.) (CONFIDENT/AL: MINNESOTA ~ ~ ~~ '~ ""',r09ACC0 LiTl0AT10N 0 C )
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Social class position of census tracts was measured using the Index of Social Class (ISC), an index of socioeconomic status developed specifically for ecological applications.10 The ISC uses three variables: the percent of the total labor force classified as white-collar workers,• the percent of the population over 25 coWpleting four or more years of college, and the percent of all fam-ilies'earning $10,000 or more annually in each census tract. The measure was derived and scored through the use of principal cor.jonents analysis. The ISC offers a number of advantages analytically: (i) the three dinensions of social class cost stressed by conter.porary behavioral scientists - incone, education, occupation - are considered simultaneously; (2) corputation of the measure is based upon . established statistical procedu:es and both the weighting and scoring procedures are inherent in the properties of the data and thus are essen- tially nor.arbitra-y in nat::-e, and (3) the variables utilited are cor.putecd fron census da:a which is at the sare tine easily accessible reliable.• and 1ig ::y The co-nce:t "ethnic status" in A.:•erican socie:v to--a,.• gene:all,v denotes me=~)e:sh.p in a Win..rity a:ocp, but at the saae ._:•e it a:sc connotes low social esteem and 1o: socioeconomic stat::s. To cope wi:- this dimensicn of life analytically, two measures of ethnicity were computed: percent of the census tract population classified as Negro and percent of the census tract population classified as having a Spanish surname. These two ethnic grouis are respectively the first and -Wn.te-collar workers are def_..ed as professi.,nai, technical a-.d kia..:ec w'o_rers managers c_..cia:s and .:op-.et.,_s; c:er_cal a-.,~ k:n,,:e~ w•orke:s, and sales wcrke:s. 6 C T R 5 1U~ 0 ,CONFIDENTIAL: MINNESOTA ~ '~ ~~~° ~TOBACCO L!T[OATION ~~^~t:,~ ~~0
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second largest disadvantaged u nority r:oups, not only in Houston and in the Southwest, but in the nation. Three separate analytic procedures are earployed to relate ISC scores with each of the seven categories of age-standardized mortality across the eensti.s tracts. First, :e:o-order correlations are computed, then partial correlations are computed controlling for percent heFro and for percent Spanish surnaae. Then the procedure is reversed, cerrela:inf each ethnic variable with the mortality rates while controlling for social class. Finally, multiple eo^elations are co=putea between each of the causes of death and social class (ISC score), percent NeZro ar,d percent Spanish su-rname. Results Four of social class tious deaths the seven hypotheses concerning the relatior.shiY between and cor:a'.ity are substantiated.ll (See Table 1.) Ir.:ec- are inversely related to social class. In fact, this is the most pronounced reiatior.s::i;7 observed. There is essent:a:i,v no relationship between degenera:ive death rates and secia: class. Ma:er- nal and infant death rates are both inversely related to social class, although the relationship for infant mortality is not sufficient to reject the null hypothesis (p >.10). Social mortality is inversely related to social class and this is the second most pronoL.^iced relatior.ship observed. There is no relationship between social class and deaths .'ror other syvptoms, senility and ill-defined conditions. Although the relaticnshi-p 7 C T R '-')151 _~CONFiDENTlAL: MINNESOTA `",TO$ACCO LITIGATION ~~ 0 23 1~~ ~
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between overall mortalit,v a.^.d social class is inverse, as predicted, the relationship is not pronounced (p <.10). Table 1. - The effect of ethnici;y on level of mortality in the census trac:s is also evident from an exanination of Table 1. Both percent T:errc and percent Spanish surnalne demonstrate pronoua:ced, positive relationships with infectious death rates. Both ethnic variables are positively re:a:e'_ to social mortality rates, although the relationships are not pronounced. Percent Netro exhibits a strong (p <.001) positive relationsl;:p wit.`h infant mortality. Percent Spanish sur.:ame also reflects a icsi::ve relationship with infant ccrtality, althoug^ i: is less pronc::nced (p <.05). -In addition, percent Spanish su-;a-ne demonstrates a positive relationsl;ip with both maternal and overall mortality. Percent Neg:o, on the other hand, is not related to either of these types of mortality. hnen ,he effects of ethnicity are cor.tro:led thro.:bh par tia: co::e- lation procedu:es, the patte= of re:atier.s ;'_.s between socia: class and mor:ality changes so^ew•hat. As can be seen ir. 'able 2, when ethnicity is controlled there is essentially no relatio.^.ship between social clzss of an area and five categories of mortality - degenerative, infant, mater- nal, other ca;:ses and total deaths. However, the relationship between social class and the ree,aining two causes of death - infectious and social is negative and sufficient to reject the null hypothesis (in both cases p<-005). As was the situation in the zero-order correlations, the most pronounced rela:ionship is between social class and rates of death fror• infectieus diseases. :+lthe.:a:: the relaticns':i^ between socia'l class and 8 .CONF[DENT[AL: M.INNESOTA ~ {'~ ,~ "NTOBACCO WTtOAT[ON ~. ~r R ~"~ O~"
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the other five causes of death are all negative, the correlation coefficients are negligible. Table 2. - Ifhen the effects'*of social' class and percent Spanish surname Le controlled, percent Negro is positively relate to t~iee causes of --Ztea;fi! in.°ec;iaus; soc:e:,--~d--:mfant. ESee-Ta'.rrr-3-}-There ir essen- tially no relationship with the other four causes of death. When the e.'fects`o.' social c~ass and Ye:cent 1:efro are :so:a;~ T:oW frioie o? - percent Spanish s;:rnane, a somewhat different pattern emerges. Percent Spanish surna=e, in the.controlled situation, is also related positively to infectious deaths, but this variable is not related to social and ir.fant mortality. Instead, it exhibits positive relationships with raternal and overall mortality at a level sufficient to reject the null hypothesis, although the latter relationship is weak. (See Table 3.) Ta-z1e 3 The cc.;.ine~ effects cf social class ar.d ethr,icity on levels of r...:al.ty are der.,.^s:rated by the zr.:l:irle correlation results in As can be seen, the coc.bined effect of social class and ethnicity is sufficient to reject the null hy;,otheses relating to five causes of death - ^fectious, social, maternal, infant, and total cortalitv. Again, the ocst pronounced relationship involves infectious mortality, followed by infant ccrtality, social no::a::ty, and Waternal Mortality. The re:ation- s^ip involving total deaths and social class, however, (p < '-0) 9 .CONFtDEN1YAL: MINNESOTA ~\ TOBACCO LITIOATtON
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Discussion Data for Houston in 1960 substantiate the results of other social tcological studies, demonstrating that social class continues to be a con- tributory factor in differential mcrtality experience. Overall, the data reflect an inverse relationship between social class and aor•,ality, e.g., higher status census tracts in general have lower rates of death tharn do lower status tracts. In addition, the results indicate that social class is not only a factor contributing to the probability of death occurring, but also to the probability of death from a given disease catezory. For example, in the controlled situation, the probability of dying from infectious causes (such as influen:a, pneumonia, tuberculosis) and frcc - social causes (hoWicide, suicide, accidents) is greater in lower status tracts. The relationship between social cla.ss and these two categories of death is negative and highly significant (both were beyond the .00S leve:). The data also illustrate the isporta.nt linkage betwee.^n merbers`,:p in low-status m_nority groups ar.d increased risks of dying froc di-'ferer.t causes. ir.e percent Negro in census tracts is pos:,ive:y and s:g-n:-ica-.:'.y related to rates of death from infectious, social and infant causes. -:^e extremely high rates of homicide among Negroes, particularly Negro males, his been well dacumented'-2 and no doubt this accounts for much of the relationship involving social aortality. High rates of death froc infec- tious diseases and from conditions attendant to birth are g:eatly determined by factors such as poor diet, poor sanitary conditior.s, a^.d poor nedica'_ care, conditions attendant to poor socioeconor.'-c c'-rc-u=s:z..;es. 10 C1R 515-1 CONFlDBNT1AL: MiNN6SOTA _ ` TOBACCA LiT10ATI0N ~~ ~~
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The ielationsr.ips -5etweeri percent Spanish su^:am e and mortalzty•reflect - essentially the saae situ.ation, with the exception of social mortality. The strongest relationships are with infectious and maternal rorta":ty, conditions reflecting poor health practices and poor medical care. The results also indicate that any consideration of social class and its relationship to hea1th w>^ ch oes not s:c^: .ane3~sTv e'Xa::+.`5e`;he role of ethnic status in American culture o--4:s a major contributory condition. Neither social class nor ethr.icity considered alone predic:e'- nortality fro= various causes as well as both considered jointly. Five of the seven causes of death were related to the combined effects ef socia: class an~ ethr,ic:ty at' a level-sufficieat to reject the nu'.i hyrct!:esis. - Howeti-er;-even though a-majority of the null hypotheses tested were rejected, and the importance of the interaction effects of social class and ethnic status were dehonstrated, the resc:lts raise several questions. If the various cor.e;ation results are reexa;:ned, one thing is strik:-.j:y clear. The explanatory power of social class and ethnicity, alone or in coebinat:cn, is not over~helW'_nF. The his^est correiatien observed (the cultiple cor.elation between class, ethnicity and infectious deaths) accounts for only 29 percent of the explained variance. In only one et::er rultiple correlation result (infant causes) is as Lmuch as 10 percent of the variance explained and for the partial co=elations only one relaticn- ship (social class and infectious causes) accounts for more than 10 percent of the variance. Only three of the :ero-order relationships - social class/infectious causes, percent Ne+ro/i.^.fa^.t causes, a^.d per:e-.t Spanish s::r-ia_:.e/i%fect'_..us causes - accounted for as much as 10 ;.ercent of the exY:a:r,ed variance. 11 C T R CONFIDENTIAL: MINNESOTA '-TODACCO LITlOATION
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=.rrelation coefficients :f this maFnitude have consistently %,-= ::_orted by researchers e:aaining the ecological relationship socioeconomic status c:d mortality rates in America. Stockwell, .: :_s analysis'of Hartford ar? Providence, could only account for about :_ :--er,t of the variance in rierall mortality using measures of income, •==ion and occupation.13 EL-tilton, in an analysis of the 100 counties =k--:n Carolina, used eight n•.asures of socioeconomic status. The cor.elation he reporte: was -.6S, between home-ownership and over- -- :.-.:tality.14 In his analy:is of socioeconoWic factors and infant -=-a:ity in Syracuse, Willie :eYorted that none cf the factors aczou.nte~ ==ver 15 percent of the var:ance in the ecological distributiorn of ft-: mortality rates.lS Sir:larly, the socioeconomic variables used ':.ckvell in his analysis of infant mortality in Providence accounted ":sss than 10 percent of ttt variance.16 `nese studies all have or.~-, key element in co-on - they e-ploy '"•.ients of correlatior. to measure the nature and =aFr:itude of . 'iationship bctween soc:c-.:;,noWic status and z.,.taiity. yany ~ical studies have used a n;ther approach. ;-:is alternate ;,soced•,:re /^s rroupiny tracts into ::ass strata based on socioeconoaic status '1, and then computing death rates for the class F-roupinPs. Studies ~ this technique report a fairly =ifo-m inverse relatior.ship •'^n mortality and social class.17 More izzportantly, ma.ny repcrt '".rtality in Class V(t::e lowest) is substantially greater than in 'hsr class, and is partic+jlarly higher than In Class I. Class ~' y ratios of u-- to 200 f~;ass I a 100) have bee•^n re:~orted for . ., 12 ,CONFIDENT/AL: MINN8S01'A ,~ ~TOBACCO LITIGATION 003,106
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various metropolitan areas in the United States, depending upon'the cause of death, with most being in the 130-170 range. Differences reported amonY Classes II, III, and IV have varied considerably, but in =eneral have been much less. The available evidence, upon exaa nation, indicates that social class^is still a factor to be considered in trying to account for differential Lortality experiences. This same evidence, however, also indicates that ecological analyses of socioeconomic status and mcr:ality yield crude data that are perhaps much more a.-nenable to categorical comparisons tlan to co^elation procedures. This is reflected by the fact that pore clearly-defined results, to date at least, have bee-; obtained using the former rather than the latter proced,.:re. Several factors may be operating to reduce the observed ccrrelaticr.s. First, r.:.n,vi census tracts a;e quite heterogeneous in their socioeconomic compositior. (a problem not restricted to Hous;on). In fact soce tracts are so socia:ly heterogeneous that i:,t:a-trac: differences are as .:ea: or greater ,:a:: inter-.rac: differences. The nore pervasive ...is si:.J- ation, the less pronounced wi:l be assoc'_a:ions involving ir,:er-.rac: cocparisons. Second, the measure of social status Way not be stringent rnougF;. The variables included in the ISC were chosen to reflect high status. Defining high educational status as four or more years of college presents no particular problen. However, 515,000 a year income aiY}a have discriminated better than S1C,000. The measure of oc::rpaticna: status was least s:r.^.$e.^.•. I.':c1L'l.':6 Cier.:a: and sales nay have d:scr.=.':a n. pcwer of this va-.a*_,ie. (ma-;V s:._.. ,:ec..e 13 CTP CONFIDENTIAL: MINNESOTA TOBACCO LITl0AT10N 0 0,6110 ti,,,l
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have low education and income levels.) Limiting occupational status to managers, proprietors, professionals, technical and kindred workers may have generated better results. A question Qight be raised concerning the use of ethnic status as neasured by the proportion of a census tract population listed as Negro or having a Spa.nish surna^e. It is doubtful that upper and m;ddle sta:::s Negro and Mexican-American census tracts exist in nany places in the h'nited States, and certainly they do not exist in Houston. Upper a^.d ciddle status minority g-.oup neighborhoods exist, but in genera: are i.n the same census tract with low status neighborhoods. In view of this situation, however, the persistence of ethnic differences in the contrci:cd analyses is even more drazatic. A Concluding Note Ulticate!y, of course, everyone dies regardless of his scc:al c:ass or ethnic status. In this respect, social class and ethr.ic sta:.:s ':ave lim.ted exrlanatory power when co-are.ad to the aging process or to the various fatal disease processes. iiowever, the evidence indicates that social considerations such as social class or ethnic status are salient factors in reYard to differential risks of dying. h'hat re-.ains ... be demonstra:ed is a more precise articulation of the interaction of these factors. In this regard, the most promising approach to the study of social class and nor:alit,v would appear to be the study of the individ::a1 decedent and his life style. This will require much more rigorous and detailed research than analysis of Wortality by the oocupation listed on 14 CTR ~ isS CONFIDENTIAL: MINNESOTA ~ '~ ~~ TOBACCO LITldATION Ch T, R, M~.:,.I ~`~ 0 13"
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the individual death record, the usual effort in this direction,l$ It will require not only considerations of current social status, but lifetime social mobility patterns as well as family, health and ethnic considerations.19 The results, however, should provide much more theor- etically relevant and empirically valid inforaation conce:ninQ the influence of social and ethnic status on probability of dyir.Y than past studies have yielded. 15 C T R CONPIDENTIAL: MINNESOTA ' TOBACCO LITIGATION ~1SJ ~; ~~~ HU'-1 '0,3 1, 11
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Table 1 • Zero-order Correlations Between Three-year Average Age-adjusted Death Rates, Social Class And Ethnicity in Houston, 1959-60-61 Cause of Death Social Class Nestro SDa.^.isti 5~.:.a=e 1, Infectious -.44 ** .30 ** .42 ** 2. Degenerative -.07 .00 .12 3. Social -.27 ** .17 ++ .15 + 4. Maternal -.18 ++ .05 .26 X 5. Infant -.10 .32 ~ .16 6. Other -.02 .01 -.03 7. Total -.15 + .06 .20 ~ CTR 51. CONFIDENTIAL: MINNESOTA , . ` TOBACCO LIT/0AT10N
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-Table 2 `-~aTCiar t~rrela:ions -$etween-Social Class And Mortality, Holding Constant Percent Negro and Percent Spanish Surna..^~e Relationshic , r t D r1,4'2,3 -.33 4.28 .0005 r1,5'2,3 -.01 .17 n.s. r1,6'2,3 -.24 2.99 .005 r1,7'2,3 -.07 .79 n.s. r1,8'2,3 -.06 .73 n.s. r1,9'2,3 -.04 .45 n.s. r1,10'2,3 -.07 .86 n.s. df - 150 1 Index of Socia'_ Class 2 Percent Negro 3 ' Percent Spanis:: Surname 4 Infectious death rate 5 Degenerative death rate 6 Social death rate 7 Maternal death rate 8 Infant death rate 9 Other 10 Total death rate CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION ~ ' ~I y y ~ ~ ~~ 0 ~ ~ ~ ~ ~ ~
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Table 3 Partial Correlations Between Ethnicity and Mortality, Holding Constant Social Class •--iable 4 5 6 7 8 9 10 1) .23 -.04 .15 -.04. .29 .02 .00 t 2.85 .45 1.87 .46 3.75 .31 .05 p .005 n.s, .05 n.s. .0005 n.s. n.s. 3 .18 .10 -.02 .20 .02 - .05 .13 t 2.30 1.24 .28 2.55 .26 .58 1.66 ~ .025 n.s. n.s. .01 n.s. n.s. .05 df - 15 0, one- taile d test ~ In,,x of Soci - Pe, - , pe :ent Negro In; "ent Spani De ictious de So: 2nerative M~c !a1 death In;irna1 deat al Clas sh Suti ath rat death r rate h rate s ame e ate Ot!•''•nt death rate Tot'-r symptoWs, senility and ill-defined cause death rate al death rate CTR 519? CONFtDENTIAL: MINNK90'fR I TOBACCA hITIAA'I161A E,r 1- 01 0
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Table 4 Multiple Correlation Between Seven Categories of Death, Social Class, Percent Negro, and Percent Spanish Surna©e Cause of Death R I F P 1. Infectious .54' 20.61 .001 2. Degenerative .12 .76 n.s, 3. Social .30 5.12 .005 4. *:aternal .27 4.02 .01 5. Infant .33 6.14 .001 6. Other .05 .13 r,.s. 7. Total .21 2.26 .10 df - 3, 150 C T R 51J3 CONF[DENTIAL: MINNESOTA ~ ~ ~--f ~TOaACCO LITIGATION ~ -u ~~ti V1 H ~~ 0 3
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References 1For 2See 3See SAn example, see Charles V. Chapin, "Deaths Among Taxpayers and Non- Taxpayers, Income Tax, Providence, 1865," American Journal o,f Public Health, 14 (AuYust, 1924), pp. 647-651; Seebo:m B. Rountree, overty an ProgTess: A Second Soc:al Survey of York, (London: Longmans, Green 6 Co., 1941); Lolagene C. Coombs, "Econoaic Differentials in Causes of Death," Medical Care, 1(July, 1941), pp. 246-255; Cecil Sheps and J.H. Matkins, "Mortality in the Socioecononic Districts of New Haven," Yale Journal of Biology and Medicine, 20 (October, 1947), pp. 51-80; and Percy Stocks, '?he E:iects of Occupation and Its Accompanying Environment on Mortality," Journal of the Royal Statistical Society, 101 (Par: IV, 1938), pp. 669-696. Iwao M. Moriya=a and Lillian Guralnick, "Occupational and Social Class Differences in Mortality," in Trends and Differentials in Mor:ality, (New York: Milbank Me=orial Fund, 1955), pp. 61-73; Edward G. Stockwell, "A Critical Exa=ination of the Relationship Between SocioeconoWic Status and Mortality," American Jou:-:e1 of Public Health. S3 (June, 1963), pp. 956-964; John M. Ellis, "Soc:o- econoeic Differentials in Mortality from Chronic Diseases," Social Problers S(July, 1957), pp. 30-36; and National Center for Health Statistics, Socioecononic Characteristics of Deceased Persons: United States, 1962-1963 Deaths. (l+ashington, D.C.: U.S. Government Printini 0::ice, 1969). Charles Kadusin, "Social Class and the Experience of I11-Heal;h," Sociological Incuiry, 34 (Winter, 1964), pp. 67-80; W.P.D. Logan, "Social Class Varia;ions in Mortality," British• Journal of Preven:i•:e and Social Meai,ine, VIII (July, 1954), pp. 128-13' an,. Saxon Granz_~•, "Socio-Econot,icStatus, Illness and the Use of Medical Se-^:ices," Milbank Menerial Fund 0.:a-;e:lv, 35 (Janua-y, 195'), pp. 58-66. 4Stockwell, on.cit., p. 956. outstanding example of this approach is provided by the dece.^.r.ial reports on occupational mortality of the British Registra: General for England and Kales. For a discussion of the British system, see Aaron Antonovsky, "Social Class, Life Expectancy and Overall Mortality," Milbank Memorial Fund Qarterly, 4S (April, 1967), pa-;..::larly pp. 63-65. 6For a brief discussion of the merits and limitations of this technique, the reader is refer:ed to Lillian Guralnick and Elizabeth Coulter, "The Analysis of Vital Sta;istics by Census Tracts," Journal of the A.:•er- :a." S:at.s:-cal Assc'ia;.oa, 54 (DecemDer, 1959), pp. CTR 519-1 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION 0 0 -.3.11 E:„,~
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7George A. Hillery, Jr., Richard L. Ludtke, and Jonathan Weisbuch, "Causes of Death in the Demographic Transition," paper presented to the Popu- lation Assoe.iation of America, Boston, Massachusetts, April 19-20, 1968. BMorld Health Organization, International Classification of Diseases (1955 Revision), Geneva, Switzerland, 1957. 9For a discussion of this technique, see A.J. Jaffe, Handbook of Statisti- eal Methods for Demographers (Washington, D.C.: U.S. Government Printing Office, 1960), pp. 43-84. 10Robert E. Roberts and George W. McBee, "A Multi-Factor Index of Social Class for Measuring the Relative Social Class Position of Ecological Units," paper presented at the ar:nual meeting of the Southern Socio- logical Society, New Orleans, Louisiana, April 10-12, 1969. The procedure used to construct the ISC is as follows: First, the three separate mcasures are computed, using census tracts as the basis for analysis. Then a product matrix of intercorrelation between variables across tracts is computed. This co relation ca;rix is subjected to principal components analysis. Unities are placed on the principal diagonal of the dispersion matrix, and all eigen-_ values and eigenvectors are evaluated using the Jacobi solution. Since unities are used on the principal diagonal, only vectors with an associated latent root of unity or greater are selected for vari.max rot3tion. This form of analytic rotation is used to evaluate the structure matrix. Next, a component index value is co^Yuted for each census tract, using the rescaled eigenvector solution for the es;ablish=ent of the weight pattern by inverting the correlation autrix and post-multiplying the inverse by the component structure matrix. This product or weight matrix is then post-Wultirlied by a z t:ansformtion of the original data matrix so'that each component index has a' mean of zero and a standard deviation of one. 11Significance tests are used here only to illustrate at what levei t^.e nu?'1 hypotheses can be rejected. Since the units of analysis do not con- stitute a sa.:ple, significance tests have no meaning in the classical sense. Forr a discussion of significance tests and their use, see Denton E. Morrison and Ranon E. Henkel, "Signiricance Tests Reconsidered," American Sociologist, 4 (May, 1969), pp. 131-140. 12$ee Albert P. Iskrant and Paul V. Joliet, Accidents and HeWicide, (Car3 ridge, Massachusetts: Harvard University Press, 1965). 13Stockwell, op.eiz., p. 960. 14C. Horace Hanilton, "Ecological and Social Factors in Mortality Variation," Eugenics Quarterly, :(Decenber, 1953), pp. 212-223. C T R (COA'F/DENTIAL: MINNESOTA ~ ~ TOBACCO LITIGATION C ~Ia ~ ~'°~1"44 ~~~t ~ 11 r
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I 15Charles V. Willie, "A Research Note on the Changing Association.BetWeen Infant Mortality and Socio-Econocic St-atus," Social Forces, 37 (March, 1959), pp. 221-227. 16Edward G. Stockwell, "Infant Mortality and Socio-Economic Status: A ChanYiny Relationship," Milbank Meaorial Fund Quarterly, 40 (January, 1962), pp. 101-111. 17Evelyn M. Kitagawa and Philip M. Hauser, "Trends in Differential Fertility and Mortality in a Metropolis--ChicaYo," in Ernest W. Burgess and Donald J. Bo~ue (eds.), Contributions to Urban Sociology (Chicago: The University of Chicago Press, 1964), pp. 59-85; Coombs, ov.cit.; Sheps and Watkins, oo.cit.; Matthew Tayback, "The Relatior.sh:Y o?' Socioeconomic Status and Expectation of Life," Baltino:e Health News, 34 (April, 1957), pp. 139-144; and Ellis, o:).c::. 18Kitafawa and Hauser have approached this problem by individual r.atc!:ing of death certificates with census inforration recorded for the decedents in 1960. Initial results have been reported in F.velyn M.. Kitayawa and Philip M. Hauser, "Social and Economic Differentials in Mortality, United States, 196C," paper presented at the annual neetinY of the Population Association of America, 1966. 19For a paper which attempts this approach, see S. Leonard Syme, Nemat 0. Borhani and Robert W. Buechley, "Cultural Mobility and Ccrora:y Heart Disease in an Urban Area," American Jou-nal of Etide^;:clogy, 82 (November, 1965), pp. 334-346. C T R 0- 19G ,CONFIDENTIAL: MINNESOTA "4TOBACCO LIT[OATION ~ ~ ~. ~ 01 C) CTR, E ~1-4
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-~ L' , , C. SOCIAL STATUS, ETH~:IC STATUS, AND lk2B':N MDRTALITY: AN ECOLOGICAL ANALYSIS* Differential mortality; social factors; hurnan ecology. Robert E. Roberts, Ph.D.** George W. Mc3ee, M.A.+ Eleanor J. Macdorald, A.8.+7 Houston, Texas 4ove.:zer, , 1969 cTR 5 19 7 TOfAC~ LtT G1AT10N MINNESOTA S ~, :~ ~~
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! ' Computer suDport for this project was provided by the Corrion Research Corputer Facility, Texas Medical Center, Houstcn, Texas. " The University of Texas School of Public Health, Houston, Texas. + Texas Research Institute of Mental Sciences, Houston, Texas. ++ The University of Texas•K.D. Anderson Hospital and Ts.mor Institute, Houston, Texas. CTR 519S TOBACCO LLT O,ATION MINNESOTA t~~ C T R11 0 '43 12"?
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AQSTRACT Ecologic studies of social class and mortality have tended to approach the problem in too simplistic terms. This study reports the results of an ecologic examination of the interrelationship of social class, ethnicity, and mortality in Houston, Texas, using a newly developet` composite measure of the social rank of census tracts and a newly developed exhaustive mortality typology. A measure of social rank is used, called the Index of Social Class, which sirrultaneously considers three dimensions of social class of census tracts: income, education and occupation. Three-year average (1959-60-61) age-adjusted death rates are computed by census tracts for seven categories of mortality: infectious, degenerative, social, infar.t, maternal, other symptoms, senility and other ill-defined causes, and all causes. Ethnicity is measured by percent Spanish surname and percent Negro residing in each census tract. _ Results of the analysis indicate that social class continues to be a contributory factor in differential mortality experience. The relationship is most pronounced for infectious and social causes. ihe data also illustrate the important linkage between membership in low- status minority groups and mortality experience. Ethnicity is most strongly related to infant and maternal mortality. The results also de^onstrate the importance of examining the effects of social class and ethnicity simultaneously in studies of mortality. tieither social class nor ethnicity considered alone preCicteC ricrtality from various causes as well as botn considered jointly. C T R ,1qy ,CONPIDENTIAL: MINNg1GTA - _'1TOIlACCO LITIGATION ~-'~ 11 H () 0 3 1' ,g ~
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Historically, research has demonstrated the existence of an inverse relationship between socioeconomic status and mortality.(2'3,24•25,26) In recent years, however, there has been less agreement relating to the existence and nature of socioeconomic mortality differentials. A nLrnber of recent studies have reported that the traditional inverse relationship continues to be pronounced,(4•16,21,21) while :he findin;s of other research efforts indicate that the generality of this finding may be still open to question.(8, 14,17) As Stockwell has pointed out, the few results questioning the relation- ship between socioeconomic.status and mortality may reflect actual differ- ences between the various populations studied, or they may reflect the results of different methodological procedures. (27) His own research indicates that the application of different measures of socioecor,o.-nic sta::;s can influence results considerably. But it is also interesting that regardless of the methodology involved, the overall relationships he observed between mortality and socioeconomic status remained inverse. In fact, the bulk of the evidence to date indicates in general that Stockwell's findings are valid. There continue to be socioeconomic differences in mortality, and the overall relationship is negative, i.e., the higher the socioecono.,ic status, the lower the mortality. C 1 P ~~:i;0 ,CONFIDENTIAL' MINNMA(1U }~ TOl'ACCO l.IT/OATIAH 1-1 t'! ;,~ tnd' i 1~+' 1u
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The basic assumption underlying studies of social class and aortality is that sociocultural environment profoundly influences life experiences. Measures of socioeconomic status in general are a gross means of describing an individual's or a group's life style, and conse- quently the conditions of living which must be coped with in order to survive. In studies of social class and mor;wlity, two principal approaches have been used. In one, deaths are classified by socioeconomic s:a::s according to some characteristic of the individual decedent himself. This is usually accomplished by using the major occupation of the deceaset, as listed on the death record. (1) The other approach assigns dea:ns to a- geographic area such as a county, city, or census tract, and then measures of income, education, occupation and other variables of a sx ioeconcr„ic nature are used to rank the area in ter:T,,s of Its socioeconomic status relative to other such areas. (9) Of these two approaches, the latter, or ecological approach, has received a 5reat deal of attention. There are primarily two reasons for the popularity of the ecological approach. First, the inforration on occupation as recorded on death certifica:es is notoriously inaccurate and, in addition, yielas only one variable related to class. Second, a great deal more social and economic data are available for ecological units such as counties and census tracts. On the other hand, the weakness of the ecological study is that it precludes generalizations relating to individual social situations and mortality. 2 CTR 5201 ,CONFIDENTIAL: MINNG50TA ',TOBACCO 4Iti"ttON :~ ~` ~ CTK ~°.01J
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The procedure adopted for the present study is the ecological r..etnct. The focus is upon comparative mortality experiences among census tracts which have been scored, relative to one another, in terms of their socioeconomic status. In the past such studies have demonstrated a number of inadequacies: (1) the concept of social class has been conceived and measured in much too simplistic te mns (Ellis and Stockwell represent ~ notable exceptions); (2) in comparisons of death rates by social class of census tracts, arbitrary cutting points have been used to set up the class groupings (all have used this technique); (3) the rrajority of ecolosicai studies have dealt little with the important factor of ethnic status' an~, more importantly, the interrelationship of social status, ethnic stat.:s an~ mortaltiy has been virtually ignored; and (4) analyses of mortality have tended to be limited to overall mortality, to a single cause of death (heart disease), or to gross categories of diseases (such as chronic diseases). The purpose of this paper is to explore the relationship between social class and mortality in an ecological perspective, and at the same time, address these issues of simplistic measures of social class, interrelationship of ethnic status and social status, and limited focus on mortality. To this end an attempt Is rrade (1) to develop and a.ply a composite measure of the social status or socioeconomic rank of census tracts, (2) to develop and apply an exhaustive, logical typology of mortality, by cause of death, and (3) to analyze the relationship between social status of census tracts and rates of various types of mortality, taking into consideration the influence of ethnic status. 'White-nonwhite differentials in mortality are well documented. Also, the fact that Anglo, Negro and Mexican Americans differ markecly in language, cultural heritage and life style is well known. In view of this, it is surprising that analytic studies of social status and mortality have virtually ignored ethnic status as a major contributory factor. 3 CTR 52U•' ~° ~°•~~'° ~ ,~ ~,~ CONPIDENTIAL: MINNESOTA ~ TOBACCO WTIBA'CI~ON ~~~ U`~ t~ S~ ~ .t ~ •'°"f
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Hvcccheses Tne analysis attec.pts to answer two questions: (1) How is social class of census tracts related to differertial rates and types of death? (2) To what extent can rates of death from differing causes be predicted on the basis of the social setting in which they occur? The basic argument is that diseases which reflect the effects of poor socioeconomic circumstances, such as poor diet, poor sanitary cor,di- tions, and inadequate medical care, will exhibit a greater incidence of fatalities in lower status tracts. This applies in particular to the infectious diseases and conditions attendant to childbirth, both fcr mothers and infants. Similarly, diseases which do not appear as closely class-related, such as senility arid chronic disease conditions ~ would not reflect the same differentials. Research to date has de:~onstrated the inverse relationship between socioeconomic status and overall mortality in a variety of situations. In an attempt to gain a better understanding of the social class/rr,rtaltiy phenomenon, seven general hypotheses are developed, su5ject verification. These hypotheses are: 1. Social class of an area is inversely related to rates of death from infectious diseases. 2. Social class of an area is not related to rates of death from degenerative diseases. 3. Social class of an area is inversely related to rates of death from social causes. 4. Social class of an area is inversely related to rates of death from'diseases of infancy. to eimpirical S. Social class of an area is inversely related to rates of death from diseases of maternity or child-bearing. 6. Social class of an area is unrelated to rates of death from other symptoms, senility and other ill-defined causes. 7. Social class of an area is inversely related to rates of death from all causes (total mortality). 4 C T R ~203 CONFIDENTIAL: MINNESOTA TOBACCO WTlOATtON ~ ~,.y R 11H 0 0
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Methodology ' The site of the study is Houston, Texas. In 1960 the greater Houston death registration area contained 154 census tracts with a population of slightly over one million. Three major ethnic groups rrade up the popu- lation: Anglo-Americans (71.0 percent), Negro-Arericans (22.6 percent), and Mexican-Americans (6.4 percent). Median family incom,e of census ~ tracts ranged from $2,159 to $21,102 per year, with an overall median of $5,793. All cases of mortality for the calendar years 1959, 1960 and 1961 were obtained from the Houston health depart.nent, and coded onto punch cards by age, sex, ethnicity, census tract of residence, and cause of death. To compensate for the usual lack of a holistic perspective in analyses of mortality, a typolosy recently developed and applied at the international level by Hiliery, Ludtke and Weisbuch was used. (11) follo"- ing their procedure, deaths were categorized employing a sevenfold classification of mortality: infectious, degenerative, social, infant, rrat.ernal, other symptoms, senility and other ill-defined causes, and total deaths. (See Table 1.) The basis for the mortality codes was the 1955 rev'sion of the Internation Classification of Diseases. (32) Three-year (1959-60-61) average age-adjusted rates were computed for each of these seven cate- gories of mortality using the lndirect method. (13) The standard population used was the total Houston population in 1960. TABLE 1 . - C I R 52('4 5 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION r",p t~ N, (JO-34
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Social class position of census tracts was measured usin; the Index of Social Class (ISC), an index of socioeconomic status develcpe" specifically for ecological applications. (22) The ISC uses three variables: the percent of the total labor force classified as white-collar workers,• the percent of the population over 25 completing four or rrore years of college, and the percent of all families earning $10,000 or more annually In each census tract. The mleasure was derived and scored through the use cf principal components analysis. Each census tract receives a unique ISC score. The scores in turn are utilized as a continuous variable for analytic purposes. 7he ISC offers a number of advantages analytically: (1) the three dimensions of social class most stressed by contemporary behavioral scientists - income, education, occupation - are considered simultaneously; (2) computation of the measure is based upon established statistical procedures and both the weighting and scoring procedures are inherent in the properties of the data and thus are essen- tially nonarbitrary in nature, and (3) the variables utilizer are computed from census data which is at the sa,^.e time easily accessible and highly reliable. The concept "ethnic stat::s" in American society today generally denotes membership in a minority group, but at the same time It also connotes low social esteem and low socioeconomic status. To c:,pe with this dimension of life analyticaily, two measures of ethnicity were corrquted: percent of the census tract population classified as NeSro and percent of the census tract population classified as having a Spanish surname. These two ethnic groups are respectively the first and 'White-collar workers are defined as professional, technical, and kindred workers; ranaSers, officials and proprietors; clerical and kindred workers, and sales workers. 6 CTR ~ 2 0 5 CONFIDENTfAL: MINNBSOTA TOBACCO LiTl~1'1AN T _ •r C ~ ~ ~~~`°~ ~`.) ~~ - :~, ~ :' (
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second largest disadvantasec' minority groups, not only in Houston and in the Southwest, but in the nation. Three separate analytic procedures are employed to relate ISC scores to each of the seven categories of age-standardized mortality across the census tracts. First, zero-order correlations are computed, then partial correlations are computed controlling for percent Negro and for percent Spanish surname. Then the procedure is reversed, correlating each ethnic variable with the mortality rates while controlling for social class. Finally, rr,;ltiple correlations are coc,puted between each of the causes of death and social class (ISC score), percent 'r'egrc and percent Spanish surname. Results All seven hypotheses concerning the relationship between social c;ass and mortality are substz nt'ated. (See Table 2.) All causes of death are inversely related to social class, with the exception of degenerative and other causes. As hypothesized, there was essentially no relationshi;; between social class and these two causes of death. By far the most pronounced relationship otserved was the relationship between social class and infectious aeaths, fol:owed by the rela:ionsr,ip between soc'al class and social deaths. The effect of ethnicity on level of mortality in the census tracts is also evident from an examination of Table 2. Both percent Negro and percent Spanish surname demonstrate moderate, positive relationships wit^ infectious death rates. Percent Negro exhibits a stronger positive relati=- snip with infant mortality than does percent Spanish surname. In addition, percent Spanish surr,ame demonstrates a positive relationship with both maternal and overall mortality. Percent Negro, on the other hand, is not relatec to either of these types of mortality. 7 C T R 5206 _ y}~~ CONFIDBNTIAL: MiNNAWA TOBACCO LtTiUA1'W~Y LJ a{  .n '~4 . ,~ \ ~4~ '-+ 03
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TABLE 2.- hhen the effects of ethnicity are controlled through partial correlation procedures, the pa:tern of relationships between social class and mortality changes somewhat. As can be seen in Table 3, when ethnicity is controlled there is essentially no relationship between social class of an area and five categories of mortality - degenerative, infant, maternal, other causes and total deaths. However, the relationships between social class and the reraining two causes of death - Infectious and social - are negative and would be sufficient to reject the null hypothesis at the .005 level if the cases otservee had consisted of a representative sample drawn from some universe. ('6' As was the situation in the zero-order correlations, the rrost pronounced relationship is between social class and rates of death fraT, infectious diseases. Although the relationship between social.class and the other five causes of death are all negative, the correlation coefficients are negligable. TABLE 3.- When tne effects of social class and percent Spanish surnarr.e are controiie:, percent Ne^,rc Is positive related to three causes of death - infectious, social ar,d infant. (See Table 4.) There is esser,tially no relationship with the other four causes of death. When the effects of percent Negro on social class are isolated from those of percent Spanish surname, a somewhat different pattern emerges. Percent Spanish surname, in the controlled situation, is also relateC positively to infectious death, but this variable is not related to social and infant mortality. Instead, it exhibits positive relationships with maternal and overall mortality, although the latter relationship is weak. (See Table 4.) TA6:E 4.- 8 C T R , , CONFIDENTIAL: MINNESOTA TOBACCO WTIGATION 520 7 ~~ t- ..'ti ~,,~°I ~;. ~~~ :~ X°z!
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1 The cor',bined effects of social class and ethnicity on level of r,crtality are demonstrated by the crultiple correlation results in Table S. As can be seen, the corbined effect of social class and ethnicity as measured by a multiple correlation coefficient generates essentially the same results as did the zero-order correlation results. Moderate to strong relationships are exhibited by five causes of death - infectious, social, r,aternal, infar,t, and total mortality. Again, the most pronounced relationship involves infectious mortality followed by infant mortality, social rrar;ality and materr.al mortality. The relationship involving total deaths and social class, however, is relatively weak. TABLE S. Although the correlations observed between social class, ethnicity and social mcrtality were rore or less as predicted, the relationships were not as pronounced as had been hoped for. A possible explanation mi;ht lie in the fact that the social mortality category includes a varie:y of causes of death, many of which are not necessarily related etiolo5icaily or epiderniologically, although they are related conce;t.;ally. A;l causes c" death in this broad category are deaths by violence. However, homicide and suicide are fundamentally different phenomena, as are traffic accidents and household accidents, for example. In order to examine the relationship between social class, ethnicity, and social mortality in greater detail, social mortality was divided into four subcategories: (1) traffic deaths, (2) homicides, (3) suicides, and (4) all other forms of violent deaths. Rates for these four causes of death for each of the census tracts were then correiated with the measures of social class and ethnic status fcr tne census tracts. C T ;s ;;`?0S 9 CONFIDENTIAL: MINNESOTA TOBACCO LLM,+TI4N CT ~~'ti 111-4 0 +~ ~ .~ ~ 0
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Table 6 presents the Zero-order correlations between social class, percent hegro and percent Spanish surname with the four causes of social death. As can be seen there is essential,iy no relationship between social class, suicide ana other forms of violent deaths. There is a moderate inverse relationship between social class and homicide and a low to-moderate inverse relationship between social class and traffic deatns. There is a moderate positive relationship between percent Negro and homici:e and a low-to-moderate negative relationship between percent Negro and suicide. Percent Spanish surname exhibits essentially nc relationship with any of the four causes of social deatn. TABLE 6.- t,'hen the effects of etnnicity are controlled, the pattern of relationsr,l;s rerains essentially the same, although the magnitude of the correlations drops somewhat. There is still essentially no relationship between social class, suicide, and other forms of violent death. The relationship between social class and horicide, while it re-ains negative, droPs substantial;y (from -.345 to -.151). The.relationship between social class and traffic deaths rerains negative and is essentially unchanged (the correlation coefficient drops only from -.137 to -.136). (See Table 7.) TABLE 7. Discussion Data for Houston in 1960 substantiate the results of other social ecological studies, demonstrating that social class continues to be relate~ to differential mortality experience. Overall, the data reflect an inverse 10 5209 CONFIDENTIAL: MINNESOTA :~ ~ 'COBACCO LITIGATION R ~°`~ 0, I 1
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relationship between social class and mor:ality, i.e., higher status census tracts in general have lower rates of death than do lower status tracts. In addition, the results indicate that social class is not only a factor related to the probability of death occurring, but also to the probability of death from a given disease category. For example, in the controlled _ situation, the probability of dying from infectious causes (such as influenza, pneumonia, tuberculosis) and from social causes (homicide, suicide, accidents) is greater in lower status tracts. The relationship between social class and these two categories of death is negative and of a substantial rugnitu_,e. The data also illustrate the importanit linkage between me.,oersnip in low-status minority groups andd increased risks of dying fror, different causes. The percent Negro in census tracts is positively related to rates of death from infectious, social and infant causes. The extremely high rates of homicide a...ong Negroes, particularly Negro males, has beer well documented (12) and the analysis de^onstrated that in Houston this accounts for much of the relationship involving social mortality. High rates of death from infecticus diseases and from conditions relating to childbirth are greatly determined by factors such as poor diet, poor sanitary conditions, and poor medical care, condi;ions attendant to poor socioeconc-,ic circcr,stances. The relationships between percent Spanish surnar„e and nor:ali:y reflect essentially the sar,e situation, with the exception of social mcrtali:y. The strongest relationships are with infectious and maternal mortality, health conditions reflecting poor health practices and poor medical care. The results also indicate that any consideration of social class and its relationship to health which does not simultaneously examine the role of ethnic status in American culture omits a rr,ajor contributory condition. Neitner social class nor ethnicity considered alone predicted mortali;y from various causes as well as both considered jointly. Five of tne seven causes of death were related to the combined effects of social 11 CtR 5210 CONFIDfihTfAL: MINNESOTA ~°"•"'~'~r~ ~,~~.~~ TOBACCO [.tTl©ATlta E.r ~ t t t 1rf ~.+4 ~N
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class and ethnicity at a level sufficient to reject the null hypothesis, had the data been amenable to such a test. However, even thoush the im;,ortance of the relationship of•sdt~2 class and ethnic status to mortality was demonstrated, the results raise several questions. If the various correldtion results are reexamined, one thing is strikingly clear. The exolanatory ower of social class and ethnicity, alone or In combination, is not overwhelming. The highest correlaticn c,w'served (the multiple correlation between class, ethnicity and infectious deat!,s) accounts for only 29 percent of the explained variance. In only one other multiple correlation result (infant causes) is as much as 10 percent of the variance explained and for the partial correlations only one relation- ship (social class and infectious causes) accounts for mcre than 10 percent of the variance. Only three of the zero-order relationships - social class/infectious causes, percent Negro/infant causes, and percent Spanish surna.,e/infectious causes - accounted for as much as 10 percent of the explained variance. Correlation coefficients of this ragnitude have consistently been reported by researchers examining the ecological relationship between socioecor,or„ic status and rartality rates in Ar„erica. Stockweli, in his analysis of Hartford and Providence, could only account for abou: 22 percent of the variance in overall mortality using measures of incore, education and occupation. (27) Hamilton, in an analysis of the 100 coun- tries in North Carolina, used eight a*asures of socioeconomic status. The highest correlation he reported was -.69, between home-ownership and over- all mortality. (10) In his analysis of socioeconomic factors and infant mortality in Syracuse, Willie reported that none of the factors accounted for over 15 percent of the variance in the ecological distribution of infant mortality rates. (31) Similarly, the socioeconomic variables used by Stockweli in his analysis of infant mortality in Providence accounted for less than 10 percent of the variance. (28) C T R • 52i j 12 CONFIDENTIAL: MINNESOTA ~ ~~~ ~',~ ~"~~`'~ TORACCO LITIGAT10t~1 7 ~
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These studies all have one key element in corrr,on -- they employ .coefficients of correlation to measure the nature and magnitude of the relationship between socioecononic status and mortality. Many ecological studies have used another approach. This alternate procedure involves grouping tracts' into class strata based on socioeconomic status scores, and then computing death rates for the class groupings. Studies using this technique report a fairly uniform inverse relationship between mortality and social class. (3,4,16,25,30) More irportantly, r.any report that mortality in Class V (the lowest) is substantially greater than in any other class, and is particularly higher than in Class 1. Class V mortality ratios of up to 200 (where Class I is the base class with a value of 100) have been reported for metropolitan areas in the United States, depending upon cause of death, with most being in the 130-170 range. Differences reported ancng Classes II, III and IV navE varied considerably, but in general have been much less. The available evidence, upon examination, indicates that social class Is still a factor to be considered in trying to account for differential mortality experiences. This same evidence, however, also indicates tr,at ecological analyses of socioeconomic status and mortality yield crude data that are pernaYs r„uch more amenable to ca;eyorica; comparisons than to correlation procedures. This is reflected by tne fact that more clearly-defined results, to date at least, have been obtained using the former rather than the latter procedure. Several factors may be operating to reduce the observed correlations. First, many census tracts are quite heterogeneous in their soc;oeconoric composition (a problem not restricted to Houston). In fact some tracts are so socially heterogeneous that intra-tract differences are as great or greater than inter-tract differences. The more pervasive this situa- tion, the less pronounced will be associations involving inter-tract coc,parisons. Second, the r.easure of social status may not 13 Cif? CONFIDBNTJAL: MINNESOTA _ ~,~'' ~~ TOBACCO LITIGATION ~ ~ ~'M1 1-1 ~`"°~ ~,p S~ 3 ,~, ~'"t
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er,oush. Tne varial.les included in the ISC were cr,osen to reflect hi;h stttus. Defining high educatior,al status as four or more years of college presents no particular proble^:. However, $15,000 a year incc-.e might have discrimir,ate~ better than $i0,000. The measure of occu;,atio-.a1 status was least stringent. Including clerical and sales occupations ray have limited the discriminant power of this variable. (h'.any such peo;ie have low education and income levels.) Limiting occupational status to managers, proprietors, professionals, technical and kindred workers may have generated better results. A question might be raised concerning the use of ethnic status as measured by the proportion of a census tract population lis:ed as Ve;r;, or having a Spanish surname. It is doubtful that upper and micdle s._:.:s Negro and Mexican-American census tracts exist in many places in the _ United States, and certainly they do not exist in Houston. Upper and middle status minority group neighborhoods exist, but in general these are in the same census tract with low status neighborhoods. in view of :his situation, however, the persistence of ethnic differences in the cor,:r:!le_' analyses is even more drara:ic. As a tool for analytic s:a:istics, a number of lir.i;ztions of cer.s;;s :. _c:s have been pointed out by Foley. (5) Two qualifications he discussec are r.c-c;ener : of the characteristics of the pcpulation residing in a tract, and tne meaning of ecological correlations. Both of these problems have been dis- cussed in the literature, the first in a paper by Myers (20) and the second in a series of papers begun by Robinson. (23) Goodr,an (7) has suggested a simple me;hod of estimating individual correlations from oa:a ( S) collected for a series of areas. Duncan and Davis have described a way to approxir.ate individual correlations from areal data. However, there are times whern ecological correla:ions rather than individual correlatior,s are the desired statistic. Tnis is particularly true when the focus is on rela:ionships between gross sociocultural conditions and general heal:n 14 CtR 52 13' CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION 0 ~,,~ 0
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conditions in a society. A lack of data on Individuals precluded analysis of individual social status and mortality in Houston. Consequently, the focus of the analysis was on the relationship between selected sociocultural factors such as class and ethnicity, and other selected sociocultural factors such as mortzlity Obviously, the proportion of variance not represented by social class and ethnicity of census tracts ray in fact be due to such individual character- istics as life style, occupation, biological characteristics, or health behavior. To the extent such individual factors override global patterns observed for tracts, to this extent the ecological correlations observed would be reduced. However, Antonovsky has argued that there are two conditions when class differences will tend to be s,.all - when nortality rates are extremely hi,~ or extremely low. (1) When moderate progress has been rade in controlling mortality, class differences are probably most pronounced. As overall sccia: status ir,.proves, such things as access to good medical care, preventive medical action, health knowledge, and limitation of delay in seeking heal:n care become increasingly i^;.crt.ant. The upper social strata are those in which these characteristics appear earliest and become mcs: pervasive. Houston is obviously a low mortality case and the class differences bear Antonovsky's argument - they are not pronounced. A CONCLUDING NC'TE Ultirately, of course, everyone dies regardless of his social class or ethnic status. In this respect, social class and ethnic status have limited explanatory power when compared to the aging process or to the various fatal disease processes. However, the evidence indicates that social considerations such as social class or ethnic status are salient factors in regard to differential risks of dying. What remair,s to be demonstrated is a more precise articulation of the Interaction of these 15 CTR 5214 ,CONFIDENTIAL: MINNESOTA ~ TOBACCO LITlGATION L' 19, 11 H () 0 ~ 1 3 G
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factors. In this regard, the most prcrsisins approach to the study of social class and mortality would appear to be the study of the individual decedent and his life style. This will require much more rigorous and detailed research than analysis of mortality by the occupation listed on the individual death record, the usual effort in this direction. (15) It will require not only considerations of current social status, but life:ic,e social mobility patterns as well as family, health and ethnic cor,sideraticr,s. The results, however, should provide m,,ch more theoretically relevant an~ empirically valid infor-a:ion concerning the influence of social ar,d e:nn;c status on prcbability cf dying than past studies have yieldeC. C T R 16 CONPIDBNTIAL: MLNN6SOTA =y ,.:, --N1 ~~ : ` TOBACCO LITIOATIGN L, ~I oo,: ~ I
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Table 1 Mortality Typolo9y* 1. Infectious II. Deoene.*ativ e 001-008 110-117 020-029 31 0-318 5 10 -527 010-019 120-138 140-148 3 20-326 5 30 -539 030-039 400-402 150-159 3 30-334 5 40 -545 040-049 470-475 160-165 3 40-345 5 60 -561 050-064 480-483 170-181 3 50-357 5 70 -578 070-074 490-493 190-199 3 60-369 5 80 -587 080-096 500-502 200-205 3 70-379 5 90 -594 100-108 550-553 210-229 3 80-389 6 00 -609 230-239 3 90-398 6 10 -617 240-245 4 10-416 6 20 -626 250-254 4 20-422 6 30 -637 260 4 30-434 6 90 -698 270-277 4 40-443 7 00 -716 280-289 4 44-447 7 20 -727 290-299 4 50-456 7 30 -738 300-309 4 60-468 7 440 -749 III. Social V. Infant E800-E202 E900-E904 750-759 E810-E?25 E910-E936 760-769 E830-E835 E940-E946 770-776 E040-E845 E950-E959 E850-E85c E960-E965 E850-E866 E970-E979 E870-E8E8 E980-E985 E890-E895 E990-E999 IV. Maternal VI. Other Svmatons, Senilitv and - efined or.diticns 640-649 650-652 780-789 660 790-795 670-678 , 680-689 'Source: World Health Orsanization, Inte-national Classification of Diseases (1955 Revision), Geneva, witzerland, 1957. 1 C T R 5216 CONFIDENTIAI.: MINN6SOTA TOBACCO LI'CIOA9'ION
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Table 2 ' ear Average Correlations BetWeen Three- Zero-order •h Rates, Social Class Age-adpndtEthnicltY in Kouston ~ her,ro ~ Span:sh Surna'~e -~ ause of Death ~ Social Class C .30 •42 1. Infectious .00 .12 2. Degenerative -.07 ..27 .17 .15 3. Social .05 .26 -.18 q M,aternal .32 .16 _,10 5. Infant ~ .01 ' -.03 _.02 6. Other i 15 .05 ,20 .. 7, Totat C T R 52 17 CONFIDCNTIAL: MINNESOTA f°. Ir= r TOBACCO LITIGATION ( -„r ~ ~~~ i 1~~'''~ ~e, =.~, ~'" y0 (,,,P „~ ~''y. .ti-ny 1 r°~! •; S) ~.
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Table 3 Partial Correlations Between Social Class And Mortality, Holding Constant Percent Negrc and Percent Spanish Surname Relationship I r rl ,4 .2,3 .33 r1,5'2,3 -.01 "1,6'2,3 .24 rl ,1 •2,3 -.01 r1,8'2,3 -.06 r1,9'2,3 -.04 r1,10•2,3 -.07 1. Index of Social Class 2. Percent Negro 3. Percent Spanisn Surname 4. Infectious Death Rate S. Degenerative Death Rate 6. Social Death Rate 7. M.a terna l Dea th Ra te 8. Infant Deatn Rate 9. Other Symptoms, Senility and I11-Defined Causes Death Rate 10. Total Death Rate C1R 5-21b CONFIDENTIAL: MINNESOTA TOBACCO LITIGAT(ON C.., TR V1~.1 002-3.140
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Table 4 Partial Correlations Between Each Ethnicity Variable and Mortality, Holding Constant Social Class and the Other Ethnicity Variable Relationship ~ r ~ Relationship ~ r r2,q•l,g .23 r3,4'1.2 .18 r2,5'1,3 -.04 r3,5'1,2 .10 r2,6'1,3 .15 r3,6'1,2 -.02 r2.7•1,3 -.04 r3,7'1,2 .20 r2,8'1,3 .29 r3,8'1,2 .02 r2,9'1,3 .02 r3,9.1.2 -.0:. r2,10'1,3 .00 r3,10'1,2 .13 1. Index of Social Class •2. Percent Negro 3. Percent Spanish Surname 4. Infectious dea:n rate 5. Degenerative death rate 6. Social death rate 7. Maternal death rate 8. Infant death rate 9. Other symptc..s, senility and ill-defined cause death rate 10. Total death rate CONFIDENTIAL: MINNUOTA TOBACCO LITIGATION CI~ti~ NN 00,23114.1.
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' Table 5 Multiple Correlation Between Seven Categories of Death, Social Class, Percent Negro, and Percent Spanish Surnane ause of Death I 1. Infectious .54 2. Degenerative .12 3. Social .30 4. Maternal .27 S. Infant .'s3 6. Other .05 7. Total .21 C T R * ~ ) Jti ' ~i CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION „ , R ~ ~ ~~ NN
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Table 6 Zero-Order Correlations Between Four Causes of Social Mortality, Social Class And Ethnicity In Houston Cause of Leatn i Social C ass , fiecro SCani sn Surra-.e 1. Traffic Death -.137 -.002 .079 2. Hcmicide .345 .4;1 .045 3. Suicide .074 -.176 .082 4. Other Violence 08? .059 .046 C T R CONFIDENTIAI.: MlNNESOTA ' TOBACCO 1X'T1GAnDK CT~'~ ~"~~`~ 0 ~~ ~ 1. L1° 3"
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Table 7 Partial Correlations Between Social Class and Social Mcrtality, Holding Constant Percent Negro and Percent Spanish Surname Relatlonship~ r r1,4•2,3 r1,5'2,3 r1,6'2,3 r1,7•2,3 -.136 -.151 .021 .054 1. Index of Social Class 2. Percent Negro 3. Percent Spanish Surnane 4. Traffic :eaths 5. Homicide 6. Suicide 7. Other Violence C T R b 22? .CONPIDfiN'flA s E3 ~TO>MM M1I0Af RM CTF12N' N f'4 0 0 ~ .14 4:
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References lAntonovsky, A.: "Social Class, Life Expectancy and Overall Mcrtality," Milbank Memorial Fund Quarterly. 45: 63-65,1967 2Chapin, C.: "Deaths Anong Taxpayers and Non-Taxpayers, Income Tax, Providence, 1865, "American Journal of Public Health. 14: 647-6E1, 1924 3Coorcbs, L.C.: "Economic Differentials in Causes of Death, "Medical Care. 1: 246-255, 1941. 4Ellis, J.M.: "Socioeconomic Differentials in Mortality from Chror,ic Diseases, "Social Problems. 5: 30-36, 1957. SDuncan, O.D. and Davis, B., "An Alternative to Ecolosical Correla- tions," American Sociolooical Review. 18: 665-666, 19E3. 6Foley, D.L., "Census Tracts and Urban Research," Journal of t^e American Statistical Association. 48: 733-742, ME.;. _ 7Goodr,an, L.G., "Ecolocical Regression and Behavior of Individuals," American Sociclocical Review. 18: 663-664, 1953. 8Graham, S.: "Socio-Econo,.,ic Status, Illness and the Use of Medical Services," Milbank Memorial Fund Quarterly. 35: 58-66, 1957. 9Guralnick, L. and E. Coulter: "Journal of the Americar. Statis:ica' Association. 54: 730-740, 1M. 10kamilton, C.H.: "Ecological and Social Factors in M,cr;.aiity Varia;icr,," Eucenics Ouarterl_v. 2: 212-223, 1955. 11Hi1lery, G.A., R. Ludtke, and J. Weisbuch: "Causes of Death in tne Derrographic Trar,sit;on," paper presented to the Po,.ulation Asso- ciation of America, Boston, Massachusetts, April 19-20, 1968. 121skrant, A.P. and P.V. Joliet: Accidents and Homicide. (Cam,bridye, Massachusetts: Harvard University ress, 1968). 13Jaffe, A.J.: HandboQlc of Statistical Methods for DemocraDhers. (Washington, D.C.: u. . Government Printing Office, 1960), 43-84. 14Kadusin, C.: "Social Class and the Experience of Ill-Health," Sociolocical Incuirv. 34: 67-80,1964. C T R 5223 CBNk1pGNTIAL: MINNESOTA TOBACOO LITlGAT10N ~, N 21k V1 0 3
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t 21 15Kitagawa, E.!!. and P.M. Hauser: "Social and Economic Differentials in Mortality, United States, 1960," paper presented at the annual rr.eeting of the Population Association of America, 1966. 16Kitagawa, E.M. and P.M. Hauser: "Trends in Differential Fertility and Mortality in a Metropolis--Chicago," Contributions to Urban Sociolocy. E.W. Qurgess and D.J. Bogue (eds. . h cago: ir,e Uni-'versiLy of Chicago Press, 1964), 59-85. _ l7Logan, W.P.D.: "Social Class Variations in Mortality," British Journal of Prever.tive and Social Medicine. 8: 128-1's ,. 18Moriyama, I.M. and L. Guralnick, "Occupational and Social Class Differences in Mortality," Trends and Differentials in Mortalitv. (New York: Milbank Memorial Fund, 1955 , 6i- 3. 19Morrison, D.E. and R.E. Henkel: "Significance Tests Reconsidered," A,:,erican Sociolocist. 4: 131-140, 1969. 20Nyers, J.K., "Note on the Homogeneity of Census Tracts," Social Forces. 32: 364-366, 1954. Natior,al Center for Health Statistics: Socioeconomic Characteris:ics cf Deceased Persons: United States 562-1963 Deatns. D. .. U. . Government Printing Office, 1969). 1947. 22Roberts, R.E. and G.W. McBee: "A Multi-Factor Index of Social Class for Measuring the Relative Social Class Position of Ecological Units," paper presented at the annual meeting of the Southerr, Sociological Society, New Orleans, Louisiana, April 10-12, ~ 2"Robinscn, W.S., "Ecclogical Correlations and the Behavior of In-ividuals,' American Sociclccical Review. 15: 351-357, 1950. 24Rountree, S.B.: Pove•tv and Procress: A Second Social Survev c= "c-K. (London: longcar,s, Green & Co., 1541). 25Sheps, C. and J.H. Watkins: "Mortality in the Socioeconomic Dis:ric:s of New Haven," Yale Journal of__Biolocy and Medicine. 20: 51-c0, 26Stocks, P. "The Effects of Occupation and Its Accornpanying Enviror,rr.ent on Mortality," Journal of the Royal Statistical Society. 101: 669-696, 1938. 27Stockwell, E.G.: "A Critical Examination of the Relationship Between Socioeconomic Status and Mortality," American Journal of Public Health. 53: 956-964, 1963. 28Stockweil, E.G.: "Infant Mortality and Socio-Econonic Status: A : Changing Relationship," Milbank Memorial Fund Ouar:erlv. 431 101-i11, 1962. CTR b 2?4 CONPIDENTIAL' M'INNESOTA ,TOBACCO LiTlOATION C.pt:.' R VIH
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4 255ym.e, S.L., N.O. Sorhani and R.W. Buechley: "Cultural Mobility ard Coronary Heart Disease in an Urban Area," American Journal of Eoidemioloay. 82: 334-346, 1965. 30Tayback, M.: "The Relationship of Socioeconomic Status and Expectation of Life," Baltimore Health News, 34: 139-144, 1957. 31Willie, C.V.: "A Research Note on the Changing Association Between Infant Mortality and Socio-Economic Status," Social Fcrces. 37: 221-227, 1959. 32World Health Organization:. International Classification of Diseases. (1955 Revision), Geneva, witzer ana, 195. C1R 522J CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION ~~ `~ ~; MH 0~°~° ~ :~ ~
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SP=-b9 THIS DOCUMENT SUBJECT T0 AUG. 20, 1985 NON-DISSEMINATION ORDER IN ROGERS AND DUKE CASES THE UNIVERSiTY OF TEXAS AT HOUSTON M. D. ANDERSON HOSPITAL AND TUMOR INSTITUTE T.us Y.lial Cw+ur M.ww+, T.,us November 27, 1972 , Mr. Tozn Hoyt E.zecutive Vice President Council for Tobacco Research 110 East 59th Street New York, New York 10022 Dear Mr. Hoyt: I am enclosing an application for a research grant in accordance with our earlier discussion, and would appreciate your earliest response. If approved the funds should be made payable to The University of Tezas M. D. Anderson Hospital and Tumor Institute at Houston, attention Mr. E. R. Gilley, Busi- ness Manager; halt to be payable immediately and haL in six months. 77025 Sincerely, ~ ~ ~~~MtG> , ~l~C~<G !~~?CLIG ~ Eleanor J. cdonald Epidemiologist .~ n v. EJM:kr ~ ~ . ~,~. Enclosure N 1y 0 , , CONFIDENTlA4.: M1WM01 TOBACCO LITIGATION CTR 5226 1-6 `j9 1d11`q(JO~ 11 :~ ~ ~~
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. THIS DOCUMENT SUBJECT TO A!IG. 20, 1985 Ii;1~~•Di33E„ItNAT10N Oi(UE2 IN ROGERS AND DUKE CASES. THE UNIVERSITY OF TEXAS AT HOUSTON M. D. ANDERSON HOSPITAL AND TUMOR INSTITUTE T.us IHdiul C.nta Mauton, Tt:as 17025 July 27, 1972 APPLICATION FOR RESEARCH GRANT L*WESTIGATOR: Miss Eleanor J. Macdonald, A. B. INSTITUTION AND The University of Texas M. D. Anderson Hospital ADDRESS: and Tumor Institute at Houston 6723 Bertner Drive Houston, Texas 77025 TITLE: Regional Patterns of Cancer of Each Site in Five Large Regions in Texas Workin¢ Hvpothesis: The working hypothesis is that the influence of a large number of factors which may affect cancer causation can be esti- mated epidemiologically if facts are scientifically collected and recorded in a study population; and if the details of the history of each individual with cancer in the same study population are also available in usable forr: , Details of Experimental Design and Procedures: The experimental design involved a long range collection plan to obtain adequate data. Sampling was not done, but rather for 23 years, every case of cancer was collected fr om every known source in 74 counties, which were grouped into five large hospital regions, with total population ranging from 300, 000 to over a mil- lion. The total of over four million people includes a million Latins, an equal number of Negroes, and over two million non-Latin Caucasians. Available are 370, 000 accessions for 270, 000 individuals with cancer. Information was obtained from the records of hospitals, clinics, and doc- tors. Death certificates are also available for all cancer patients who died from 1944-1972. On hand is taped information on environmental factors for each county. The total population in each region for each of 23 years, by sex, age and ethnic group, his been determined. True age- adjusted incidence rates of cancer for 23 years may now be figured for an area as large as France, with a total population of over four rnillion. A preliminary study of the median five-year average age-adjusted cancer incidence rates in several sites revealed unexpected differences between regions, in the same and different ethnic groups. 1 CdNPIDENTIAL: MINNESOTA TOBACCO LITIGATION CTR 522; C 1' 00. '31'1•9
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THIS DOCUMENT SUBIECT TO AUG. 20, 1985 NJh-DI,iSEMINATION ORDER IN RvGEr~~ h.t0 DUKE CASES. Page 2 Help is needed to check the 370, 000 alphabetically listed accessions to eliminate the 100, 000 estimated multiple accessions for the same indi- viduals, which our method of data collection engenders, and to finance computer time, programming time, and statistical clerical services to enable computation and analysis. Subsequently age-adjusted and more importantly age-specific incidence rates will be computed for 23 years, individually, and by five-year averages. Changes over time will be demon- strated by this study. The knowledge of the location of high and low risk segments of the population for each site of cancer, .vhich this approach promises to reveal, will suggest the exact regions and cancer sites to study in-depth to find the reasons for such differences in risk. Race, age and sex differences as well as environmental and geographical fac- tors, mar ital status and occupation are the variables which will be ex- plored first, analyzed and reported. Twenty years of effort and hundreds of thousands of dollars have gone into the collection of these abstracts and follow-up reports, an unparalleled data bank. 3ud¢et: For one year. Personnel: Statistical Clerks (6 @ $4, 800. 00) $28, 800. 00 Unit Equipment Operator 5,784.00 Key Punch Operator I 5,028.00 Subtotal $39, 612. 00 Eouin::zent: Rental: 1 024 @ $43. 00/month $ 516.00 1 056 @$55.00/montb $ 660. 00 Subtotal $ 1, 176.00 Overhead (15°io of Personnel) $ 5,942.00 TOTAL $46, 730. 00 , CTR 522S CONF7DENTIAL.: MlNNBSOTA _ TOBACCO Li'if(3ATION ~ C ~+R%W•4
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1 Environmental Regulation-How Much is Enough? . PART 11 AUDITORIUM - HOUSTON MUSEUM OF NATURAL SCIENCE 8:00 PM, Tuesday, February 12 TAe Prb(it Is Mvlt.d te at.nd. klef w.sentaloru by pnel wsen+b.a .r{p `0 fellowed by op.ft d"u• aution end questieeu trocn tM wiienca. PANEL MEMBERS John E. Barker Director of Environmental Enpin.erinp fLRMCO Steel Corporation ~ Gerald E. Hopkins Maxw.ll HoAkins ond Pric. Attorne s , ~.~,,i,. ~, y I Herbert C. McKee Sovthwest Research Institute (Former Chairman, Texas Air Control Board) ,, ;. John Ray Harrison ..~t} Mayor, City of Pasadena . • .r+..r!~:. t  Eleanor C. MacDonald Professor and Chairman, Department of Epidemiology, Univ.rsity of T.xas- . M. D. Andersorr Hospital and Tumor Institute. Hon. Joe Pentony I a,1111,i : State Representative, HarrisCounty, ~ ~ j District 80 T~: .aw+o ~ f•r.s.nt.d lby: The Am.ricen Ch.mical Secloty, Tho Houston Post end th• Houston Muceum ef tiotvral Scionc.. Iorfvrth.rinfortnatloncnll: Dr. Walter Abbott SZ9•SS96 C T R 5229 , ~c -~. ~~ a1~ K V11-4 00°~ 1
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FORUM ON SCIENCE AND SOCIETY Environmental Regulation - How Much is Enough? Tuesday, February 12, 1974 Llea.nor J. Macdonald In epidemiological studies the demographic approach has been a fruitful source of valid scientific l.ads. It was ob- served in Houston that there was a great difference between census tracts in mortality from lung cancer. A study has been made of the 30-year mortality experience from all causes in Houston by regions around the 17 air pol- lution collection sample stations. These rates have been ad- justed to remove the differences due to age and to make them comparable to one another. There are enormous regional differences ..ithin the city in mortality from cancer of the lung and from heart disease. In ar, attempt to understand the underlying causes of these regional differences, such demographic factors as number of years of residence in the same house or the same census tract, the general age range, the ethnic composition and the median income have been studied and compared. The retes in certain regions are high whether the median ages of the residents are relatively young or old. The River Oaks,-.,10, and Memorial, 17, regions have low lung cancer rates, fall in the older age group and have a high median income. The contiguous region, 7, south of River Oaks between Main, Old Main and Chocolate Bayou also has a low mortality rate for lung cancer, has the same older population, a large pro- portion of long time residents, but a very low median income. The rates are highest for the center city, and the Heights, 2, and for the Spring Branch region, 11. The rates in the last region have doubled in 15`years since the entry of heavy industry into the area. The ages of the inhabitants are in the younger category. CTR ~~v0 ~'~ O
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2. Tbe industrial area between Griggs Road, 6, Walker and Chocolate Bayou, has a very high rate of lung cancer. West of Mykewa, 5, the age is young, there, is much heavy industry. The rates for lung cancer are high. The region on the other side of Mykawa, 4, mostly resi- dential, with ssany long time established areas has a middle range income and a low lung cancer rate. The regions with low rates are out of the path of the usual prevailing winds carrying pollution and have little or no industry within their borders. Atmospheric pollution or lack of it seems to be the major difference between regions of high and regions of low lung cancer mortality. Some indication of the potential of atmospheric pollution may be derived from observing the change in lung cancer mor- tality before and after heavy industry moves into a residential area. In the Spring Branch area, for example,• the rate has more than doubled in 10 years. Since the rates among women are so much lower than among men, it is possible that a combination of the effects of occupational exposure and at- taospheric pollution may account for the high rates among males. In any sound study one must be constantly aware of the movement of populations as well as of industries. Studies similar to this and demographic studies in- variably provide clues relative to other areas and population subgroups requiring further investigation. It is apparent that there is a large area of scientific unkrnowns relative to the long term health effects from the complex microchemical environment. Thousands of chemicals and chemical combinations exist, the effects of which con- stitute scientific unknowns. There is no simplistic answer to the cause of cancer. The study points out the need for the scientific com- munity to redirect its attention and research efforts to ex- plore the carcinogenic potential of the microchemical en- vironment - a virtually unexplored area. , CTR 5231 N ~`°•~ ~~ +~ ~ :~ E313
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\ ~ ~~ ~~ H 144 ~`.~ 0 23 1. S ~~:
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER hs x.lia.l O.wla lLom"ok r.~ sfo:4 July 12, 1974 ~ THIS DOCUMENT SUBIECT TO AUG. 20, 1985 NON • DISSEMINATION ORDER IN RDGEF,; AND DUKE CAS,--,, , Dr. Robert Hockett Research Director Cmuncil for Tobacco Resear ch - USA 110 East 59th Street New York, New York 10022 Dear Bob: Enclosed is a brief progress report on the status of my study. This was requested by Dr. Gardner. He wanted it about 2, 000 words long, which saves you the perusal of 25 books of tables in computer printout form. Sincerely, , 6 4'4'(1 Eleanor J. Macdonald Professor of Epidezniology Department of Epidemiology EJlv:/mp Enclosures C T R .~ M D AVD[RSOti' HOSI:T.U MID 7UMOR NS7TMZ M-Lr+ Sw RrA anLum" Cnun " IXT7UMURAt IROGIUMS OMSIOA' ORrebp CermN-D.awea~.) lwme.novu COll.ro.aewt 5b.4n f.Ne.nsu [RO..ow~ r*~a Sc+r^=r ra UNNUtSR-Y GtNC[A fOUhD.4T10/.' Tw A+te+s" M.rler - CONFIDENTIAL: MINNESOTA . _ TOBACCO LITIGATION ~~.h ~~0 ~ . ~-';~~
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St 4 7o T(//y 117t_ THIS DOCUMENT SUBJECT TO AUG. 2'J, 14g5 NOFi-tOISSEMINInTION Or,vEn IN R:,,E%3 hoiD DUKE THE COUNCIL FOR TOBACCO RESE.ARCH - USA PROGRESS REPORT BY MISS ELEAINOR J. MACDONALD .t Professor of Epidemiology Department of Epidemiology The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor In.titute Texas Medical Center Houston, Texas 77025 C T R 5234 CONFIDENTIAL: MINNESOTA ~ TOBACCO LITIGATION L", "#" 01 C)
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PROGRESS REPORT TO THE COUNC:L FOR TOBACCO RESEA_ttC'r? - USA In Houston. Texas in 1967, a collaborative study was begun between the Depirt-ment of Statistics of the Houston Health Department and the Departznent of Epidemiology of the University of Texas System Cancer Ctnter, M. D. Anderson Hospital at Houston. In the several year s follow- ing, each of the 235. 000 deaths from every cause for 30 ye.ar s from January 1940 to January 1970 were coded to the rubrics from the U. S. Bureau cf the Census in effect in 1967. The introduction of new rubrics every few years in the International Classification of Diseases and Causes of Dea:!% makes studies over a period of years difficult and often imprecise. A eniform nomencLature applied to thirty years of consecutive records nets homogeneity of classi.fication and thus accuracy. The address on each cer tU'icate was census tracted to the 1967 census tracts in Houston. The origi.:al rubric coded was carried in a se :arate place on the card as vras the secondar y cause of death when it cvas given. Because of local concern in the incr easing pollution observed as the population tripled and industry expanded, ast_'-ma, bronchitis and emphy- ser-ia were coded separately when they were mentioned. . Concurrently with the mortality study, the incidence of cancer in Harris County and 71 other counties Was being ascertained in a separate study. Cancer records from all the general hospitals, laboratories and clinics in Harris County (Houston) were indexed and abstracted for the C1R 5235 C_ n ~ .~ ~ CONF/DENTIAL: N,1Nh'ESOTA TOBACCO LIT/GAT/ON C RN I-IN 00,
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. -2- THIS DOCUMENT SUBJECT TO AUG. 20; 19?5 NON-DISSE,1tNATION ORDER IN R;,~"V: AND DUKE CASES. 23 year inclusive period from 1944 through •1966. Comparison of the diagnosis in the hospitilised cases wit.h the reported cause of death re.ulted in many corrections through the cooperative efforts of the Health Department and the physicians. The death records were then coded for Mexican-American surnames, edited, checked and taped in the Department of Epidemiology at the M. D. Anderson Hospital. The census tracts, their populations, the cancer records and the general mortality records were then assembled in regions ar ound the 17 air pollution sample collection stations. Age specific and adjusted rates .ver e computed for each cause of death for each region in the city, by sex and ethnic group. Table I gives the rates for heart, cancer, str oke and cancer of the lung and cancer of the total respiratory tract for each region for the five year period 1965-1969. There are enormous regional differences within the city in mortality from cancer of the lung and fr om heart disease. In an attempt to understand the underlying causes of these regional differences, such demographic factors I as number of years of residence in the same houwe or the same census tract, the general age range, the ethnic composition and the :nedian income have been studied and compared. The rates in certain regions are high whether the median ages.of t.he residents are relatively young or old. The River Oaks and Memorial CTR 5236 CONFIDENT)AL: h:INNESOrA TOBACCO LITIGATION C"TR"'4 11H 00,3Q E-+ ~`"„~
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` , -3- T.IiS DO;,UMEh1 SU?iE^T TO AJS. ?~ 1985 NON'•DISSEI INATIuN pk;,"; IN RS AND DUKE CASES. regions have low lung cancer rates, fall in the older age group and have a high media.n income. The contiguous region south of River Oaks between Main, Old Main and Chocolate Bayou also has a low mortzlity rate for lung cancer, has the same older population, a large proportion of long-time residents, but a very low median income. The rates are highest for the center city and the Heights and for the Spring Branch region. The rates in the last region have doubled in 15 years since the entry of heavy industry into the area. The ages of the inhabitznts are in the younger category. The industrial area between Griggs Road, Walker and Chocolate Bayou, has a very high rate of lung cancer. West of Mykawa the age is young and there is much heavy industry. The rates for lung cancer are high. The region on the other side of Mykawa, mostly residential, with many long-time established areas has a middle range income and a low lung cancer rate. The regions with low rates are out of the path of the usual prevailing winds carrying pollution and have little or no industry wit.hin their borders. Presence or absence of atmospheric pollution seems to be the major difference between regions of high and regions of low lung cancer mortality. The annual wind rosettes of the Houston Healtb Department show that for most of the year the winds carry indus- trial pollution over the center city and then in a westerly direction. ( 1 I CONFIDENTIAL: ts1INNESOTA ' TOBACCO WTIGATION J . 2 3 l 1 ~~f~ ~~~~`~ ~,~~~`~.~ ~ ~r~
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-4- THIS DOCUMENT SUBIECT TO AUG. 7:. 19&5 NON•DISSEMINATION ORDER IN ROGERS AND DUKE CASES, Some i_ndication of the potential of at^zospheric pollution may be derived from observiag the change in lung cancer mortality before and after heavy Industry moves Lnto a residential area. In the Spria.g Branch araa, for example, the rate has more than doubled In 10 yaars. Since the rates among women are so much lower than among men it is possible that a combination of the effects of occupational exposure and atmospheric pollution may account for the high rates among males. In any sound study one must be constantly aware of the movement of populations as well as. of industries. Stvdies si:nilar to this and demo- graphic studies invariably provide clues relative to other areas and popu- lation subgroups requiring further investigation. It Is apparent that there is a large area of scientific unknowns rela- tive to the long ter:rn health effects from the complex m.icro-che:r.ical environment. Thousands of chemicals and chemical combinations exist, the effects of which constitute scientific urK^owns. There is no simplistic answer to the cause of cancer. Cancer of the liver in Houston is being studied by region, occupation. and types of exposure to explore the possibility of vinyl chloride as an etiologic factor. These studies point out the need for the scientific com.-nuni- ty to redirect its attention and research efforts to the exploration of the carcinogenic potential of the micro-chemical environment - a vir tually unexplored area. CTR -023S CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION ~ , T. R :~ E~ ~~ C ) ' '3
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THIS DOCUMENT SUBJECT TO AUG. 20, 1985 NON•DISSEMINATION ORDER . S- IN ROGEP,S AND DUKE CASES, Seven members of the Air Control Board of the Environmental Protection Agency in Austin met with the Professor of Epidemiology and r.leased the detailed pollution emission records from Houston industries. The Board is collecting and ana'.yziag a number of com- pounds and its h.ighest aerosol read3ngs are in the regions with high rates for lung cancer. The Board is discussing a method of continuing the data base from 1970 through and beyond 1974. The number and type of business establishments with the numbers of employees and whether the businesses were established before or since 1960 is known for each of the 17 regions. Reports are bei.ng finalized on this study. As an educational tool, 26 graduate students of the University of Tezas School of Public Heath in Houston have used the Houston mortality data or the registry data for their adva..nced degrees, both doctors and masters. There have been 23 other user s of the data for various educaticn- ai and planning purposes. This includes teaching high school, college and medical students. Computer izing and visual availabUity of all the facts on 235, 000 death certificates for 30 years serve as an administrative tool releasing employees for other functions. In a city of over one million population, daily requests for individual death certificates run into the huadreds. There was no index before this study. C1R 5239 CONFIDENTIAL: MINNESOTA TOBACCO LiTIGATION ~~ :~ c-, 00,11
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6 \ THIS DOCUMENT SUBJECT TO AU;. ;- 1985 NON•DiSSEtr,INA1tOh IN ROGEP,E AI'D DUKE C::, The request to the Council for assistance in data processing arose when the regional medical programs i.n the U. S. were unexpectedly cut- off leaving the Departnent of Epidemiology with 350, 000 accessions-to be processed and without adequate personnel to process them. The funds requested and received were used to complete coding of these abstracts, to combine all the charts of the individuals represented more t.han once who had more than one cancer or who had been to more than one institution for diagnosis or tr eatment . The editing netted coded mater ial for 250, 000 individuals for 72 counties or 7 regions rzude up of the combined counties around the medical center. Programs were written for f iguring the age specific and age ad- justed rates by site of cancer by sex and by ethnic group for each of the regions. The first adequate skin cancer figures complete for a population were obtained from this material and have been used by the Climatic Im:.act Com.-.r-iittee of the National Research Council in studying the effects of the Supersonic Transport in checking the cli.._^^.ate. A report on multiple pri- mary cancer has also been published from this material. A librarian has assembled and kept current coverage of the cancer and epidemiological literature since 1946. This is divided,up by its relationship to specific anatomic sites. The additional support is sought to elicit environmental factors as they apply to cancer by site in different regions in Texas and to publish a book on the subject. CTR 524 0 July 1974 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION ~ +.~ I =~0 ~ ' ~9~ € ~~~
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Station Total All Causes No, Rate 2 8,588 1,112.07 3 2,654 857.46 4 1,182 .504.83 I 5 1,868 819.94 6 3,798 991.78 7 3,267 901.12 8 2,805 857.76 9 1,793 602.88 10 3,065 808.57 11 2,636 858.63 12 5,803 927.18 13 3,724 •932.66 14 1,261 1,016.76 15 -16 352 787.50 17 970 720.43 TATILR I fURRTB OOUTTI'Y MORTALITY EY POLLUTION STATIONS AVP.RACP, ACE-ADJUSTCD MORTALITY RATE PER 100,000 TOTAL POPULATION 1965-1969 ToEal Heart Total Cancer Total Stroke Lung Pri.ary- Secondary Total Malianant ' RespiratorT No. Rate ' No. Rate No. Rata Not Rats No. Rate 3,392 433.28 1,395 180.88 . 870 111.03 322 41.81 346 44.89 1,002 347.52 500 162.41 262 94.48 121 38.63 132 42.21 435 211.80 257 106.09 101 53.32 75 32.15 80 34.28 630 338.89 362 165.59 184 102.77 82 39.49 87 42.05 1,438 393.19 648 169.63 398 111.68 162 42.28 174 45.48 1,206 327.74 520 143.51 370 99.75 123 34.17 128 35.58 1,214 381.63 681 198.36 287 96.78 143 39.69 149 41.63 628 2/i4.73 432 1/i6.50 164 70.13 85 29.75 86 30.19 1,298 332.94 571 14i4.35 384 100.33 111 27.26 118 29.02 966 365.52 556 181.32 267 108.12 130 44.12 135 46.05 2,189 388.22 1,051 170.94 564 103.39 245 39.75 258 41.83 1,294 371.90 645 170.43 368 62.49 119 32.07 ~126 34.00 437 398.99 260 220.92 112 103.14 50 40.56 52 42.16 127 344,70 61 124.60 39 122.80 11 22.60 12 26.27 371 308.06 231 157.63 104 93.32 45 30.01 47 31.35 ~ n ...r.~ --~ ~ .~~.+ 0 ~ ~ 1 r *~, z ~ ~ ,., c v a v z r•~ y 0 n ~ cc) -r --~ O T ~
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7HiS DOCUMENT SUBIECT TO AUG. 20, 1S85 kON•DISSEMINATION CRDER 1M ROGERS AND LUKE CASES. I 0 10.s 127 (1) (2) 13) (4) NOTES ANNUAL WIND ROSE Gitr o! 14ounor+ DeprMtynt of P ub(ic IiMftA Ah frdkrtwn CcY+trut Groqrsm Anrt,b.I Rpcxt, 1968 l4 124 CALM 1.3 Dir.ctions xe to the 16 pant eomom with north it the top UpOtr number 4 the tx+ctnt /repu*ncv of ocCurrence of %%,nd from tMt direction Lo++t* number 11 the eve+-sge s t! from that direction in mph. Numtxrs are wsro on reco.ds collectec ourrn9 the perloc 1951 tnrougn 1960 at Nouston internationa Airport. CTR 524? CUNF(DSNTIAL. [,iflNNESOTA TOBACCO LITIGATION ~ "I R H ~ H H ry 231 Gn 4
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THIS DOCUhSENT SUBIECT TO AUG. :'!, \ 1985 NON•D{SSEMINATION OP,I,LA IN ROGERS AND DUKE CASES. M . -" --+-.." W ~ ~~-----,` ; . ,.........: < s ! I . u a~ N S ~ ~ ~ \ / _ _ ! I CTR 4r . 5243 ICONFIDENTlAL: MINNESOTA f~~~; ~;,~ ~^~~-.~ ~TOBACCO LITiOATlON ( t ~ _
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4 4 . TKIS DOCUti'ENT SUBJECT TO AUG. 20, 1985 N0N • DISSWINATION ORDER IN R;iGEk; AND DUKE CASES. C TR 5244 CONFIDENTIAL: MINNESOTA ' TOBACCO LITIGATION lY.~ 0 03 .i, b
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THIS DOCUpAEN1 SUBIECI 10 4UG 2'j. 1985 N0N•DISSEMIh'A110N OkD:r IN RRg AND DUY,E CA-SES Deecriptive Data by Selec'.,ed Ce..-ira-- 23~acts. Iious tot, Tez aa Standb..'d !'Set.ropo? itan S`,.atiatical Jlrea Census of Populatioa trd Boua:.:,.g U. S. Dtrpa.--tmeat of Coams^ce BLL^eau of the Ceaat:a 1,050, 1960, 15r(0 and l.ge A:-tusteZ Norta-lit7 Ratec per 100,000 F•er:-:.a County, Tvcaa (Selected Ceasw 2.^a.cta) 1950 II . S. S•..aade,rd , CTR 5245 ~CONFI DENTiAL: 1A1NN6SOTA `,TOBACCO LIT/OATION
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Po7~'a:`cr L L^.r 1~ 113,096 59•9 1961~ 77,989 48.2 1970 67,701 47.7 Nsdi am Age 1256 g 63 iq?o L^.glo 32.3 36.7 36.2 La tin I,c. 21.1 2.6 1.8 .8 1Scr~ ~.` •re 29.1 25.6 25.4 Toul 30.1 28.9 28.8 S:.LZON 2 ..,_ ..._ IN ., . .._. . . GER~ i.crD DUK.E Cn;ES. La•`n k-- . Von-ti+TM:te To•a1 17,576 9.3 25,974 16.0 1°,977 13.4 56,253 30.6 58,017 35.8 55,268 38.9 1;;,925 100.0 16,1,980 100.0 141,946 100.0 • 2SeZiaa Yea.^s k.aCie.^ Medi a.^. Inco©e In School Per Houeehold lQ6lJ 1960 19?0 i25-0 1960 197-0 1-05-0 12~-o lo'~ 6694 377 4.8 5.6• 7.5 4.4 4.3 :.: 1707 75 7.6 8.4 9.1 2.9 2.8 ?.: 2491 3940 6399 9.0 9.0 8.7 2.8 2.5 2.L Residance .. Di':e.^e.nt Hcuae, Maved, Reside=e P-ev. P:ve Same F.cuee Seme 3r"5A IYif !e^ent S?+SA Not Reoo:-tec Yea..-s +1250 1050 T0 +12~.O 14 0 1970 +1250 2060 1970 +1250 14''O 1'--~ lrglo f a * * * * * * * * * t La ~ia ar. * * No ~e 78.6 4-".0 To s.al 73.3 43.8 fi~.se C~r.: e: Oc c~.~ . 35 . 4 N.rs. : ieo' 66.5 loye1- En.- 56.0 , 36.4 * * 38.1 20.7 * * ~ .. 47.4 16.8 44 .5 37.5 3.2 7.6 6.3 1.4 3.9 E.: 46.1 18.8 40.2 34.8 5.8 12.0 11.6 2.1 4.0 ", .; Percent 1 J I .~~ 34.1 31. o 62.1 56.6 54.4 55.6 b^. g' o . . i.,a•`_m L--. N^n te '.'``~ V :~: ^>r~es •'- P.r-e t+c Ra -.e Nc. Ft a-e 5070 929.21 6Y- 1'-5^cs . 52 3015 12, 09.12 8779 105~ -: 1 :'E :-": v 4555 922 .06 901 146_.66 3:32 13 57.22 8533 - S:c;,e 0.1-q 2-.39 3.77 3.`v Hner-' ~~%-: 1930 3~ . 3° 15? -365.05 874 4. 5.16 " 2~~ 1 ~ z2.-= 19ry~i 2032 3$1.29 266 544.92 1094 51 4 . )..1 '3y2 43i •- Slope 2.93 1-' .05 7.92 4.6° S:-roke 195 ;-5- c59 101.16 :39 9$.05 1 70-61 04 19~65-%9 ~69 85.79 63 121.05 3~3 1 60.78 870 S_ope -0.5: 1.74 -0.36 -0.16 Cancer 195~-^-5- 843 1500.26 76 152.58 379 1 72.28 1298 158. - 19r5-69 776 153.50 136 250.69 483 2 20.37 13?5 16: .- Slope 0.08 6.64 2.72 ~ J.1 ?te! ` 1?T--:- 4:~ 72 . 93 92 149.79 243 1 03.04 741 e~ = ~. 52 1 10{ . R vc 'v 97 163.74 314 12 8.26 932 12C . S'_o7 e 1.7; 0.74 1.00 ,,6n -- F'.E._' r . Re s 7 ~ 195~.-j- 12p- 22.48 10 17.56 38 17.96 176 21._; ~--- ' 9-6) 5-69 212 41.83 26 50.79 108 4 9.21 346 4'' - , . _' ~ S'.ope 1.32 2.10 1.91+ 1.55 Papulatioa Danaity *t:ot Avadlable % Dec.^ee.se +Reside :ce i,: 19~'~p..60 _14.3 **lvr :idble :or ~. ~~. 196,:-70 -12.4 0:`.7 ." L:."^`I RA -'" .'"=- CONFIDENTIAL: MINNESOTA ~ L ~ Ct TOBACCO LITIGATION C) 3"
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MTICK 3 Pop~:let:on A =1 o 57,816 86.8 60,208 80.3 63,182 80.8 wdSer. Are Im ,00 1970 Acb1o 28.8 30.6 30.7 i~ . G~ 19t5 NON-DlaSEfdINAT1uh IN ROGERS AND DUKE CASES. 7,256 10.9 1,511 2.3 12,369 16.5 2,372 3.2 12,309 15.8 2,656 3.4 Wd1nn Ir.ca-,e 1.2~0 1 14T0 ltdicn 7c.rj In SC1~OOi 1~^A ' ~n0 L222- Latin A n. 20.1 19.5 19.5 * 4071 7973 4.2 ' 5.9 8.8 X o,-vhit* 27.4 22.7 25.8 * 3072 4787 6.0 7.8 8.5 Tct_&1 27.9 28.3 28.5 3723 5988 8094 10.7 10.3 10.2 ReolCence Prev. Tive Yca-c 4, A rz1 c Dif!erent House, Sare H"e Ssx S1:.'A DL•J'e=c^t S1t;a + oC~ i c 1Q7C +1 ,~C 1~r7 ` ri•i7 * * * * * * * * * Lat_n Am. * F.'on-Vhite 74.7 T v: a'_ 68.7 Total+-* 8.-x:se O6mer 0ccup. ?+.a.--r: ed F2~ :oyed * 38.5 * * 35.6 * * 19.1 26.7 44.2 20.5 48.3 39.5 2.6 •21.4 7.0 48.3 46.9 20.9 33.3 29.5 9.0 16.0 16.9 Percent 1C`Z 1960 1970 57.5 59.2 50.4 75.9 72.1 66.3 54.6 56.3 59.9 Populatioa Deneity % L^.crease 195,~660 12.6 1960-70 4.3 143t'~'•AL=7C FwTES Anrz1o A' 1 Ceuses Iio. Ret! 15r50-54 1565 769.78 1965-69 2147 809.10 Slope 3.43 Hec^ 195J-5L 557 307.55 19E5-69 855 337.07 Slope 2.63 Stroke 195~-54 19b5-69 Slope Ca ^^cr 195-" -56 1965-69 Slope 152 84.49 218 90.08 0.21 274 139.18 426 158.59 1.25 95 46.11 256 94.23 3.11 34 16.40 120 43.63 1.84 Latin Am. No. Rotc T2t;b 87.32 394 1127.99 10.22 56 329.63 107 420.73 8.41 19 93.06 31 . 114.31 -0.28 37 171.75 63 200.69 3.38 30 101.56 32 88.42 -1.14 3 14.38 7 26.12 1.03 36 568.81 40 473.41 -9.52 7 122.53 13 165.16 2.95 17 268.94 11 132.60 -8.02 11 155.32 14 154.05 0.51 2 23.81 5 62.36 2.96 , '•`at..l 66,583 100.0 74,949 100.0 :'u,147 100.0 itt:an Persoc:e Pe- Rabel:old 1250 lrlt7 1 L * * * 4.2 4.3 3,6 3.0 3.2 2.^ 3.1 2.8 2.6 •Tiot 1va11a,+.,le +Reaideace '.n_1gi:; **Jiva'rlable :or on? 7 '^crta: No. Rate 1T50 820.52 2654 857.46 • 3.27 649 316.10 1002 3.47.52 2:80 178 86.57 262 94.48 0.23 328 145.67 500 162.41 1.24 136 54.81 302 95.82 2.65 39 16.24 132 42.21 1.79 CTR 52 4 i fion-Vhitc No. Re;;o 11T 1707.27 '113 1188.40 -37.95 CONF1bENTlAL: MINNESOTA ` TOBACCO LITIGATION t-~~ C T ~?5 H U4 ~~ (31 '1 16
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;Ttr T 1 Ckt ~ Ili RJGEP,S AND UKE Cf,S;S. Populat Son A na, 1 0 Latin Am. Aon-4ll:lte Totel 1950 1960 1970 16,523 9!D•7 45,220 97.6 92,671 95.1 365 2.1 929 2.0 3,968 4.1 207 166 836 1.2 .k .8 17,095 100.0 46,315 1n0.0 97,475 100.0 >;cdian 7esra 1•iedian Peraona hediaa A¢e }led:an Inco= In School Per Rouaeho2d 12 50 1960 1970 1.25 0 f0 1.2~0 12LO 1950 1960 ITC) Aag1o , 26.0 2 . 25.0 - a a a a a a a a a Ltin Am. 21.0 21.9 19.5 a a 11882 a a 12.4 a a 3.7 -wb ite Eo 6 28 8 23 8 29 a a a a a • a a „ n Tota1 . . 25.9 24.4 . 24.8 3089 7292 12125 11.5 12.0 12.6 3.2 3.4 Betideace Di!'terent Hauae, lb.cd, Reaidence P-e.. Tire 8arx House 8are tf AS .: DL'Ye^eat 9WA 21ot Revcm-tea ee :-s 1950 1920 1 0 1950 1260 19170 12~O 1 .1!~70 1950 ' 1 19?G A ngl o • a a a a a a a a a a . Latin Aa. a a 30.0 a a 39,4 a a c6,4 a a 4.2 Ron-Vhite a a a a a a a a a a a a To,,.a1 65.5 35-0 36-8 18.3 40.6 31.3 14.7 23.2 27.6 1.5 1.2 4,3 Tota'.** I 050 fia,:a e Owne.^ oc c^,ip . 79.1 Ma.-ried 73.4 Ft-'1oyed 45.0 *Not d^a:1at'_e +Reeidance 's 194; +*bva~l ab1e !ar :,o z . on:y A na1o Latin Ar. Son-ithite Total A' Caueee Bo. Rate Po. Rate No. Rate No. Rate ~ ' 1950-54 309 531-97 12 723.61 7 17T+1.23 4 ~27 5 uo 503.24 1965-69 1 44 494.98 28 1010.12 1.182 504.83 - Slope -4.27 -3•02 -80.63 -k. 61 Een-: . 195G-5u 95 2-'1.68 2 220.23 1 h01-83 98 2_3.3F 19E5-69 411 212.41 15 202.97 9 371-.00 ~:35 2__.5 s lope -1,93 3-9'T -2b.11+ -2.09 st-^:~e 195~-54 29 62.11 0 0 0 0 29 6C.3L .1965-b9 94 52.62 3 55•68 4 i8o.oc 101 53•32 Slope -o. 98 3.27 9•9e -0.85 anCeT 1950-5)' 62 109•90 0 0 1 343•01 63 10E.32 1965-69 21+8 10 7 .68 5 56.21 u 151.79 25-t 106.0; Slope 0.25 6.59 -8. 52 0.33*+* A'? Rest. -._ 195 18 32.86 3 186.L5 1 202.97 22 36.6: 19c5-69 129 60•37 3 33-L8 k 145,06 136 59•75 Slope 1.99 -2.32 2.63 1.89 M&_!a. Reep. 1 95,~ -54 9 16.80 0 0 0 0 9 16.3= 1965-69 76 34.61 1 10.52 3 122.03 80 3L,2t Slope 1.25 2.08 6.73 ,_,28 +•-•63-6L 116.5E C T R Pe^ceat 1 0 19170 Population DenBity 85•4 65.7 % Inc..~eaae 80.5 71.3 195C'-60 . 170.9 69.5 63.9 196C.-70 110.5 KamI. "^.' RAT'Es 529~ CONFtDENTIAL: IdINN ESOTA ~ TOBACCO LITIGATION ...yr -y
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THIS DOCUMENT SUBIE;,T TO A'.l^ " !~CLfLVN 5 ISE" Njh-DISSE'.SiNAT iG;i Population Aa$lo Latin A.:.. IN Non-White RuGERS AND DUKE CtiSFS, TotaT- 1950 5,269 58.3 - - 3,769 41.7 9,038 1oc.0 1960 1970 31,472 50,808 55.1 53.4 666 1,038 1.2 1.1 24,940 43.7 43,327 45.5 57,078. 100.0 95,173 100.0 tiedian AAe ?Set~ ia•a Income ?Sedian Years In School Kcdian 4crsoc:, Per fivuwnho:d ~.~ ~~ ~Q 1950 1960 1970 1950 1960 1970 1950 1950 1970 Aag1.o 27.6 23.2 23.6 +r . w ,~ s< * _ * ~ * Latin Aa. * 22.4 22.3 +~ * 10232 + +t 11.2 . ~ 4,5 23on-Llhi te 25.9 21.2 24.4 2181 4290 8992 7.0 10.4 12.0 2.8 3.8 3.7 ?otal 27.0 22.5 23.9 2852 5'T31 10154 9.3 11.2 11.7 3.0 3.6 3.6 Ra s idsce Diffsrent Bousa, hav+cd, Raaid.eacc PraV. Fire Sa..^~e Eiwae Same S?53 111,tirrnf cvCA ..p.+ !+nr A•;.. Yaars : +1950 1960 1970 +1950 1960 1970 +1250 ,,960 1970 _ „- +1950 1960 1970 Aaglo ~t a * * s * • * * w Latin Aa. * * 25.4 * • 1f 43.2 ~ * 25.3 * * 6.~ }ion-Yhite 74.7 44.7 43.1 21.5 44.4 39.1 3.2 8.2 9.4 .6 2.7 8.L ;otal 75.1 39.2 43.7 18.2 4o.0 34.9 5.1 18.5 13.9 1.6 2.3 7.; Percent :bta, *+ 1 or,0 1 0 Population Dena. , *l:ot Ava'_ :ab:.e cc-.:5 e Owne r Occup. 70.0 87.2 80.6 % Inc.-eaae +Reeidence in 19.''0 r'.a..--~-i ed 75.9 79•0 68.3 1950-60 531.6 **&vailable :-:~ loyeV 55.0 59.7 65.2 1960-70 66.7 only " MRTALI'. Y TtATE S An.glo Iatin 1=. Non-White Tota: All Causes ao. . RAte ?30 . B.A te tio. Ra' 2 • t:o. Rnte 1950-54 132 467•91 4 ' 1062 .30 173 68 • 309 570.0, 1965-69 762 650.39 57 2109.61 1049 983.22 186-: 8~9.w Slope 11.90 112.6.4 22.13 16.9:: Heart 1950-54 35 14-4.7$ 0 0 49 2 3;.76 84 18L . 3 ~ 1965-69 262 276.99 14 9:=+.96 35i+ 3 97.14 630 3~x .K 9 Slope 8.03 66.06 ' . 11.68 1p,1c S t rolce 1950-54 17 78.85 0 0 17 79.69 34 80.3 ~ 1965-69 56 65.38 0 0 128 1 47.19 164 102.1 7 Slope -0.39 4.7? 1.96 Cancer 1950-54 22 87.14 0 0 24 1 17.64 46 100.'. 3 1965-69 176 153.31 ' 10 403.82 176 1 76.43 362 165.5 9 Slope 4.16 23.31 4.63 4.46 All Reep. 19;0-54 5 18.9o 2 478.62 10 35.52 17 3C.2 • 1965-69 93 89.84 8 402.80 73 70.12 174 82.9 C S1oQe 3.42 9.22 3.14 3•2-2 V.iliR. 1950-54 1 2.27 0 0 0 0 1 1.2 0 1965-69 57 54.7 ~ 3' 124.83 27 26.66 87 42.0 5 S lope 2.60 6.43 1.57 C T R 5249 ,CONP1D.n.NT1AL: N,INNE50TA ",TOBACCO LITIGATION E ° `I PP1,1W 11111 UL4 ~`.) 0 3
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THIS DOCUMENT SUBIECCT TO ti!ir3, ?n 1985 V nf~ ~ • 6 Ih R'uGEk~ AhD DUY,E t:C~ P l Letin An. tic -~? 'tc - '*:tel Cfi..t a '- 950 ~ 3~- * 4 29,799 40.0 7L,k92 100.0 ly6L9,1 1970 j:2,: 3,156 3.7 2,898 3.3 32,624 43,340 38.1 49.0 85,518 88,355 100.0 100.0 - ~ h }ie;'ian Incczr •lt~diar. Yearr In School ercna Hed!s 1 T Pa: HoL'setiold 770 14"50 10 1g0 1970 1'K~: 1w 0 ~ 470 1y0 1~~ l S O Arglo 4. 30. 3.1 w . . . . . . w . Lat in A c. Kon-v;i•,.e Tacal 26.9.8.7 •4333 TN6 29.1'5:6 1595 3002 6891 30.0:8.6 3247 5252 7250 • ' 8.5 S.o 9.4 10.7 10.7 10.2 10.9 io.6 . . 3.0 2 9 2.8 2.7 3.6 2.8 2.14 Residence Dif.e"&. poLse, Mwed, Reside^te Prtv Five Sa Sa-e D1'!s!--ent Sit:; 17ot Rer.c..-~ted . Years +1q5J Z0 •.1950 1~L 1070 lO : t . k, Letin Am, • 4.7 . * 41,.7 * * 23.1 # +~ 7.5 ron=h.:te 75•7 2.3 18.0 L8.5 40.6 4.8 14.3 11.4 1.5 3•1 15.7 TotL,i 68.2 0.1 21..5 36.8 34.1 7.9 16.6 15.1 2.4 2.6 10.7 tle:'Ce^.t Total~ I 10'l0 Popu].at;-ion Dersity *2.'0 -. 1Sailable Fo,:a e Wna: Oc c..;, . 45.3 7-*. 0 % Iacre as e +Re a. danc e in 194p Mar= 1ed 66.6 57.4 1950-60 14.8 *-K A:-a4lable Sor tot~ F2:ployed 58 7 t 1960-70 59 3.3 o;,. :. y . . NM^.AL':"Y FJ.2IS Aru Lstia A=. Ko^ k':ate Tctal .' Ca-uses l n c- . Rate N c ro. Rate 17c. Re: _= . . ...__. 1 y;J-54 1565-6 9 r47 1891. 28 1208.19 158 2369.63 1346 1119•54 1746 1185.88 2612 913.48 3798 991.78 Slcpe 3.4; 66.53 4,63 ' . 5•75 UeCrt ~ 15~F0-54 501 8 595. 59 396 361.50 905 315.8r 14~5-69 769 36 870.39 , 633 483•37 1438 393.19 Slope 3•: 10.24 8.12 5•2;4 St:-o'xe 1950-54 13t+ 0 0 178 1'R.30 312 1.2.16 ' 9t, 5-6 9 201 10 179.25 187 1k7.78 398 111.68 Slope 0.6 10.37 -1.16 0.15 CaMer 1950-54 270 3 124.61 168 143•L9 4-41 1k4.35 1516 5-69 382 : 24 500.82 242 173.32 648 169.63 Sicpe 1.5 23.65 2.39 2.04 A 195~-54 101 3 112 •33 l06 81.87 210 65.73 1 t-.~5-d9 231 20 31L.35 1t+7 97.34 3 lo3•Cn 1 ~iope 2.71 10.51 0.95 2.32 48 1 L8. 5 L' 15 12.70 64 20.53 ~ ;.;5-c9 125 5 101.02 ~ 31.86 171+ 1+5.48 :i'-c;R 1.71 1.32 1.50 1.65 I CONFIDENTIAL: MINNESOTA ' TOBACCO LITIGATION C T R 5250 U "` : ~~~ VIN00 31~c-2'
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lr"~ u.;_. .,. __. _ . 57:Al'IUN 19E5 NUN -UiSSEt,ti,;,;,iiun ;~ 7 IN ROGERS ANO DUKE Population Iln^lo l.atin /--. Non-White Total 1950 53,106 1960 42,054 1970 25,659 91.9 63.4 35.0 + 1,426 736 +~ 2.2 1.0 4,658 8.1 22,838 34.4 46,841 64.0 57,764 100.0 66,318 100.0 73,236 100.0 Medien ARe Kedian Income . liadian Ye.ars In School LSadian Parsoas Per EouseholC I950 1960 1970 1950 I960 1970 1950 1950 1970 1950 1960 1970 Anglo 34 -2 35•3 37.4 Latia Aa. +~ 22.4 22.2 6763 * +~ 10.4 2.9 2Soa-tJh.ita 31.9 26.7 28.1 18?9 40'37 6748 7.5 11.0 11.4 2.4 2.9 2.6 Zbti.1 34.0 . 31.3 30.8 36>3 5747 7600 12.0 11.8 12.0 2.6 2.3 2.1 Rasidenuca Differtut House, ?Saved, Rasidence Prav. Fiva Same Houte Same SMSA T)-( ser-T.,,,,t n_ .c., u., .¢o--00 urs h +1950 1960 1970 Y +1950 1960 1970 +1950 1960 1970 +1950 1960 1970 _ Aaglo * * ~ A * * ~t * * * * * Latin Am. +~ * 17•5 ~ ~ 26.4 * * 49.1 ~ * 7.0 T.on-te 69.8 26.5 37.3 24.6 54.3 37.2 4.9 15.0 12.0 .7 4.2 13.5 :ota1 64.6 36.1 35.1 22.2 37.0 33.1 10.0 23.0 19.6 3.2 3.9 12.2 Peme^` v ~ ~ +# 1 1 1 m0 Population Density **iot tvailab',e F3cus e Owne r Oc c,.zp. ~9 . 6 3 27.7 % Iacz'a aa e +RB e i deac e:__^ f~;9 Ma--:-ied Flpioyed 67.7 59.6 54.3 195o..60 14.8 57.8 58.2 65.3 1960-70 10.4 #-*Ava_lab1e 'o- ..-e~. crly AnR1o MD FZAL ZTY MT:: S Latin An. Non-Uhite Total All Cavices No. Fute No. Rate No. Rate •?30. Rate 1950-54 2232 8t0,28 27 4345.77 1026.54 2553 872.22 1965-69 1921 851.16 56 2542.97 1290 865.00 3267 901.12 Slope 2.63 -115.59 -11.85 • 3.37 fiea^t 1950-5=. 1965-69 921 333.45 804 318.12 5 1157.58 16 86-;.P1 85 386 347.21 303.93~ 10l1 12Jr ~2 3"7 . i i •.327.7L Slope 0.16 -9.4= -3.82 0•32 Stroke 1950-54 274 100.33 3 576.24 39 149.45 316 106.88 1965-69 235 86.61 6 429.69 129 107.71 370 99.75 Slope -0.72 -36.45 -2.21 -0.34 Cineer 1950-54 390 141.12 , 3 462.4o 51 158.06 4.w» 145.70 1965-69 . 3:;5 153.56 6 3-16.55 169 123.31 520 143.5. Slopa 1.20 8.24 -.2.57 0.34 ~ All ReaP. 1950-54 142 51.72 3 445.79 18 59.76 163 54.25 1965-69 1r.~- 87.29 3 180.72 130 84.42 328 91 `~ ... L . Slope 2,30 R 0.R 1.87 2.41 Rp.sp. ~ 1950-5~ 6;, 2'• .25 1 110.65 2 5.06 63 20.3f r-- :965-69 84 37.52 1 83.14 43 30.97 128 35.5a v 5:ope 0.95 1.74 1.50 0.88 CONFIJGNTlAL: MINNESOTA ., TOBACCO LITIGATION C I R M-4 ~~ ~~ ~ ~ ~r ~
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: ~ n) lUN 0, 1~ h"-DISSEr'1Nti110h 1N OGERS ANp UKE C~S;S• Yopula:ion P.u:1 o Ara. 1_nn-3rii tr TotRl 19 91 ~5,34~ 99:4 _ 275 .6 _ _ 619 10: o 1960 72,66=. 43.6 759 1.0 290 .4 73,713 100 0 i970 7y,8S2 G7.~ "-, .9 836 1.2 . 76,524 100.0 Y..:di.ai: Year^ ;•!iuian Fertons _ ~todiAi: P..i~' . __j%:dijn 1ncAmwo 11 ~ C!lo~ ~ p~i ItOu;::ho 1'i 1950 146V 1970 _ _ _ 1y5U 15~c~ 1970 195i1 196U _ 7 970 1950 19GIi 197 Ant lo ~- - ~ --~- ~- --~-- 31.7 33.? 32.9 0 -~- -~F- -~-- -9C-- " t:u Am. - 19.8 19.8 * * 11969 * * 13.6 ~ Non-White 37.2 35•8 35•5 2.8 'Total 31.7 33.3 32.8 4979 9628 12222 12.6 13.0 13.0 3.2 2.9 2.3 Residence Diffcrca: llouse, Moveri l;asidcn:L~ °rev. Five S:c.a• Ilo„sc Sz,;c: S;:SA , _ _ Years +1y;0 1960 1970 ;-195u 1)~J 19)0 +1950 1960 1970 +1950 1960 1570 M[;lu -* * -~ -x -~--- --1 - -'IF-- --,r-- Latin Am. * ~ 35.7 ~ ~ 26.3 * ~ 341 .8 * ~ 3 . 2 n-Wni te 78.0 * * 16.8 * * 4.6 * . * .6 * * :ota1 67.1 49.1 51.9 20.4 28.7 24.7 9.8 21.2 18.8 2.7 1.0 4.6 Percent 3 160 1970 Population Density *Not Available Total*-* i ~ sidence in ~,~t +R O 0 ccu 77.3 80•1 66.5 % Increase e ~ .-mer 13ouse Married r.-~.:p1oye~- p. 76.8 71.2 53.0 56.4 64.9 1950-60 59.8 i96o-70 61.6 3.8 a'_ *-*Availab-_e for only 1Ji.?,N?.:TY l'.f1T. E.°, `Ang1o Ton-l.'nite Tot L1 All Causes No. . ?;,2 ce _Ratc _ NG. k,; n t:o. Rate 1950-54 1267 665.90 15 3670.94 13 1~;71 .49 12i5 viJ.v. 1965-69 2754 851.65 35 ?3?1.76 16 677 .42 2305 857 Slope 12.81 -3': . L 4 -','9.0: 12.49 }ieart 1950-54 510 286.L4 3 1046.01 5 552 .81 51~ 2K . c 1965-69 1195 379.46 14 1':20.76 5 265 .75 1214 331 " Slope 6.55 213 .:5 -2:.46 16 .54 Stro'xe 1950-54 128 76.71 1 223.70 2 381 .52 '-3= 7 1965-69 282 5'o.1_ 1 89.30 4 203 .72 2S7 9~. Slopc 1.51 -23 1 E -1 5.39 1.;, j Cencc.r 1y50-S4 249 12J.73 3 806.77 5 253 .>2 257 12 ~ - 1965-69 669 196.93 i0 76S.88 2 53 . ~04 681 19S.--:, Slope 4.68 -9.21 4 . ~7 ~., . ., ~ 7,11 Rer2 . . i950-54 62 32.46 2 217.96 0 0 6': ,~ . ; , ~ ;_ _ : 19!,`-G5 257 75.72 2 9).27 1 38. 8~; 260 . 75. ~ 2.78 6.8; 2.66 2.75 ~ ' 35 17.oS 0 0 0 0 35 ~- 16 . ~'J 19-- 5-6;' 148 41.82 0 0 1 3S . 8'~ 14.) U 1:1. 63 51opt+ 1.57 3•66 1.55 CONFIDENTIAL: IdINNESOTA 70BACCU L1Tl(iATION CTF`Mutil 0(x-ile-t,,,,
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15Z5 NON-DISSEf.:1t,kTIOh ORD'.P, b'I,\iiON 9 IN ROGERS AND DUKE CASES, PopalatioD Ant1o Lat in Am. Non-Vhite T~•tal 1950 2,161 1960 37,449 71.9 90•1+ 4,545 3.7 845 2,456 28.1 5-9 3,006 100.0 41,450 100.0 1970 134,909 87.2 16,423 10:6 3,375 2.2 154.7c7 10c.0 • lSedian Yaars i'.edian Porsoas ?Sedian ARe !'.edian Income In bchool Per Kouseho?d 1950 j960 1970 1950 1960 1970 1950 1960 1970 1950 1960 1970 Anglo 30.8 23.7 24.9 l.at in Am. * 17 .3 17•3 ~ * 12179 +~ 2.2 13.5 * ~ 3.7 e+ion-vhite -Z3.9 21.2 25.9 • 3795 5676 +~ 9.3 8.4 2.7 3 •L 3.2 ?ot.a1 2$.1 23.2 23.8 3245 8525 14885 10.5 12.8 13.6 3.2 3.7 3•4 p.eaid.nc. Different liousa, Prrv. Pive Saue Rouse Sa= S`SA n~~fwr ~e ~!S,1 Moved, Reliderue M-9• pp•2Qr-p•1 )'ears ~ +1950 1960 1970 +1950 1960 1970 +1950 1960 1970 ;1950 1960 1970 Aagle s a< * . . * ~ a Latit Aa. +~ + 28.0 • * ^24:8 • * 44.2 * * 3.0 Non-White 7'8.9 62.9 61.4 15.8 28.0 27.0 4.3 7.4 9.1 1.0 1.,^ 2.5 Total 64.5 28.0 33.3 24.1 39.0 29.2 9.7 31.8 32.8- 1.7 1.2 4.7 'lbta' ** &uee 0irnsr 2+.a.- :-i ed F=ployed Pe:-ce^.t 50 t 1 0 Po~lation Dnnait's 0c cup . 67 . 6 89•1 a. 2 % 7nc.--e aa e 77.9 82.8 7-,.4 1950_60 1278.9 52.2 58.7 6».8 1960-70 273.2 *i:ot lva'.rab:e +Raeideace +f+tlvailable :os tat,a:. ory; 2iDFQALITY RA."'ES Ang1o IAtim Am. Non-White Total All Causes l3o. • Rite 2io. Rat e 240. Rate No . RB t e 1950-54 89 482.06 5 554- 99 35 718.55 12 9 501.31 1965-69 1625 607.70 50 475- 56 118 867.28 1 7 93 602-88 Slopn 2.37 -6.12 2.24 -0•9~ liear• 1950-54 25 174.80 3 474. 97 9 243.67 37 1~ .3`- 1965-69 5'(8 247.64 1~ 170. 07 36 28v.22 6 28 2L 'r •r. Slope 2.66 -16.62 0.84 G.'c Stroke 1950-54 9 58.84 0 0 5 132.56 14 67 • 7:. 1965-69 145 67.51 6 96. 02 13 110.9•5 1 64 70•13 Slope 1.58 3•78 -1.11 0.66 ~ Cancer 1950-54 19 122.03 0 0 2 41,71 21 10'.83 1965-69 401' 150.9=: 7 46. 52 24 190.27 4 32 1L6.5~ Slope 2.08 ' 3.09 7.98 3•06 A1l R.eso. L . 1950-54 7 40.90 1 40. 01 3 43,17 11 37.4$ L 1y65-69 145 59•96 3 54. 98 10 57.12 1 . 58 5c•r~ ^~ S1oYe 1.29 2.23 -0.47 1,2: Malir,, RtSp. ~ 1950-54 3 15.65 0 , 0 1 19.14 4 1-1.a9 ~-- 19G5-69 82 32.47 2 28 .34 2 15.82 86 30-19 U Slope 1.53 2.24 -0.24 ~FiNfGtSO ~'>G 77 CONFIDENTIAL: MINNESOTA TpBACCO LITIGATION 3 1 ';-~ c:' ~ ` r 0 0
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N01.LVOLL1'I 000v90.b V.LOS3NNIW :7V11.N3a13NOJ ~ c9'0 o9•t 66'1t LL'0 adoj S -~ zo'SZ 8a LS'9z ~ LZ'~SZ 9 LS'LZ 601 69-S95T ~ ?~•9t 6c 0 0 0 0 Z7'Lt ~ti 7S-C(:6T ca,4 FTri ~ zS' t hL'9 Y6•tZ rZ't ;?doiS .: ZZ'5Tt t: OL•ZLC Ot Lc•C9 :.ZZ 69-S9GT 96 L8'91C S 0 0 06'zi- t6 '7i-OS6T •asay Ily E6•0 5z•Sz- • Y6'o a-doT S . = L . -~..'.5 tt a So•Sc9 et 69-596! ..L•yZZ 9~Z C4•SZt tt C9•Lt6 c z~•Szt zLz '7S-OS6 : ia-3 uz:) 65'0 Lt'tt Z9'80;- CL'0 --%d oTS s' COL +r~ '.9'CSt ht ZZ'tLt 9 L t ' 96 *9c 69-S96i .. , C- 6 'SYt ~t tt''sGZ Ot gl.' 9g 5i.t tiS-0S6t ~~7S L6•ot '9'=~S CS ~9•LC- ~•ocg ~ 7LZ OL' -1 OO' Lz L `J' ZZt *dot S 69-596t tZ' fity LC . Tttz ZZ 0t•r-6Z Zr9 •,K-0S6t u"R ~z•z zz•8 6T'z9t- -adoIS ~?60t 80t S~•Stzz 5L 99 '9LL SLnZ 69-S96i L99t r0' `r40t ZOt Re •-9SS C~ 9CL ~L~t 'rS-0S6I aa" •o.I • 04" •oN aasg •oi1 a1rt~ ' 'o;~ oa-aas0 ITY Iv:oZ a4TM-a oli 'a! IITjB'I oT ay S3m kLITmW S~o S • CC 0L-o56 t L'S9 z•65 • S a:- tra.19#r 6 6 ~ 6•zZ c9-oc,6L Z'SS Z' * g 9 L'0L 7 .~ • a xvpT fl v~s* awea=na J; ` 0• L Z L• S £• trS • drzop .: amm0 a vrrv -~;~aQ uoT~vtnCod OL6 L ;.z:ao.:ad •:'9 9•z S•t S•9Z 6'6t 5•8 9•~ Z'zE L'oZ Z'~ t'S+r C'69 I*~a.~ 5''= 7'C tl•t 8•S C'8 L'tl 9•Ctt C'CS t•0Z L•Lf 8'Lf 8'U azTqn-UOti t' 8 * s S' 6~ n * 6' L~ ~. * S' ttt +~ w '~Y IIT3ri * * * ~r +t * * ~r +. * ir * otfty OL6I 096T OS61t UL6T C96T CS6T+ OL6I 096I OS6I+ OL6T 0961 0S6I+ Y r • , ss..4 rl$'Kg xss ablaoR a:cs5 aaT j•eud oauaPT~aZi 'PVAa3t `amag Zuaz.;3TQ ;Mpug PTood 5't C'z 6'Z £•Ct o•C'C S•Z•t 966Ct 6YLot LL9tr 9•+K S'Sc 8'Z£ t*3aZ 9'z 7•Z. S•Z 6•8 6'8 ,~ 6K~ h'rLZ ~ L'LZ . L•SZ L'0C nzqa-=V t' zT £ • L * CSZ6 6•zZ t•zz - •MF UTI*'i ,. . ' ,. ~. ,. . . ~. * t•SC VX 6•z,C a'itw 0461 0961 OS6I 0461 096T CS6T 0461 096t 0S6T OL6t 09-~6 RUT PIoSasno}; isd tooqjS aI aaooal mrTpa3d M pTPW}i suoYiaa uTTP*H azsax usTPaK . .: •'.;Ot tCS' C1. fl' ~ SOS' Z 0' Z 9'*6 gG '69 0461 c•co~ s3to'SS S•+, gSn'z t•z L9t't tt • O CZtt' tS 0961 C•'JOt Z8='}rn 8•S L eS'z Z•'r6 LCZ'Ztt 0161 I-4o.l azTyLm:-uoN •=l a T:a'I oTaaY aoT3itndod `'::°.~,%: VI 01 "0T T.V 1S
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BmTIQF 11 Populrtioo Ana1o Latin Am. lfon-u*ite 1950 16,821 79.0 100 .5 4,362 20.5 1960 71,819 84.3 1,455 1.7 11,894 14.0 1970 119,948 86.4 2.396 1. 7 16 ,t~ 11.9 1N S U'~ ;fii SL:.1 :,, 1~ I~v~i' (JiJ~E~ I~,hZIJ~r Or L:n IN ROGERS ANC DUY,E CASES. Total 2:,283 100.0 85,163 100.0 138,808 100.0 liedian A Mledian Incame •}bC i a n 7e ars In 8chool Ncd i.a n Pers o os Pe-- 8ousehold ~J /0 1.2~0 1°` l0 }QL 1260 1270 Aag1o Latin Ac. 27.1 15.4 24.4 20.2 24.3 20.3 * * * * * 11660 * * * * * 12.1 * * • * * 3•9 !(oa-Vhite 26.5 21.8 22.1 1235 3481 6258 6.9 7.9 9.2 2.8 4.2 3.7 * &I'al 26.9 23.9 23.9 3280 6712. 11045 9.9 11.1 11.7 3.2 3.6 3•L Re.ie.xe Dit':ez+at House, )bwsd, Residexe Prev. Tiw 8ame Hovse Sa.me 8)'SA DL'!e-etrt 8NS4 Not Re= teC 7ears 4 + 012~O 1970 +12~O 1 oC 1 70 +_ 0 1 ~+1 0~ 19 C Angl.o . * * * , s * * * * * * * Latin An. * * 40.2 * * 32.3 * * 23.6 * * 3.; aoQ-vh:te 79.6 Tatil 74.3 26.2 39.0 's'b tal ** 1pc,0 - Souae Ow~a Occ.za . 7u 1 Ma,.-~-ie3 78 •7 E=P1oyed 52.0 64.0 17.5 59.5 27.0 2.0 10.2 3.5 .9 4.1 ~= 4{.1 19.4 39.7 29.0 4.8 19.8 20.1 1.5 1.5 4.E PeTMeat 104,0 1070 .4 72 77.9 71.0 57.7 64.4 P0Pu2a'.;-:= Deneity *l.ot lvai? able ~ 9=9 x Inr.reaae +Raeidenee in 1 9°j4-.b0 300 .1 **.kva:1 abi e: o r~rr:: 1960-70 63.0 only ' WaMLSI Y RAM A ns ! 0 Latin A A n llon-White Total A11 Caueee 2(o. Ratt Ho. Rat e bc. Rate Bo. Rate 1950-5~4 448 579•75 16 164 4.51 229 W.53 693 635 1965-69 1932 814.39 6: 128 6.50 6L3 1089.74 2636 856.6: Slope 16 . 36 -4..69 '.04 • '-3•35 Beart 1950-54 137 22~.''3 12 1. 06 3 4 1965-69 710 347.63 16 50 5, 2~ , 3•48 ., 966 3v:•52 S lope 8 . 9_ 29.99 7.46 6.36 Si•.Toke 1950-54 32 56.83 4 57 4•95 1~ 76.25 55 61 . 7= 1965-69 178 95 .51 4 11 3 .34 85 160.03 267 Slope 3. 37 -51.96 3.45 3.17 Carre:- 4 1 0u 04 6 c : 6- 1950-54 70 6 -5. 1 7 2; 11 . 9. 1o 9 . 1965-69 440 183.74 13 ~3 7•1+8 103 179.49 556 18=.32 S l.ope 4 . 74 12.5. 3.28 4.49 All Reap. 1950-5L 32 37•37 17 9•04' 79•58 55 ~•9= .1965-b9 193 89•73 13 0.68 5~ 93.92 '257 86.6=- Slope 2 .67 7.31 0.75 2 .20 M-A-lia. Res_o. 1950-5- 9 10 .59 0 0.00 3 12.i3 12 11.32 1955-69 111 4,E . 9:: 3 8 :•33 2= 36.9R 135 46 ^5 Slope 2 .Or 9.09 1.81 2. 0L C T R XONAiDL'NTUL: MINNESOTA C I ~_ ~~IL ~ I, R,.,.~c Y~ ~.~ f-,, ~ ~ ~ TOBACCO LITIGATIO ~, € ~' N
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3^'~ iOtJ 12 19fi NO~~ t7lS~Giblhkllu„ ur, c IN ROGERS AND DUKE CASE.S, Lz.... .L- . No:, 1Wh~t te ?btai 1950 63,99" 76.9 858 1.1 16,239 20.0 81,091 100.0 195,^ 108,3~-5 77.4 6,000 4.3 25,624 18.3 140,019 100.0 19''0 150,1:7 76.2 8,362 4.2 38,582 19.6 197,061 100.0 Med.:an Years lSe:!:a:. Pe."o:.a Mec.'t &n lae Mec::an Incoae In School Per fibsaehold 1...2 .l9~t2 1,M S..Z 12~2 197 C) ~aQ`2Q 1~ ~Q 1~0 c~ 0 .tngl.o 26.3 26.3 25.7 * . ~ « .~ * Latsn L:. 19.7 18.8 18.3 + 4470 9126 + 6.5 9.5 4. 1; 4.0 Nca-W*.:.i•„e 25.8 22.6 23.6 1739 3296 5907 7.0 8.4 9.9 2.9 3•3 3.3 Zbt,el 26.2 25.3 24.9 2889 5147 8873 8.8 9.5 10.6 3.2 3.3 3.2 Reaidezce Dif:.:•aat &ua e , Maved, Reside•nce Five v P Same 3asee S ame S2~: A M_'!e:4--t SMSA N^•Reao:~e~' v . -e a Y " +=9=•J 1960 1970 +~=0~,0 1?50 ~0 +19=~0 }~ 1470 '- 14~^ ,0 0 +~ v ~ e - * . * .F ir ~ ~r a * laglo 1 : L + * 44.2 + +~ 32.0 + * 19.6 • * 4.2 at m . n Nor.-kh. re 76.4 53.7 57.5 17.6 36.9 31.2 2.8 7.8 4.4 1.2 1.6 6.9 Tota: 72.9 50.0 48.8 20.6 37.7 33.7 5.2 11.0 11.7 1.3 _.3 5.r Pe..-cent To "Iel" 1950 1960 0 PoDulation Density '"tiot Ava':Ll"ab':e F~o:ee O`raer 0cc%::P. 76.1 76.0 (;.2 % Inc..^e aa e +Ree:deace '-.:. 19•'»; -:-: e d M,a. 77.2 74.3 69.5 1953-60 102.2 *+FAva.ilable : C%.^ tat-a'. . E=p'.c-ed 53.5 55.0 60.7 196-3-70 20.2 O^.:1j M2:-c_.:..7.^Y RA... W /lrigl o Lat:a !m . Non-White ^rt~ 1 Cs:eee A2 Nc. Rate No. Rate No. Rate Nc ?E -1 1F~5 764 .81 66 130`:.04 690 981.12 2`»c E3:.2-z 1 5-67 416=~ 863. 36 250 1531.34 1389 L11.8 0 50~3 92~ Slope 4.G~ . -12.20 6.17 5.,' e _'~ ~' l cfj,_5. 624 3oC7.02 ~ 213 356.2 1 ~~., . ~., 8:~-o 195 5-6 > 153° 36 _ . 48 . 62 5~ .2 53: 483.6 c 38=.~- =' Slope 4.11 -8.85 9 .13 5 . _c St---.)'r.e 195%-54 175 8S .41 2 E2.43 81 133•5 6 258 5'•56 1965 69 412 97 •75 18 158.41 134 120.5 1 564 103.39 - Slope 0.36 3•56 -1. 44 0.04 Cmcer ` 19j~-: - 305 130 . 00 7 142.36 76 109.98 3K- 12 ..37 1965-69 799 165.81 33 23i.41 219 185.32 105'. Slope 1.61 1.95 4.71 2.~ :.1: Fea- 1 ~S 66 . 37 1c 9 173•10 56 70.2.4 223 Ct .2: , 4°3 103 •'-5 26 216.77 122 94.14 6»3 10-- .~c S:o; e 2.05 1.71 1.08 - ~i us' :r. P.e°= 1 c5;- c.. r~ . 2, $- 1 ~ 21.85 7 5•38 59 ~=:_~ lo ti~g v 216 ~:.8:) 8 57•70 34 27.7 5 25= Slope 1•41 1.57 1.24 1.41 CONFIDENTIAL: MMNESOTA ~~ ~TM~k ,r° ~ ~ '~21 C"',~ TOBACCO L[7iGArro ~' { ( "g l €.N
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SraTlc!r 13 population Anr1o 1950 ,'~ 1960 51,507 53•9 1970 50,649 39-8 l.ctin Am. 4,3e,z b.7 8,256 8.7 6,656 5.2 . . .. .. . . ~.... ,n ivi~ Vn.,~r. lti G R 1,tiD UKE CESES, Non-Wt:i te Total 10,317 21.0 49,093 100.0 35,747 37.L 95,540 100.0 70,010 55.0 127,315 100.0 ?Sedian Age Ned i an 1 n c oae Median Years ln School ?.edL.n Pcrtons Pe` liouatholc 1950 960 1970 1950 1960 1970 1950 1960 1970 1950 1960 1970 Aaglo 24.7 23.3 23 -1~ * * * * * * * ~ * Latin Aa. 17.9 17.2 17.2 * 3778 8115 3.7 4.2 7.1 4.7 4.8 4.4 P.on-L3i t. 24.4 21.2 21.4 * 3470 64-69 7.6 :7.7 10.0 3.1 3.5 3•1- ?ot.a.1 24.0 21.9 22.0 2520 4904 8787 8.4 9.0 10.4 3•3 3.5 3•J- D.asideace Different Aousc, lfoved, Raeide:,ce Prrv. Five Sar-.c Rouee Sa,c S^tSA n. ffd-r-t ~'_I_+c. - - $o• ~(!...~. .~ - Ysars 1 +1950 1960 1970 +1950 1960 1970 +1950 1960 1970 ;1950 , 1960 1970 A.:.g1o * * * * * * * * * * * * l.ati.n Am. * * 59.8 * * 27.6 * * 7.9 * * 4.7 lGoa-Vhi t.e 75.1 48.o 43.7 20.8 41.9 39.8 3.2 7.6 7.0 0.9 2.5 9.5 Tot.al 72.7 44.6 48.7 21.1 41.6 35.1 5.0 11.3 9.2 1.2 2.5 7.0 Pe *,c e .^.t 1 ~0 ~ 1~0 Fia.~ e Ouae_~ 0c c~. 73 . 7 75 • t PoPaation De„-LS:ty 3 94 9 dv aa ab: e Ma .i ed . % Iac:,eae e +r e a ide nc 1 : i .. ~ loved T-7t- 74.9 73.3 49.1 52 • 8 66.4 195a..<,o 94.6 59.6 195-~-7 0 33 . 3 . **A c v ca a'.r y e a51 9 :: r e :o: tc;a :: !lO RiALZTY &!S Ax~g1n Latin Aa. tion-WF:i'e Total All Causee No. R.te No. RBte No. &at e No. Rate 1950-54 954 774 •3r 157 991.8=+ 564 1019 .96 1 67 5 857•00 1965-69 1607 896.68 226 15+9•73 1891 922 .55 3 72 4 932.66 Slope 6.80 31 .82 -8•53 3. 32 Hea-- 1950-54 295 29r.53 2' 225.40 13 ~ 300 . 03 44 7 2 a - 1965-69 612 376.21 62 ~ 58:•.; 6.2 352 •4;. Slope 5•" 21 .22 3.8 St:-oke 1950-5G 73 73•75 10 101.12 59 14 5 •37 14 2 9L.2; 1965-69 142 19 165•73 207 12-2 • 78 36 8 10c.87 Slope 0.88 4.91 -1•93 0. 93 Cancer 1950-s4 155 14"•26 18 165.5r 65 142 .70 238 143.7' 196S-69 293- 170.88 ' 35 266•85 312 165 .40 645 170.L3 Slope 2.09 5•13 . 0.82 1. 64 ~. All P.rrp. L^. 1950-s4 79 67.13 26 162.06 34 49 .25 139 69.63 1965-69 166 92.82 24, 202.62 174 80 .08 364 89.83 L~. S1o~e 1.07 1.18 1.46 0 .70 Helif,. Retn. ~ 1950-5k 33 3J•22 2 27.05 4 8 .80 39 2L .2r_1 ~-- 1965-69 6~ 35.26 6 63.29 5y 31 .85 126 3~• . 0Z~ '~ v Slope 0.53 2.48 1.42 0.77 CONFIDENTIAL: MINNESOTA C`1g DO h ~ ~ ' TODACCO LITIGATION
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14 THIS DOCUtdEN1 SUB1E'.11 i~ :,',1G. 2:. 1985 NON • DISSEMINAIION ORDE2 IN ROGERS AND DUKE CASES. c.t;orA '' 4 • ~ I.~:Lir, f~. - 2 ~>y; 1900~ ~6~ • 1 64 5 2.1 10r~ 3 331.6 8 30597 i00.0 1~• 15768 40•7 3813 9.8 19189 49.5 38770 103.0 19tC 1574J 42•5 3746 10.1 175J1 47.4 37052 1.03.0 I _n t f'Ji t!.' T'LT :': ::U. i 1 CIj•t _ _ 0 25.3 23 .3 2,'~.3 I t 7 r1 i, ~.. 20.7 17 • 8 17.6 ~ 4571 6759 ~ 6.8 6.5 4.0 4•, '.3 f;r)^-'.7i,1te 22.4 23.1 22.4 2109 38W 5185 8.7 9.8 9.7 3•'- 3•3 3• T;::.a ; 25.9 2~ .2 23.6 2695 4780 7576 9.0 9.3 9.3 3.2 3.2 2.3 ,. ir'~. F _ :; . '. , ~• , , ra:. . : . . ..•3,..;t, f .. :V• )' 1\~ _ tt Lc.ti 1 ,;t~. 48.7 35.0 77.9 43•9 65.6 17.7 44.3 22.2 3•4 9.8 5.4 1.0 2.0 6•8 75.0 46.4 60.8 18.1 40.4 25.8 5.2 11.1 7.4 1.7 2.1 6.0 Percent -cta1'~~ ~05'0 1'0 1 070 Population Dens;ty *Not Available Oa•ne^ Occup. 65.2 62.3 59.0 % Increase +Residence _•. ; -~ ti'_a= i e d 75•7 70.7 62.0 1950-60 26.7 **Available `c= tJta_ c;;loyed 55.3 54•8 56.8 1960-70 -4.4 only i<u~_.:LTV RAT:: A r^l.o _Lnt i n A r.:. i t c _--- - '- _ _- t~: 22r';,e IL` i ~'J 446 766•95 25 1210.=!3 427 1016.45 900 8?' 7c ~ 5 _ 502 72-1•0g 135 2954.1'' 62': 1300 • 77 ]26'_ 10:. ?o : 7 op? 8;.2~ 19.09 r~~ •I -t, 1','S0-S • 1-5 278.14 1; 230.9 122 344.31 261 3=: .•_ 176 269.81 37 1302 93" 22~ 558.8=1 4 3- S1c[+ -0•„~ 71.92 15.31 6•5~, St.ror:e 34 74 .76 0 0 L' 7 130.42 81 9;.8E 0`5-r•+.) 44 70.94 1 7 241 .2R 61 143•64 112 1~3.:~ _ -.~/.(~ Jy 19.0'+ 1.09 0.73 Ct• nc •r i9;it-54 74 142 •34 5 502.09 61 170.9J 1~0 1~~.02 ).r -i;-+_ ~ 120 174.21 27 802.89 1'_3 263.17 260 c2~ .- : 1 oFr 1.84 5•97 3•92 irJ:J-~i+ 43 69•31 2 137•5'' 27 62•li7 72 6".^= 69 9'~ • 3~ 10 218.01 58 109.80 137 102 1•63 -9•61 3.95 2.4Q I1 1I:J. );c~ o, . _ -' 1 75 0_ 5+ ~,- _ 17 31.32 1 111.22 5 17.6u 23 26.6 ~ 29 39•39 4 145•83 19 41.86 52 cjr: 0.69 -8.05 2.15 1.24 CTR 525S .CONFIDENTIAL: MINNESOTA '\TOBACCO LITIGATION ~ ~~~ NIllil 010,23,116.0
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Population An 10 1950 9, 95 ~)• 1960 15+107 g6-0 1970 19,993 95.3 ?Sedian ARe 1950 ]~960 1970 Anglo 24.6 23.6 24.0 Ltin atn. * 22.8 22.7 }ion-Wbita 23.0 '21.4 21.8 Total 24.5 23•5 23•9 1HI5 D9CUMEHT SUEIECT TO 1~5 NON • DISSEMIhA1I0h SIATI035 15-16 !N ROGERS AND DUKE Cl.SL;. Latin An. Non-S7hite Total - ~ ti 4. 1 j, &7 v~ . . 209 1.3 29, 1.4 ~ -rrz 17 2.7 1.~~.. 100.C 686 3.3 20,970 10c.~ Kedisn Yaars 2Sedisa Persons ?Sedian Incooe In School Per Aousehold 1950 1960 1970 1950 1960 1970 1950 1960 1970 * * * * * * * * . * * 10291 * * 10.7 * * 3.: * * * * 11 0 12 , 9 7 3351 6239 10398 9.7 10.3 11.2 ~.. 3.4 3.6 3.•. y,eaidance Dittereat Bouse, Kovad, Rasidence Prrv. Pive Sa=be flouee Same.S11SA ,bisf.re-r Su«- *tntRg:~n•»Pa 1'ears X +1950 1960 1970 +1950 1960 1970 +1950 1960 1970 +1950 1960 19iJ AaYlo * * * * * * * * . ,~ . .~ Iatin At:. * * 46.3 * * 18.8 Iion-White * * 83.9 * * 14.6 * * .5 * * 1.. - - ,,'> n S1 .0 25.0 39.4 28.5 9.9 17.1, 12.4 Frr.iee Wrner 0ccu,. Ma_-:-ied Er:~loyea Percen` ...°` ~ ~ ~1070 64.1 79.2 75.3 78.6 78.5 71.7 54.2 49.0 61.0 .B 1.: 7.2 PoPulatica Deaai'.y *i.ot lvaileble % Incre aa e +rZe s ide.ac e ia 1950-60 54 .1 *•*Lva'-'abie 1960-70 33.3 0nly AnRlo ?UB2Ai.ITY RlTBS Latin Am. tion-White Total All Causes No. Rate 2+0. B.ite lio. Rate -- T:o. Rate _ 1950-54 50 147. 7 ~ 72. -,. -•--, ~- t~cy.-, r 7 1965-69 329 799.24 9 1062.62 14 590.'S ,3 52 ., ;-z 7; S lope 42.63 22.78 -2.55 39.57 fieart 1950-54 8 35.81 0 0, 3 205.37 11 ~5. 1965-69 119 "52.13 . 1 193,18 7 31i,.R; 12"' ~ Slope 21.10 16.25 7.13 19.8~ Stroke = 1950-54 4 17.38 0 0 2 120.7, 6 23. 1965-69 35 12o.41a 0 0 4 176.16 39 12Z..;. Siope 6.61 2.2^, 6.2? Cancer 1950-54 7 19-66 0 . 0 I G:,612 8 23.6' 1965-69 58. 126.66 3 479•73 0 0 61 124.5? Slope 6.64 27.6-S 0.08 6.60 ~. All Resp. 1950-54 2 ~.03 0 0 - 0 0 2 1965-69 28 66.15 0 0 2 64.70 30 62.2= - ~. Slope 3.`v"C 2.57 ~ 58 *LaliR. Resv. 02 54 1 2 950 0 0 1 1.G- cr: . - 1 1965-69 12 28.56 0 0 12 2 6 . 2" ~- Slope 1.72 ~ 1.58 CONPIDENTIAL: MINN T09ACCO LITIOAT ESOTA IOh ' 1° t j 13 1 s
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ti'l.1'1'1uN 1'T Poyulatioo hm!a 1.at!a l=. 1950 . 4 87, . 195 5.4 1960 20,024 97.7 269 1. 3 1970 58.118 95.8 2.202 3.6 ?S.dian "e Hedian Income In Sehnol Per Rouaehoid 1950 960 1970 1950 1964 1970 1950 1960 1970 1950 19cJ 19 70 Anglo 29.4 Latin Aa. 14.8 R°°->~ita .22.0 30.8 30.4 20.1 25.7 36.9 34.9 * * * * * 17571 * * 5676 * * * * * * * 15.2 *- * 8.4 * * * * 3. * 3. 6 2 27.9 30.7 30.0 3248 15223 19196 10.2 14.7 15.4 3.2 3.4 3. 0 Raal.de.ace Prev. Yiw Sas,e House Dtffernnt fiouse, Swoe SMSA f11eow•.r-r c.rcb Moved, Rtsi.deace Hnt Pr-+n-t?_ Yurs ~ _ +1950 1960 1970 +1950 1960 1970 +1950 1960 1970 +1950 1960 19 70 Aagl° * * * * * * * * * * : - _ Latin 1,z.. * * 28.8 * * 24.1 * * 43.4 3. 7 ?ton-ih.i t e 77.4 * 61.4 17.3 * 27.1 4.3 * 9.1 1.0 * 2. 4 ?ou: 77.0 26.5 31.1 17.9 47.1 28.4 3.9 24.5 36.5 1.2 1.9 4. 0 De_^CF--: t t O-r'3 ? '~i7 1O7C Papalatiaa Dewi',-y *3Jot lvailn5le Fisse O.rner Occ.:,.. 77.9 92•5 +.'T % Inc:~ease +Rseideace 1._r. rse.,,.:-i,d 78.0 77.8 66.5 i95o-F.,o 468.1 +f*Ova{..1abe t~r ~ ta F=ployed 51.7 52.1 6;.; 1960._70 195.1 c:L1q Aztg lo ?DP=ALITY RAi'" l.a t in An. TS Ra n-i,'h i t e Tota1 All Causes Nc. Rate No. Rate Ko. Ra-e t+o. Rate 1950-54 87 395. 1 0 i -6 2T0 .37 5 -Y8--6-.o 6 99- 411.30 1965-69 953 728.52 10 463.83 7 527. 71 970 720.43 Slope 24.45 -55. 00 25. 92 23.04 Rear: 1950-54 35 174. 10 1 964.40 1 90. 63 37 176. 04 1965-69 367 311.77 1 123. 64 3 320. 94 371 308. 06 Slope 9. 97 -20. 06 1 13. 52 9;-72 S t :-oke 1950-54 - 7 41. 4-4 0 0 0 0 7 39.77 1965-69 104 95. 07 0 0 0 0 104 93. 32 SloP+ 3. 52 3.51 Cancer 1950-54 17 78.83 2 375.69 0 0 19 80. 53 1965-69 226. 158.80 ~ 4 18,9. 99 1 64.72 231 157. 63 Slopa 5. 93 -5.82 7. 10 5.86 A11 Resy. 1950-54 3 11. 61 0 0 0 0 3 11.17 1965-69 79 57.21 2 155.30 1 54.43 82 57. 65 S:ope 3.47 2.29 -0. 65 3. 33 ?!n1iA. Resp. i950-54 2 9.22 0 0 0 0 2 8.67 19C:5-69 45 30.77 2 155. 30 0 0 1-7 3~ 3: S lopc 1.70 2. 29 ~- 63 CTR 5260 1^.J UJ...•.~1i ...._.-.. ,. ' , h.:ii-D'1;~EMINATIDh ORDER IN ROGERS AND DUKE CASE.,,, Non-ti'hite Tote: 257 7.1 3.606 100.0 203 1.0 20, 496 100. 0 329 . 6 60, 649 100. 0 . N.edian Yaare r.adizr. Pe;3onS CONFIDENTIAL' MINNESOTA TOBACCO LITIGATION C~#~ .11~ HN
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. THIS DOCUMENT SUBIECT TO AUG. 20, 1985 NON•DtSSEMINATION ORDER IN R;Ert, Ac,G k~!g CASES, THE COUNCIL FOR TOBACCO RESEARCH - USA . PROGRESS REPORT BY MISS ELEANOR J. MACDONALD Professor of Epidemiology Department of Epidemiology The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Inttitute Texas Medical Center Houston, Texas 77025 , CONFIDENTtAL: MINNESOTA TOBACCO LITIGATION C T R 5261 CTRi~~''~ 00,3163
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___. _ . __...n.. v. .._.: IN ROGERS AND PROGRESS REPORT TO THE COUNCIL FOR TOBACCO RESEARCH - USA In Houston. Texas in 1967, a collaborative study was begun between the Department of Statistics of the Houstoa Health Department and the Department of Epidemiology of the University of Texas System Cancer Center, M. D. Anderson Hospital at Houston. In the several years follow- ing, each of the 235, 000 deaths from every cause for 30 years from January 1940 to January 1970 were coded to the rubrics from the U. S. Bureau of the Census in effect In 1967. The introduction of new rubrics every few years in the International Classification of Diseases and Causes of Death makes studies over a period of years difficult and often imprecise. A uniform nomenclature applied to thirty years of consecutive records netS homogeneity of classification and thus accuracy. The address on each certificate was census tracted to the 1967 census tracts In Houston. The original rubric coded cvas carried in a separate place on the card as was the secondary cause of death when it was given. Because of local concern in the increasing pollution observed as t.he population tripled and industry expanded, asthma, bronchitis and emphy- serna were coded separately when they were mentioned. Concurrently with the morta.lity study, the incidence of cancer in Harris County and 71 other counties was being ascertained in a separate study. Cancer records from all the general hospitals, laboratories and clinics In Harris County (Houston) were indexed and abstracted for the , C T R 5 26' 29 CONFIDENTIAL: MINNESOTA TOBACCO LIT[GATION _ 0 0 ~ ,~ ` 4
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TNIS DOCUti1ENT SUBIECT TO AUG 20, 1567 It0i1• DiSSE1dIlinlION Onu:R IN ROGERS n1;D DUKE CASES. 2 23 year inclusive period from 1944 through,1966. Comparison of the diagnosis in the hospitzlized cases with the, reported cause of death resulted in many corrections through the cooperative efforts of the Health Department and the physicians. The death records were then coded for Mexican-American surnames, edited, checked and taped in the Department of Epidemiology at the M. D. Anderson Hospital. The census tracts, their populations, the cancer record.a and the general mortality records weu then assembled in regions around the 17 air pollution sample collection stations. Age specific and adjusted rates _ were computed for each cause of deat_h for each region in the city, by sex and ethnic group. Table I gives the rates for heart, cancer, stroke and cancer of the lung and cancer of the total respiratory tract for each region for the five year period 1965-1969. There are enormous regional differences evithin the city in mortality from cancer of the lung and from heart disease. In an attempt to understand t:he underlying causes of these regional differ ences, such demographic factors as number of years of residence in the same house or the same census tract, the general age range, the ethnic composition and the median income have been studied and compared. The rates in certain regions are high whether the median ages of the residents are relatively young or old. The River Oaks and Memorial CTR C_ ONFIDENTIAL: MINNESOTA TOBACCO LITIGATION 52G3 ~~ I R NIN' ~'.~0'i 18"s
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Tuic p')?"WchT SUBJECT TO AUG. TJ, lzoi .-,-u.;;.Ei.iiNATIDN ORDER IN RUi;EK_~ AtrD DUKE CASES, 3 regions have low lung cancer rates, fall in the older age group and have a high median income. The contiguous region south of River Oaks between Maia, Old Main and Chocol.ate Bayou also has a low mortality rate for lung cancer, has the same older population, a lirge proportion of long-time residents, but a very low median income. The rates are highest for the center city and the Heights and for the Spring Branch region. The rates in the last region have doubled in 15 years since the entry of heavy^industry into the area. The ages of the inhabitants are in the younger category. The industrial area between Griggs Road, Walker and Chocolate Bayou, has a very high rate of lung uncer. West of Mykawa the age is young and there is much heavy industry. The rates for lung cancer are hig h. The region on the other side of Mykawa, mostly residential, with r.-iany long-time established areas has a middle range income and a low lung cancer rate. The regions with losv rates are out of the path of the usual prevaUing winds carrying pollution and have little or no industry voithin their borders. Presence or absence of atmospheric pollution seems to be the major difference between regions of high and regions of low lung cancer mortality. The annual voind rosettes of the Houston Health Departrnent show that for most of the year the winds carry indus- t-ial pollution over the center city and then in a westerly direction. C T R 5' 26 ,1 CONFIDENTIAI,: MINNESOTA TODACCO LITIGATION CRf ~R ftu"l 00 .,k Be
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THIS DOCUMENT SUBJECT T0 AUG. 20, 1985 NJn•DiSSE.AiNATION ORDER !h OGEK~ AND UKE CASES. 4 Some indication of the potential of atmospheric pollution may be derived from observing the change In lung cancer mortality before and after heavy industry moves into a residential area. In the SpriDg Branch area, for example, the rate has more than doubled in 10 years. Since the rates among women are so much lower than among men it Is possible that a combination of the effects of occupational exposure and atmospheric 0 pollution may account for the high rates among males. In any sound study one tnust be constantly aware of the movement of populations as well as of industries. Studies similar to this and demo- graphic studies invariably provide clues relative to other areas and popu- lation subgroups requiring further investigation. It is apparent that there is a large area of scientific unknowns rela- tive to the long term health effects from the complex micro-chemical environment. Thousands of chemicals and chemical combinations exist, the effects of which constitute scientific unknowns. There is no simplistic answer to the cause of cancer. Cancer of the liver in Houston is being studied by region, occupation, and types of exposure to explore the possibility of vinyl chloride as an etiologic factor. These studies point out the need for the scientific communi- ty to redirect its attention and research efforts to the exploration of the carcinogenic potential of the micro-chemical environment - a virtually unexplored area. CTR 52bz"') CONFIDENTIAL: MINNESOTA •e ~ TOBACCO LITlOATlON 0 2 " +t S
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5 Irv ~ v JJC i/11A~lUfr UKJfS`V RC`, L) C u~ CAS:S. Seven me^-iber s of the Air Control Board of the Environmental Protection Agency in Austin met with the Professor of Epidemiology and released the detailed pollution emission records from Houston industries. The Board Is collecting and analyzing a number of com- pounds and its highest aerosol re.adings are in the regions with high rates for lung cancer. The Board is discussing a method of continuing the data base from 1970 through and beyond 1974. The number and type of business establishments With the numbers of employees and whether the businesses were establishe'd before or since 1960 is known for each of the 17 regions. Reports are being f'uialized on this study. As an educational tool. 26 graduate students of the University of Texas School of Public Heath in Houston have used the Houston mortality data or t.he registry data for their advanced degrees, both doctors and masters. Ther e have been 23 other users of the data for various education- al and planning purposes. This includes teaching high school, college and medical students. Computerizing and visual availability of all the facts on 235, 000 death certificates for 30 years serve as an administrative tool releasing employees for other functions. In a city of over one million population, daily requests for individual death certificates run into the hundreds. There was no index before this study. C T R 5261E CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION C"°7jy R #-a1/A#
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THIS DOCUMENT SUBJECT TO AUG. 20, 1985 Nun • Di;SEMfiNATION ORDER - 6 - IN OGERS AND DUKE CASES. The request to the Council for assistance in data processing arose when the regional medical programs in the U. S. were unexpectedly cut- off leaving the Department of Epidemiology with 350,000 accessions to be processed and without adequate personnel to process them. The funds requested and received were used to complete coding of these abstracts. to combine all the charts of the individuals represented more than once who had more than one cancer or who had been to more than one institutior, for diagnosis or treatment . The editing netted coded material for 250, 000 individuals for 72 counties or 7 regions made up of the combined counties around the medical center. Programs were written for f iguring the age specific and age ad- justed rates by site of cancer by sex and by ethnic group for each of the regions. The first adequate skin cancer figures complete for a population were obtained from this material and have been used by the Climatic Impact Committee of the National Research Council in studying the effects of the Supersonic Transport in checking the climate. A report on multiple pri- mary cancer has also been published from this material. A librarian has assembled and kept current coverage of the cancer and epidemiological literature since 1946. This is divided up by its relationship to specific anatomic sites. The additional support is sought to elicit environmental factors as they ipply to cancer by site in different regions in Texas and to publish a book on the subject. CTR 526 7 July 1974 CONFIUEN'I1AL: h!1NNET(9TA ToBACCQ "rWATloN CTV , NI"i 0012316s)
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CONFIDENTIAL: MINNESOTA ' TOBACCO LITIGATION THIS DOCUF'ENT SUBIECT TO AJG. ?p, 1So~ trun D~SSE,~IIh'ATION ORDER IN R_ O~S AND DUKE CASES- ~ O - v CTR 5268 ~ 'I ~ N ~``4 0 .~ 3 ~
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'1'A111,IS 1 HARRIS COUNTY MORTALITY 8Y P()Li.lffION STATIONS AVERACE ACE-ADJUSTED iU RTALITY RATE PER 100,000 TOTAL POPVLATION 1965-1969 Station Total All Cau..a Total Neart Total Cancer Total Stroke Lung Pri.ary- SecondarT Total Malignant Reapiratory No, Rate No, Rate No, Rate No. Rate Noi Rate No. Rate 2 8,588 1,112.07 3,392 433.28 1,395 180.88 870 111.03 322 41.81 346 44.89 3 2.654 857.46 1,002 347.52 500 162.41 262 94.48 121 38.63 132 42.21 4 1.182 504.83 435 211.80 257 106.09 101 53.32 75 32.15 80 34.28 5 1,868 819.94 630 338.89 362 165.59 184 102.77 82 39.49 87 42.05 6 3,798 991.78 1,438 ` 393.19 648 169.63 398 111.68 162 42.28 174 45.48 7 3,267 901.12 1,206 327.74 520 143.51 370 99.75 123 34.17 128 35.58 8 2,805 857.76 1,214 381.63 681 198.36 287 96.78 143 39.69 149 41.63 9 1,793 602.88 628 244.73 432 146.50 164 70.13 85 29.75 86 30.19 10 3,065 808.57 1,298 332.94 571 144.35 384 100.33 111 27.26 118 29.02 11 2,636 858.63 966 365.52 556 181.32 267 108.12 130 44.12 135 46.05 12 5,803 927.18 2,189 388.22t 1,051 170.94 564 103.39 245 39.75 . 258 41.83 13 3,724 932.66 1,294 371.90 6/i5 170.43 368 62.49 119 32.07 126 34.00 ~ 14 1,261 1,016.76 437 398.99 260 220.92 112 103.14 50 40.56 52 42.16 ~ 15-16 352 787.50 127 344,70 61 124.60 39 122.80 11 22 60 12 26 27 . . 17 970 720.43 371 308.06 231 157.63 104 93.32 45 30.01 47 31.35 ~ -.~ ..,.,, +yn.~ Z N (O ~ ~. v i:r 0 . . ~ c. C-) ~ c --{ .~ i 0 ~ Z T (n -~ ~ ~e+a , [" O O vi N m c = OW 7 In C 3 (-) ~ 1 m ~. Y t ^~ O~. L ~ O L C - ) ~ C ti N
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0 THIS DOCUMENT SUBJECT TO AUG. 20, 1985 ttvtt -DlSSEivIINATIOt; ORDER It, h ^ .,,U UJKE ANNUAL WIND RO:E Gnr of Hanton Departm.r+t of Pubtic 1isaltn Ar Potluuon f;.a+tror Pro4'sm Ar+rwad RepOrt, 1 G68 CAI.K' 1.3 ~ NOTES rt. D-cuc~s are to the 16 nant rw+?russ s,v-rn nortn at tn. ~ 1?I Uc+uN rM+mtS- rs tAe yercent IrrCltM.xr ol pc-yrrenCr ol :. '0 ~ /ro^+ tMl ArrK9-On ~ .3' Lo-wrr numOe rs tA! hRtlOl {(1lTC t.CY^ tf4t tlrreCtron r1, w"I on rlCOam CO•.rC7-: ovrHlq trw fYYro': I ldjt tnrp,rnr. 19U0.1 Movstom Intr*na!•oMl Antrort C T R CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION 5270 c tt~y R ~~ ~
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i THIS DOCUMENT SUBJECT TO AUG. 2L, IN ROCERS AND DUKE CASES, C T R 52-11 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION C ~~ ~~ ~~~~ ~~ ~~ ~ .~ ~~ ~
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7 THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER T.cu M.dtmt G.nt.r Horaon, Tau 77025 August 27. 1974 Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Research - USA, Inc. 110 East 59th Street New York, N. Y. 10022 Dear Mr. Hoy-t: THIS DOCUMENT SUBIECT TO AUG. 20, 1985 NUN•DISSE41INhTION ORDER 1N ROGERS AhD DUKE Ch;---S. Attached is my application for a research grant. The plans for the next year are as follows. First, we plan to engage a systems analyst named Morris Burns, the most able man I know in this field. His salary will constitute one-third of the total request. This is essential because we need his speed and know how. We presently have tapes of all the in- formation on cancer from all sources from 72 counties in Texas includ- ing Houston, as we.ll as the death certificates not only from cancer but frorrm all causes for Harris County (Houston) for a long period of years (23-30 years). We have figured rates on them by seven large geographi- cal regions. These rates are for each type of cancer by Latin, Negro and Anglo and by male and female as well as by total population. , We want rapid programming to elicit in..ormation of all the counties at t_he same latitude and altitude to detect the ef.fect of these variables. This will mean taking the records of all individuals with cancer for each county on a specific latitude, separating them into the altitude groupt and studying the differences. A gradual increase in cancer of the skin as the latitsdes approach the equator has been hypothesized. Our studies of seven large regions show the Corpus Chsisti region to have higher rates for skin cancer for white males, excluding Latin- American, than the regions further south. We have determined that this is because there is a preponderance of individuals of Irish descent in the Corpus Christi region and not in the counties further.south. Each of the seven regions covers several latitude degrees. We would like to tie it down to lateral counties on the same degree latitude north. It becomes important to have a valid incidence for sun induced skin cancer and except for our f igures none exist. This is one example of why we need extraordinary CTR 52-, 2 M D.th'D[RSON HOSP:TAL A.ti'D TUMOR A1S77TLTi A++rn..! Rrst.hLuhe. Cr*un EXTRAMUW PROGRMIS DNIS/Oti' Uh1vERSfTYCwn+CER iOUh'DAT7ON CONFIDENTIAL: MINNESOTA "'-TOBACCO LITIGATION O.c.bty C.rncJ-A.swN.ca! Lsnhne'u C.14M•.nor S++.vn TAr Mdnsoe M.y/u• S.trw.no•u ERr~ro++,r•.utSnr+u Pr•. ~ `5 ~~N ~~'1~"q 003 1 ~K
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i r -2- Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Research - USA, Inc. New York. N. Y. ' August 27. 1974 THIS DOCUtdEHT SUBJECT T0 AUG. ?Q, 1965 NON -DISSEtIINATION ORDER 1N ROGERS AND DUKE CASES, skills in a programmer. We have noticed also that the mortality of cancer over time is higher in counties that seem to follow geographical contours, whether waterways, mountains or valleys. We want to study the data grouped in this manner to see what is the factor involved. A11 this involves manipulation of the data already taped by intensive pro- gramming. Mr. Burns is the one who did the programming for the Rehabilita- tion Institute in Houston. In this Institute, every event that occurs and is reported on a patient's chart is processed daily on a computer so that a current chart printout is on the physiciang desk each morning. There .are only 15 beds there but it is a demonstration of a rapid, accurate, total hospital record concept. Mr. Burns has also been working on the total computerization plan for hospital charts in t.he private company where he has been working. I want to use these skills to see iS he can help me complete a totally functioning method for registry and follow-;;p programs on cancer in individual hoepitals. I plan to write a monograph on this later. The requests I have had so far for consultations on this subject are too numerous for me to accept. So I'll put this in_'or:nation berween covers and sell them a book. I have a complete bibliography for the last 26 years with copies of t~e papers on epide:niological, statistical and etiological relationships for each site of cancer. We have a trained librarian assistant epidemi- ologist who spends full time checking the entire volume of all reports, checking for ideas and new leads each time we make a study. Each of these new leads can be checked out in our data. It has taken a life-time to get a data base like this and the prospect of getting the answers is almost too good to be true. This will be the basis of the book on "Epidemiology of Cancer" authorized by Dr. Clark, which will be com- pleted in a year. Plans are pending wit.h Williams and Wilkins as publishers. The other workers on the grant are fr om my ranks of experienced workers, which will be another asset. CTR 5273 CONF19fiNT1AL; b71NNESOTA ?'0]LAM LITIGATION C ~~~ 'ti N~~`•~ ..~ ~.~ ~ ~, ~~ ~~
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I. r 3 Mr. W. T. Hoyt . Executive Vice President Tbe Council for Tobacco Research - USA, Inc. New York, N. Y. Augutt 27, 1974 THIS DOCJ~,!EN1 SUB!E^T T0 AUG. 2,", 1985 Nun DiSSE;,tY;,iION ORDER IN ROGEP,S AND DUKE CASES. Aleo attached is my Progress Report eumrzurizing what has been accomplished to date. Sincerely, / ~z(C ~;Gt Eleanor J. Mi'cdonald Professor of Epidemiolgoy Department of Epide:niology EJM:r::a Enclosures C T R 527q CO ~OBACCO L1T GAT pK TA CT ~ti r I t `I ~'~ 0 '23 1, 1 E i h-
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THE UNIVERSITY OF TEXAS SYSTEM ~ S 3 CANCER CENTER 7.+v 11./-sl Centr HOrtO+• 7IY/ 77073 June 11,.1974 I THIS DOCt1k1ENT SUBJECT TO nll 1, 2", 150j ii3N-DiSSEniiNhTIDN Dn1CR IN ROGERS AND UKE CASES APPLICATION FOR RESEARCH GRAhIT II` VES T IGATOR : Mis s Eleanor J. Macdonald, A. B. INSTITUTION AND The University of Texas System Cancer ADDRESS: Center. M. D. Anderson Hospital and Tumor Institute 6723 Bertner Avenue Houston, Texas 77025 TIT LE: Regional Patterns of Cancer of Major Sites in Five Large Regions in Texas and Regional Patterns of Mortality in Houston, 1940-1969 Workinc Hvoothesis: The working hypothesis is that the influence of a large number of factors which may affect cancer causation can be esti- mated epidemiologically if facts are scientifically collected and recordec in a study population; and if the details of the history of each i.ndivid;:al with cancer in the same study population are also available in usable for-ns• and the demographic and environmental factors in the community are known. Dctails of Exnerimental Desi¢n and Procedures: As previously stated, data have been collected on every case of cancer for 23 years from every know n source in 74 counties in Tcxas. These counties are grouped into five large Hill Burton hospital regions, with a total population ranging from 300. 000 to over a million. The total of over four million people includes a million Latins, an equal number of Negroes, and over two million non-Latin Caucasians. The 370, 000 accessions for 270. 000 individuals with cancer have been checked to eliminate the 100, 000 estimated multiple accessions for the same individuals, which our method of collection engenders. Codir•g of data on each primary site of cancer for individuals has been comoleted. These data have been data processed and are on magnetic tape. Multiple edits have been run on these data before computations were run. C T R %t V ANnCRSUK IIUSP/7AL AND TUMOR IN57ITUT( A++ii .-/ R,ee"dd.no- Cr+tr• (\ TRA.NURAI IROGRAMS D/VJSION O.rN•7y lwwrt.trm CFtLb•ubt•. Snlin s.luuw.r u1;It'( R SITY CANC(R fOU.vDAT1Ol: 71v A+Lne+ M.y/al (nn+~na; S,n..n tnl C4NFIDENT/AL: tdINM1tESOTA " TOBACCO LITIOATION C. `~"~ ~~~°~ C~~.~ 3:~ ~~ ~:y
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-2- THIS DOCUMENT SUBJECT TO AUG. 20, 1985 Niti-DISSE1.11NMTION ORDER IN RuGERS AND DUKE CASES Closely associated with regional patterns of tancer are the regional patterns of mortality in Houston which encompasses the same 23 year period and an additional seven years. The Houston area represents the largest of the five hospital regions and the three main ethnic groups are well represented. 1.4ortality data are available for each census tract. grouped into 17 district regions for the five major respiratory diseases, heart. cancer and arterial diseases. Demographic factors relating to the census tracts are recorded 7or correlations of the widely different meteorological and economical sit::a- tion:; found in the district with mortality from the above causes. The regions within the city of high and low incidence in total cancer, in lunr, cancer, in all respiratory diseases and in heart and stroke have been identified. The high aerosol readings of the Texas Air Control.Board match the rcFior.s of high lung cancer mortality. This high mortality is ir. regions subject to wind-carried pollution fr o:n the heavy industry area around the Houston Ship Channel. The work donc on the previous grants enablec the cditine and nre'.imir.ary processing of this data base. This request is to complete the calculations, anaiysis and publication of the findings. Dr. R. Lee Clark has promised to support publication uf a book at an est:- r:-.ated length of 300 pages on regional differences of cancer in Texas as soon as the data are processed from the region.al cancer study, and the Houston mortality study. Personnel: I neec one year of support for a q::aiified productive pro~rar:.- mer, (systems ana'yst), a secretary, an assistant epidemiologist, and a statistical clerk, and would spend 70% of my tirne completing and publish:ng the results of intensive research into the epide-niology of the major sites of cancer. At present we use a programmer of known competence part time for this proicct. His othcr commitments make the speed of accomplishment vari- able. The systcros analyst I have in mind has had extensive experience in the programming of medical data as we11 as in industrial applications. His present salary is $20, 000. , CTR 527 6 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION ~Is- RI~~N Cl~ ~~3 ~~~E3
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THIS DOCUPJEIrT 1985 SUBIECT T0 AUG. 20, D;~SE1d~h'A110N ORDER /NR~yyAl,D DKE CASES. 3 BUDGiT - 9-1-74 / 8-31-75 FiB Systems Analyst Secretary Assistant Epidemiologist Statistical Clerk Machine time Tzavel, checking leads by surveying $ 20. 000. 00 8.436.00 9.024.00 4,944.00 5,000.00 2, 000. 00 $ 49,404.00 2, 870. 00 7, 84:. 00 $ 60.115.00 S 1.002. 00 S 683.00 718.00 467. 00 2,8"0.00 F /B 15~ia Overhead Total CONFIDENTIAL: MiNNESOTA TOBACCO LITIGATION 67 CTR 527 7 CT ~~ 1a11-4 D 0,J 19 9
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THIS DOCUVENT SUBJECT TO AUG. 2C. 15o.i hoti-DISSEMINATION ORDEr iN RDGERS AND DUKE CASES. 8 O E E~. K 22.. G 2. E ~ .r CTR 5278 CONFIDENTIAL: MINNESOTA _ ,{° TOBACCO LITIGATION ~` iR N~'-~ 00320 RrO
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A O y Z E0 s 1" . -11Ti!'•1: 2 A Z A'['7N X-iT7fTCA1I -- = 1 A _ M•.l o-~ Frxst o_ t:n! p F,rinl e 1^n1tv 3 ~ : 'Stc fctf.e 1!? I;g. I'nto 110, Rntn IJ:tL 7h},e --- --•----- _ ~ L __ 3161 1210.11 2759 1?59.6'1 1909 1776 666.70 635.45 407 1291.39 '557 1826.35 287 31,4 1022.04 1113.E0 1667 1450.44 1817 1645.18 1348 1315 1154•35 1101.09 5235 1309.19 5133 1444.96 354f+ 3'155 836.21 821.-1 l ^;;F )I.rt9 -1.89 38.12 11 .21 11.86 -2.72 9.75 -0.78 1261 1178.21 669 224.74 88 387.67 69 340.91 1178 459.58 396 372.12 1827 476.49 1134 274 .:3 1192 516.02 840 269.38 172 716.97 911 378.85 589 582.84 505 454.83 1953 550•90 1439 33~ 3.83 3.03 20.53 2.03 9.38 6.9 4 5.93 4.21 t 2 :okt. 1 - 1' 3 r_.;%r 308 119.86 251 84.17 16 77.85 23 119,47 1117 148.98 196 191.10 471 126.84 170 . 6 1 1 ?~ ;-'? 10 216 253 81 20 38 147.211 25 q1.03 168 170.25 i70 153.77 422 120.17 448 103.25 93 . . 0 6 -1.16 0.09 5.22 -1.60 1.66 -2.16 0.09 - .3 r ..;-r. 1451 168 .53 392 133.33 36 143.28 bo 165.29 195 184.73 184 160.75 682 172.211 616 j11,.-3 48 1 2( X) 106 48 251 68 67 69 251.96 279 .267.91 204 1?7.63 832 233.55 563 13'.=~ 6 2 2 .53 ~ . . r 0 8 1 c,Pe 2.76 -1.96 8.28 5,09 4.99 0.7 1 3.90 .7 - p eA n g 2 128 8 216 ll7 -) - 324 88 120 82 28.27 55 176.71 37 120.72 146 127.97 97 77•9 5 5 . 9 . ' ' l . 6 61 218 64 36 102.98 232 199.75 82 61.64 718 199.93 214 5 . ; 1125 190•15 96 .53 3 . j0 2•~t'e 3.96 0.36 2.73 -1.01 3.48 -1.17 3.97 -0.03 '.T. ,111 e . ..... r9,. , ~. 4 0 53 16 5 48 5 16 411 5 19.09 31 2 9. 53 7 6.45 148 36.16 28 112 18 . 02 82 23 . 8 99 22 . 84.h8 tl 17.23 86 81.f15 22 18.93 297 82.97 119 •-. . 0 9 2.80 . 0. 24 . 11.09 0.17 3.26 0.7 5 3.06 0.38 0 0 ge Ad,Ius tMi Mortnl i ty Rntes pnr 100,(XN1* 'I`rnetn ~ nrrl s Crninty, T(-x nn (,^W10r• t.r,d Crnnn.3 i(r)n tJ. S. C T R 5 279 THIS DOr,uF1ENT SURICCT TO AUG. 20. 19A., r4,;n UISS[MINAIION ORDER >u RJGERS AND DUKE CASES. March, 19yh
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A 3 A r" A 7 --- O> -• ' Rntr! Jnt, _:..---- o~z ~~~--- ~ 7 L 978 1003.47 ~ 587 558•97 154 996•52 112 967•72 76 209r--.50 43 1262.05 1208 1041.96 7112 613.5= 4 .. tlQ 3o 1 4o2 23 90 157 883 71 1468.74 42 935.65 1640 1139•35 101 613.E- 1352 1091.03 815 569 • . 7 • 8 0 13 ;>« 7.68 0.60 27•79 -4.78 -43.29 -29•57 .27 . - 71 377 4 32 180 195.()6 25 261.67 31 388•73 23 679.29 13 415.81 425 424.64 224 215.":- ' . J 12 21 53 63 1195 li1l348.89 26 626. 4 5 14 346.82 645 b83.78 ?57 230.= t ~ . 556 479.5 299 7. • 4 8 0 1 ~ 4.03 1.91 17.95 -0.07 -6.36 -11.48 . 7 .5 88 103.93 61, 67.28 11 911.195 8 89.92 4 118.62 3 110.96 103 104.02 75 70.2? ;- 1p•T 101 28 111 81.59 16 120.21 15 109.05 7 177.92 6 144.43 130 105.88 132 > . r 82 2 95 08 -0 0.F; :,r c. -o.23 0.67 -0.04 l 0 -0. 3. . . ,_ ~.. 137 1 5? 83 137 • 129.09 22 186. 66 15 155•19 10 324•93 7 204.25 169 161.71 159 132.:: . 4 8 Jt1 276 4 0 22 139-37 7 149.81 100.31 305 216.67 19, 1i6.:= 257 211.82 169 11 . 0 . 4 1 6 3 89 ;.;,r 3.92 -1•06 7.38 0.29 -10.0 .5 - . 1 ~r , 41 4 1o4 36 93 78 75 1 : 33•=: r T 11 2 70 4 56 23 22 14 87.72 16 118.60 - 7 216. . • . ..-: 7 , . 1 117 50 11 61 53 10 219•53 4 70.96 239 164.94 63 36•=: 4 208 168.47 ~r' 48 31 •99 . 2 . 0 09 r°r 6.112 0.54 1.39 -3.80 0.02 -0.84 5.77 . ....4 I +r ..... ~ 2 61 1 15 6 1 22.87 1 20.85 32 26.01 7 6.:: 29 2t;.72 ~ 5 5•M 3. 2 . 8 ~+ 8 1 24 86 116 79.60 16 9•-' ~'j-r "l 108 85.77 12 7.112 4 31.76 3 22.1 9•39 . h 58 ?l ^ o!:L• 3 83 22 0 1.03 1.09 5.70 -0, o 3. -• 0 . . f 0 :a Ar1 tuste<1 tkortnl lty Rntes per 1(10,000w trris C",nty, Tt,xnn (Seloct.eri Cennue Tr•n(-.ts) THIS DOCUMENT SUf31ECT TO AUC. 2{J, t 1985 NON-DfSSEMIN/1TI0N ORDER Mnrc`,, 1<)•J1r ~ 950 ^Lnndnr.1 114 lti)C( l1S lIrVU Ul1Ki CAS1 S. IN) C T R
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;1~~•r . . h c.• J' ~1.. -- --~--1~=--- -- --~ ;_" l.r -- ----..~Ir --- -- - -•~--^ 1:3.1 (ri1 ..ir1 12() 1127.'~5 8 F,-)ri.rA !! 2 55.2'S ti t11QG.3t1 t~ l! 'j~/l.t111 20 fJll9.O7 1t{ 1Q75,~C ~11/ 1$0~~.49 7?j G10.~ 1159 '''.~>." : -1ti.11 1F3.117 -161.c17 -?y.51 -3.55 - r ~ ;);1,r ,1 39 1(;S.2 351 .53 0 0 1 <S8.85 0 0 59 259.32 3r) .1t,S 2G/~.t; tllt~ t55.l,G 7 IY) .(,8 << 2hh.53 h G1it.03 5 b31.0'! 2711 25I.97 1F,1 1('I.:;. -1.E,n .-?.51 ._1.99 15.7.i -5•37 -25.2j -2.1l1 -2.?2 ~ R MM~ ..,.~ ~ .a.., i 1 l16.7)7 18 70. 311 0 0 0 0 0 0 /4 1 11 s3 149.119 0 0 3 109.60 2 1A1.60 _1.,,-) P.F3 .;0.GS _ ,~i 11~,'!(3 ',2 •1r)S.j3 0 0 ;) U 1 2(1`,~.7t -~ t•'t11 1aj.`;~I 10!I fTo. s~ 11 Q7.f52 1 21.1t2 2 3i7,31 -0.7r G.a3 6.03 -78 .30 . _---- s:,c,- cti I_^ 2 GG5.53 196 G50.(N{ 1v 11 '"• 0 0 11 1111.111 1FS 6c}.~7 2 261 .72 118 53.37 52.;.; 15.18 -0.21 0 0 ;1 113•70 32 1(] 1 2 261,72 150 127.fivo 107 •`.3r,. :'3 -n,1t I 1.50 7l f;c).2/1 3 7.9~-) 2 23r,.' ?n 1 7/1.26 1 453.111 0 0 1f? 67.47 .`)9 31! 2 5J.`)5 1 E1.~Yl 3 'Y)1 .90 1 9`j.45 100 F)2.n'I .'f). ;- . „r."ll t.3(-2.7h -').51 5.87 7.70 2.117 1•35 ? 3y .'/J 0 u ~ 0 O 0 0 0 `,r, 16 1 3.77 1 7,) .6ti 0 O 2 317.31 t..- 0.f.1h 3.13 16.YI 4c1,1 c . • .1 6s . ^ I •r'I T?:. t.rr:, 1 . t O,), (YN')w r frt Cor.,,r1'1•. 0 0 9 32 .97 c 0 1 T).h5 63 5`i.:` 17 1.5.= . 5 . 31t 1. /.7 . Q'J THIS Dn''11•el-NT SU(tIECi TO AUG. 1-0. 198;r Ws„d i)I:;.,I -MIN/I1ION URDER ~ IN RUI;IItti AND UUKE CASES. t~;rt c I,, Itrf'h C1R ~i,2 ti1
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.~, r- - .).,._ . ,~;1 r >.12 52 i73.93 11 22C~3.f1c) 0 0 77n.r"'t 307 559•C'3 ?,4 25On.64 28 1712.56 t`,.Gl 1211.11 102.116 ~1,•. f:,,. . ..;t ! . tnt s cvo.9'1 72 r~55.136 185 6fS3. t7 t2q t,5<, ;. 56 1 t037.63 t!&9 9j9•3s 10115 9U'3•1''1 8'3 'Trlli ,- 1'1.7G 31.01 11.91 23.111 2:' 165..?. 1 5 125.35 0 0 0 0 29 27f3.13 lc ! S;i,,n9 1(1i 22~).(,') 10 1>(pi.09 11 G13•5j 19' 3')0.21 9.1); 7.1/5 93.10 ir;.7f3 7.88 11 tn1,~~'1 itl r~~,f);.' G `il.`)5 i' i'.1••l7 (r (1 0 0 9 R').of3 0 (1 O 0 (i2 1 h (1. qkr3 'i,50 ~ 1 107.17 9- 7U.rc 0 0 11': 2:1''..?i) 62 1n5 6 r,1j9.98 ,14.36 31.Q2, 11 .'q. fi' 1 9.5! 2 'J91 .57 7s 1h 20 .Sr;,29 3 425.'~6 1t 2..1'j 2.!1q - 1 4. t2 n ) c) ~/ 2 2I r. ;~ .,,.I f,,,•1-:1;.• 1(r,t, : l,,:r '1'6:) ii. .- . .~. ,~ I:.~. . CTR 0 0 16 1F2.(VI /l 2711.86 `:;Ci 111,1, 1 1 16.0', 1.9)1 0 0 6 -011.27 5 30`').05 1(i0.4 1 20.02 0 t) 0 0 1 3'i .76 21 40.G:" ?.t3 2.23 2~) 187.31 51 214.15 ;.3 172 Y13.42 353 369.'1', 277 -51r,:;; 15.76 9.3'i 11.50 fl 71.0G 20 9t;.62 14 E,<;.%- GC 152.Gf3 i'.,; r)3. s't 0'3 t 12.=.; (..'.'1 0.15 ~.Sn FS '!3 . E6 29 130.80 17 70. ~.; ~'0 167.43 20G 198. Or) 1 J6 1 i5. r: 7.40 3.111 5.89 ~~ 35. 311 12 3R.10 5 23 4U.87 126 125 ."l: hft il~,, 1.59 11•5Ci 2.00 ~ ~ 1 2.22 G 1 S.r1 70 70 0,9i 3.119 7H/S D(1C(/P1ENT C1/fI/fCT TO ANG. 70, ]985 NUN 'UI;;:;LM1fINql1UN ORDER ~ IN J?OGLRS l1ND DUKE CASES. 0 n 1l 111, ~ rlt,rrli, 1'ij?.
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~ ~- ~ -- - 1L'1T'1 i:A r•:',T••!2 1 P ":1-;11'!1" - ..-, =r1 to -~- 11 09 toc>n.'l5 E43 9n;3•05 3%5 1191.19 239 853.5t 1005 1025•12 070 lr-6t>.j'9 1O<3 9 11111,n5 802 763.69 2229 1121/.l!:) 1/1'i, Es.r>cl 1{.Sn 3:~.112 32.10 -6.5~~ 11.£~9 2.:It i0i /IC-i.7.; ')U t7"',il(, 11 75 10 217•119 75 351t,t'T 56 251.5A 291 379•79 156 2._. .r:. ll(:rl ll'i'I.G? 212 2fF.71j j6 ii3 2( (lll.'3 Slf5 ll!)£3.'(2 275 'SO5.71 'j81 11116.111 `'i1J .?t. 20.'sc) 22.71t 11.50 3,1t7 11.8G ';.r/11. , - s'i 75.09 35 71.66 11 ~;h.ilj 6 104.35 3'1 16t,11/ 25 127.146 76 99 -EJt (0" :~: > ~~; £:~,.9h 75 9-.7'l ~) 1~.5.112 10 2:?6.13 to9 1ho.9'1 99 lc,~~.99 1n~, t13.7(> t£33 t.;, j.• 1.117 1.~7 9.65 -t.t•'! -2.15 l).8)1 t.lll 71 125 . j~~ F ')'- .1 z 12 ?~ll 3'1 161 .26 31 121.66 1211 1// n. 7!5 t 1 l{ t`= , i 1 jh 1; ~,1:2 15 19;•137 ; 0 3~,`~. ;0 171 1t)lt.~,1) 1l{t 111a.2~ 350 1£~~.113 2r)r• 1` -. . l.~l{ ~.7I1 2.01 1.(~ 0.30 2.89 ()."in .+.r 4 +....>< .+~., .•,:. t r. r r~.7? 17 51.7:5 t~it 1'Ih.00 33 3r)•7; • v _0.111 r.3 t t '- `.» t . O.'!i U. lfl 21 i.(•5 8 99.75 23 6.3.07 11 30.311 103 tCo.1rj t'l 11t7 1ho,00 122 121 .76 ~j2 112.17 267 t37•2) (rl t,£31 0.'': 2.f~1 0.27 1.92 _t~, 3.'. ; ll'j.ll? 0 0 3 111,£j2 2 JiR .95 !1(> ~>1 •?1; 1 ,5') 3.56 Ar,` r..r t,r.;r. •) 11.:.1, •) f Ly !'nLr._~ ~rc 1 ir).1~(1!1:/* 'I'rnr •rl t.1~•1 1 1 2.79 35 11 1 .611 /1 13 111.29 1or) 5-5.1:3 ^(; l).`_ir J t.15 O.ll~> THIS DOCII'!ENT S(IItIFCT TO AUG. 20. 1985 NuN UiS;EMMAnuN oRUER IN ROGERS AND DUKE CASES, Mr~ 1~, trJr C T R
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28 1 0 167 570. 57 13 1291.77 3r>>I 9M.2.'r t9(t 5',0.77 713 _Wr;.7O 7, ) ~ql:.33 40 1 j3.3r, 1t 11/1f3.25 110 3i • 60 1f3•r.GO 23 1370.43 -O.r1q -0.11 56.01 ,: . U n :.g.55 19 F10.`s ?tl f39. r,7 20 ~~ .£3(> h 7 20. 25 2.?O -1.9ii 19.87 43 170.59 31 11(.31i 2, h1rr.91 <)9 2'0.I6 51 138.t16 111 8'9•8'j 1.71 28.01 :tt ;.: •.. jp 1 n/r . n'f 13 ,11.17 1 tl'1. 5~ ~~.o,) 6 2(vl.nfi 0.20 12.tEt 54.01 3 9.21 n 0 1:' ~.,; r 2h 7 `; t?,(r 3 176 .~.'t 0. 97 0.0S 11.61 ;,FY• r..lj„r,l.,,:l t• t(~r),rxx,M li:,rrI . l.•/, (' 7 f) ~ ., „ : 7!`' i' ~' Y1 1 rl , 12 1093.111 2:52 1078.6c) 195 957 . 39 526 1017 . f>'j 374 c ,7 29•r7.G0 3,, r•! 1/If;0.9`3 270 11..'~3.31 . '~36 .12114. i'r ',2~ . , .'. 1cxo.r10 25.81 12.511 15.73 `, 0 0 79 r129. i2 43 250.27 178 L 0O . 52 P 3 2.'., trr 1350.0? 119 595•05 )f3.02 11 ,77 105 r321.p9 257 117r.7=j 19.52 5.~o 0 0 2?. 112.111 25 15r).37 37 8r . jrj t{it ~.•~..' 3 117.55 37 153.99 29 1_13.3j C,0 120.3s1 r.2 •. ~. 15.16 3.68 3.12 3 5535.26 23 1116.97 38 203.0; 68 1 ()t .07 72 ': 1-3 fs'Sr/.60 69 332.56 h h 192 . 55 152 27s3. 23 109 3.211 11.19 0.13 6.113 . 1.59 1 209.74 13 60.00 11 1 1 1.24f :`i -3`-;,30 6,)Ih 1 209.711 3 28.02 t 70. r,t1 113 69. 37 3.349 ,h F,5.of3 114 87.3t 2° 23 73.03 95 197.t7 1.117 11.73 0.~13 2 8.5E 17 43.03 6 .; 3 13.88 43 73.01 9 -, 0.89 2.11 71m [t!+r:lrr,tf r!1 Sllrtlfri 1(t /lIlr,. 20. 1985 NON DIStiLM1NAIION ORDER IN ROGERS AND DUKE CASES. td,ircti, 1(1,
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_ ;h~lil p.;1T1tI~An •1,riI' _ 'l,f ;1,;11 :t_'_'._ ~':_',. 17) 1•. 30 23 14G..82 • tc,) l15 13rj (25.11 3(i.2'! ?r;.06 I :, ...;. • Ti 1167. t't _ II;> 2j1.71t .'f? . 1'3 1?t .7•i .• :, t11,(1•) 2 1ri.13', 1(1(i.w) ?0 127.57 } 20.0_3 'I 19. 59 ;2 1~~.`r'l N, 1G2.•(i1 6.0. 5.01 ~..t 1 3•511 ~ y..' . 19 ;o;.en 5 .rf T~-_:;~, t 3.5't tl rjl.l:l ,. .1 ;rl 3 37115.93 0 0 7 751.39 5 680.35 113 20%74 23 1;; . '5 1069.10 4 1087.q1 6 1166.64 8 '105.67 210 949.t; V12 (o,-: :. -17.17 65•75 -20.',9 15.03 !~O.10 2').?'-• O 0 0 0 2 254.09 1 1110.96 0 0 1 386 • 36 4 3311. C,7 3 503.21 23.110 2.74 10.22 0 0 0 0 0 0 U 0 (~ (1 0 0 0 0 1 ' W.3F 2 601.69 2().•10 37.82 O 1 1:.69 9 0 2.51 0 0 2 3 .Nl .09 ll 112 6.53 F.58 1 150.69 0 0 0 0 1.35 8 5'.GS 3 '' .`:. 81 445.sr llfi 2/S.h1 1)I,!{y 2 t7.'~t ll ? ~.' h.E17 7.n6 U 1l 27.~6 4 0 33 149.52 2,1 1; : 8.23 0 0 0 0 0 0 0 0 2 131.97 0 0 5.33 O p tl (, 0 3 'i.` ~ (1 ~) 0 Agn I ! ,,`.(1M Ilrrrr i:- t'rr .•1 •, T sa,r 'Ir•n'•In) 21 q(',,10 9 5,14 2.3h 0 0 0 0 0 1 3.,1:") u 4(i, il 'S t) 7 0 0 fl 9 0 2.511 , THIS "C(IMCNT SIIRIFCT TO Allr,. 21, 198.`i NUN 'UI;iS( ,t1INA I IUN ORDER 'N RUGERS ANU QUKF CASES. I c I R ~i1!1')
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1. ^I-..'r'1N 1•? ~' - 1'( '~lr: 1"tl~ „~rr.rl~0 l.tii~ )'(t^Clrr I'r11C 1r' - i( : r 20 31 2u5.1t5 9, 2<;~2.52 1 2110.99 2 2(~3.31 3 517.6£3 63 5'9.2t 35 2~ 1i' 1(A i:'.~') t(i '~r7."l2 11 90.92 6 U2'S.E~f> 5 ~tv2..5;) % 12~5 .('~ 1199 ~1•nq 1t11 `•cti; - ~'3•5f 29. 56 91.4 ~) -rf.4r1 i0.81 11.(iJ !T .r; r t i'1 3:,3•01 6 56.01 1 1607 I , . _i 1'>{c r.13. 1;, 169 2 s5.rt(r 0 0 !:;:ri " . I.~l 12.1xs -G7•2'; 71 2 15.2? 5 ',rt.r,2 121 •l_j,'1 l'i.? fi2.8f) Jlol : .;9 1.fic/ .. f.; ~ r. 1 g 'i7 . 22 9 77.2C 114 2 57 112 130. 51 3.98 ..~ 1 .76 119 1os).'i) 3c 3a,6, 'i •76 1t7.1th 1.26 c) 0 0 0 1 ?35.E30 311) 2S)F3.53 7 1 2F33•G5 ' 532.05 1 62.ryt 200 110G.Jc'a 171 2 29.10 -35.2tr 3.09 12.01 0 0 0 0 0 0 0 l, 0 0 0 0 2 (~?10 0 2 ' 01.61 2 329•53 -37.69 3 0 .6G 0 (U 0 0 1 119• 95 1 283.65 .-1),E;r! 17.22- 0 0 1 171,51 9.1I0 0 O 2 1h.r1 0 l~ 1t? 117.79 b.49 1,R(1 0 0 10 82 . 44) 9 0 0 117 232,Q1 111t 1; 10.49 . 4,W, 0 0 0 0 2 20, ;'2 ' .. 1 129.1n U 0 .~1 5t =.'= 51 105" 5•!17 5•51 7.:( o 0 . 0 0 0 0 0 0 1 16.29 1 (1q.9j 1 0 0 C 0 29 46 .fS7 113 2' _ t 3. tslt 17 . 22 2.15 1.31 I tttrs DocU'lENr SunlFr;r TO nuc. 20, 1985 NON-DfSS[MINA110N ORDER 'N OGERS AND DUKE CASES, P:rrv:11, in'i i. -; k s~ 9 3
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THE LINIVERSTTY OF TEXAS SYSTEM CANCER CENTER r.... J/.u..lc.wW Qcwutvw, ra.. 7roa Ju1y 11, 1975 ML-. Tom Hoyt Executive Vice President Council for Tobacco Research - USA, Inc. 110 East 59th Street New York, New York 10022 Dear Mr. Hoyt: THIS DOCUMENT SUBJECT TO AUG. 20, 1985 NON•DISSEtdINATION ORDER IN ROGERS AND DUKE CASES. Enclosed is a progress report and application for continuation of the grant for another year. Sincerely, Eleanor J. MaUonald Professor of Epidezniology EJm: : v Enclosures M D Al.'DIRSONHOSL^.AL.I%J:JM,7RD.'S.'TTJTI Mwn~wjRiMNiirroeCr.rr• [XTR.tMUR.U IROGR.tMS DrvlSIOti' Owc.lsfy C...d l+wr~c.ll.w wro v C.lLbMn.. Sr.d.n UMVLRSlTY CM1C[R lOlA1DATlOh' Tlv AwAr+.e% Akt&W.n CTR 5294 5.~++seeiei C w.a++.w. uW scva. /. ,c .CONF1UiNT1AL: MINNESOTA '-~,TOaACCO 1.1TIGATION N N ~~ ~~ J Zp 1 b
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THIS DOCUMENT SUEIECT TO AUG. 2J, 1985 NUw -DtSSEtdINATION ORDER 1N ROGERS AND DUKE CASES. PROGRESS REPORT ' TO TF.TE Council for Tobacco Research .itutional Suo rt from the K. D. Anderson Hosoital and .)r Institute General use of all the facilities is graciously supplied, .e.,space, furniture, use of unit equipment for preparation f computer input, the institutional computer; staff time as aeeded, especially in the area of bibliography search; and one-third time salary of principal irivestigator. Description of the data base A detailed bibliography in abstract form of the literature for the last.45 years is filed by site of cancer, the usual way for studying this disease. - All cancer cases for 56 counties in Texas for 23 years from all sources are available, as well as cancer cases foT 15 years from several other counties. There are over 350,000 accessions for cancer. By our method of collection from all sources, there are multiple accessions for many individuals. After these were alphabetized by computer by place of residence, by name, site, sex, age and admission date, they.were inspected to assure an ;ndividual was counted only once and that the earliest date of all his accessions was the listed one for figuring incidence. This netted 200,000 individuals, of whom at least 10% had mul- tiple primaries. The data for the counties are now grouped or. tape by Bill-Burton hospital regions around the following cities: ' Houston, Corpus Christi, San Antonio, Harlingen, Laredo, and El Paso. A population of 4 million is covered of whom 2 million are white, excluding Spanish surnames, and the other two milliorn are about evenly divided between Negroes and Spanish surnamed individuals. Age-adjusted incidence rates have been figured using three different standard populations in order to make com- parisons with the first, second, and third national ca.ncer surveys, and with the world figures out of Lyon. For mortality, we have on tape our own collected data from 1940 through 1959, for every cause of death by sex, by white and ncn-white for every state, for the District of Columbia and for the United States as a whole. Age-adju.sted rates by year and bS, 10 and 20-year averages have been calculated. Regional studies of comparative mortality have been made, but none to the depth of the one under discussion. We have the excellent compilatio.^. C T R 5295 CONFIDENTIAL: MINNESOTP. ( y TOBACCO LITIGATION
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~'~.;. .... . .. . _ '. . ._. Ih ROGEit~ hhD UKE CASFS. Progress Report to the Council for Tobacco Research Page 2 of Dr. Tom M.ason of the Epidem.iology'Branch of the NCI which averaged cancer rates by site for male and female, White and non-White, for 20 years from 1950 throuch 1969. Throuch the beneficence of The Council for Tobacco kesearch crants to the Houston Deoartment of Health.recodinc of the 235.000 deaths from all causes for thirtv years from 1940 to 1970 for Houston was effe-cted. These records are all coded to the rubrics and ICD classification of 1965, thus are homoqeneous. Durir,q this recodina process, correction to the richt pri.marv site of cancer of many incorrectly coded death certificates was made possible bv checkinq with our data base from all the hospitals in Houston which was available in our office. This is the onlv lonq time exaerience coded to one ICD classification, and checked for accuracy. The street addresses were looked up and entered in code by census tract. Then the census tract oopulations and death records were combined in the 15 regions by air pollution collection sample stations. Age-adjusted rates by sex and ethnic group were figured and analyzed. Comparison within the city showed real di:- ferences between regions and between ethnic groups, not only in cancer but in heart disease and stroke and other respiratory dis- eases. It appears that the petrochemical pollution from the ship channel area is carried by the prevailing winds over the center city, one of the older settled sections, and on to a relatively new real estate development. In the latter region, there are alsc saany chemical plants which moved out there when land was cheap. ke are trying to determine the relative importance of each of these variables as well as that of the major highways that bisect this region with the attendant truck and auto pollution. (See attac:e=. taap) Grants of approximately $200,000 from the Recional Medical Program enable accu.mmulation of the 56 county incidence data mentioned above. When one-third of this project was completed, the funds for continuance were transferred to another prograir., and we were left without the personnel to realize the analysis of t::is wonderful data bank. This data set is over time and is larger than the total cases in the Third National Cancer Survev, which cost a reoorted $5,000,000 to collect, with another reported $5,000,00C for processing. Results of Support from the Council for Tobacco Research The past support enabled whipping into shape the data base includinc coding, checking for duplicates, taping and program.,,:r.c. Some incidence rates were prepared (for the last five years by CTR 5296 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION CT~~:.4
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SJSIE~^T TD AJu^. 20, 1985 Nun•DjSSEr.,ihA1i0f; ORDER /N ROGERS AND DUKE CASES. Progress Report to the Council for Tobacco Research Pace 3 region). The skin cases were prepaxed for the Climatic Impact Committee of the National Research Council in the SST contro- versy. In comparison with the federal outlay on a smaller data base composed of a three-year average, and contrasted with an over time accuasmulation of 23 years with several consecutive five and ten-year averages, our compact and qualified coordi- nated team on a relatively small amount is developing mortality and incidence models through the special skills of Dr. Dorothy Wellington (Doctor in Biomathematics). We are analyzing every conceivable variable by more sophisticated mu.ltivariate procedures than have been used hitherto in this type of data. We are seeking to determine what proportion of an incidence of a particular site of cancer can be explained by a particular variable, and by what combination of specific variables. As an example, what proportion of the lung cancer rate can be explained by petrochemical exposure, by ethnicity, by climate or by smoking ? What other variables are buried in the recur- ring highly significant variable of densi•ty of the population? This is a much more indepth analysis than at first seemec - possible. When the models are fully functional for mortality, they will be used with morbidity data.by region by cou.nty by different time periods in Texas in the 56 counties for which every death and every case are knowr.. I was Chairman of the Ninth International Pigment Cell Conference held in Houston early this year. It was not prac- tical to activate the grant until Karch lst, because of the time consuiaing project of running that meeting. The effec- tive dates should be changed from September, 1974 - August, 1975 to March, 1975 - February, 1976. To complete this projec_ properly and write the book as planned will take an additiona_ year through the spring of 1977. Will the Council be able to finance this project for-an additional year? And could it consider an additional $10,000 to enable employment full-time of Dr. Wellington, who is now employed half-time7 Your group has done an immense public service in making possible the full use of this data bank. I also appreciate the personal kindness you have done me in overcoming the frustration the loss of this material would•have meant to me. It took an iacnense amount of plan.ning, energy,of inspiring and training the personnel with the attendant atten•;:ion to detail and public re- lations to assemble it. It is a tribute to all concerned that I never encountered a single refusal from physican, laboratory, or hospital. CT(', 5297 CONFIDENTIAL: MlNNESOTA TOBACtO LITIGATION , ti ~„ ~ R N~'"~ ~ ..;¢`..~,~~'..c~ M1
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Progress Report to the Council for Tobacco Research YNIS bOCUt,'ENT SU?Ic';T i " • :.., ~SO~ (~viU ~JC"Uiri+llvi. "vi,JCt~ IN RCGEic~ AhD WL~E. CASE.S. Page 4 At the personal level I cannot find words to express my heartfelt thanks for youz support. Attached is a technical report of what we plan and what has been accomplished. 7/75 CTR 529S C'UtvFIDi•t:TIAL: MINNESOTA TOBACCO LiT10ATlON CTR flt-•f ~'.0,1~'.`2"`0'
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,... _.... _,~ .....,.__~ _. ~ , 685 M1Ut, -UISSE-',11Nl,110~Y Unilui ` MI ROGERS AND QUI E WES Plan for Anal sis of the U. S. Mortality Data Usinc Aee-ad~usteA. Deat Rates We want to confirm the regional differences in mortality, using the ten geographic regions as the basic classification of states. Next, we want to see what factors (covariates), which are measurable by state, are associated with different levels of mortality. When two factors are correlated with a specific mortality, we want to _see whether each factor is still corre- lated when correction is made for t.he effect of tlhe other factor. The correlations are across the four states. One can say, thus, if levels of Factor A are high, mortality is also high, or vice versa. Similarly, Factor B may be testec. What must be determined is whether Factor A is acting through Factor B on mortality, or whether it is independant and acting on its own. For example, assume that low income levels and low breast cancer mortality occur in the same states, also that hic:^.e= levels of breast cancer mortality and larger percentages of for- eign born occur together in the same states. Does this mean that high income levels and large percentages of foreign born occur together in the same states? If so, then either income level or ethnic background is effecting the mortality rate directly, but not- both. If the two factors are not themselves correlated, t5e.-m each one is effecting the mortality separately. If this is the case, it is also possible that the effect of income and the effect of ethnic background, rthough independant of each other, may in- teract on mortality so that their effect together is greater tha:n the sum of their individual effects. It could then be that be:^c affluent has an enhancing effect on the ethnic influences on mortality, or that being foreign born enhances the income leve_ effect on mortality. This is called interaction and it can be positive or negative. There are many ways of determining the form and extent of t:e influence of several factors on the dependant varieLe, the mor- tality rate. Another method besides using multiple regressior. equations, is principle cvmponents. These are linear functions of the factor variables, with coefficients which reflect the importance and input from each factor. When there are many interrelated factors to deal with, the principle components reduce them to the one or two which account for most of the variation among the whole set of factors. The principle components are not correlated with each other, so eac` one represents an independant set of-forces acting upon mortalit•:. For example, if you were looking at all the body measurements asa factor in total weight, the first principle component would be a linear sum function of all the measurements with all positive coefficients, representing a general size component. The seconz principle component would be a linear function of all the measure- ments, of which some would be positive and some negative coeffi- cients, such as width of shoulders contrasted to width of hips plus length of arms contrasted to circumference of arms, i.e.,a CTR 5299 CONFIDENTIAL: MINNESOTA _ TOBACCO LITIGATION ~ '"~ ~.M 1°~I.,~ ~~~~ ~~~ 1
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THIS DOCUM:NT SUBIECT T0 AJ0?p, 1985 NON DISSE IhnTIOy Oru_P Plan for Analysis of the D. S. IN ROGERS At& OUKE CASES. Mortality Data Using Age-Adjusted Death Rates Page 2 muscular vs. fat contsast, etc. Since usually one or.two principle components can stand in for all the factors, a regression model using them as the independant variables and using the mortality rate again as the dependant variable can be applied to the data. When the variation among the states in mortality levels can be 'explai.ned' sufficiently, either by individual factors in a regression equation, or by principle components (linear functions of the variables) in another regression equation when 'sufficiently' is defined as explaining at least 75% of the variation, then we want to see if the regional differences will hold after these variables are allowed for, or corrected for. For example, if all the states had the same income level, would the regional differences in breast cancer mortality stil: exist? Just as there can be more than one factor variable, so there can also be more than one dependa.At variable. In the case of this survey, there are twenty individual years of mortality ra?es. -Each one can be the independant variable, or the average of a set of them, or their average change over time. One can determine a multiple regression equation for the average of the first period of years a.nd a multiple regression e wation for the average of the second period of years, each in terms of the same factor variables, and then one can test to see if the coefficients are essentially the same in bo Lh periods. Thus, one can tell if income level, was more important in the earlier period than in the later period in affecting the level of mortality from breast cancer. When regional differences are tested, using either the original dependant variable (mortality rates by state), or those rates 'corrected" for state differences in the associated facto: variables, contrasts amang regions may be tes-ted. For example, are the Western regions generally lower in cancer mortality than the Eastern, the Southern than the Northern? Are the inland regions lower than the coastal regions in cancer mortality? Another statistical method being applied is discriminant analysis. This assumes that the factor variables are important in determining the dependant variable's level. It starts from the regional division that is given. It then_produces a linear combination of the factor variables which causes that division tc be the greatest. This linear combination produces a new depen- dant variable (in principle components, new independant varial-les were produced), which, when used in analysis of variance instea-' of plain mortality rates, results in the largest significance when testing differences among regions for that particular type of mortality. , CTR 5300 COIr'F7J~l: i tat-. ;,, '7OBACCO LITIGAT(ON ~.~t~ ~'~''
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TH!S D~-=""ENT SUQIECT TO 0G. 2u. 1985 N:l:i-DISSEMINATION OnJER Plan for Analysis of the U. S. IN ROGERS AND DUKE CAS`-S• Mortality Data Using Age-Adjusted Death Rates Page 3 . We plan to do the above analysis on the age-adjusted mortality rates for some thirty different causes of death, for the years 1940-1959, then add 1960-68, for 48 states and the District of Columbia as the •individual obse:-va- tions.' Perhaps ideally, when determining the i.mportance of factors, it would be useful to weight the states according to their importance, defined as the state's percent of the U. S. population. But when testing regional dif.'erences, each state properly stands alone. Rhode Island is as im- portant an individual in the New England group, as Texas is in the West South Central group. Because of wide differences in racial composition arnor.c the states, only the white males and white females are inclu- ded in the mortality rates. In the factor variables, such as density of the population, the total population of the state _ is involved. The per capita income level for the whole popu- lation is one variable, that for whites only is another vardable, and each one reflects something different about a state. We anticipate very different analysis results among the different causes of death, and some difference between periocs. To date, important factors by state associated with hich age-adjusted mortality rates for cancer of the bronchus, trac'nea and lung with specified and unspecified as to primary are as follows: White Males-Averave (1950-1969) 1. Density of population - the greater the density, the higher_the mortality. 2. Elevation - the lower the elevation, the higher the mortality. 3. Temperature - the milder the winter, the higher the mortality. 4. Precipitation - the greater the precipitation, the higher the mortality 5. Public drinking water - the laraer the proportion o: the population drinking public ~rinking water, the higher the mortality. 6. Malt consumption - the higher the per capita malt consur•ption, the higher the mortality. CTR 5301 CONFIDENTIAL: MIIh'NESOTA ~ ~ TOBACCO LITlGA1YUN ~~~~~``~ ~~~~~~~,.~ ~
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T- Plan for Analysis of the U. S. IN ROGERS AND D'JKE CASES Mortality Data Using Age-Adjusted Death Rates Page 4 7. Scandinavian population - the amaller the proportion of Scandinavians, the higher the mortality. 8. French, Italian, Latin American, except Mexican s- the higher the proportion, the higher the mortality. The following are other factors also correlated with cance: mortality rates of the bronchus, trachea and lung, but they appear to be related through their mutual relationship with the above factors. White Females-Averaoe (1950-1969) 1. Wine consumption - there is a positive relationship. 2. Percent of population living in urban areas - positive relationship. 3. Temaewatuze - positive relationship with mild winter. The same models described above for t.he mo:tality data analysis will be applied to the incidence data of cancer b•,• site in the 56 completed counties in Texas. ~ 7/7S C T R 5302 CONFIDENTIAL: f.:IItNLSOTA TOBACCO LITIGATION E ' KF}R ~ 11H '^'N f-- Q:;~ ~
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER `~cfl 14 ~O l ~ ; O . TY... Yedta/ Crnw+ XoWroe, Tesu 77025 A )~ rarc A r.. July 28, 1975 THIS DOCUiAENT SUBJECT TO AUG. 20, 150) hiN• DISSEhSINATION ORDER Mr. W. T. Hoyt Executive Vice President IN ROGERS AND DUKE CASES. The Council for Tobacco Research, USA Inc. 110 East 59th Street New York, New York 10022 Dear Fs. Hoyt: I am afraid I was not explicit enough in my request to you of July 11, 1975. On page 3 of the Progress Report in the third paragraph, I explain why the grant was not activated until March and went on to say I need an addi- tional year to complete the project properly. I was rew estina a total of $71,000 to continue the grant from March, 1976 to February, 1977. The additional $10,000 for Dr. Wellington was to cover fulltime salary from March, 1976 to February, 1977. She is presently half-time. Sincerely, Eleanor J. M~cdonald Professor of Epide.-aiolocy EJM:rv , M D~t.ti'DLRSON HOSPl7AL AND TUMOR INS77TUTL Merr eti R...~drurw. C..rr LXTAM4URAL PRC>GR,MSS DfV/S1ON Owrelotr Ce.. td•lwvdKd Imnr.rrenr C.l4br.uw Sn.d.n UNNLRSlTY CANCLR fOUNDATION lA, A.dr..oe M.vl.r• CtR 5303 S.Mur,e+r l4r.ro.w..uf S.rr.c. P.'r E`@~~R ~`~~4~ ~.~0 11 Z°Z'~r
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i C --, ;; 6 THIS DOCU?.IENT SUBJECT TO AUG. 20, 150; „j`•D:SSEr~IIrATION ORDEn Ih ADGER S AND DUI;E CASES, CURRr.":r'T STaTUS OF STGDY Fleanor J. kacdonald December 16, 1975 - - CTR 530.1 , CONFIDENTIAL: MINNESOTA "' 9'OBACCO LITIGATION L' TR, rit~I ~`~0"J" ~'.'~'b
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. 20, ~u~~innllun vn./Cf~ IN ROGEP,S AND D'UY.E CI,SEc. U. S. Cancer Survey A comprehensive study is being aiade of the factors which are associated with high cancer mortality rates in a state or re7ion of the continental United States. Age-adjusted death rates for mare than thirty cancer primaries, averaged over four time periods, 1940-1948, 1949-1959, 1940-1959, and 1950-1969, for each of the 48 states and D. C. are the dependent variables. In addition, for t~ne first three periods, the average rates of change in mortality, both linear and logarithmic, are in the data matrix. This study deals only with the white population, since the nonwhite data represent a racial composition which - differs greatly by state, with male and fernale mortality treated separately. In addition to cancer deat,hs, the data includes mortality rates from all the major categories of disease includ:r.c "Violent and Accidental" as a comparison with the patterns of ma'_i5nancy. For the independent or explanatory variables, sets of factors representing each state's relative position with respect to ethnic composition of the population, pollution, consumption and climate, some at different points in time over t1he period of interest, are used (Appendix I & II). The purpose of this "macroepidemiology" is to determine which factors of a-more specifically etiological nature are behind the association often found between high rates of cancer mortality and a high degree of urbanization, a high population density, and a high income level. Is city life car- cinocenic because of pollution,the ethnic composition of urban CTR 5305 CONFIDENTIAL: MINNESUTA " TOBACCO LITIGATION ~ ~~` ~``~ ~~~~~~~.~
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1505 riul~ D~SSD,tINATIOh urtJEP, Ih rGERS hND UKE CASES. ;; . S. Cancer Sur vey Page 2 people, their consumption habits, the climatic positioning of large population formations, industrial labor, or simply the stress of crowding? Is urban life a higher risk for all-kinds of cancer? What aspects of high income level lead to its association with cancer mortality and does this association hold for all cancer mortalities? The analysis appropriate to this type of demographic- sociological study will naturally differ from that used in the more concentrated "microepidemiological" study which establishes that a specific etiological factor is a carcinogen. If the pe: capita consumption of malt in a state is associated with a high mortality from cancer of the intestines in that state, this in no way determines that malt is the etiological factor. Snstead, _t raises questions about what other factors, associated r.ith both, are the real reason for this high mortality rate. !:a:t, or some element in its compositior., may be a:ina'_ etiolo- gical factor, or it may be one of the links in the search. Since there are large differences between t.he states and regions in mortality rates, they should be understood and explained. Descriptive statistics are not adequate for ferreting out those patterns and relationships atnon7 all the mortality and factor data which will provide the clues for the final etiology. On the other hand, traditional statistical methodology was not de- veloped for this type of data, which is a rough measurement of the whole population rather than a careful measurement of a randc'. , C1R 5306 TOBACCO L1T1GAfI0N CT R` N H (30 11
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C ~ l~w /'0"-ll1SSb4iirKliuJY UrcUER~ IN OGERS AND UKE CASES, l G. S. Cancer Survey Page 3 sample of that population. Statements of.significance are appropriate only when making inferences about population para- meters, not when dealing with then directly. However, some statistical methods are effective in organizing data efficiently to delineate patterns of relationships arsong variables, and t.hese have been used with caution on t2:is data. i The chief problem in analyzing this data is the frequent one of colinearit . Correlation among the independent variables is so great that the primary effort must be to deterr..ine which variable is actually associated with a particular mortality rate and which variable is statistically but artifically associated with the mortality through their mutual relationship with a_zother known or unknown factor. Correlation ratios between a factor and disease, and among factors, are just the first indi- cation of the possible true relationships, and can only form t.he basis in the search for patterns between sets of factors and sets of mortality rates. The inferences in this type of analysis must be made from observation of repeated patterns and a com±aon sense consideration of the inner logic of the relationships indicated. Preliminary results From the study of the 20-year mortality averages of the period 1950-1969 emerged a spectrum of cancer mortalities with respect to their most highly related sets of factors, displayed in the accompanying chart. With some overlapping, 25 of the cancer mdrtalities can be divided into three groups, one an 1- ethnic-consumption-income group, another a pollution aroup, and CTR 5307 CONFIDENTIAL: MINNESOTA ~ ~~,, ,~ ,, r , f. , ~~ t C TOBACCO LITIGATIO i~ i'~ N ry ~ ~~ I ~ ~ ~ ~ ~ ~j i
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i,.j(N-UjSJEMINATION' ORDER IN ROGERS AND DUKE CASES. U. S. Cancer Survey _ Page 4 the thir a climate group, the latter dividing into cold and warm subgroups. High death rates from skin cancer for both males and females are associated with warm winters and heavy rainfall. Since the association between sunshine a-nd skin cance: is known, it is clear that `warm winter" is the variable repre- senting hours of sunshine. The reason that cancer of the Buccz: Cavity and Pharynx in females is included in this wa.--m winter subgroup is unknown, but it may reflect the custom a:..ong older southern women of "taking snuff.," that is, keeping a plug of tobacco inside the lip. Thus a climate factor may stand in fo- a sociological-consumption one. • Most of the five Cancer mortalities associated pri.a.zril-% • with cold winters also have ethnic associations. k.ale and fe:..ale stc.:ach cancer is highest in the colder winters and is also associated wit_h the percent of the state's white pcp::- lation who are foreign born, especially Ger-maz and Russia..^, (" and the percent who are of foreign stock (mixed parentage)• Cancer of the prostate is associated with cold winters and wit!: the percent born as French Canadian or other Canadian. Since most Canadians in this country have settled near the Ca.nadiarn border, it is difficult to determine which of the factors is (1) The various ethnic percentages are, of course, very s:nal'_, but they are taken to represent a state's relative positiorn w;:`: regard to:its native population of each ethnic background. CTR 5305 CONFIDEt7TIAL: MINNESU'f'A TOBACCO LITIGATION L , . I ~ ~ ;M1 1• r ~ti~ ~~ ~"`'~ ~
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C ct4T SU6JECi Tv AUG. 20, hvl~-DISSEMINATIOti ORDER IN ROGERS AND DUKE CASES. U. S. Cancer Survey Pace 5 prima-_-y, c1Lmate or ethnicity. There is a somewhat weaker association between Scandinavian etrzicity and cancer of the prostate, but the Scandinavian stock also live in the colder climates here. However, it is interesting to note that t.he Scandinavians have the highest rates of prostatic cancer amonc the white populations of the world. In contrasting the other two groups, it can be noted that t-he more exposed sites of cancer are t_he most consistently related to pollution factors, while the more internal sites are related to ethnicity and consumption. _ Further analysis of this data will involve const.:uctinc mortality models in order to determine, with extreme caution, t_he "best" set of factors in each case (Appendix III). Principal component analysis will be applied to concentrate the factor va..riation in a few independent variables. Specific state ancd regional interpretation of the results will be aade. Then co- variance technicues will be used to measure the relative' size of regional differences in a specific type of mortality when the factors proposed as deterr=dnants are corrected for. 12/75 A CtR 5309 CO1:FIDENTIAL: iv.1NNESOTA ~p ~ ~ TOBACCO UTIGATION C . o1 ~~ j ~ 3
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F.bSrevia tions FNBW Foreign born white - 1950 (THIS DOCUtitENT SUBJECT TO AUD 20 1525 NON•DISSEMINATION OpDER IN IO,GRS AND LUKE CASES. Country of birth of the foreign born white - 1950 POLA Poland BRIT British Isles GERM Ger-many ITAL Italy RUSt Russia LITE Lithuania CAND Canada FN.y3 Foreign stock white - 1950 N,f,I^ . Malt consu=rtion per capita - 1950 CIGS Cigarette sales per capita - 1955 TINC Total income per capita - 1950 A^"-FR Percent males employed in manufacturing of total employed a.a? es - 1950 Fu7-R Percent females employed in manufacturing of total exployed fe.-les - 1950 ViaM Total vehicle miles of travel per square mile of land area (loge) fiYCf, Tons per year of Hydrocarbons per square kilometer of land area (loge) Cn-MO Tons per year of Carbon Monoxide per squar e kilometer of land area (loge) `1_OX Tons per year of Nitric Oxide per square kilome:.e_ of land area (loge) C1P 531U CONFIDENTIAL: M.lNNESOTA TOBACCO LITIGATION ~~ 0-1 .~ ~.~ '1
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i-., . U.;..,;F.:E',i ,~;c1ECT TO AUG. 20, 1985 NON -DIS~MINATION ORDER IN ROGERS AND DUKE OASES.. 2 SUDI Tons per year of Sulfur Dioxide per scuare kilometer of land area (loge) pp,RT Tons per year of Suspended Particulate per sc-.:a_e kilometer of land area (loge) w;~M.? Average maximum Janua_-y temperatt:re 1921-1950 RAIN Average azinual precipit.ation 1921-1950 EI,...°V Average elevation CTR 5311 -..J1A ~ TUBACCO L1T1GATlON 11 00,323,
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0 '3 Y S x x x SUd1Ei,1 T;,' AUG. 2' 19$S KON•OISSEtdINATION ORDER y LN.LOGERS Al1D 'JK' CkSE$, ft x:c x x x x x x>; x .r N x x x x x:Ix x y :< X x r. X x x x F ~ CTR 5312 CONFIDENTIAL: MINNESOTA ",TOBACCO LITIOATION ~` ~~~~0 ~'~~•l`.~~~ ~~° ~4
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THIS DOCUMENT SUBJECT TO AUG. 20, 1985 NON-DISSEMlNATION ORDER IN ROGERS AND DUM,E CASES. Progress Report to the ' Council for Tobacco Research, USA, Inc. Current Status January, 1976 TABLE'OF CONTENTS A. Accomplishments during year B. Time estimated for completion C. Recent publications D. Science article E. Outline of book F. Data base Eleanor J. Macdonald Professor of Epidemiology Department of Epidemiology The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute Houston, Texas A , CONFIDENTIAL: MIhNESOTA TOBACCO L[TIGATION C T R 5313 ~ 'f"~~ ~°`~~'~ 0t~~ ~ ~'Q ~ ~c
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V-- lz` 1%,,,-u,3SE4IHATIUN ORDER 1N OGERS AND DUKE CASa , A. Accomplishments in current year 1. Aae-speci_'ic an-d age-adjusted mortality rates for each year and five-year averaces Were figured for totals for deaths from all causes for Houston (30 years, 1940-69), for males and females by Spanish Surnamed, Anglo and Negro for the total city and for 16 areas within the city. The 16 areas are grouped census tracts around the air pollution collection sample stations. The rates are figured for total cancer, 34 cancer breakdowns and other major causes of death. Analysis of mortality rates and pollution readings was undertaken. 2. Age-specific a.zd age-adjusted cancer incidence rates for 56 counties in Texas for 23 years (1944-66) were !~ fig-sred for cancer for the"three ethnic groups for males and females for each county. Note: Individual counties. 3. Age-specific and age-adjusted cancer incidence rates / for six Hill-Burton regions in Texas (total of 56 v counties) for 23 years (1944-66) were figured for total cancer and individual sites of cancer for three ethnic groups for males and females. Note: Grouped - counties. 4. U. S. mortality by state , After compiling the raw data, the first step was to take all the variables and correlate them with each individual site of cancer. Those that were found significant were then subjected to mayltiole revressio analysis to see what proporticn of the rate cou c be attribute.ad to air pollution, for exa.aple, and what to genetic background, etc. A program was,developed whereby all the factors under consideration could be subjected to recression analysis without prior selectio:: by correlation to make sure that the correlation of these environmental factors with a specific kind of cancer was not an artifact. These environmental factors were then subjected to multiple regression analysis with prior selection (Lincur). The relimina:v resul-s in several cancer sites were identical or nearly so and reenforced the correlation data. Thus the models we have seem to be a true measurement of the relationshit> of the demographic and environ=ental variables to the~ cancer mortality and these methods will be used to complete the analysis for each site of cancer. It is of particular interest that these models have used not or,ly established technic~es but a new and advanced innovative procedure de•:eloped by my biomet=iclia::. The next step is to co:aplete _:ese models and them to the Texas county data. CTR 5314 CONFIDENTIAL: MINNESOTA ~ ~ ~ ~ TOBACCO LITIGATION Le t~ 0 C)
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T:::S D)"""ENT SUBJECT TO AUG. 20, 1SE5 NUN •DISSEtr,iNATION ORDER lN GERS AND DUY.E CASES. i B. :ime estimate A real:stic estimate of time for completiorn of the book is one year. 1 CTR 5315 CONFIDENTtAL: MINNESOTA TOBACCO LlTIGATION c `Ip R~ NH ~`.,032~3 I.v
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THIS DUCUL'ENT SUcJ:C1 70 AUG. 20, 1985 NON•DISSEtAINl,TION ORDER IN ROGERS AND DUKE CASES. C. Recent Publications 1. Macdonald, E. J.. Incidence of mul tiple pri.;.L: y cancer in three regions in Texas 1944-66 (Proceedings of the Vth Perugia Quadrennial International Conference on Cancer, Perugia Dniversity', 1973). In Multiole Primarv Malianant Tumours, ed. Severi, L. 5ivis:on of ancer esearcn, Perugia, Italy, 1974,pp. 123-142. 2. Macdonald, E. J.: Ethnic and Regional Considerations in Epidemiology of Breast Ca.cer. Journal of the American Medical Women's Association, March, 1975, 30 (3) :105-113. 3. Macdonald, E. J.: Association Between Cancer Eye and Solar Radiation. In Imcacts of Climatic Chance on the Biosohe:e, Climatic Impact Assessment Program, Monograph 5, Part 1- Ultraviolet Radiation Effects, Depart-ment of Transportation, Climatic Impact Assess- ment Progra.-n, Washington, D. C. September, 1975, p. 6-20. 4. Macdonald, E. J.: Epide.miology of Melanoma 1972. I:: Vol. VI, Procress in Clinical Cancer, ed. Ariel, I. M.- Grune and tratton, Dece:.,oer, ic, pp. 139-149. 5. Macdonald, E. J., Dmochowski, L. L., and Jesurun, H. M.: A Study Among Lactating Latin and Anglo Women in El Paso County, Texas, to Deter-mine Presence of Virus-Like Particles in the Milk. Proarama Resumenes de Com^u::i- cacions, 2nd Duran-Revna s Internationa Svmoosium: Viral Re::~I.ications and Cancer, Barcelona, Spain, June 21- , , A.ostract No. 30. (in press) 6. Smolensky, M. H. Sannueloff, S., Earlevy, B., Macdona:d, E. J., and Reinberg, A.: Circannual Heart Mortality. An attempt to identify possible endogenous and exogenous factors in seasonal variations in heart deaths. Israeli Journal of Medical Sciences, 1974. (in press) 7. Macdonald, E. J.: Epidemiology of Skin Cancer, 1975. A collection of papers presented at the 20th Annual Clinical Conference on Cancer, 1975, at The University of Texas System Cancer Center M. D. Anderson Hospital and Turnor Institute, Houston, Texas. (in press) 8. Macdonald, E. J.: Incidence and Epidemiology of Melanoma in Texas. A Collection of papers presented at the 20th Annual Clinical Conference on Cancer, 1975, at The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute, Houston, Texas. (in press) C T R 5316 CONFlDENrIAL: M,iNNESOTA TosAcco LIrIcArrox ~~ 0 ~ ~ f ~ ~
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THIS DOCUIdENT SUEJECT T0 AUG 2C1985 NON•DISSEIdINATION ORD;p IN ROGERS AND DUKE CASE;. D. Science article . The paper has been submittea to referees and is being revisea. It will be out in February. A more detailed paper will be presented at the National Institute of Environ,mental Health Sciences Sysaposium, March 1-3, 1976, and will be publishe,ad in the Environraental Healt^ Perspectives. © C T R 5317 CONFIDENTIAL: MiNNESOTI+ TOBACCO LITIGATION• CTK" HN ~~0.3~'~~.~~'~
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SU")EC1 i0 AUG ~ 1985 NUtti•DISSEMINk110N OROER IN ROGERS AND DUKE CkSES, E. Preli^.inary Outline of Book - EpideTa olocv of Cancer I. Historical Trends in Cancer A. Historical Development of Cancer Programs 1. American College of Surgeons, 1913 2. First State Health Department, Cancer Department, 1929 a. House Document 400 - Massachusetts, 1924 b. House Document 1200 - Massachusetts, 1926 3. First comprehensive epidemiology report - 4. Frederick Rof:man, 1915 Origins of National Cancer Institute, 1937 5. National Advisory Cancer Council B. 1946 to current - Period of financial expansion I:. General comparative epidemiology of cancer as measured by cancer mortality in U. S. (1940-1969) and 20 countries. Epidemiology of Cancer A. Discussion of need relating theoretical.epidemiology of cancer to actual data B. Discussion of each individual site of cancer by the following breakdowns: 1. Morbidity 2. Mortality 3. Regional and international differences 4. Ethnic and sex differences 5. Brief literature review 6. Occupational and environmental implications 7. Specialized cancer center (MDAH) and co=unity level cont:ast IV. Future Directions * (The major groupincs of the sites under III.B. are:) 1. Skin 12. Gallbladder 2. Soft tissues 13. Pancreas 3. Bone 14. Colon 4. CNS 15. Rectum 5. Upper respiratory 16. Kidney 6. Thyroid 17. Urinary bladder 7. Breast 18. Prostate and testis 8. Esoo::aous 19. Female Genital Tract 9. Lung, trachea and bronchus 20. Reticuloendothelial Sys--e-. 10. Stomach 21. Childhood and Teenage tumc:s 11. Liver 22. Tumors of Old Age CTR 5315 CONF1£4:f41AL: MINNESOTA TOBACCO LITIGATION C ~' ~„h NN ~'~ C4 ~ 240
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:~ JUBIECT 10 AUG. 20. l5 h'UN•DISSEMINATION ORDf~ ~ RRS AND DUKf CAS fS F. Data Base and how they interrelate ~ I 1. 2. 3. 4. 5. Mortality data, Y.ouston - Ail deaths in Bouston for a 30-year pe:ioc, 1940-69, for males and females, Spanish Surnamed, Anglo and.non-white. Mortality data, U. S. - A11 deaths, including violent and accidental deaths, for a 20-year period, 1940-59. Slopes and trends figured. Mortality data, U. S. (Mason's data) - cancer deaths only for a 20-year period, 1950-69. Incidence data - all cancer cases for a 23-year perio-_~, 1944-66, for 56 counties in Texas for males and females, and three ethnic groups, Spanish Surnamed, Anglo and non-white. The difference in Mason's data and our data is: a. Mason's data are age-adjusted mortality rates for the total time period, 1950-69, and for malignant deaths only, for white and n males and females. o n-white b. Our data are age-adjusted mortality rates for individual years plus five-year averag e s as well ~ as for the total time period, for mal ig nant deaths and for all violent and slopes and other causes of death, in accidental deaths. We ha trends on our data. This cl ve ha uding figured s not been done by t'.asor.. CTR 5319 ,CONFIDENTIAL: i' ' "U,NESUTA ""',TOBACCO LtTIGATiON C T R.~ ~~ ~, J 0 0 3'^- ",,1~ ~~ '~
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C APPENDIX 1 Methodology M1S DOCUMENT SUBIECT TO AUG. 20, 1985 NON-DISSEMINATION ORD_R !N ROGERS AND DUKE C:,ZES_ The independent variables for this study were gathered from reference sources including the Bureau of the Census reports, Environmental Protection Agency reports, World A1m-anacs, Statistical Abstracts and various tax reporting agency reports. Some variables were entered into the com- 01 puter in raw form;and transformations performed within the computer. Other variables such as weighted density and weighted vehicle miles had to be figured on desk calculators and then entered into the computer. It was necessary to transform some variables to norr..a- lize the distribution of the variable and to ata.bilize the coefficients of variation across regionc. Natural logarit.h.:.ic transformations were used on the density, total vehicle miles of travel, weighted vehicle miles of travel and air pollutiorn calculations (designated by L prefix in abbreviation). Sc-,uare root transfor-...atior.s were performed on the air pollution data also. In order to compare data among states more readily the foreign born white, country of birth of foreign born white, foreign or mixed parentage, urban foreign born white, Jewish, and urban populations were converted to percentages of the state white population. CTR 5 321 U CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION
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C 1935 NUti• DiSSEN.IhMtuh ur%ULx IN RpGERS AND DUYE_ CASES,. 2 Appendix II contains a list of the 175 independent variables presently in the study. These, together with 343 dependent variables (mortality statistics), were keypunched and entered onto files in the CDC 6400 computer. The mean, variance, standard deviation and coefficient of vaziation were calculated for each variable for the United States and for each of the ten geographic regions. Several available statistical program packages were examined to determine which would be the most appropriate for these data. The Biomedical Computer Programs (BY.D) from the Health Sciences Computing Facility, Department of Biomat.hesnatics, School of Medicine, University of California, Los Angeles, wa s- chosen as a good basic system to analyze this material. The Statistical Package for the Social Sciences (SPSS) , from the University of Chicago was reviewed but did not meet our needs as well as the BMD package. The linear least squares curve fitting program (LINCUR) developed by Daniel and wood and available from the CDC Library in Minneapolis, Minnesota, has been adapted to our data and provides another tool for use in model construction. A ridge regression program from Shell Research in Houston is now being converted for use on the CDC computer by our systems analyst consultant and will allow further refinement of our model construction technicrues. 12/75 r, CT R 5321 CONFIDENTIAL: MINNESOTA ~ ~~ ~, ~ TOBACCO LITIGATION C T C) 0
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C . 1985 NONDISSEM •INAIION ORDER tN ROGS AND DUKE CF SE , S . Appendix II Independent Variables Data calculated for each of the <"o states WPOP 30 White population 1930 WPOP 40 White population 1940 k'POP 50 White population 1950 h'POP 60 White population 1960 WPOP 70 White population 1970 P 30 FThite male population 1930 k:*Cr'? 40 AThite male population 1940 h'*TP -50 White male populatior. 1950 w':'`.PP.60 White male population 1960 WV?P 70 White male population 1970 w'L'?P 30 White female population 1930 hiPP 40 White female population 1940 w':'?? 50 White female population 1950 wiPP 60 White female population 1960 WF?P 70 White female population 1970 FNBH 40 Foreign born white 1940 Count:--y of birth of foreig-n AUS': 40 Austria CZEK 40 Czechoslovakia DENM 40 Denmark EYhA 40 England and Wales FIhL 40 Finland 1 CONFIDENTIAL' MINNESOTA ~ TODACCO LITIGATION and D. C. born white 1940 CTR 5322 CTRI,'. VIN 0032°,'1°4., C 1NIS DOCUf,1ENT SUBIE"T TO hJG 20,
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IrilS DO;,Ut;ENi SUBIE;,T IO AUG. 20, 1985 NuN•DISSEtdINATION ORDER IN ROG ^ E ~ ?~ AD L-KE CASES, FFtXI`v 4 0 France GER.'4 4 0 Germany GREC 40 Greece HC1NG 40 Hungary EIRE 40 Ireland ITAL 40 Italy NORW 40 Norway ' POLA 40 RUSS 40 SWED 40 SCOT 40 Poland i Russ.ia i Sweden Scotland YUGO 40 Yugoslavia LITE 40 Lithuania hIF,E 40 Northern Ireland Y-EXI 40 Mexico OLAM 40 Other Latin America CAFR 40 Canada - French OCAN 40 Canada - Other 2:EBE 40 Netherlands and Belgiun BRIS 40 England, Wales, Scotland, Ireland, Northern Ireland SCAN 40 Denmark, Norway, Sweden CAND 40 Canada - French and Canada - Other FN.PW 40 Native white of foreign or mixed parentage 1940 SPFS 40 State percent of total Onited States foreign white stock 1940 I CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION C T R 5323
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C ! .JucJL:,i TO AUu^. !C NON•DISSEMiNAT1ON 0r?pER IN R,`CERS AND DUKE CASES, UFNB 40 Urban foreicn born white (foreign born white tainus Dezmark, Finland, Norway, Sweden, Mexico, ' Canada-French, Ca.nada-Ot:her) 1940 FNBW 50 Foreign born white 1950 AUST CZEK DENM EtiwA FINL Country of birth-of foreign born white 50 Austria 50 Czechoslovakia 50 Denmark 50 England and Wales 50 Finland FRAN 50 France GERM 50 Germany GREC 50 Greece HLJhG 50 Hungary EIRy 50 Ireland ITA.Z. SO Italy NORW 50 Norway POLA 50 Poland RUSS 50 Russia Sh'ED 50 Sweden SCOT SO Scotland YUGO 50 Yugoslavia LITH 50 Lithuania NIRE 50 Northern Ireland MEXI 50 Mexico OL.h.M. 50 Other Latin America CF.FR 50 : ~ Cainada-French OCAN 50 Canada-Other 1950 CTR 5324 1,:::.- '.:3,1nLSOTA ~'TOBACCO LITIGATION ~. ~f _R NN ~°~ ~~ `IZ-4940
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SU8/ECT T0 AUG. ?p. Nuh•DiSSE.~„,IN.,,1101r ERS AND ORDZR 1H~~ UME (;•( -- NEBE 50 Netherlands and Belgium "L,)• BRIS 50 England, h'ales, Scotland, Ireland, Northern Ire_a-,c SCi+N 50 Denmark, Norway Sweden CA2:D 50 Canada-French and Canada-0ther FKPW 50 Native white of foreign or mixed parentage 1950 SPFS 50 State percent of total United States foreign stock 1950 IIFNB 50 Urban foreign born white (foreign born white r minus Denmark, Finland, Norway, Sweden, IKexico, Canada-French, Canada-Other) 1950 FNBW 60 Foreign born white 1960 FMPW 60 Native white of foreign or mixed parentage 1960 SPFS 60 State percent of total United States foreign stock 1960 Jk'TP 17 Jewish population 1917 Jti,^2P 27 Jewish population 1927 JW:'P 37 Jewish population 1937 JW':P 51 Jewish population 1951 J1%'TP 58 Jewish population 1958 DENS 40 Density per square mile land area 1940 DENS 50 Density per square mile land area 1950 WDEN 50 Density weighted by central city population/area, usban fringe population/area, outside city popu- lation/area and rural population/area 1950 DE::S60 Density per square mile land area 1960 DENS 70 Density per square mile land area 1970 URBW 30.1Urban white population 1930 UR.BW 40 Urban white population 1940 C T R 5325 CONFIDENT/AL: h:INNESOTA TOBACCO LITIGATION 'C' TR 111H ~'~01 , 12 e-1.l '~
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~ C THIS D 1$85 lN OCUMENT SUBJECT TO AUG p"; NOH•OiSiEi.tiNAiION ORD:R ROGERS AND DUKE OA.SE& URBw 50 Urban white population (old ce nsus d efinition) 1950 URBw SN • Urban white population (rew ce nsus d efinition) 1950 URBW 60 URBh 70 UP.WM 30 Urban Urban Urban white population 1960 white population 1970 white male population 19 30 URWM 40 Urban white male population 19 40 URw'M 50 i Urban white male population (o ld cen sus de:inition) ~ 1950 URWM SN Urban white male population (n ew cen sus definition) 1950 _ URWM 60 Urban white male population 1960 UR4+'M 70 Urban white male population 1970 URWF 30 Urban white female population 1930 URk'F• 40 Urban white female population 1940 CRw'F 50 Urban white female population (old census definition) 1950 URw'F SN Urban white female population (new census URw'F 60 definition) 1950 Urban white fennale population 1960 URCr'F 70 Urban white female population 1970 INWATR Percent inland water of total area TOTw'AT Ratio of all water in state to total area MIPR74 Ratio of state milk production to white population 1974 UVUW40 Urban vehicle miles traveled per capita urban _ • white population 1940 CTR 5326 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION 0 0
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C THIS DOCUMENT SUBJECT TO AUG. 20, (1985 NON-DISSEMINATION ORDER IN ROGERS AND DUKE CASES. TV?r'.PS4 Total vehicle miles traveled per square mile land area 1940 WVRUW4 C1VUT 6 2 UVUW 62 TVMPS6 ' Vehicle miles traveled weighted by urban/rural population and area 1940 Urban vehicle miles traveled per capita urban population 1962 Urban vehicle miles traveled per capita urban white population 1962 ~ Total vehicle miles traveled per sclv are mile land area 1962 WVRUW6 Vehicle miles traveled weighted by.uxban/rural population and area 1962 TINC 40 Total personal income per capita 1940 TINC 50 Total personal income per capita 1950 TINC 60 Total personal income per capita 1960 TINC 65 Total personal income per capita 1965 MDIW 49 Median income white population 1949 NFtMIW Non-farm median income for white population 19;9 TY6PJAN Mean January temperature 1921-1950 TMPJIIL Mean July temperature 1921-1950 TV.PDIF Mean July temperature minus mean January temperature 1921-1950 Tr":WY,M Average maximum January temperature 1921-1950 TMWMIN Average minimum January temperature'1921-1950 TMSMAX Average maximu.~~, July temperature 1921-1950 TN.SMIN Average minimum July temperature 1921-1950 PRECIP ~ -..kverage annual precipitation 1921-1950 CTR 5 327 CONFIDFNTIAL: BC1NhESUTA TOBACCO LIT/GATION Uff~k
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~ n~~ UUi Jf1,Eh T SUBIECT TO AUG. ZV ~ ~ 1985 NON•DISSEMINATION OPGER IN R`DERS AND DUI E CA,SES. E:..EVAT Average elevation HFCOAL Percent house heating using coal/coke Dw'FLUR ,' Percent of population using fluoridated drinkinc water Dw'PUBL Percent of population using public drinking water PARKIL Suspended particulate (tons/year) per square kilometer land area PARTIC Susp4nded particulate (tons/year) per square kilometer land area weighted by population PARCAP Suspended particulate (tons/year) per 1,000 population SULKIL Sulfur dioxide (tons/year) per square kilometer land area SULFDI Sulfur dioxide (tons/year) per square kilometer land area weighted by population SJLCAP Sulfur dioxide (tons/year) per 1,000 population CI.RKIL Carbon monoxide (tons/year) per square kilometer land area CARBMO Carbon monoxide (tons/year) per square kilometer land area weighted by population C.ARCAP Carbon monoxide (tons/year) per 1,000 population HYDKIL Hydrocarbon(tons/year) per square kilometer land area HYDRCA Hydrocarbon (tons/year) per square kilometer land area weighted by population fiYDCAP Hydrocarbon (tons/year) per 1,000 population C T R .CONFIDLNTIAL.: MINNESOTA ""TOBACCO LITIGATION ;32S ~ ~~ ~~ 0, ~`~ -
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C ~J~J^ ( 15GJ NUN • DISJ: ui~nJIU ~ U20, 1N ROGERS ~`"'`R ~ AND LUME GkSES• NITRIL Nitric oxide (tons/year) per square kilcmete. !anc area NITROX • Nit:ic oxide (tons/year) per square kilometer land area weighted by population NITCAP Nitric oxide (tons/year) per 1,000 population PARTC2 Suspended particulate (tons/year) per weighted by area capita SULFD2 Sulfur dioxide (tons/year) per capita weighted by i area CARBM2 Carbon monoxide (tons/year) per capita weighted by area H:DRC 2 Fiydrocarbon (tons/year) per capita weighted by area NITRX2 Nitric oxide (tons/year) per capita weighted by area RPSKIL Suspended particulate and sulfur dioxide per square kilometer of land area RCE:.'K.: Carbon monoxide, hydrocarbon, a-nd nitric oxide per square kilometer of land a=ea MAGR 40 Percent males employed employed males 1940 in agriculture of total MIN 40 Percent males employed in mining of total employed males 1940 M.M.FR 40 Percent males employed in manufacturing of total employed males 1940 P.MrR 50 Percent males employed in manufacturing of total _ employed males 1950 CTR 5329 CONFIDENTIAI.: MINNESOTA TOBACCO LITIGATION ~~Y~~~ V1N 00,3121254
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iN'S D ~ 1985 ~ /N OCU N0 R` h;ENT SUB/ECT TO AU~ 2~ N • DISSEMINATI01r paDE~ ERS AND DUKE CkSES, Ft'T'R 50 Percent females euployed in manufact uri ng of total employed females 1950 CIGS 71 Cigarette sales (packages) per capit a 1971 CIGS 55 Cigarette sales (packages) per capit a 1955 CIGS 60 Cigarette sales (packages) per capit a 1960 CZGS 65 Cigarette sales (packages) per capit a- 1965 CZGS 70 Cigarette sales (packages) per capit a 1970 MAS.:' 4 0 Consumption of malt beverages per ca pi ta 1940 t+.AL,T 5 0 ConstL=ption of malt beverages per ca pi ta 1950 1 lr.n:.T 5 5 Consumption of malt beverages per ca pi ta 1955 MA:.^ 6 6 Consumption of malt beverages per ca pi ta 1966 t-'Y.^ 66A Consumption of malt beverages per ca pi ta adult population (21 and over) 1966 k=N66A Consumption of wine per capita adult p opulation (21 and over) 1966 DIS66A Consumption of distilled spirits per c apita adult population (21 and over) 1966 12/75 CTR 5330 CONFIDENTIAL; MINNESOTA TOBACCO LITIGATION C`#' 00,3z~ ~Iz.
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Appendix III Preliminary Models ( THIS DOCUt!ENT SUBJECT TO AUG. 20, 1985 h04•DISSEMINATION ORDER Iti R03EnS AND DUKE CASES. Following are some examples of the model construction techniques which will be applied to all dependent variables. At present only the 1949-1959 and 1950-1969 mortality rates are-being considered. After analysis of the massive correlation matrices from i which it was determi.ned that the cancer mortalities divide 1 into three groups, we began model construction usinc those sites related to the pollution group of variables: Buccal Cavity•and Pharynx, Esophagus, Larynx, Bronchus, Trachea and Lung, and Liver for males; Esophagus, Bronchus, Trachea and Lung, and Bladder for females. For mortality rates in the 1950- 1969 time period (E)., the circa 1950 independent variables are used. For the rates in the 1949-1959 period (B), independe:.t variables centering arou,-id 1940 are use-3 when available. Male Buccal Cavity and Pharvvc (1950-1969) Independent variables entered into program: LTV2:S6, RPSKIL, RCHNFCL, M2ff'R50, POLASO, BRIS50, FRANSO, Jh:P51, CIGSSS, WIN66A, DIS66A, PRECIP, ELEVAT. Regression Equations: B~ LINCUR WM140E - .163 + .496 LTVALS6 + 2.604 FFtaN50 + .037 PFEC:? + .209 DIS66A + .310 BRISSO R2 (coefficient of variation) - 90.6 CTR 5331 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION
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l ~,SIC SET: , LTVN.S6, PR:..C:?, D=S66;:, BP.IS50 EES: SET: BASIC SET + FRTc:50 2 THIS DOCU?4ENT SUBIECT TO AJG. ?C. ]98; NDr;.DtSSEMINkitON ORC: ~ 1N R`OS tihD D_ KE CASES.' Order of Ir..portance of Variables CoTalete Set Be st Set b%, t by relative by t by r elative value influence valu e infl uence PP.rCIP L?'V*:S6 L:'V:? S 6 L:' V*.5 6 LI'VM56`~ DIS66A PRE C IP DI S66A Ec..S50~ PRECIP DIS6 6A P r.CIP D_566:-. BRIS50 BRIS SO fiw. _S5C rRnN50 FRA2:50 FZP.N 50 FR ?.2:50 ~'h,P51 Jk^_PS1 kI2:66A F;:::66A RC'rI`.ZE :.. FPSKIL ELTN'n:' RCt::'s:i RPSK:L CIGS55 CIGS55 !•^ilr R50 N*"rR50 POi.A50 POi.A50 State Mortality Rates Sta Overestimated by U te b:ortali nde.estima ty Rates ted by Best Model Best Mo del h.J. k.Va. Ore. Mo. La. Tex. Ver. 2:.Y. Con- Ga. I. r, N.ir.:, - - - r:.c. M~. Ari z. C T R 533w CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION I:-At
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ORUEr2 IN ROGERS AND UKE CASES, 3 Male Buccal Cavity and Pharvnx (19"9-1959) Independent variables: . J:?Sti , R.Sf:IL, RC::.rF.:., N,;rR4 :i, T~ ~ ' pO:,F.40, BRIS40, Fr^,A2:40, ITAL40, LITH40,'Jh;P37, CIGS5S, WIN66A, DIS66A, PRECIP, ELEVAT. Regression Equations: ...Eta.D -. h'N.140B = 1.009 + .347 LTVKS4 + + 2.080 LITH40 + .174 DIS66A R2 . 67.3 ' 4.313 FRA2:40 + .041 PRF.CIP t LINCV'n - h'N. 140B = 1.145 + .258 LTV:?S4 + 4.082 Fr2'n2:40 PRECIP + 2.252 LITH40 + .174 DIS66A + .102 RCE^,~i.:, R2 . 87.4 BASIC SE T: F^.A2:40, LITH40, RCH::=:.,, DIS66A, PRt'CZP BEST SET: BASIC SET + L':V!:S4 Order of I-•acrtance of Variables Comclete Set Be st Se t by t by relative by t by relative va1ue ~n`lue nce value in°_uen ce P'r.: C IP D:S66N PKECIP PR:,CiP LITH40 FrZ1-N 4 0 FRA2:4 0 L':'L'*:S 4~ FRn`:40 Pr'tF.CIP LITH40 FR.•=,.':40 J DIS66A LITH40 DIS66A DIS66A RC H':'•: L LTVt'.S4 LTVN:S4 LITH40 RC?i2:KL LTV'*:S 4 hI2:66'r ,, RCh2:KL RCHI:}'.L ~ BRIS40 S;I`.66A Jh:P37 1 ITAL40 B-_S4C POL'n40 C T R 5333 CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION VIN '.~0.ti~; ~~ ~ ~ ~: :~,~..
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( 4 ~ tf`*,-7 "" RS0 J P~ Si:I L :Tni,4G I . ELEVAT TMIS DJCUMENT SUBIECT TO AUG. 2C. l9La5 NON-DISSEhlNATiON ORDER !N ROGERS AND DUKE CASES, . nt) CT; TT. xsu PO:.A40 ELEVAT CIGSS5 State Mortality Rates Overestirsate3 by Best Model O:e. k.Va. Ver. h.C. 2?inn. Ind. Fla. State Mortality Rates Underestimated by Best Model Ko. Ga. La. Neb. ke. Del. r: . K . 12/75 CTR 5334 CONFIDENTIAL: -,TOBACCO LITIGATION ,..: ~' s~~ R .~ ~~ ~:~.~: ~~ E °~
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THE LINIVERSITY OF TEXAS SYSTEM CANCER CENTER THIS DOCUMENT SUBIECT TO AUC ?~ 1~5 ,;~h~i~O~r C~~ Ta.. Y.lle+l C.ntn Horston, Taa+ 77025 NON•DISSEr . IN R- 6ERS 4tvD February 20, 1976 Mr. Tom Hoyt Executive Vice President Council for Tobacco Research - USA, Inc. 110 East 59th Street New York, New York 10022 Dear Ms. Hoyt : Attached is the application current research grant. for continuation of my Sinperely, . ,P(Gyf1 D?i . // l!r, EJM: rv Attachments Professor of Epidemiology Eleanor J. Maot'3ona1 CTR 5335 M D Al.'D[RSON HOSPITAL AvD ;UMOR P.'STTNTI A.nri.e/ Rr+.h7iunoft Crwtrr LXTRMIUR,U RROCRMtS DNtS1ON CMreiejy C.rnnlJw~nr[.r.l /iuurrnen. C.lLbm.rvt SwLn S.Hunoet E.nro-rwul Sn"rr P..! UNlVCRSfTY CANCEA IOUh'DrlT1Oh' Thr A./rne+ M.vra1 CONFIDFNTIAL: MIhNESQTA TOBACCO L1T1fMT1AN ~x `~ F°~ .
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER ~\~ f;, .RQ..~ r.,...r.a,..l unle• xarao.. r.~.. »oa THIS DOCUMENT SUEIECT TO AUG. 2p, 1985 NUN•DISSEMIhATION IN DGcR '~ E, February 19, 1976 -_S AND DU E APP:.ICATION FOR CONTINUATION OF CURRENT RES£ARCS GRANT, TEE COUNCIL FOR TOBACCO RESEARCFi-USA,INC. INVESTIGATOR: Miss Eleanor J. Macdonald, A. B. INSTITUTION Ah'D ADDRESS: The University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute 6723 Bertner Avenue Houston, Texas 77030 TITLE: Regional Patterns of Cancer of Major Sites in Five Large Regions in Texas and Regional Patterns of Mortality in Houston, 1940-1969 S:r.R':ING DATE: March 1, 1976 A.N'='ICIPA':'E D DURATION OF TRIS SPECIFIC STUDY: One Year BR:EF Dr-SCR_P:',ON OF S:J:)Y: See attached Progress Report, 1976, pp. 2-4 BUDGET: See attached p. 5 :;a n::a::•, CTR 5336 I.S D ANDLRSON HOSPRA: AND TUMOR OdS7T7UTL A+efl I+I Rr+.hl~une. C"In [X'RAMURAL PROGRJtMS DNIS7OK Oetaory Ceeen7-ho.Nuel lwsrorno-u CelLb.urx Sl+t~n S.Nuneeb [.eiro+.Mut Scvnn P.•k UNIVLRS(a CANC[R fOU.ti'DAT1Oh nr Akatnoe Mev/en CONFIDENTIAL: XINNESOTA TOBACCO LITIGATION ~°'• ~° ~~e ~~ ~.,~ ~"'~, ~~ ~ 25-8
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Pace 2 THIS DOCUMENT SUBJECT TO AUG. 7 Progress Report to the 1.$5 r;J;;.DISS.t„Uil,ilON O,D~ Council for Tobacco Research, USA, Inc. ^ January, 1976 IH R_ D~S AND DUKE CA I. Accomolishments durina current vear A. Age-specific and age-adjusted mortality rates for each year and five-year averages were figured for totals for deaths from all causes for Houston (30 years, 1940-69), for males and females by Spanish surnamed, Anglo and Negro for the total city and for 16 areas within the city. The 16 areas are grouped census tracts around the air pollution collection sample stations. The rates are figured for total cancer, 34 cancer break- downs and other major causes of death. Analysis of mortality rates and pollution readings was undertaken. B. Age-specific and age-adjusted cancer incidence rates for 56 counties in Texas for 23 years (1944-66) were figured for cancer for the three ethnic groups for males and females for each county. Note: Individual - counties. C. Age-specific and age-adjusted cancer incidence rates for six Hill-Burton regions in Texas (total of 56 counties) for 23 years (1944-66) were figured for total cancer and individual sites of cancer for three ethnic groups for males and females. Note: Grouped counties. D. U. S. mortality by state After compiling t.tie raw data, the first step was to take all the variables and correlate them witi^h each individual site of cancer. Those that were found - significant were then subjected to multiple regression analysis to see what proportion of the rate could be attributed to air pollution, for example, and what to genetic background, etc. A program was developed whereby all the factors under consideration could be subjected to regression analysis without prior selection by correlation to make sure that the correlation of these environmental factors.with a specific kind of cancer was not an artifact. These environmental factors were then subjected to multiple regression analysis with prior selection (Lincur). The preliminary results in several cancer sites were identical or nearly so and reenforced the correlation data. Thus the models we have seem to be a true measurement of the relationship CTR 533`r CONFID61:T1AL MINNESOTA To9ACCO LMOATtoN i ' ~~~ Rrl 1E ~ C-11
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THIS DOCUti!ENT SUB1E^* 1985 N0N•DISSE„,J ~N yl TO AUG. n, Page 3 IX RS ~D AbE k 0Ri1cr( ~CASFS, of the demographic and environmental variables to the cancer mortality and these methods will be used to complete the analysis for each site of cancer. It is of particular interest that these models have used not only established technicues but a new and advanced innovative procedure developed by my biometrician. The next step is to complete these models and apply them to the Texas county data. II. Data Base and how thev interrelate A. Mortality data, Houston - All deaths in Houston for a 30-year period, 1940-69, for males and females, Spanish surnamed, Anglo and non-white. B. Mortality data, U. S. - All deaths, including violent and accidental deaths, for a 20-year period, 1940-59. Slopes and trends fig-ured. C.- Mortality data, U. S. (Mason's data) - cancer deaths only for a 20-year period, 1950-69. D. Incidence data - all cancer cases for a 23-year period, 1944-66, for 56 counties in Texas for males and females, and three ethnic groups, Spanish surnamed, Anglo and non-white. E. The difference in Dr. T. J. Mason's data "U. S. Cancer Mortality by County: 1950-69" and our data is: 1. Mason's data are age-adjusted mortality rates for the total time period, 1950-69, and for malignant deaths only, for white and non-write males and females. 2. Our data are age-adjusted mortality rates for individual years plus five-year averages as well as for the total time period, for malignant deaths and for all other causes of death, including violent a.nd accidental deaths. We have fivured slopes and trends on our data. This has not been done by Mason. CTR 533S reeACEO LITIGATION CTR NN
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THIS DOcUMENT SU81EC7 TO AUG. 20 1~ kON•D(SSEtdllikTlON OcJ;~ Pac_e lH.8.Q2ERS AMD ~ cI.SE.S Recen t Publications 1. Macdonald, E. J.: Incidence of multiple primary cancer in three regions in Texas 1944-66 (Proceedings of the Vth Perugia Quadrennial International Conference on Cancer, Perugia University, 1973). In Multiole Primary Malicnant Tuaours, ed. Severi, L. Division of ancer Research, Perugia, Italy, 1974, pp. 123-142. 2. Macdonald, E. J.: Ethnic and Regional Considerations in Epidemiology of Breast Cancer. Journal of the American Medical Women's Association, March, 1975, 30 (3): 105-113. 3. Macdonald, E. J.: Association Between Cancer Eve and Solar Radiation. In Imoacts of Climatic Chan e on the Biosphere, Climatic Impact Assessment Program, Monograp , Part 1 - Ultraviolet Radiation Effects, Department of Transportation, Climatic Impact Assessment Program, Washington, D. C. September, 1975, p. 6-20. 4 4. Macdonald, E. J.: Epidemiology of Melanoma 1972. In Vol. VI, Pro ress in Clinical Cancer, ed. Ariel, I. M. Grune a.nc Stratton, December, 1975, pp. 139-149. 5. Macdonald, E. J., Dmochowski, L. L. and Jesurun, E. M.: A Study Among Lactating Latin and Anglo Women in El Paso County, Texas, to Determine Presence of Virus-Like Particles in the Milk. Proarama Y Resu.menes de Communicacions, 2nd Duran- Revnals Internationa vmposium:-Vira eDications and ancer, Barcelona, Spain, June 2- , , Abstract No. 30. (in press) 6. Smolensky, M. H. Samueloff, S., Harlevy, B., Macdonald, E. J., • and Reinberg, A.: Circannual Heart Mortality. An atte_Tpt-to identify possible endogeneous and exogeneous factors in seasonal variations in heart deaths. Israeli Journal of Medical Sciences, 1974. (in press) 7. Macdonald, E. J.: Epidemiology of Skin Cancer: 1975. A collection of papers presented at the 20th Annual Clinical Conference on Cancer, 1975, at The University of Texas System. Cancer Center M. D. Anderson Hospital and Tumor Institute, Houston, Texas. (in press) 8. Macdonald, E. J.: Incidence and Epidemiology of Melanoma in Texas. A Collection of papers presented at the 20th Annual Clinical Conference on Cancer, 1975, at The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute, Houston, Texas. (in press) C T R 5339 . . - ,:.., ......I.b4UTA 7OBACCO LITIGATION Cf- ~' N ~`~ ~~~~ ~~'. ~ ~
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i . - THIS DOCUMENT SUBJECT ~ lg<°. NON AUG. 2Q,., • 5 OISSEMINATION ORDER `ace lN-8Z-UR AND 22g CASM BUDGET March, 1976 - February, 1977 Salar y F/B Assistant Epidemiologist - 1/2 time $ 7,43 4 556 Assistant Epidemiologist - 1/2 time 7,43 4 556 Secretary III - fulltime 9,64 8 787 Systems Analyst - 1/3 time 7,65 2 538 Progra=er - 1/3 time 6,92 6 492 Biometrician - 1/2 time 11,00 0 778 Statistician - 1/2 time 4,66 8 384 Subtotal: $54,76 2 $4,091 Travel 1,00 0 F/B 4,09 1 Subtotal $59,85 3 15% overhead 8,97 8 GRA.2:D TOTA:.: $68,83 1 CTR 5340 AONPIDB1~TtAt,: r~..1~t~~SOTA \TOBACCO LITIGATION f~~~.' .,) 0 3 2
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THE UNIVERSITY OF TEXAS SYSTEM ", CANCER CENTER Trs. L.d~e.! Cant~ Howto~. Tau 770JS March 11, 1976 !'.r . hl . T. H oyt Executive Vice President The Council for Tobacco Research-USA, Inc. 110 East 59th Street New York, New York 10022 Dear Tom: THIS DOCUMENT SU1T)ECT j0 AUG. 70, 1985 NON•DISSEMINATION ORDER IN ROGERS AND DUKE CqS;S, Thank you for your part in helping me finish my work. It is going very well and I think will constitute a real contribution. I am tightening my activities and production schedule to complete it in a year. It is a great opxrtsnity and one I am enjoying immensely. - Last week I presented the regional mortality in F.ouston by its relationship to exposure to pollutants, from the Houston Ship Ct:annel. It was well received and caused much interest. After the meeting, the E.P.A. representatives asked me to see that our local rising young lawyer, Terry O'Rourke, who is working toward action on reducing air pol- lution in Houston, have an early copy. Thank you aa_ain for your support which has enablec me to complete this i.mportar.t work. Sincerely, "Wt Oj'n /11 El eanor J. Mr cdona ld Professor of Epidemiology EJ*:: rv CTR 5341 M D Al.'DERSONHOSPRAL A).'D TUMOR 1!.'S'RUTE Ae..,.-lRrA.hl+unoe Cr.ir EX7RMAu1Gtl PROGMMS DNlStOn' OecoLojy Co.Rnf•lje+r4c.l lw.nrrro+s CelLlo•.nor Srrl'n S.Ne.noe§ U•ti'IYERSfTY CM'CEP fOUn'DA71O.N Ti+. Ae.rw. M.vl.n Ew ro.nmia! Scvwt* Pr'r 00-32b3
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THIS DOCUMENT SUBJECT TO AUG. ?0; ' 1985 huN-DISSEMINATION ORDER 1N ROGERS AND DUKE CASES, October 13, 1976 Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Reeearch-OSA, Inc. 110 East 59th Street New York, Nev York 10022 Dear Mr. Hoyt: Pursuant to our telephone conversation of October 12, I.ould like to purchase an ISl+i Select:ic II typerrriter for $655.00. There are sufficieat funds in the bur.set in our"machine time" category for this purchase. Sincerely, Eleanor J. Macdonald Professor of Epidemiology Dtpartsent of Epidemiologv. EJM:rv Approved: - W. . Hoyt Datei C T R 5 3~~ C ~' ~ N~~ ~~~a~2 6 4
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V11[Tt{SMAY SC;E:XE I?;F0/°,'aATICN EXC'a,',.GE Room 200 • 1730 M Srr"t. N N• Wasnlrc-7',)n. 0 C. • 7?036 Ttieornone,2021 3a1-d711 •Tt/•= 25•tec NOTICE OF RESEARCH PROJECT I _OUNCIL .J..O•TIhO 0/1.•hl2.tiOh. :OPAC, RES, U•S.,~. INC a:., 2.,[ h.. _ vH-47C {V..O.TIwG O.G•h12•TIOh c"1/E1 I . ~ •.O,[CT T•1T.[: 'USa-INCICENCF, nORBIDI:Y AND Na:'JRAL HISTORT OF VAPICUS TTPES OF Ca!:CER ~ B: THR1E lSAJCR ETHIC GROUPS IN TEXAS /11rt.Tla.TO11I.1: oc...TY[/IT1..cC1..TT: E f1ACDCNALD EPIDE':IOLOGY I 1i/1FO.Ylwo O11•.M12•tlOp: 0194100 .o• Twls N11•: UNIV, OF ?fXAS 3/75 TC 2/76 l:.D. ANDfRSON HOSP. L INST. F77.5 FUNDS UNKN0'N P.O. BCX 20036 HOUSTON, TEXAS 77025 I •.OJ[CT /VYY~/1eT: ' Objactivo: Th yurpose of this project is to deterrnlne inc!dence, Isurvival, natural history, and differences of various types of cancer-by race and geographic area at the coaaunity level. I Approacht Each of the problens related to hunan cancer and its ,etioloqy must have true incidence as its base line fcr sound evaluation. the task of deterainln, 1) how auch cancer exists and 2) its geograr.hic `and democraphic dlstriLutlon has been accepted as the first ;responsitility ef the epideoiolo:,ist in cancer research. The state was Idividec! into the 21 Hill-Burton hospital reoions. Six regions were 1;cocDleted refore the RQgional hQdlcal Program funds were d!scontinued. ,Records frcn. all hospitals, dershatology, radiology, and pathology icf'_ices In the regions have been included. The El Paso County study has , turned out tc te the Podal for o*_ta1n1n0 true !ncidence of cancer. 'S1:*ilar studies have been cocpleted for Austin and Abilene for a 15-year iperiod, which include the skin cases as vQll as those froc hospitals and :clinics. ~ Progress: Corn;a:ison of cancer incidence of E1 Paso with other counties reveals significant reglonal and ethnic differences in breast, ceivix, escphaous, and many othet kinds of cancer. It was noted that ,there was an excess of lung cancer ap%ong Latin vomen in El Paso. A survey of environoental factors showed a multitude of possible etiological factors, the aost inflortant of which was residence at t!Te ,of blrth tc adult life in an adobe house. Analyses cf these data are ;revealin9 hitherto unrealized reClonal differences in incidence of r+anv sites of cancer, for exaaple, in cancer of the colon rectum which occurs "in every known hunan toculat:on in all ave arouts in both sexes, although it is rAre in those under 15 rears of aoe. Further in-dept" analysis is cngoin9. , CTR 5343 6 .
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S':ITt'.SI0N!AY SCIE,';CE Il;FC'~;~T1GN EXCH:,NGE Roc.m 300 • 1733 1.1 Street. N.W..tYasn,n7ton, D.C. • 20036 TNephone (202) 381-4211 . Telex 89495 ,..[ M. rY[• QH-469 ~~ NOTICE OF RESEARCH PROJECT ..L.O•rlw0 O.•.wl:.rlOh. _OUNCIL TOPAC. RES, U,S,A• INC E6/E1 --- ..0.[CT " r.[: SPECIAL PRCJECT CF THE COUNCIL FOR TOBACCO RESEARCH, U.S.A. - GEOGRAPHIC DI1'FEREVCES IN HORThLITY PATTERNS .r.c[r....o.t[): E nhCDCNALD K..O.r1w• O.•AwI3ATIOw: •[A1oo •O Tr1[ wwr: UhIY, OF TEXAS 3/7S TO 2/76 M,D, At+DFRSON HOSP. C It:ST, FI7~ FUNDS UNKNOVN Pe0• BCX 2C036 HOUSTON, TEXAS 77025 HOIttT .YYrA.r: Objectivet To study the Snterrelationships and profiles of cancer mortality in the U,S. over time by OeoOraphic region and by status within the regions to the total region, as they relate to deaoaraphic factors. 70 study the changing patterns in mortalitv over a 30-year period bY 15 regions in Houston[ Approach: Deaths from each cause were obtained froRm the Vital Statistics Data Processing Division of the National Center for Health Statlstics fcr each year by white and nonvhite and by sex and age fron 1940- 1959 and from 1963-1967 for each state. Recoding of all the death certi:icates for the ;erlod 1940-1969 in the Hcuston PuSlic Health Departeent tc the 1967 revision of the International Classification of Ciseases has been done. Prooress: Age-adjusted and specific aortality rates by race, sex and re9:on have been fl9ured, Five hundred va::ables are being analyzed by sophisticated c+ultlvariate procedures to deternine what Droporticn of and,incidence cf a particular site of cancer can be exclained by a pazticular variable and by what combination of speciflc variables. Wher. these models are fully functional for •ortality, they vill be used vith the availatle Texas morLidity data for siailar inderth analysis. The :exas incidence data is for 200,0D0 individuals, eomcrisin0 every case .froa every scurce for 23 years to 56 counties. CTR 5344 e[.A/1Yr[wr1s.[cLAlrr: EPIDEMIOLOGY ~o ~.,~ J 2 E-A b
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THE IINIVERSITY OF TEXAS SYSTEM CANCER CENTER Tfu. Yf{4.l CGnta Hewton, Tfw 77030 January 4, 1977 :+~ . Tom Hoyt Executive vice President Council for Tobacco Reseaxch-U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dear Toro: TH!S DOCUt,.c,"~,,, . ` SC(~::Cl T, , ?~ ! "?~~'~ OR~;D I wish to request per:nission for an extension of time w•ithout additional funds for my staff until the funds are expezded, approximately four to six months. A re•-narka5le advantage accrued to us by the fortuitous availability of the data manager for the Apollo Progra;,. He was between assigrments. His experience and skill in handlinc corplex models and data processing with speed reduced the cost- to us that a:ulltime pedestrian progrwn.-ner would have charced in progra-^cning as well as excessive machine time. We saved the statistical clerical salaries by using the services of f or-ner e-mployees who voluntee: ed their services to work on the data they had helped to amass. Will you please indicate your approval on the original and return to me? Sincerely, Eleanor J. Macdonald Professor of Epide=iolocv Depa_ tment of Epidemiology Ap proved: Ta^n Hoyt Date: ic--7 .. ,. =,. - / % l:~ 1\(n e3n\ lll)Sr•(7 A C i\(1 T( VUR l%'SY1T(Tc R.hab,Lr, .,,•. C.,.r.. I%r; 1)11 I>r()\ rp,cC-l..r. C...."d ('fiJ.nfJ.(di /nlwn.r,e••r e:o11j6n.:.- .St.dq. S..DU•.n..u 1-vc++-rol Sc..ncf Fa.i r K%17 t t/\(.l R/.)1 N~D117U\ 77ir 1•.ar•l..•. rlarl.+i. C T R 5345 .~ Cr ~ F~,
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER Ts... Y"1o.1 Gntr Xou.tow, 7e- 7702$ Mr. Tom Hoyt Executive Vice President Council for Tobacco Research - U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dear Tom: March 18, 1977 TNIS DOCUMENT SUBIECT TO AUG. ?0, 19ES NOpi D;SSE {ti:i{ON ORG i IN ROGERS AND pUKE CASES, I have been invited to present a paper at the VI Perugia Conference on Tumors in Early Life in Man and Animals, June 30-July 5, 1977 in Perugia, Italy and to the Heidelberg cancer institute to present my Houston pollution study. The Heidelberg group is taking care of my expenses from Perugia to Heidelbe rg. I applied for travel funds fram the National Science Foundation last fall and just this week received noti- fication that my request was not approved due to lirnitation of their , budget. I have also requested travel assistance f rom the M. D. Anderscn. State funds cannot be used for foreign travel so any support from here rtwst come from special sources, of which there are none at this time. I have available for travel in my budget $1,966.00. May I use some of these funds to defray my expenses for this trip if funds are not forth- coming from the institution? The estimated cost for the Perugia Conference is 51,400.00. Enclosed for your interest is a copy of the pollution paper. A pre- liminary report several years ago to the Chem.ical Society was part of the stimulus which resulted in the raising of a fund locally, around a millicn dollars, to find the carcinogenic pollutants in the environment and seek to eliminate them without outside financinc. The comnittee, under the Chamber of Commerce is hard at work. Their study supervisors have been in here to get mortality data. Our study has aroused much interest. Three weeks ago I was asked to present it at the kickoff meeting of a new branch of the American Chemical Association in Houston. There were 90 there. I have also spoken to the Chamber of Cortmerce group. So our mutual efforts are bearing fruit. Sincerely, C071 EJM: rv Enclosure Eleanor J. Macdonald Professor of Epidemiology C T R M D ANDERSON NOSIllAL M.'D TUMOR NSTT:UTE Mui owI Rit+.hLc.n.- Gntn EJ(711M/UR'tL IROGRMtS DMSION O.cototy c.r+n1•Im.W6ca1 I"ntrne+u c.Ua+e..+*w Strl.n UNn'ERSr'r CtivCER fOUNDAT1ON TAr Aw4.v. Mlyln. S.Nunoiu 5346 EternnaItal Sevwer Int c~ R NN
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INTE?NATI,Ot:AL CONFERENCE on TUhOURS OF EARLY LIFE IN rAN ....... .. ..... .... .. ... AND ANIMALS . . . . . . . . . . 30th June • 5th Juiy., 1S77 SECON,^. PR_L:!;:h/,RY PR0uRr.M«E cf THE PAR;:CIPf.' Tne titles 2isted have besn pffered in reszCnsc tc personal letters cf Sr.v:tation frcm Professcr L:::: Severi. All titles •re to be considered ae tenta•:vs, e-_ may be chanted until such time as the defin:tive pr-- tramme is rsady to Yc tc press. V , CTR 5-34; ~ ~f sF HH0.~~:'~~ ~'~
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PERUGIA UN:VERSITY f1ED:CAL SCHOOL DIVISION OF CANCER RESEARCH The OrYen:z:ne Com^.:ttac ennouncee THE S:XTH PERUGIA QUAORENNIAL INTERNAT:ONf,: CONFEREN:: ON CAN:.ER :' U Y. 0 U R S 0 F ° A R L° L I F P I F XA F AN J A F: X 1, :, S 0P :,A N. ZIAG CEALe?kAA Profissor Lucio Severi, Director, Iestitute of Patboloqical Anatomy and Histolo5y, and Division of Cancer Research; Dean of Peruqi. University Itedical School. C T R 534 S cw.. NN DO,- ~ ~:'~0
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I GENERf•L C.;'L?NE OF PROGRaMr,E as et I 5th Novemcer , IS76 OPENING LECTURE 1). Incioence enC epldemiology Q). in n+arn b `, . in ar.in4ls. i 2). Lymphcre:iculer tumours c) . in e+ar. b ) . in ¢ni.rnGGb. ~). °re:n end nervous system tumcurs a), in ncnn b) . in antmcLs. 4). Nephrogeni;el tumours c.) . in Imcn b) . in ar.i.r.: L-6 . l 5). Epithe:la:, ccnneC:ive ;Issuo ano risCelleneoug f f f 1 tumCure G). .C n 1R G r. ~ b). in a r..i, e+:..Le . E;. Teratcid, am-'ycr,c:, ger- ce:: anC e:_:eC t;• .:! a) . <r, t+arn b ) . 4 n Gr.inGt.S . ' 7). Cerclncgenos:s ~ c) . Gene.:.i_-s and r+ecFGr.<.bnfb OS 1 cc-tCLnoQtneb.Cd ~ b). 7Aer.a ptacen.t.:t end pf e.r.:..'_1L ) f induct-ion c) . •Peninc..tiaL and poetn,acl in- f duc.Li on. I ( d). Compcrison o.' humen and animal tumours ot eerly 11fe. 9). Pre=;:=a. 1•,c.ceticns. C 1 R 534~ ° - fs~ ~"~~~~~ .~~~~ ;~` 1
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1 c T M E 0 P E N I N G L E C U R E will be delivcreC by -Dr :JOPS' L. (U.S.A.) 1). :NC:DENCE ANC EPIDE"::C'LOSY c). In men PRAUXc'N:, J. P. Jr (U.S.A.) DRL PPRII - G. J . _ (U.K.) (.'1 i,:,IANS, A.0. ( N:GE=c:A) K:,CDCN.t--:), E.J. (U.S.A.) (iSRAE~) PDWL...:, J. (U.K.) ASc".,---`' J.B. , (U.K.) KEA DO'-'S, A. (U.S.A.) X; LSOR, L. K. X. (U.K.) Fer.,lly cencer tynCromes. Epicer.,Iclogy data relating to the genetic comeonent in the eetiology of chilChcoC cencers. EplCemiologic pattern - recie: and geogrephic Cifferences. Regicne: ethnic C'_ffercnces in tumcurs in ch/lcren in Texec. St=-.t:. tr,s . me:=ornatior.s en tumaur s . , Tumcurs in chil..r er. - lncice^cs by age In releticn to the h/st- ogenesie. Sex differences in chilChccc tu~- ours•. Sponteneoue and treatment reiet- sC second melignent neopleeme in children. Doutle primery tumcurs in chil- cren. C TR 535 0 f'"',k ~~ ~" ~ f4I .~ .) ~ ~' ~:"~'
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER Tyiai lf.d(c.l CfArn HouuroA. T.+6. 77030 September 14, 1977 Mr. Tom Hoyt Executive Vice President Council for Tobacco Research-U.S.A., Inc. 110 East 59th Street New York, New York 1002 Dear Tom: THIS D0CUh1ENT SUBJECT T0 AUG. 20, 1985 NUN • DISSEPr11NATI0N ORDER IN ROGERS AND DUKE CASES. As you will recall, we received funds from the Clayton Fund in Houston for partial support of our project and were able to save some of our funds from'the current Tobacco Council Grant to use when the Clayton Funds were expended. We need these funds from the current grant for salaries, and the Business Office requires authorization from you. Will you please sign and return the original enclosed letter? Our first volume, 700 pages of incidence data, will be published by Raven Press in October. I will give you more details about what we are doing in a letter which will follow shortly. Sincerely, Eleanor J. Macdonald Professor of Epidemiology Department of Epidemiology EJM:ve Encl.. .N O.th'OERSO.ti' HOSPITAL AND TL'MOR lS'STTTLTc Rrlr.bi(rr1 now C.wrr• EX'RAML'RAL PROGR.SMS OlV7SlON Oncoiory Ca..~c.:•aro-taua;lvnn.nov CoJabo•anw Sn.a.rr Srerru.owr En.~.w.w..xral Scx~cr P..i L'ti'lvERS/TY CANCER FOL'.VD.t:ION -.~c A-ar.+o" .Wrlo.• C T-R ,CONFIDENTIAL: MINNESOTA 'NTOBACCO LITIGATION C T R"~~ ~ ~ `.o 0
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4 THE UNIVERSITY OF TEXAS SYST E,'v1 CANCER CENTER Tr+s. Nrdre.( Crntn NOWfOA. TfIY 770)0 . ; Mr. Tom Hoyt Executive Vice President Council for Tobacco Research•U.S.:., 110 East S9th Street New York, New York 10022 September 14, 1977 , THIS DOCUMENT SUBJECT TO AUG. 2r.1, 1985 Nu"i-DiSS:.'r;1NATICti Cr',D;z IN ROGERS AND DUKE CAS" Inc. Dear Tom: I wish to request pernission for an extension of time without acC'tionz7 funds until the funds are expended from my current Special Project of the Council for Tobacco Research-U.S.A „ Inc., Grant. Will you please indicate your approval on the original and return to :-,.rv-: Sincerely, 6~14, EJ"': ve ~ . Approved: Tom Hoy: Date y "• Eleanor J. Macdonald Professor of Epiderniolocy Oepartnien;, of Eoidemiolocy •_f ^ i1~OF.RS0%"HOSi'lT1LA% G!\'S"•'C-~ Crnrrr !•RC:,RA.% IS Jli•I)ifl` :JrL:fJ•1n" jrrarN Sc:rwtr 7c.e :'~:1 (RSI~i"C.1.~'CER fOC,vD1T;/1\' f7~. !wdr•tn~ 1ta~r_ r CQNFIDEN11At,; ",TOBACCO LITIGATION C T R 535 12 t C L1' {~ {'h {l { 1 4{ C-) c) 3 ,da. rR l.
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1 THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER T.,.. 1r.tLa1 C.nt.. Dou.fost, Ttio.. 7ruts September 20, 1977 Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Research, USA, Inc. 110 East 59th Street New York, New York 10022 Dear Mr. Hoyt: Enclosed is a budget totaling $88,773 which is being requested to enable us to continue work on the second and third parts of this project. The first, a 700 page reference book, is completed and in the hands of the Raven Press, New York. In this volume will be given the incidence of 96 sites of cancer, - including 43 histologies for a population of 4 million in Texas by Spanish surnamed, white excluding Spanish surnamed and nonwhite, for 23 years. It demonstrates the ethnic and regional differences of many sites of cancer, which strengthens the environmental theory of etiology. The second volume, which will be a monograph on the relationship between demographic and environmental variables and cancer mortality, has been discussed with the Raven Press people and they have several chapters and the Table of Contents under review. Williams and Wilkins wrote August 29th, 1977, asking to be considered as a publisher for volume II also. Additional co=uter analysis of some of these data will be performed in the development of the mathmatical models involved. Writing the third, the text on epidemiology and cancer program develooments and history, will be an additional major project this year. Therefore, the requested funds would support our work from October 1, 1977 - September 30, 1976. Several research papers referring to our total project are presently in progress. We obtained a grant from. the Clayton Foundation which will carry us through September of 1977. Our gratitude to the Council for making it possible to place this incortroarable and never to be available again reference material on cancer in the public domain is beyond words. Without your continued support it would have been lost. EJM:ve Encl.. THIS DOCUMENT SUBJECT TO AUG. 20, 1985 NON • DISSEr,1INATION 0PG_R IN ROGERS AND DUKE CASES. C T R 5353 M J A'.'D[RSOM HOSI?.tL .WD TUMOR a/STr:'.17i Mur u! R.hs..l1w s. G~m+ cxT7t.wuRdL rROCRAhIS DtVlsrON O.cslory c.r.cd•iw.c.f t.s+ta..ft c.¢...'.mr. ssbe scvne. rat Ut.',LTJCSrrY C.tNCUt IOUNDATION Pw MiyJ+v Sincerely, ~ C~* ~lClllll~ ~~ - (~ CI(-LZwc Eleanor J. Mac4onald Professor of Epidemiology Department of Epidemiology C ~~ti 1`~~~ ~.~'~~
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1 THIS D"'C 1985 N IN RO BUDGET REQUEST October, 1977-September, 1978 U . ON G 'ENT SUBJECT T0 AUG. 20, -DiSSEr,1INATION ORDER EP,S AtiD DUKE CASES. Biometrician (50%) 12.000 Assistant Epidemiologist (100%) 14,865 Assistant Epidemiologist (100%) 14,865 Secretary (100X) 10,495 Programmer (33:) 6,451 Systems Analyst (Consultant as needed) 3.500 Subtotal 62,176 Computer Time 4,800 Cortuumble Supplies 1,000 Travel 3,000 Fringe Benefits (Salaries) 6.218 Subtotal 15,018 Subtotal 77,194 15X Overhead 11.579 TOTAL $ 88,773 CTR 5354 ~'~C) "I<-, ':~'b
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R,.. , .~ ~,. THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER T.r. L.llal fwwrw RoWtoti Ttr. 770Jd October 14, 1977 THIS DOCUh1ENT SUBIECT TO AUr,. 7.1 1935 t~;t~ D;SSE;,;;n„iIGN GP,GER 1N ROGERS AND GUKE CASES, The Tobacco Research Council 110 East 59th Street New York, New York 10022 Dear Sir: Is it possible to obtain a copy of the following pamphlet? Todd, G. F.; Lee, P. N., Wilson, M. J,: Cohort Analvsis of Cicarette Smokino and Mortality from Four Associate~ Diseases. Tooacco Research Counci_1, cw siona Paper 3, 19pages. Sincerely, „7<",- x .~~ Eleanor J. Macdonald Professor of Epidemiology DepartTnent of Epidemiology E.iM: ve 1 C T R 5355 M D titiDUtsor.• xosrrr,u A.ArD rJMOR a1STrnl a AAa.nd R.w .,da.m. cj%a• CX'R.tMURw /ROGR.tMS DIYISION CreebCy G..~+vi• i0-r.c.l twesmw+ C.iLM'+..*r S..6r S.i.k++r i..w++.ewu! Scy+.a Ivt l.'N7YER5r.'Y Glti'C:R fOUNDATION Thi Mk++m Mey/.+r 1.'~ C f R H~ ~H4
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THE ZINIVERSITY OF TEXAS SYSTEM 0 CANCER CENTER t T.a.11LlL.a1 C.niw aor.roti j.a. 7TOI( October 19, 1977 !-!r. W. T. Hoyt Council for Tobacco Research U.S.A., Inc. 110 East 59th Street New York, New York 10022 De!r Tor,: THIS DOCUMENT SUBJECT TO AUG. 2'', 15S5 NGH•DISSE11it:ATIuN ORDER IN ROGERS AND DUKE CASES, The check arrived in the office of the Vice President for Business Affairs. I want to express my appreciation for your continued support of my project. It is very exciting to be able to carry on with the next logical steps in the analysis and utilize the data base fully. The first volume on incidence data is scheduled for publication in early 1978. Sincerely, ~~r , 417 zti Eleanor J. Macdonald Professor of Epide:miology Depart:nent of Epidemioloev EjM:ve C T R 5356 .N D A.ti'OUtSON HOSIIT.tL M!D'UMOR 14ST::UTE A+nvr od RU A.winr. Co-r+ [X.')1lMURJtL lROG/UMS DMS7ON Owcobfy Cow.eti•Irv~.ca! L.aneew. C.Lai.Mtrs Sa.k. Ss+acao.r Fxv..y.aru.t Scv.¢y lot U?.'NUlS.^.'Y "NCUt fOtL'.'DAT7Oh' Tlw Aw.nvw Mrvru. C-TR ~~H
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. THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER 7h:.« M.[.e.f C.nfn Mr. W. T. Hoyt Executive Vice President Council for Tobacco Research U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dear To,^.:: HOWfOn. TI.Y 17030 April 14, 1978 THIS DOCUMENT SUBIEC'T TO AUf,. ~-3, 1985 NuN • DISSE ~'IN:,TIO', OrO:,-, IN ROGERS AND DUKE Cf.SES, I wish to request permission to use my grant travel funds for foreign travel for myself and my biometrician, Dr. Dorothy G. Wellington. Dr. Wellington and I are presenting papers at the XII International Cancer Congress to be held in Buenos Aires, Argentina, October 5-12, 1978. We applied to the National Academy of Sciences - National Research Council, Division of Medical Sciences for travel grants but rre re un- successful in obtaining then. The state of Texas requires your prior approval for use of these funds for foreign travel. I would appreciate your signature below, if you agree. Sincerely, ~ ~ Eleanor J. Macdonald Professor of Epidemiology Depa rtment of Epidemiology EJM: ve ~ Da t e: a-<.+ A d l ' ) pprove : t. . . f Mr. W. T. Hoyt . nr u,.wL, . .~ At D.t.'.'DERSO.1w HOSPITAL AND TUMOR K.'STITL7E R.k.bilrt.now C.wrr. EXTR,tMI,'R.4L PROCJLAAiS D/VtSlO.'.' Oncolotr Co.wwcii•dio.w.d.c.Jlwrnrwnov ColLecwnw Srrd,u Srbff.rfo•tr En.,.onw..wu! Scrncr P..: lINlVERS'TY CANCER fOUNDAT/O.Y inr Awd...on Mr.~or CTR . ~ l"Rs rrq~t~lt 535 7 a ~~ RVtN
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER :l. Ttia. Y.gic.! Gnu, llo...lews~ Tu+r 1f0t0 June 29,*1978 THIS DOCUMENI' SUBJECT TO AUG. 20, 1985 NON•DISSEMINATION IN BOGERS AND UKE CASES. Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Research U.S.A., Inc. 110 East 50th Street New York, New York 10022 Dear Tom: Thank you very much for the consultation fee which came this morning. It comes at an very exciting time because Wednesday, June 28th, yesterday, the Raven Press called and said the Epidemiology of Cancer in Texas (see enclosed) Kas off the press and the editor had the first copy on her desk and I should see it today or tomorrow. On Fbnday of this week. I received the contract for the second book entitled "ENVIRONM a1T, CJNSUMPTION, AND ETHNICITY IN THE UNITED STATES CANCER Ml?RTALITY", which will be returned innediately. They promise delivery in 1978. I am beginning work on the third volume of the planned three. Sincerely yours, E l ea n or J. Ka cdditia l d Professor of Epidemiology Department of Epidemiology EJM:ve A[ D ANDERSON HOSPITAL AND TUMOR !h'S77TUTf ReA.bjliral+" C.wrel EXT R.tAdl'RAL PROCRMfS D/ NS/O.~' Onroiojy Go.,ncd-ew~.dK.i ln+nn.no-u caa.borrnw Srrd+.r Srbr1.l6o.u Er.+rowwvwu! Sciencr P.ri L'MVERSrTY CANCER FOUND.4T1On' The Awdr..a, Mq/.i• - C T R 5 3 5~ C TR. t°1H ~`~O 3~'.60
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t) 4 ....f .r*... .-rom rlre Foreword ry R. Lee Clark, M.D., President T. (Ini..nrry of T.... Srrnm C.nc.. OnW ~ D AnaF..r.n llnurr.l.nd rvnrr fnrrrrvre rron, R..r , r; In 1948, when I vldted the Connectkut Cancer Pro- ,em, I tuyqerred that I'.ofer.or Eleanor Macdonald -)ntider that pioneerlnj effort to b.e pllot ttudy .r.d ut the come so T.wa to d.termin. the true Incidend I cancer In this vast ttete of p.eet ethnic and environ- rental vrl.tiont. The data In thit volume re the retultt of that .rfy rppettbn. In Connecticut, or.ly hospitals were tur.eyed. r Texit, every m.dkal sourc..vtn covor.d. Nothing -.t left to dhenc+. Every patient record from J.nu.ry 944 throuqh pec.mMr 1U6/1, from every cause of ite.w In every dlnic, l.twr.tory,.nd ho.pltel, wet In- »cted by tr.fned f{etd epidemiologlttt. E.ch number.d hrt wM located. In one hwpit.l, 26,000 recordt til.d ut of pl.ce wen found .od retlk.d. In .nother, where record librarian hsd ntiQned th. trrw number to every lmlrtion on a given dey for .5-ye.r period, worken om our.t.ff plec.d the chrtt In o.d.r by moment o/ dmietion .nd renumber.d the records. All the cancer .wt w+re Indexed and abettrncl.d. AM dermatolo*Lt., raro frKticef, .nd rnrnkq homa vwrs sppro.ci..d, nd th..bove procedure wn r.p..t.d. Fkt.lty, the ent/re it wa checked .g.Intt repor/ed car><.r death records > ryitter the 3 to 5% not found kn other sources. There re nerfy twlcd a m.ny IndF.idudt In the ref• rtry .nd fotlow-tq prop.m th.n thwe we retld.ntt ith cancer In the oountiet. Slnce poQnletbn-b.sed In• denee must be limited to retide.rtr, the tfwwendt of dyrr+tt .nd reddentt In other countlet or countries we rcluded from Incidence raet but are Intluded In com- unity tervket end in reportt to Indlvkhr.l deta sources. 'r. 350,000 scce+sions for Texa retldentt In the 56 Wen Press (S40 Avnoiue of Ihe Nmerlcnt C T R ;a~~9 of retlrlence. After rqrmerout cornputer eheckt. It we1 d.termined that the only tu.e way to.xelude duplic.tet and to determine whkh tumon were second and tub- sequent prlmeriet wa to h.ve tr.lned worken ex.mini the Ilrted eccertiont and atiqn a matter numher to the kidlrklvel. TTre Indivktuel't earliest entry Into the dets bank was the dete uted for Inckfenc.. ThiY careful review took 4 yert and netted a total of 159,100 Indlvkfu.lt wlth cenar. The tumor hittoloplet that w.re unusual or oontr.dlc- tory In multiple entrlet were dreck.d with the reporting petholoplrtt .nd/or with the staff petholoqittt of the M. D. And.rton Ifo,pltel. The resultant computer tepe it, therefnre, one of the most carefully collected and prepared cancer deta haet ever produeed. For th. first time, for a lonp period of time (23 yewt), the actual can- cer incidence of three dittlnct ethnic groups In the s.rne communitiet. In tix different npions with similar dleq- nottic proceduret and environmental expoturet, it .vsilehle. The Incldend of csnc.r In th. Sp.nhh-turn.m.d group It a dramatic first. Th. Spenlth-.urnnn.d group has a low Incktence of c.nar In every tlt., .xwpt cer• vlu and lung. Amonq a population of four mlfllon, 58.2% were white excluding Spanish tum.med, 31.7% Sp.nish- wrn.med white, and 10.1% nonwhlte. The whites had 76.1% of the cancer, the Spanish tum.med 16.0%. .nd the nonwfdtet only 7.9%. InclrKled In the ttudy r. Irp metropolitan wen (tloutton, S.n Antonlo,.nd Corpus Chrletil, rx1 tm.ller onet (El Pato, Lredo, r.d IleNln*.n). Th. 56 counties turveyed oomprlee 22% of the 264 oountiet In Texn and contain approximately 40% of the total popul.t/on of the state. The cancer Meidenc. (n Noutton, where more than half of the petrochemitaf Induttry of the United States It dnter.d, It of special Inhrett. Mott Impo.tent of all perhaps I•t the poput.tion b.sed Incklence of the 54 cancer sites by histology In which histology It Import.nt In propnotl..nd treatment pl.n• ninp. A tribute to Prof.nor MectSan.dd't special ability to p.in cooperation from various medical commrmitlet should be mentioned. She h.t conducted epidemloloalc rereuch In three famous tthte programs (Mett.chutettt. Conn.r.ticur, and Texet) and het been pr.nted total ec New Ynrk,Nevi'york 10016 19.S A. records It well known rwl eptwecleted. /ler derlle Lelp the clink.n with tormd, useMe facts of c.ra+.r . to give him a method for timpllfyinp complete follciw r tervip to p.tlent rd phy[icl.n het been the motiverf" force In tAlt prodigiovt effo.t. It It with prkfe th.1 we present this reference bor•k on th. Incklence of cancer In Texn .morq four mllllor, people living .t different latitudes, at tea level .nd htph er dNtudet. In tinple and averaged yeert, Mtiutted for qe utin'three tt.ndrd populetiont for easy comper• ability with exlttlng publications. Feb. 1973. Approximete/y 665 pages, probnhly $45.1?0 /SlJN o-891X}4-2o3 9 f/se Nx eonvrn/e+rf on}rr fo.m on Me AxA. \rVl 1frC116.S Ftxeword-R. Lee Clerk. Introduction Methods Tables 1-54: Age-Adjusted and Age-Specific Cancer Inci dence Rates per 100,000 Population by E th nic Group - All Regions. Tables 55-96: . Age-Adjusted and Age-Specific Cancer Inci dence Ratet per 100,000 Pofxtlatlon by E th nic Group, Selected 111stotogic Types - All Regions. Tables 97-318: Age-Ad(usted C+ncer Incidence Rates per 100,000 Population by Ethnic Group, Six Regions. Tables 319-325: Number'of cases by Site, Sex, Age, and Ethnic Grotrp, 1944-19G(i. Suh/rct Irn1ex.
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k TiIE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER Ttirv Yr6Lra7 CGnlr. Ho,uton, Trs.r 77070 Mr. W. T. Hoyt Executive Vice President Council for Tobacco Research, U.S.A., Inc. 110 East 59th Street New York, New York 10022 v+ August 25, 1978 THIS DOCU1dENT SUBJECT TO t., 1985 ti0h-DISSE~-:iNAT10P' 6.,,,_. 1H ROGERS AND DUKE CASES, Dear Tom: Dr. Wellington and I both received Travel Grant funds from the National Acad emv of Sciences for the International Cancer Congress. So we will be able to use our tobacco funds elsewhere. I appreciate your approval of the funds as requested earlier. Sincerely, EJM: ve ) Eleanor J. Macdonald Professor of Epidemioloay Department of Epidemiolocy M D.4n'DfRSO.' HOSPITAL AND TUMOR lNsnrcrT RrAa6Purar.on Gwrr £X TRAML'RAL PROGR.4MS DIV7SION' Oticoiorr co-n6l.8,o-~ra cal lnrnn.no.u Go.".abor.nw Srrdar Swbrralic•at E-.ow.wr«u! Scx++cr Pr.: L'.ti'! V£AS.'TY C.l•vCER FOLtA'DAT70.ti' T1,r A.drrion M~j.,. C 1 R 5361 `~ ~~z ~~ ~`~ ~`~# ~~ 0 ~ ~' 6, 3
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t THE UNIVERSITY OF TEXA.S SYSTEM CANCER CEJN'TER Tr... r.s,e.l c.nr.• Mr. W. T. Hoyt Executive Vice President Council for Tobacco Research, U.S.A., Inc. 110 East 59th Street New York, New York 10022 Ho,..r~. r..... 71030 August 25, 1978 THIS DOCUMENT SUBIECT TO AUG. 2U, 1985 NON•D1SSE'.1IK:,TION n~^=3 IN ROGERS Dear Mr. Hoyt: Through judicious planning of our work and supplemental funds from another granting source, we will reach the end of our granting period w?th a balance rerraining. I am hereby requesting extension of time without additional funds through February, 1978. The second book to be published by Academic Press is at the printers now. The title has been changed to Cancer Mortality: Environmental and Ethr,ic Factors. Response to the first one has oeen entnusiastic. Again I wish to express my appreciation for your support. With best wishes, Eleanor J. Macdonald Professor of Epidemiology Department of Epidemiology EJM: ve M'J .1 ti'DE RSO.ti' HOSF!'A L.1SD T(.'MOR 1Nsr. rL'*E R.+..bil+unaw c.~..• EX: R.IML'RA: RROGRAMS Dl VISlON Oncoiory Coywcil•b,o+,.a,c.!lwinn+nov CollabOprRr. Srrd,tl Srbci.noau Fs.,row...rnt.J Scvncr Avi UN7VERSlTY C•4h'CER f0(.'.,'D.1TlO..' 77,r Andrr+ow Mq/an CTR 5362 ~ ~`~ C I ~R t~t~~'.~ 3
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i l THE UNIVERSITY OF TEXAS SYSTEM ~ CANCER CENTER ' N. .. • n... .r. s,c.J c.n r.. Mr. W. T. Hoyt Executive Vice President Council for Tobacco Research, U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dea r Tom: Nor.ton- Tbw 77030 July 12, 1978 THIS DOCUMENT SUBIECT TO AUG. 20. 1985 NON-DISSErr,INATION GRuEp 1N ERS AND DUKE CASES. Under separate cover, I am sending you a copy of my book on incidence just off the press. The contract also has been signed with AcadeTic Press for the second book on the analysis of U.S. Mortality. Now my time is devoted to writing the third one, my views of the epidemiology of cancer with much historic and new material. Raven Press has expressed interest. Your support especially during the past four years has made it possible to continue this project and again I wish to express my appreciation for your help and encourage*nent. Both Dr. Wellington, my biometrician, and I are presenting papers at the International Cancer Congress in October in Buenos Aires. Our request for travel funds fron the National Acade-my of Sciences rras approved so we will not have to use our grant travel funds for the trip. With best wishes. Sincerely, Eleanor J. Macdonald Professor of Epidemiology Department of Epidemioloo_y EJM:ve A/ D ANDERSOS' HOSP/T.4L 4KD TUMOR Lti'Si TLTE R.'vbiLranon Gwrt. EXTRAML'R..tL PROCRrtMS D/VISIOti' O-oio1Y Ca.n~J-Bw+..du.i /nrnrunau C.ou.bc.+t»w Sn.d,ar Srbrrano~r E-w•o-~r'.1 Sc+.nc. Pa.: LT7VERSITY G.SNCER FOUA'DATION' n. Andraon A(.vjau CTR -036p E ' `~R fi~~~~`~ ~`'~ ~~6-2
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. --?.-7a- TNIS DOCUMENT SUBIECT T0 AUG. 1^, 1985 NON-DISSEt;INATION ORDER IN ROGERS AND UKE WES, P20GRESS REPORT Special Project of tile Council for Tobacco Researcfi - USA. Ir.c. 1977 - 1978 1) The -.ajcr accomplishments for the pas: year include: Publication of the 645-page book entitled, The Eoidemiolocv or" Cancer: Incidence Analvzed bv Tvae, Ethnic Grouc anc Geocraonical Loca*_ion, aven ress , rlew YorK, u y, yi . 2) In press, a r.)ook of approximately 300 paces, Cancer Mor.alitv: Environ- montai and Ethnic Factors, Academic Press, t:ew York, ,r'uuli- cation scne,.uled for late 1978 or early 1979.) ?) In preparation, a third volume, my overview o: 50 years in tne field c` cancer epide,niolocy, including discussion of the ethnic and ceo- grapnical differences in cancer, survivals, and historical data . not docunented elsewnere. Selection cf publishine company has not yet been made. Consideration of request by Raven Press to craoh or r,;p the incidence figures and publish a conpanion book Lo the first one, which wil i result in a fourth book. . 5) Papers presented by Dr. Wellinoton and me at the XII International Cancer Conr,-ess in Mroenttna in Octeber, 1973. hAltnouch I have been the Emeritus Professor c` EoideTiclogy since Secter-.oer, 1974, with my time devoted solely to the conlaletion of analysis cf my oncoing studies for the past 30 years, I have been asked to continue on several hospital co^mittees, These are stancinc study com-it.ees and include: 1) the Breast Cancer Cormittee, 2) the Lympnoma-Leukemia Study Co^r.:ittee, and 3) the Surveillance Comittee. Tne Surveillance Comnittee is conoosed of three lawyers from the community, 16 representatives of the different specialties, members from the Chaplain Corps and several business executives from the cor,munity. The purpose of this committee is to review every research project involving patients. Each study has to have an "informed consent" form. These are carefully reviewed. This is the critical cormittee in the institution. It is an honor and a great responsibility to be on it. Each of tnese comnittees meets once a month. I have also been able to.serve as a consultant to several researchers when possible to do so with minimal cormitmen*t of time., For example, advice was given to a staff inember of Social Service on setting ua worksnops on follo.q-.,o of oat'ents and on Illethods of recording the quality of the :s lives f:,llowin, thera^i. CtR 5363 CONFIDENTIAL: MINNESOTA --- - -- TOBACCO LITIGATION
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IL THIS DOCUMENT SUBJECT T0 AUG. 2fl, 19Pa NON•DISSEMINATION ORJE2 IN ROGERS AND DUKE CASES. PROGP._SS REPOR' P 2 ace ~ Master's ane Doctoral students at Tne University of Texas Scneei of Public Health continue to be referred to me to discuss their. projects. The most recent one is studying Spanisn-surnamed incidence of cancer in Laretio. Of course, this is covered in detail in my recent book. He has additional factors and needs infor:nation on correct populations which was made available for him to copy. Year In June, 1977, 1 participated in the Yith Perucia tluadrennia; icternatic%, Conference on Turr.ors of Early Life in Man and Animals. Tne oaper I;resen:ec at the conference was entitled "Regional and Etinic Differences ir. Tui!:crs ir, Children in Texas." In conjunction with the sare trip, I was invitec to cive a seminar on methocs Gf conductinC a study of ineasuring the effects of poliut'o^r in a city to the faculty at Heidelberg, Germanv at the inStltutc of DCu:sc^^S icre5sfcrschungszentrum, for Documentation, Inforr„ation and Statistics. I attended the American Association for Cancer Researcn mee*.inc_ in ~asn- incton, D.C., in Aoril, 1978. In meeting with and listening to t:^.e work of my colleagues, my ow•n norizons exaand and sugcest greater utilization of my cata bank. I continue to serve as the Section Editor (Epidemiology) for the Book of Cancer, p~,'3lished by Year Book Publishers, Chicago. Ectn Dr. Wellington and I presented papers a: the XII intern,.tional Ccnce- Concress in Argentina in October. We applied for and received travel crart avdards for the trip from the National Academv of Sciences. The biocrapher `ror the t;ational Academy has just written a brochure for the y.C.i. or~ wcmzn sc,e^- tists who have mate major contributions in the fieid cf cancer. ~!y t'ecra.ny is inciuced. : nave been asked to participate in the S.-r::.es;um or _.;ee~ oloc': St:,c"es of _ow-Level Raciaticn Exoosure" at the January, 1,.~79 meetin, o` tne American ~sscciation for tne Advancement of Science. The Radcliffe Quarterly asked that I submit a brief article for their centenary issue on "Distinguished Alumnae." I have also been asked to sceak to the Houston Antibody Club on "Introductory Eoidemioloey for Blood BanKers" and to the Institute of Religion Chaplaincy trainees os my incidence data. I have prepared a closed circuit television interview for our library on my experience at.the M.D. Anderson Hospital. I was asked to orecare an article on Dr. R. ;ee Clark for a soecial issue of the Cancer Bulletin comnemorating his 30 years as heac of the M.D. Ancerson Hospital. I still receive interesting requests from him for all kinds of infor- mation. C T R 5 36 4 ~Y:~.:.~~ ~`~1`°~ .~~~ `~~~~
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THIS DOCUMENT SUBIECT TO AUG. ~, 1985 NUN•DlSSE«INATION ORDER !N R_OGERS AND DUKE CASES, Pace ., Dr. Dorothy G. Nellington, biometrician, served as consultant in statis- :icai aspects of biomedical investiaations to the Pan American Heaith Organiza- tion, WHO, in Mexico City. At her own expense, Dr. Wellington at:enccd tne statistical course on "Time Series Analysis" given by the Institute ::r r-ores- s':.nai Educatior., at Arlington, Virginia, in May. Time series is a particular interest of hers and the attached correspondence with Dr. Durbin reyarding Sir Maurice Kendall's book is interesting. At her own expense, Dr. Wellington has also attended the International Statistical Association meetinc in Warsaw, anc rec:,larly attends the regional meetings of the American Statistical :,ssocia:'en. Suoplemental funds received from another source enabled us to cor,tinue cur oroject tnrough February, 1979. Permission for extension of tire wi:nc:;: accitional funds has been received fror, Mr. William T. Hoyt. Our new 5udge: recuest for tne period March, 1979 throuyn r"ebruary, 1980 is at.ache:. Eieanor J. Macdonald Professor of Epidemiology Department of Epidemiolocv The University of Texas Svstori Canc;r M.D. Anderson Hospital and Tumor ins; .,j__ Hous:on, Texas 77030 ;;oveT;b2r, 197S C T R CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION C ~YR"
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THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER TLs.. M.d.tea! Gntr. ~ Huuron. ra.r 77030 Z ` r \~ February 13, 1979 h'r. W. T. Hoyt Executive Vice President Council for Tobacco Research, U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dear Tom: fn -1~ THIS DOCUMENT SUBJECT TO A1!G ?^ 1985 NuN•DISSEIdIfi:,TIUti Gn)cn 1N R GERS AND PUKE CASES, Last August, I requested extension of time for my grant without additional funds through February, 1979. We still have snall amounts of funds in our c anputer time, consumable supplies and travel accounts which we will need. hti y we have permission for extension of time without additional funds throu9h August, 1979? Sincerely, L EJM: ve Eleanor J. Hacdonald Professor of Epidemiology Department of Epidemiology 1r D.l.ti'DERSON; MOSI:TAC .tA'D TUMOR 1NSTTTL i'f Rewabihttr.ow Gwrer EX: RA-M~ R.,1L PROCR.tMS D/ OSION Oncoiotv Cornci!-BioTidual l.vnnno.u Coi:abo•unw Srrba Srbrrarunt E.ow+~uIScwwce P..i L^.7 VERS: Y C4.4CER fOUND.iT1O.%' T3,..1ftor•..ow MeyJ.,• CTP, 5366 0032-88
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,v,- THE UNIVERSITY OF TEXAS SYSTEM CANCER CENTER T...r A/.dia./ CGnte, Howrto.. 7.a.. 77029 April 9, 1979 Mr. Tom Hoyt Executive Vice President Council for Tobacco Resebrch U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dear Tom: .a n - THIS DOCUMENT SUBJECT TO AUG. 22~. 1995 NON•DISSEhtINATION ORDER IN ROGEP,S AND DUKE CASE:S„ Enclosed are the page proofs for the Table of Contents of the second book. I thought you might be interested in seeing them. The book will be out in June or July. I signed the contract last week with the Raven Press for the third book with a tentative completion date of December, 1980. So my wonderful team and I are hard at work. Sincerely, . ~ ! ,//~"'7/` 7 . Eleanor J. Macdonald Professor cf Epidemiolocy Depart~nent of Epidemiology EJM:ve Encl osures CTR 536i M J Ati'DERSOwHOS17ALM'DTUMOR:VS'^VT: Mnr...lRr+.ftLurm+CrwIr EX"'RAMUR.4L IROGRMtS DMSION O+cau{y CO.ncY-/.e+v6c.11wsnwe.V CoiL#o.ant Sft4es UVNERS'Y CAI.'CER FOUNDATION 71e Awfr.ww Miyrtn S.Mt.row Enro+•v*u Soewcr Lrt ~`~~ ~ r ~~~ t~~ ~e ~~~
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. CANCER MORTALTTY . Environmental and Ethnic Factors C-T R 536S CONFIDENTIAL: MINNESOTA TOBACCO LITIGATION e- C -1 x~ti
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CANCER MORTALITY ENVIRONME'v'TAL AND ETHNIC FACTORS by Doroth,v Gaites W9^llinston ~- E]eanor J. ,titacdonald Patridz F. Wolf Deparrnent of E?ide:niolosry Th li i J f T S n vers e ty o ezas ystem Gncer Centcr Texts Medicil Center Houston, Tr-as ACADE.tiI1C PRESS NEW YORX S.1.V Fr2A:\'C1SCO (ANDON 7979 A Swbssdwy ,~ Htn.+rrt 5F.rr f,tvn,ruh. P1ofc~lury 1 CTR 536J CONFIULN7IP.L. w:jnilmcs0"PA TOBACCO LITIGAT/ON
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CO_\_../NUS 0+aptes I Description and PurT+os.e of the Study I B ac k prourd znd pu rpose o f the S tud y 1 11 Statiural %1ctAoaluluXy and ComFvtr. Pnmtrams 4 !u The Dsu 6 Clupter 2 The Factor Variable Pools I Corrr!stiom brtwccn Respvax Vzri.abks 17 R Chuosins the Fa;tcx Vanabk Ponls 20 1I1 Fuul Variable Pools 29 IV Collincuirv in the Vasvbk Pools :9 V Rcl:ulns Ethnic t.`fec:., to Europran \tottalitY Pattcrsu 31 C}upter 3 The Cancer !rtortslitv `iodels I 1navdur.ion 33 U The ~todeis of \tak Canee: %Sortaliry 64 UI The Atodcis of FYma1c Can.w Mortaliry 91 IV The Stak and Fcmalc Skin Carscer SloctsJirv Modcts 121 V The M.ak and Female Toul Canccr Mortaliry Modets 128 Qapter 4 Comparison of Factorn in the ,tortality Modelt of lndiridual Cancer Sites I Brst Subxt Mo.kls 131 11 RiJpe RcFrssWn AJUlvs,is li_ Chapuer 5 Outlien in the Afortality kiodels for lndiridual Cancer Sitrs I Rcsidual Chulicn 147 II Owtlicrs tn the lnflwnce Spxe 169 0 I I , C T R CONFIDENTfAU MINNESOTA TQSACCO LITIGATION 5370
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I •t ConL4n Chapter 6 Comparison of Factors in the Mortality Modds of Major Categories of Death I Inaoductiots 179 It Noneshnic Facscxs 179 M E.eAaic Facaasa 181 - iV^ Lks-du from-Atl Causcs " _ I 86 V Ridte RtZitasioo Aaalysis 1t7 Chapter 7 Outliers in the Mortslity Models for Major Cstegaies of Death I Residusl thuclicrs 191 il O4rJirn ia the Influcnce Spre :'01 Chsples 6 Additional Factor Vaxiablems: Radiation and Mezian Ethnic Eackgroaad ity I B ac kpounC Rad i at ion is a Facum 205 11 7?ic Effcct of BQckground Rsliatim in Rtspir..txy Cinctt Mortal iry 2131 fil Radixroo as a Pvsitive Effcct in Other Cu,cr. Mortaliry 213 IV Componencs of Back;round Radiation 215 V Rsdisrion as a Frcot in tAe Ma1a Curgoncs of Deuh 219 VI The S4exican Ethnic Fxtor W Chapter 9 Su.mmiry and Conclusion I CritiGue 2_'7 11 Dynarnics of Stue Mutulity Putcr.u 2:8 III Epidrrnjological Investitation Surgc•str' b,v Consumption and E:Enic Effccu in the Canccr Morul,cy Stodcts :32 IV Surnmuy of Statiuical Procrdum-s 238 V Surarnary of Rtsults :39 la.irl 241 231 I ICTR CONFIDEtiTIAL: MINNESOTA TOBACCO LITIGATION I ~' ~`~f'I 0 +~~ ~ ~Q 1-4 °~ C
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I -- TABLES I Facn.or Variabks - 7 U III IV Response Variables: State A=e-Adjusted Death Rues Canccr Sitrs with~.~ ont _tlun SO'{ Comrnon `'uiation in Sute Mortalin•`K.ates The Variapk Pools a 29 V Corscluion Matrix of the Factor Variables 30 VI Interprrution of Factor EfTeas in the Slortaliry Models 34 V1I Coefficient Patterns in the Cancer Mortality Mode ls- \ lalcs 36 VIII Coeffscient Patterns in the Cancer Mortality titodels-•Fcrriaks 40 IX Coefficient Patterns in the Cancer Mortality titockls-!•taks aad Femaks 44 X Coefficient Patterns in Skin Cancer Mortality 1.4a3cls-Males and Frmalrs 4S XJ XII XIU X1V Coefficient Panerns iew the Vsortaliry Models for the Majot Cstetorics of DraaA Subili.ned ElTecu in the Ridt•e Trace fof Each Type of Caacrt Mcxuliry Stabilaod Effers in ttse Ftidee Tract tor Fx'a !rLjor Carcfory o( Mocialiry Ruults o( Dividing the ••pthcr Eumpean" VsriaDk SO S: SE earo Its Compoee•at Exhnic ElIecs: C=srunlc. atal- iaes. and Slavic 63 XV CocnQarison of Et3utic and Noacchnic Eftc;ts in the Models of Mak Mortality for Four Relaxd TYpcs of Cancer 74 XVI Compsrison of Fxtor Sijnificsnre in ioteszini! at~d Rrctil Cancer Storuliry 104 XVIt Compsrix+n of Can:ct S1orulitics Inllucnce-,d by Each Stodel Effect 132 XVIII Summary of M1.Jcl Effects CoRunort to Both Rlale and Frmale Moraliiy ~t~xkb (ur IndiviJu:l Cancer Sites 136 XIX Cocsipsrisun of Ethnic Efferts in U.S. Muctality MoJ• cls with Forcip Rr.:kinj in InJiviJual Cancer Sites 140 CTR 53- ~ ~ t CONFIDENTIAL: MINNESOTA ~^~-~ TOBACCO LITIGATION ~~ ~~,~"'~' ~ ,,;f 4-
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.~.. .IU TAeL•ES - XX Comp.rison of Canecr MoeuJiciCS Influenccd by Each Staailited Model Effoct 144 XXl ResiduiJ•Oaclrcrs in the Cancer Mortality Models 150 XXII Stase R:nlcint in cbt,Faceot Variables 1S2 XXl11 Model E.ffecta in 4tak LAmj Cuxw Moruliry 155 _ XXIV Model F1feCs in Mile Kidacw Mortaliry wcth Coetfi- - - - - cieat Rinkias -- - - -- 162- X X V • Modct ElCxv ia Mak lioctaLor fineo Pod t3cin's Dir C.1" - • -- -. . . 164 -- XXV1 Poseruial Oualiers in ctve Iaflucncr Sprx of the Bcst Subset Model for each Cancet Moruliry 1%t XXVII Chsnses in Bcst Subset Motkls of Cu+cts Moruliry Vr'hen Ej-atme val ues in In n uexe S pace Ars Om incd 1?: XXVIII Compuison of Et.tinic Effecu in U.S. Moctaliry htod- cis wittt Foreisn R3n1:int in S1a,ior Causes of Dcath 182 XX1X Residuil Outliers in the Models for Major Categories of Desch from u+e S- and 12-Variable Pools 192 XXX Poccntial Oucliers in che Influence Space of the Subset Model for Exh `tajo( Cste=ocy of Dcuh :01 XXXI C'unM in Subset Siodets of Major Cate=or,es of pcattt whca Extrtmc Valua in [nlluectr Spa7e Are OaiiacE 203 XXXII The Rxliatioo Effect in Caace: Mortaliry _08 XXX11/ Radiacioo as a Factor in Res-pirauxy Cancer Moresliry 210 XXXIV Radiatioo as a Facoor in the Stab;lized Canccr Mocu]- ery Models of the Ridfe Ttre 214 X X X V Rad iac ioc as a Positive Facsor in C a:ncet \ iotta! i ry 216 XXXVI XXXVU X X X VU I XX77X R-idiatioa Facux in the Major CueFocics of Death Coctelations between the EariroamcncaJ V.-riabics aad dr Ucb.n/Dcruiry Vanablea Me i;r ao Ertsnic Fx•wr in Ma jLx Cau=oc.es of Dcs:h Staodard Deviaciocs and Coctficienn of Variszion of An-AdJusaed Death R.acr_s fur the Mijor Csuses of D~ in Sciecud Years 29 XL Cacsumption and Ethnic Ef[ects in U.S. C=acrr Mor- ts)ity Models 233 XL! Relacive Rankint in Canccr AtonaJiry of the Cocmtries of Ori=tn Repcrscnttd by thc Ettnkc Vanibks :36 TR 5 3 7 ) ) CO TOBACCO LITIGAT ON TA . - _.,~....~ ` r~~RHUI
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THIS DOCUMENT SUBJECT TO AUG. ?0. ,-- - 1985 NON • DISSEt,1INATION On~'LR IN _ROGERS AND DUKE CASES. Budoct Peanest Special pro;;ect of the Councii for Tcoacco ?esearch - USA, ;nc. M.arc.^., '.:79---eDruary, 1920 Sa laries J Research Assoc ia te (100w.)' Assistant EpideTiologist (100t) Assistant Epidemiologist (70%) Programmer (501)• $22,332 16,170 11,316 3,144 ' Secretary III (100%) 11,016 Clerk-Typist (33X)' 1,704 Subtotal S65,6S2 Fringe Benefits 10,877 Computer Time 1,50C Consultation Services I,000 Travel 3,500 Consumable Supplies 1,0CC Other Expenses (ar: work, subsidy for third book) printir.c 3,000 Subtotal 26,8,'7 Subtotal S92„55.~' Overhead 15% 13,884 Subtota 1 13,684 " - Gnntip TO i:.L -Partially funde: from otner sources. CTR ir. ~o,442 ~374 November, 197.0, C'C':.:. 1: 1,.:!.1 ti':R!;; ,, _ ~e'UBf.C'CCr l IHGn11U~ t~(X „i
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T'r.C U. \;\ ::.S: :':' C=' .,, S'.'jT _. : Cn.':C'E .. CE \ ' . --- . . M. D. Anderson Hospital and Turnor lnstitute Texas MedicaJ C.enter Houston, Texis 77030 January 7, 1980 Mr. W. T. Hoyt, Executive Vice President Council for Tobacco Research - U.S.A., Inc. 110 East 59th Street New York, New York 10022 Dear Mr. Hoyt: THIS DOCUMENT SUBJECT TO AUG. 2^. 1985 NON-DISSEMINATION OftD:"ic IN ROGERS AND DUg CASE& I would like to request an extension of time from February 1980, to ADril 30, 1980, without additional funds for our Special Project of the ToSacco Council. If this rrwets with your aoproval, will you please sign below. Your cor,tinued support is appreciated. Sincerely, Eleanor J. Macdonald v Professor of Eoide^ioloc Department of E?ide^iology EJM.: vs Approved: Z4 ,r. N. i oyt ' Date: ~ el- u.. /v / CjR Rc-.abiaution Centcr The Unrversirv Cancer Foundotion The Andcrson I-'.+%'i•t' Estramural Programs Dtvtston: Envtronincnul Sctence Iar1 • Oncoion Counctl biomedicil Instntuttont Collaboraer.e 5tudres Substin1u1t C T ~, '.) ~"~
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THE 11NIVEkSITY OF TEXAS SYSTEM CANCER CENTER, n~ x.sic.r c.~t.. HeW.roA. n... 77030 May 8, 1980 Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Research-USA, Inc. 110 East 59th Street New York, N.Y. 10022 Dear Tor,,: THIS DOCUMENT SUBJECT TO AUG. 20. 1S~ NuN•DiSSEidINATION OnDi:r2 IN ROGERS AND DURE CASES• I wish to request extension of time without addi- tional funds for the period 4/30/80 to 8/31/80. Will you please sign the attached copy and return to c*, if you concur? With best wishes, Sincerely yours, 9 1~ ~Nr___ Eleanor J. Macdonald Professor Emeritus of Epidemiology Department of Cancer Prevention EJM:en enc. Approved Da t e .1! D M'DF.RSOti' HOSPlT.1L AND TL'MOR !h'S'~TL'.'T Rei,abihut.pw Gtntt• FX-R t~iL'R.1L PROGR_4MS Dl t?510.' O• cour Co. nc~ d o~ta ca Inrnrrnov Collaeo.rnw Strd;e~ Srotruo.+i En.~.a•..+v~ta! Scwwce Pt+e L'~7 t EASITY Gt..'CER fOU.~'D.1T/ON T'nt .4nant~ Mwla,. C T R ~I Rk
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Tne Universitv of Texas Sylstem Gancer Center M. D. Mdenon Hcxpiul and Tumor Irutiruce Tuui Medocal Ccncer • 6723 Bercxr Ayrnue • Houxon. Tcrw 77030 June 2, 1980 Diriam. of C--crr Prer'.siorr 1"IS DOCUMENT SUBJECT TO A!1; 2,~,, 198~ Nuri-DISSEMlNATIDN ORDER IN ROGERS AN D DUKE CASES, Mr. W. T. Hoyt Executive Vice President Council for Tobacco Research - USA, Inc. 110 East 59th Street New York, New York 10022 Dear Mr. Hoyt: Enclosed is my application for renewal of my project for the period June, 1980 - May, 1981. Sincerely, Eleanor J. Macdonald Professor Emeritus of Epidemiology Department of Cancer Prevention EJr4ew Enclosure CTR 5377 . CONFIDENTIAL: MINNESOTA ~ }' ~ ~ ~ ~" '~~'"4 r"`o '" 1 J ,~ ~"0a [ TOBACCO LITIGATION L-t i i : ~+~ , ~-~ ~' ~ ~ % 9
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l , Special Project THIS D^"':Jh!ENT SUB1CrT Trr g„^. 2,. 191," i% lOlv ORDER Budget Request IN ROGERS AND UKC11.SES„ of The Council for Tobacco Research, U.S.A. June, 1980 - May, 1981 The major project of the next year will be the completion of the third bock, my overview of the epidemiology of cancer over the past 40 years. Incidence in the six regions in Texas representing a population of four million will be analysed. In addition, the incidence, mortality and survival in Houston, a 23 year continuum, will be an important detail. The years covered, 1944-1966, cover the transition of a city of 800,000 population in 1944 to one of about 2,000,000 population in 1966, through the great surge of expanding industry. The environmentalists, with their rising interest, will have in these data a background on which to base analysis of the changing cancer picture. This is a basic source available only in this petrochemical center in the U. S. where the exact facts are known for every kind of cancer for the last quarter of a century. And these facts represent the situation before, during, and after the most rapid r.assive urban expansion of any city in the U. S. Two-thirds of all patients with cancer experience the most serious chases of their disease as a result of inetastases rather than of the prir,.ary itself. And yet metastases have been nearly untouched as a research area. We have taped the details of the 100,000 mestastatic lesions. This is the total number that has occurred in 30 years at this cancer hospital. Analysis of this material by sophisticated statistical methodology promises great rewards in anticipating and pernaos preventing this serious aspect of cancer. Part of the next few months will be spent by most of the staff in an intensive check of the durations from onset to diagnosis of each of the metastatic lesions. The third main project will encompass ora:~r,inc the incidence rates of each site of cancer, which were given in ;:)idemioloav of Cancer in Texas: Incidence Anal sed by Tvoe, E:^nic rouo, ane eooraonic ocationF inis has been requesteo oy tne puoiisner and by tne aaministration at the M. D. Anderson Hospital. Eleanor J. Macdonald Professor Erneri tus of Epi demi ol ogy The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute Houston, Texas 77030 CTR 0-37S CONf1Ul1NUn..• n:..•:NL~)UTA ~ ~ ~~ ~~ TOBACCO LITIGATION H 14 r"~ 0
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If ~ t_rS lN O~t GERS AtiD pUi CASES BUDGET REQUEST Special Project of the Council for Tobacco Research - USA, inc. J une, 1980-May, 1981 PERSONNEL Dorothy G. Wellington, Ph.D. Asst. Biostatistician (100A) 27,540 Veda Sheppard Secretary III (100%) 12,372 Evelyn Heinze Asst. Epidemiologist II (70%) 12,676 Patricia Wolf Asst. Epidemiologist II (70%) 12,676 "argaret Daniels Asst. Epid. (Prograsmtier) (50%) 6,954 M,a-y Pae: Clerk Typist III (5CA) 5,598 rR:NCc BENEPITS 25.56'. of Personnel -10!'!=STIC TRAVEL ^^'-9'JTER COSTS 77,816 20,746 3,5-00 5,000 Subtotal 107,062 OVERHEAD 1--: of Total Direct Cost 16,059 TOTAL 123,12i C1R 53 7y CONbIU'.:r: i ir ~ • ...... .-:SOTA ~ `,'I'OBACCO LITIGATION 01 ~ ~ 0
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THIS DOCUMENT SUBJECT TO A1M 2n 1985 NuN•DISSEidINATIUN IN ROGERS AN D UKE CAzEa. THE UAtTVF.RSITY OF TEXAS SYSTEM CANCER CF2`t'TER M. D. Anderson Ho>rpital and Tumor Institute Texas Medical Center Houstors. Texu 77030 March 3, 1981 Mr. W. T. Hoyt Executive Vice President The Council for Tobacco Research-USA, Inc. 110 East 59th St. New York, NY 10022 Dear Toms I wish to request extension of time without additional funds through August 31, 1981. If you concur, will you please sign the attached copy and return to me? With best wishes, Sincerely, . Eleanor J. Macdonald Professor Emeritus of Epidemiology Division of Cancer Prevention EJM/kvd Approved : Date: C T R 5381 , Rehabilitation Center The Universirv Cancer Foundation The Anderson Ma%-Eair Extramcral Programs Divisior.: Environmcntai Sc,ence Par: Oncolon Council gsomedscal Institutsons Cnllaboratrve Studies Substat.o-s C ~f `~ ~~~#"~ ~~ o~ ~ ~ aZ.
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I THIS DOCUMENT SUBJECT TO AIM,, 2" 1985 NUti•DiSSE;Aii1i.Tlvii .,.....n IN ROGERS AN D DUKE CASES, 7ne U~ersitv of "Rlxas System Cancer Center M. D. Anderson Hospital and Tumor Inscicuce Teus Medical Center • 6723 Bertrwr Avenue • Houston. Texas 77030 ~ June 12, 1980 Mr. W. T. Hoyt The Council for Tobacco Research U.S.A., Inc. 110 East 59th Street New York, New York.10022 Disrai...f Csnce. F'rewsr;o,r Dear Tom: k you for your letter advising me of the continued financing of my research. Your generous support enables my staff and me to concentrate totally on adding solid facts to the growing knowledge of carcinogenesis and its epidemiology. Sincerely, Eleanor J. Macdonald Professor Emeritus of Epidemiology Department of Cancer Prevention EJMew CTR 5380 ' ~- ~ N~~~ oo.~o ~
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