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The effect of prenatal exposure to radiation on birth outcomes: exploiting a natural experiment in Taiwan

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Abstract

We estimate the effect of prenatal exposure to radiation on infant health. By exploiting the 1983 Taiwanese radiation-contaminated buildings accident as a natural experiment, we compare birth outcomes between siblings and cousins exposed to different radiation levels. Given the 1983 accident was unanticipated and exposed cohorts were unaware of the risk until 1992, our design isolates the effect of radiation exposure during pregnancy from other effects. We provide the first evidence that prenatal exposure to a continuous low-level dose of radiation significantly reduces gestational length and increases the probabilities of prematurity and low birth weight.

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Notes

  1. These apartments were contaminated with cobalt-60 at a total activity ranging from 1 to 140 μSv/year.

  2. There is evidence that maternal stress tends to affect birth weight especially during the first trimester of pregnancy (Torche 2011), while nutritional changes have their greatest effect during the third trimester (Almond et al. 2010).

  3. It is generally accepted that the fetus is most susceptible to radiation during organogenesis from 2 to 7 weeks and in the early fetal period from 8 to 15 weeks after conception (McCollough et al. 2007; Williams and Fletcher 2010).

  4. While some studies show exposure to medical radiation during pregnancy increases the risk of having a low birth weight child, others reveal no significant relationship (Hujoel et al. 2004; Mortazavi et al. 2013).

  5. Yen et al. (2014) use 5 mSv as the cutoff of radiation exposure, Lin et al. (2010) use 10 mSv, and Hwang et al. (2008) and Hsieh et al. (2010) use 50 mSv.

  6. We do not rule the possibility that radiation exposure may impair spermatogenesis. Although a study of male patients with thyroid cancer shows elevated follicle-stimulating hormone and decreased inhibin B levels 3 and 6 months after radioiodine therapy (Wicher 2000), there is no direct evidence that low-dose radiation detrimentally affects male fertility.

  7. The linkage to non-exposed sisters may be incomplete. We are not allowed to identify the non-exposed sisters of the RCBs mothers in cases where their mother (the grandmother of the birth) was dead.

  8. The cutoff of 10 mSv was adopted by Lin et al. (2010). We alternatively use 4 mSv, 30 mSv, and 50 mSv thresholds for robustness checks.

  9. As noted by a referee, the RCBs mothers and their non-exposed sisters may have different family environments and so the difference-in-differences estimates using the mothers-only sample are more credible.

  10. Due to the incompleteness of information on moving-in and out dates, we are not able to measure the exact duration of living in the contaminated buildings for each exposed mother. Nevertheless, to our knowledge, the vast of majority of the exposed residents lived in the RCBs over the entire sample period 1981–1991.

  11. We have also used probit and logit models to estimate the regressions with binary birth outcomes. Unfortunately, the estimates do not converge, which may partly due to the small incidence of low birth weight and prematurity.

  12. Due to sample size on same-sex siblings, we cannot precisely estimate whether boys or girls are more affected by radiation exposure in utero.

  13. We have also tested using other cutoffs of birth weight (2400 g, 2300 g, 2200 g, 2100 g, and 2000 g) and gestational age (36 weeks, 35 weeks, 34 weeks, 33 weeks, and 32 weeks). However, results are insignificant, presumably because of small sample size. Five children were born with birthweights less than 2500 g (2400, 2300, 2250, 1500, and 1460). Similarly, five children were born with gestational periods less than 37 weeks: three at 36 weeks and one each at 32 and 31 weeks.

  14. Given the half-life of Co-60, exposure during the second period should be about half as large as during the first period. Although information about the contamination was not disclosed until 1992, it is conceivable that some residents may have been aware of something wrong with these apartments and decided to move out. If so, the estimates could be biased towards zero. However, the symptoms of low-level radiation exposure are extremely modest, so it seems unlikely residents would have been concerned. Moreover, as the vast majority of exposed residents live in the RCBs over the sample period 1981–1991, any bias should be minor.

  15. Almond et al. (2009) use a measure of the total beta radiation in situ (i.e., on the ground) expressed as kBq/m2, while Black et al. (2013) additionally use a measure of the total beta radiation in the air expressed as Bq/m3.

  16. Our main conclusions are unaltered when excluding birth order controls in the regressions.

  17. There is no strong evidence that birth gender is endogenous in Taiwan. Chen et al. (2014) report that the sex ratios of firstborns were very stable over the entire 1980s in Taiwan. Their result also reveals that the gender of second-born children is random, conditional on other covariates. Since the mean of birth parity in our data is 1.9, this study is less subject to any pro-male bias.

  18. We thank a referee for the suggestion to use the alternative cutoffs. The thresholds of 4 mSv and 50 mSv are motivated as follows: First, Almond et al. (2009) report that the maximum dose of radiation exposure for Swedes following Chernobyl was estimated to be 4 mSv in the first year (Edvaron 1999). Second, the one-shot dosage cutoff widely used in medical literature is 50 mSv. The cutoff regarding 30 mSv is included as an alternative between 10 and 50 mSv.

  19. Similar results are also found when using 40 mSv as cutoff.

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Acknowledgements

This research was supported by the Ministry of Science and Technology, Taiwan (Grant 101-2314-B-002-155-MY2 to Jin-Tan Liu). Two anonymous reviewers provided valuable suggestions.

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Authors and Affiliations

  1. Graduate Institute of Industrial Economics, National Central University, Taoyuan, Taiwan

    Meng-Wen Tsou

  2. Department of Economics, National Taiwan University, Taipei, Taiwan

    Jin-Tan Liu & Chyi-Horng Lu

  3. NBER, Cambridge, MA, USA

    Jin-Tan Liu

  4. Center for Risk Analysis, Harvard University, 718 Huntington Ave, Boston, MA, 02115, USA

    James K. Hammitt

  5. Toulouse School of Economics, Université Toulouse Capitole, Toulouse, France

    James K. Hammitt

  6. School of Public Health, University of Minnesota, Minneapolis, USA

    Szu-Yu Zoe Kao

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  1. Meng-Wen Tsou
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  2. Jin-Tan Liu
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Correspondence to James K. Hammitt.

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Appendix

Appendix

See Tables 10, 11.

Table 10 The effect of prenatal radiation exposure on birth outcomes (birth weight and gestational age)—DD with mother fixed effects
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Table 11 The effect of prenatal radiation exposure on birth outcomes (birth weight and gestational age)—DD with mother fixed effects (two periods)
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Tsou, MW., Liu, JT., Hammitt, J.K. et al. The effect of prenatal exposure to radiation on birth outcomes: exploiting a natural experiment in Taiwan. JER 71, 379–403 (2020). https://doi.org/10.1007/s42973-019-00016-9

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  • DOI: https://doi.org/10.1007/s42973-019-00016-9

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