Assessing health outcomes associated with exposure to polychlorinated biphenyls (PCBs) is important given their persistent and ubiquitous nature. PCBs are classified as a Group 1 carcinogen, but the full range of potential noncancer health effects from exposure to PCBs has not been systematically summarized and evaluated. We used systematic review methods to identify and screen the literature using combined manual review and machine learning approaches. A protocol was developed that describes the literature search strategy and Populations, Exposures, Comparators, and Outcomes (PECO) criteria used to facilitate subsequent screening and categorization of literature into a systematic evidence map of PCB exposure and noncancer health endpoints across 15 organs/systems. A comprehensive literature search yielded 62,599 records. After electronic prioritization steps, 17,037 studies were manually screened at the title and abstract level. An additional 900 studies identified by experts or supplemental searches were also included. After full-text screening of 3889 references, 1586 studies met the PECO criteria. Relevant study details such as the endpoints assessed, exposure duration, and species were extracted into literature summary tables. This review compiles and organizes the human and mammalian studies from these tables into an evidence map for noncancer health endpoints and PCB mixture exposure to identify areas of robust research as well as areas of uncertainty that would benefit from future investigation. Summary data are available online as interactive visuals with downloadable metadata. Sufficient research is available to inform PCB hazard assessments for most organs/systems, but the amount of data to inform associations with specific endpoints differs. Furthermore, despite many years of research, sparse data exist for inhalation and dermal exposures, which are highly relevant human exposure routes. This evidence map provides a foundation for future systematic reviews and noncancer hazard assessments of PCB mixtures and for strategic planning of research to inform areas of greater uncertainty.

Background: Evidence is emerging that exposure to persistent organic pollutants (POP) is a risk factor for atherosclerosis-related diseases and for diabetes mellitus (DM). We hypothesized that residential proximity to sources of POP will be associated with an increase in hospitalization rates for ischemic stroke (IS) with comorbid DM (IS-DM). Methods: We examined IS-DM hospitalization rates in the New York State (exclusive of New York City) during a 12-year period. POP exposure status was assessed based on residency in a zip code containing or abutting environmental sources of POP. Adjusted relative risks (RR) of IS-DM hospitalization were estimated by multivariate Poisson regression. Results: A statistically significant 10% increase in IS-DM hospitalization rates was observed in populations environmentally exposed to POP (adjusted RR 1.10, 95% confidence interval, CI, 1.01–1.20; p = 0.031). IS-DM hospitalization rates were also higher in males (adjusted RR 1.34, 95% CI 1.30–1.39; p < 0.001), in blacks (adjusted RR 4.54, 95% CI 4.16–4.94; p < 0.001) and in older age groups (p for trend <0.001). Conclusions: Residential proximity to sources of POP is associated with an increase in RR of IS-DM hospitalization. Our findings support the hypothesis of POP being a risk factor for IS. Further studies are warranted.

Environmental exposure to persistent organic pollutants (POPs) has been associated with an increased risk of both acute myocardial infarction (AMI) and diabetes mellitus (DM). A study of first-time hospitalizations for AMI with DM as a comorbidity in populations presumed to be exposed or not exposed on the basis of residence near POPs sites was conducted to investigate whether exposure to POPs increases the environmental burden of disease. We examined the association between residential proximity to environmental sources of POPs and hospitalization rates for first-time AMI with comorbid DM in 31,428 patients aged 25-74 years, using the New York Statewide Planning and Research Cooperative System data for a 12-year period (1993-2004). Environmental exposure status was assessed based on the zip code of residence. Adjusted relative risks (RR) of AMI hospitalization were estimated by multivariate Poisson regression. Hospitalization rates for first-time AMI with comorbid DM were significantly greater in populations living near POPs sites (adjusted RR = 1.169, 95% CI: 1.014-1.347, p < 0.05). These rates were also significantly higher in African Americans than in Caucasians (adjusted RR = 1.902, 95% CI: 1.659-2.180, p < 0.001), in males (adjusted RR = 1.767, 95% CI: 1.695-1.843, p < 0.001), and for older ages (p for trend < 0.001). These findings, consistent with established non-modifiable risk factors, support the plausibility of our model. Residential proximity to environmental sources of POPs is associated with a significant increase in hospitalization rates for first-time AMI with comorbid DM, compared to respective rates in populations not exposed to POPs.

Studies suggest that environmental exposure to persistent organic pollutants (POPs) may be an emerging risk factor for ischemic heart disease, including acute myocardial infarction (AMI). However, some studies indicate that exposure to POPs may also be a risk factor for hypertension, a well-established risk factor for AMI. To investigate effect of POPs on the environmental burden of cardiovascular disease, a study of AMI with comorbid hypertension in populations environmentally exposed to persistent organic pollutants, based on the zip code of residence, was conducted. Data on hospital discharges for AMI with comorbid hypertension were obtained from the New York Statewide Planning and Research Cooperative System for 1993–2004. Patients residing in zip codes containing or abutting POPs contaminated sites were considered environmentally exposed. Relative risks (RR) — with corresponding 95% confidence intervals (95% CI) — of hospitalization for AMI with comorbid hypertension were estimated by Poisson regression, adjusting for known confounders. Adjusted hospitalization rates for AMI with comorbid hypertension were 12.4% higher in populations residing in proximity to a POPs site (adjusted RR = 1.124, 95% CI 1.025–1.233, p < 0.05), compared to not in proximity to a POPs site. Also, hospitalization rates for AMI with comorbid hypertension were higher in males than in females (adjusted RR = 2.157, 95% CI 2.100–2.215, p < 0.05), in African Americans than in Caucasians (adjusted RR = 1.631, 95% CI 1.483–1.794, p < 0.05), and in older age groups (p for trend <0.05). These findings are consistent with the established effects of non-modifiable risk factors and serve as indirect quality indicators for our model. In conclusion, our results support the hypothesis that environmental exposure to POPs increases the burden of cardiovascular disease in exposed populations.