0.40 for the Utirik and Comparison group, indicating nostatistically significant differences. Causes of Recent Mortality: The number of deaths occurring in 1988 through 1991 is as follows: Rongelap - 1: Utirik 3: expanded Comparison group- 10 (see p. 1 for the description of this group). The clinical events surrounding the deaths are described below. 100 TYPrprrrprerrprr rrp rrr pr ree pr rrr yp rr rrp err 80 - 4 + Bor Q 70F 4 4 > ee tee = er & sop 2 40 ~=—— RONGELAPANDAILINGNAE EXPOSED(86) 30k ------ UTIRIK EXPOSED a9 RONGELAP COMPARISON GROUP : 7 4 w (167) —(86} 4 10r 4 go bttetitbrristiiisntisii tigitiriitbiii itis 1955 Fig.1: 1960 1965 1970 1975 YEAR 1980 1985 1990 1995 Percent survivors of the different exposure groups since 1954. The numberof persons initially in each group is shown in parentheses. Rongelap: Subject No. 1. Advanced complications of diabetes mellitus were the cause of death in December 1991 of this 58-year-old man. He had been referred to the Straub Clinic in Honolulu a month earlier for a scheduled colonoscopy because of a history of colonic adenomatous polyps. At that time no evidence of malignant disease was uncovered, and chronic renal failure was felt to explain the anemia, abnormal mental status, and neuropathy that had been developing in recent years. Utirik: Subject No. 2. The death certificate of this 54- year-old woman lists "sepsis" and “diabetic gangrene/cellulitis (left) foot" as her cause of death in April 1991. She had diabetes mellitus with retinopathy and probably nephropathy, and she was last seen by the medical team in March 1990. At that time she had a guaiac-positive stool felt to be due to hemorrhoids. Her mammogram was “negative” and her Papanicolaou smear was normal, An alpha-fetoprotein level was normal (she was known to be hepatitis B surface antigenpositive), and a chest x-ray showed only pectus excavatum. Subject No. 3. This 52-year-old man,a cigarette smoker, died in 1990; death certificate cause of death: malignant lymphoma with marked gastric involvement. When last seen by the Brookhaven medical team (April 1989) the patient had borderline hypertension requiring no therapy. No lymphadenopathy or splenomegaly was noted. He had symptomsconsistent with esophageal reflux, for which he was given antacids. His blood count, urinalysis, stool guaiac and electrocardiogram were normal. A chest x-ray had been normal in 1988, and a flexible sigmoidoscopy was normal in 1987. His serum was known to be positive for hepatitis B surface antigen, but the alpha-fetoprotein level was normal in 1988 (2.5 ng/ml). The death certificate diagnosis was made onclinical grounds. No tissue diagnosis was possible. The patient died while departing Majuro to have an evaluation in Honolulu for his dysphagia and weightloss. Subject No. 4. This 80-year-old woman died on Utirik in 1988; in recent years she had become severely incapacitated with shortness of breath and arthritis of the shoulder. A medical team cardiologist diagnosed mitral regurgitation (secondary to ruptured chordae tendineae) and mild aortic stenosis/insufficiency. She was on digoxin and hydralazine for this. The joint problem, which was due to a shoulder injury at an early age and subsequent degenerative changes, was handled with acetaminophen. Her blood count when seen in March 1988 was normal except for a mild anemia (hemoglobin: 10.1 g/dl), present since 1984 (hemoglobin: 10.6 g/dl). Serum creatinine was normal in 1987, as was a Papanicolaou smear. Because of restricted mobility her medical exams were done in her home. She was unchanged clinically when last seen in September 1988. The cause of death is unknown. Comparison population: Subject No. 5. This 67-year-old man died on Ebeye in 1988. When last examined by the Brookhaven team (1985) his medical problems included marked obesity and chronic renal failure of