Human Health StudiesHuman Health Studies

Partnership for Environmental Partnership for Environmental Research and Research and

Community Health Community Health Symposium on Project Symposium on Project

OutcomesOutcomesUniversity of West FloridaUniversity of West Florida

Conference CenterConference CenterOctober 26, 2009October 26, 2009

Presented by:Presented by: John J. Lanza, MD, PhD, MPH, FAAPJohn J. Lanza, MD, PhD, MPH, FAAP

Florida Department of HealthFlorida Department of HealthEscambia County Health DepartmentEscambia County Health Department

ObjectivesObjectives

To evaluate possible adverse health To evaluate possible adverse health effects on residents living in an exposed effects on residents living in an exposed community near Superfund sitescommunity near Superfund sites

To perform biomonitoring of residents who To perform biomonitoring of residents who lived near Superfund sites lived near Superfund sites

To determine knowledge of health To determine knowledge of health advisories by a specific populationadvisories by a specific population

To measure heavy metal levels in a To measure heavy metal levels in a specific populationspecific population

All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy.

-- Paracelsus (1493-1541)

Percent Contribution to Cancer(Doll and Pelo, 1981)

Pre-PERCHPre-PERCH

To evaluate possible adverse health To evaluate possible adverse health effects on residents living in an exposed effects on residents living in an exposed community near Superfund sitescommunity near Superfund sites

Environmental Justice issues - 1998Environmental Justice issues - 1998 CATE projectCATE project

Mount Dioxin

Superfund Site Chemicals With Maximal

Soil Concentrations Off-site

Escambia TreatingArsenic

Benzene

Benzo (a) - pyrene

Benzo (b) - fluoranthene

Benzo (k) - fluoranthene

Benzo (a) – anthracene

Chrysene

Dibenz (a,h) – anthracene

Dioxin – TEQ

Indeno (1,2,3-c,d) pyrene

Naphthalene

Pentachlorophenol

AgricoArsenicBenzo (a) – pyreneBenzo (b) – fluorantheneBenzo (k) – fluorantheneBenzo (a) – anthraceneChromium (VI)ChryseneDibenzo (a,h) – anthraceneFluorideIndeno (1,2,3-c,d) pyreneLeadManganeseSulfateVanadium

1, 2,4 –Trimethylbenzene1,3,5-Trimethylbenzene2,6- Dimethylnaphthalene4 – biphenylamineAcenophthaleneAcridineBenco (e) pryeneBenzo (g,h,I) peryleneBenzo (j) fluorantheneBenzothipheneBromomethyl (methylpropyl) – pyrmidioneC2 AlkylphenanthreneC2 AlkylnaphthothiopheneC2 AlkylbiphenylC2 AlkylpyridineC2 AlkylnaphthaleneC2 AlkylquinolineC3 AlkylnaphthaleneC3 AlkylbenzeneC3 AlkylbiphenylC3 AlkylquinolineC3 AlkylpyridineC4 AlkylbenzeneC4 AlkylnaphthaleneC4 AlkylpyridineC5 AlkylbenzeneCarbazoleCarboxylic acid

CareneChlorethaneChloro (trichloro (chlorophenyl) – ethyl)benzeneCopperCyclopena (d,e,f) phenanthreneDecylhydroxylamineDibenzofuranDibenzothipheneDihdrophenanthreneDimethylbutanolDimethyleneicycloheptaneDimethylhexeneDimethylmethylenebicyclohephtaneDimethyloctanolDimethylpentanolDioctylphthalateEthylhexanoic acidEthylhexanolFormic acid, butyl esterFormic acid, methylpropyl esterHexadecanoic acidIsopropanolMethoxybuteneMethoxypropenylbenzeneMethylbiphenylMethylcarbazoleMethyldibenzofuranMethyldibenzothiophene

EthylethylpentanolMethylfluoreneMethylhexanolMethylnaphthaleneMethyloctanolMethylphenanthreneMethylpropanolMethylquinolinen-Dodecanen-UndecaneNitrocarbazole OctanydrodimethylphenanthreneOxybismethylpropanePentanePentylcyclohexaneQuinolineSulfateSulfideTetrachlorodibenzofuranTetramethylphenanthreneTitaniumTrimethylbicycloheptaneTitaniumTrimethylbicycloheptaneTrimethyclyclohexene methanolVinyl acetateYttrium

Escambia Treating Company

The following chemicals were detected at this site. There are insufficient toxicological data available upon which to base an assessment of their public health significance.

CATE ProjectCATE Project

Began July 1, 2000 – continuingBegan July 1, 2000 – continuing 3 components-running concurrently3 components-running concurrently -1. ID those who live or lived in PRA-1. ID those who live or lived in PRA -2. Pt exposure evaluation history, -2. Pt exposure evaluation history, exam, labs, etc.exam, labs, etc. -3. Education of providers, referrals, -3. Education of providers, referrals, epidemiology, toxicologyepidemiology, toxicology▪▪ Referred into PERCH biomonitoringReferred into PERCH biomonitoring

CATE Health ScreeningsCATE Health Screenings

Elevated prevalence of diabetes, Elevated prevalence of diabetes, hypertension, hepatitis (A,B,C), and hypertension, hepatitis (A,B,C), and obesity relative to national averagesobesity relative to national averages

Increased obesity may be related to Increased obesity may be related to etiology of hypertension and diabetesetiology of hypertension and diabetes

Uterine/cervical and prostate cancers Uterine/cervical and prostate cancers were observed in greater than expected were observed in greater than expected numbers numbers

PERCH BiomonitoringPERCH Biomonitoring

Escambia Treating Superfund site as baseEscambia Treating Superfund site as base Subset of CATE participantsSubset of CATE participants 47 residents or former residents47 residents or former residents Generally, eldest who lived the closest or Generally, eldest who lived the closest or

who worked at the sitewho worked at the site Completed physical exams, labs, etc.Completed physical exams, labs, etc. -Standard lab tests-Standard lab tests -Biomonitoring testing – dioxin/furan, PCP, -Biomonitoring testing – dioxin/furan, PCP, PAH’s, etc.PAH’s, etc.

Cohort DemographicsCohort Demographics

PCDD/PCDF study: 47 participantsPCDD/PCDF study: 47 participants Ages: 13 to 85 yr (mean: 55.8 yr )Ages: 13 to 85 yr (mean: 55.8 yr ) 27 female; 20 male27 female; 20 male 46 black; 1 white46 black; 1 white 9 were previous employees of ETC9 were previous employees of ETC 38 current or previous residents38 current or previous residents Exposure ranged from 2 to 63 yrsExposure ranged from 2 to 63 yrs

PCDD/F StudyPCDD/F Study

TEQ’s ranged from 8.4 to 711.1 pptTEQ’s ranged from 8.4 to 711.1 ppt Used National controls for comparisonUsed National controls for comparison Median TEQ of 21.5 ppt exceeded CDC Median TEQ of 21.5 ppt exceeded CDC

national ave. of 13.6 pptnational ave. of 13.6 ppt Removing outlier decreased mean TEQ Removing outlier decreased mean TEQ

to 20.9 pptto 20.9 ppt Increasing age correlated to increased Increasing age correlated to increased

TEQTEQ Length of exposure not correlated to TEQLength of exposure not correlated to TEQ

PCDD/F Study (cont.)PCDD/F Study (cont.)

Elevated TEQ’s seen in all age groups Elevated TEQ’s seen in all age groups indicating that PCDD/F exposures were not indicating that PCDD/F exposures were not restricted to the period of plant operationrestricted to the period of plant operation

No significant differences in TEQ’s between No significant differences in TEQ’s between male/female or black/whitemale/female or black/white

Removing outlier, no difference in TEQ’s Removing outlier, no difference in TEQ’s between workers and non-workersbetween workers and non-workers

Blood profiles for ETC differed from the soil Blood profiles for ETC differed from the soil profiles -- ? bioavailabilityprofiles -- ? bioavailability

PCDD/F Levels and DiseasePCDD/F Levels and Disease

No correlation to diabetesNo correlation to diabetes TEQ’s were significantly correlated to TEQ’s were significantly correlated to

hypertension – unclear etiologyhypertension – unclear etiology No correlation to cancers reported by No correlation to cancers reported by

the cohortthe cohort No correlation to liver function No correlation to liver function

indicatorsindicators No correlation to hematologic No correlation to hematologic

indicatorsindicators

Clarinda Triangle BiomonitoringClarinda Triangle Biomonitoring

31 persons across Palafox from ETC31 persons across Palafox from ETC Soils with elevated dioxin and arsenicSoils with elevated dioxin and arsenic Dioxin TEQ’s similar to that of ETC cohortDioxin TEQ’s similar to that of ETC cohort Elevated hepatitis A levelsElevated hepatitis A levels

StudyStudy

Why the study?Why the study?

-Mercury Deposition Network of National -Mercury Deposition Network of National Atmospheric Deposition ProgramAtmospheric Deposition Program

-FL Panhandle and peninsula increased levels of wet -FL Panhandle and peninsula increased levels of wet deposition of total Hg in U.S.deposition of total Hg in U.S.

-Coastal populations consume locally harvested fish -Coastal populations consume locally harvested fish and shellfishand shellfish

-FL fish consumption advisories locally and -FL fish consumption advisories locally and statewide for fresh and saltwater speciesstatewide for fresh and saltwater species

-Studies showed Pensacola, FL fish species exceed -Studies showed Pensacola, FL fish species exceed EPA screening values for recreational fishers (0.4 EPA screening values for recreational fishers (0.4 mg/kg)mg/kg)

The Mercury CycleThe Mercury Cycle Mercury is emitted from hazardous waste Mercury is emitted from hazardous waste

combustion and from the stacks of coal-fired combustion and from the stacks of coal-fired power plants because mercury occurs power plants because mercury occurs naturally in coal.naturally in coal.

Mercury can remain in the atmosphere for up Mercury can remain in the atmosphere for up to one year, mercury is deposited on land and to one year, mercury is deposited on land and water bodies within 50 miles of the source, water bodies within 50 miles of the source, then finds its way into aquatic ecosystems.then finds its way into aquatic ecosystems.

Bacteria in the sediments of aquatic Bacteria in the sediments of aquatic ecosystems can convert inorganic mercury to ecosystems can convert inorganic mercury to methylmercury. methylmercury.

Methylmercury is a form of mercury that is Methylmercury is a form of mercury that is especially toxic to humans and wildlife. especially toxic to humans and wildlife.

GI AbsorptionGI Absorption

95% methyl mercury (MeHg) 95% methyl mercury (MeHg) absorbed in GI tractabsorbed in GI tract

25-40% inorganic mercury 25-40% inorganic mercury absorbed in GI tract (rat absorbed in GI tract (rat and mice studies)and mice studies) Metallic mercury not Metallic mercury not absorbed (< than 1%)absorbed (< than 1%)

Hg Health IssuesHg Health Issues Fish are good source high quality Fish are good source high quality

protein, vitamins, are low in saturated protein, vitamins, are low in saturated fat, and have high levels of omega-3’s fat, and have high levels of omega-3’s

MeHg T ½ = 60 days, pregnancy issueMeHg T ½ = 60 days, pregnancy issue Neurodevelopmental problems in Neurodevelopmental problems in

children – cognition issueschildren – cognition issues NHANES > female fish consumers with NHANES > female fish consumers with

3X, and 2X for children higher MeHg3X, and 2X for children higher MeHg Hair deposition of MeHg useful indicator Hair deposition of MeHg useful indicator

ESC/SR Mercury StudyESC/SR Mercury Study

Child-bearing age women 18-49 y.o. in Child-bearing age women 18-49 y.o. in Escambia and Santa Rosa counties, FLEscambia and Santa Rosa counties, FL

Two components:Two components: --QuestionnaireQuestionnaire *Fish consumption practices*Fish consumption practices *Awareness of fish consumption *Awareness of fish consumption advisories for Hgadvisories for Hg *Demographics including pregnancy status*Demographics including pregnancy status --Hair sampling –non-invasiveHair sampling –non-invasive

 RESULTS

Interim results for 70% of the study population have been received and analyzed. The mean Hg (μg/g) in the hair was 0.581 (0.117, 0.282 and 0.610 at 25th, 50th and 75th percentiles, respectively) and 16% fell above the recommended EPA known safe level of 1.0 μg/g Hg in hair (NRC, 2000). There was a significant correlation between increased MeHg levels and increased self-reported consumption of fish over the previous 30 days (Pearson Correlation R=0.210; p<0.01) and 60 days (Pearson Correlation R=0.207; p<0.01). Only 15.7% of the study population reported catching their own fish, while the majority purchased fish at a store (60.8%) and/or consumed fish at a restaurant (64.4%). No correlation was found between MeHg levels and knowledge about the fish advisory although people who caught fish were 2.7 times more likely to know about the fish advisory than people who did not consume fish (p<0.05), and 1.7 times more likely to know about the advisory than people who bought their fish at a store or restaurant (p<0.05).

Biomonitoring of Mercury Levels in Hair Samples from Women of Child-Bearing Biomonitoring of Mercury Levels in Hair Samples from Women of Child-Bearing Age in Escambia and Santa RosaAge in Escambia and Santa Rosa Counties, FLCounties, FL

Distribution of Hg in Study Population

1.50%14%

84.50%<1 μg/g1-3 μg/g> 3 μg/g

Aware of Fish Advisory

68.60%

31.40%

YesNo

ABSTRACT

Background - According to the U.S. EPA, nearly 75% of fish consumption advisories in the United States have been issued due to mercury contamination (U.S. EPA, 2003). Despite a significant reduction in the use and release of mercury from industrial processes since the 1970s, mercury contamination associated with increased fossil fuel combustion poses a growing contamination problem in many areas (U.S. EPA, 2000). The Southeast, and in particular the Gulf Coast, experiences the highest levels of mercury deposition in the U.S. (NADP, 2004), and the State of Florida issues fish consumption advisories due to mercury levels on varying fish species. Thus, the human population in the Florida Panhandle, near Pensacola, is potentially exposed to highly elevated levels of mercury, primarily through the consumption of regionally caught fish species. Many of the fish consumption surveys that have been issued in the U.S specifically target women of child bearing age because of the concerns that maternal intake of contaminants poses a major health risk to a developing fetus. The human nervous system is highly vulnerable to methyl mercury (MeHg), and exposure to high levels of MeHg during the last two trimesters of pregnancy produces documented neurodevelopment problems in children (McDowell et al., 2004). Biomonitoring of human hair for mercury is a useful indicator of exposure over extended periods of time and hair-mercury concentrations reflect longer-term averages than levels in the blood (Budtz-Jorgensen et al., 2004).

R. Rao, N. Renier, J. Lanza, P. Wilson, D. Hodges, S. Rivers

Escambia County Health Dept. and University of West FloridaPensacola, Florida

MATERIALS and METHODS

The study collected hair from approximately 600 participants (women 18-49 years old regardless of pregnancy status) from Santa Rosa and Escambia Counties, Florida. Only persons that had resided in the study area for at least one year and could give informed consent were included. Hair samples (approximately 100 strands of hair ~ 50 mg) were collected by trained staff, and sent to a certified analytical chemistry laboratory for analysis of mercury levels. In addition, each volunteer was interviewed regarding demographic information and recent fish consumption practices. Demographic data collected included residency zip code, race, gender, years of residency, age, and pregnancy status. A follow-up survey was given to the participants to allow for feedback and a satisfaction rating of the project. Descriptive statistics and correlation analysis were run using SPSS version 12.0 (SPSS, Inc., Chicago, IL).

CONCLUSIONS

The information gained through this biomonitoring program has established a baseline mercury data set that can be used in future studies to determine whether levels in the human population change in response to new environmental regulations. Local fishing populations appear to be better informed of state fish consumption advisories, although it did not decrease the amount of MeHg that was found in their hair. The data suggest that public health interventions such as education and fish advisories should be geared more towards pregnant women, who are at most risk. Public health education may need to be focused on fish markets and restaurants because the majority of the study population consumed their fish through those avenues and they were less likely to know about the fish advisory. Future studies should focus on species of fish consumed and a more detailed inventory of fish consumed to better understand the risk factors involved with elevated MeHg in this high risk subset of our population.

REFERENCES

Budtz-Jorgensen, E., Grandjean, P., Jorgensen, P.J., Weihe, P.l., Keiding, N., 2004. Association between mercury concentrations in blood and hair in methylmercury-exposed subjects at different ages. Environmental Research 95, 385-393.

NADP, 2004. National Atmospheric Deposition Program 2003 Annual Summary. National Atmospheric Deposition Program (NADP), Illinois State Water Survey. NADP Data Report 2004-01.

National Research Council. Committee on the Toxicological Effects of Methylmercury. 2000.Wahshington, DC: National Academies Press

McDowell, M.A., Dillon, C.F., Osterloh, J., Bolger, P.M., Pellizzari, E., Fernando, R., Oca, R.M.d., Susan E. Schober, T.S., Jones, R.L., Mahaffey, K.R., 2004. Hair mercury levels in U.S. children and women of childbearing age: reference range data from NHANES 1999-2000. Environmental Health Perspectives 112, 1165–1171.

SPSS, 12.0 version 2002. Chicago, IL

U.S. EPA, 2000. Guidance for assessing chemical contaminant data for use in fish advisories: fish sampling and analysis. US EPA.

U.S. EPA, 2003. Update: National Listing of Fish and Wildlife Advisories. United States Environmental Protection Agency, Office of Water.

Acknowledgements: This study was supported by Grant # 1 R01 EH000096-01 from the U.S. Centers for Disease Control and Prevention (CDC) to the University of West Florida (Principal Investigator, K. Ranga Rao). The contents of this abstract are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

n=343

Supplies used for hair sampling. A copy of the Florida Fish Advisory was provided to each participant.

Approximately 100 strands of hair were collected from an inconspicuous location close to the scalp.

n=602

The majority of participants were unaware of the Florida Fish Advisory prior to the study. No correlation was found between levels of mercury and knowledge of the advisory.

Interim results for 70% of the study population have been received and analyzed. 16% fell above the recommended EPA safe level of 1.0 μg/g.

Results of Hg StudyResults of Hg Study

Aware of Fish Advisory

68.60%

31.40%

YesNo

Results of Hg StudyResults of Hg Study

Distribution of Hg in Study Population

1.50%14%

84.50%<1 μg/g1-3 μg/g> 3 μg/g

Esc/SR Hg Follow-up StudyEsc/SR Hg Follow-up Study Escambia/Santa Rosa - Marketing campaignEscambia/Santa Rosa - Marketing campaign -Outreach – radio, billboards, wallet card-Outreach – radio, billboards, wallet card -Questionnaire – Did you learn?-Questionnaire – Did you learn?• • Results (preliminary):Results (preliminary): -29 % aware of any fish advisory (not asked -29 % aware of any fish advisory (not asked previously)previously) -65 % aware to limit Hg eaten (pre-survey – 31%)-65 % aware to limit Hg eaten (pre-survey – 31%) -56 % heard radio or saw billboards-56 % heard radio or saw billboards -88 % felt wallet card useful-88 % felt wallet card useful

Duval – Questionnaire and hair samplingDuval – Questionnaire and hair sampling -15.7 % aware of fish advisory-15.7 % aware of fish advisory -63.4 % aware of Hg fish exposure-63.4 % aware of Hg fish exposure -7.3 % hair Hg above 1 ppm-7.3 % hair Hg above 1 ppm

Hg Wallet CardHg Wallet Card

PERCH Lead StudyPERCH Lead Study

50 to 75 k homes in Escambia build prior to 50 to 75 k homes in Escambia build prior to 19791979

Lead is neurotoxicant to young childrenLead is neurotoxicant to young children 33 homes tested for lead33 homes tested for lead 51.5 % had detectable lead levels51.5 % had detectable lead levels 21.2 % had lead levels above HUD guidelines21.2 % had lead levels above HUD guidelines Education and recommendations on remediationEducation and recommendations on remediation

What are the numbers?What are the numbers?

Has anything changed in the past 9 Has anything changed in the past 9 years?years?

Is it too early to tell?Is it too early to tell? Some data to ponderSome data to ponder

Age-adjusted death rates (per/100,000) from selected chronic Age-adjusted death rates (per/100,000) from selected chronic diseases for 1998-2000/2006-2008 3-year Rolling Average all diseases for 1998-2000/2006-2008 3-year Rolling Average all

races in Florida (FDOH, CHARTS, 2009)races in Florida (FDOH, CHARTS, 2009)

DiseaseDisease FloridaFlorida EscambiaEscambia Santa RosaSanta Rosa

All DeathsAll Deaths 804.0/804.0/679.679.88

965.3/965.3/817.2817.2 931.0/931.0/773.0773.0

Chronic Liver Chronic Liver Disease & CirrhosisDisease & Cirrhosis 11.0/11.0/10.110.1 12.6/12.6/10.210.2 12.0/12.0/11.511.5

C.L.R.D. Including C.L.R.D. Including AsthmaAsthma 41.0/41.0/36.236.2 52.2/52.2/48.548.5 68.6/68.6/54.754.7

Cardiovascular Cardiovascular DiseasesDiseases

314.3/314.3/209.209.99

377.4/377.4/252.9252.9 365.7/365.7/227.9227.9

CancerCancer 190.2/190.2/162.162.33

222.7/222.7/191.4191.4 202.0/202.0/177.1177.1

DiabetesDiabetes 21.3/21.3/20.620.6 28.0/28.0/33.533.5 28.1/28.1/25.525.5

  All Causes Rolling 3-Year Age-All Causes Rolling 3-Year Age-Adjusted Death Rate Per 100,000 PopulationAdjusted Death Rate Per 100,000 Population

  All Causes Rolling 3-Year Age-All Causes Rolling 3-Year Age-Adjusted Death Rate Per 100,000 White PopulationAdjusted Death Rate Per 100,000 White Population

All Causes Rolling 3-Year Age-All Causes Rolling 3-Year Age-Adjusted Death Rate Per 100,000 Black PopulationAdjusted Death Rate Per 100,000 Black Population

  Chronic Liver Disease & Cirrhosis Rolling 3-Year Age-Chronic Liver Disease & Cirrhosis Rolling 3-Year Age-Adjusted Death Rate Per 100,000 PopulationAdjusted Death Rate Per 100,000 Population

  Chronic Liver Disease & Cirrhosis Rolling 3-Year Age-Chronic Liver Disease & Cirrhosis Rolling 3-Year Age-Adjusted Death Rate Per 100,000 White PopulationAdjusted Death Rate Per 100,000 White Population

  Chronic Liver Disease & Cirrhosis Rolling 3-Year Age-Chronic Liver Disease & Cirrhosis Rolling 3-Year Age-Adjusted Death Rate Per 100,000 Black PopulationAdjusted Death Rate Per 100,000 Black Population

  Major Cardiovascular Diseases Rolling 3-Year Age-Major Cardiovascular Diseases Rolling 3-Year Age-Adjusted Death Rate Per 100,000 PopulationAdjusted Death Rate Per 100,000 Population

  Major Cardiovascular Diseases Rolling 3-Year Age-Major Cardiovascular Diseases Rolling 3-Year Age-Adjusted Death Rate Per 100,000 White PopulationAdjusted Death Rate Per 100,000 White Population

  Major Cardiovascular Diseases Rolling 3-Year Age-Major Cardiovascular Diseases Rolling 3-Year Age-Adjusted Death Rate Per 100,000 Black PopulationAdjusted Death Rate Per 100,000 Black Population

  Cancer Rolling 3-Year Age-Cancer Rolling 3-Year Age-Adjusted Death Rate Per 100,000 PopulationAdjusted Death Rate Per 100,000 Population

  Cancer Rolling 3-Year Age-Cancer Rolling 3-Year Age-Adjusted Death Rate Per 100,000 White PopulationAdjusted Death Rate Per 100,000 White Population

  Cancer Rolling 3-Year Age-Cancer Rolling 3-Year Age-Adjusted Death Rate Per 100,000 Black PopulationAdjusted Death Rate Per 100,000 Black Population

Age-adjusted incidences (/100,000) for all and selected Age-adjusted incidences (/100,000) for all and selected cancers all races in Florida, 1998-2000/2004-2006 Rolling cancers all races in Florida, 1998-2000/2004-2006 Rolling

Average (FDOH CHARTS, 2009)Average (FDOH CHARTS, 2009)

Cancer LocationCancer Location FloridaFlorida EscambiaEscambia Santa RosaSanta Rosa

All CancerAll Cancer 495.1/495.1/452.5452.5 509.1/509.1/461.1461.1 469.1/469.1/485.2485.2

BreastBreast 128.0/128.0/108.3108.3 123.7/123.7/114.3114.3 131.3/131.3/108.1108.1

Uterine Uterine (SR data 03-05)(SR data 03-05) 20.3/20.3/19.119.1 15.3/15.3/15.615.6 20.9/20.9/14.614.6

CervicalCervical 11.3/11.3/9.19.1 10.2/10.2/8.78.7 NANA

ColorectalColorectal 57.9/57.9/45.045.0 54.5/54.5/42.042.0 49.9/49.9/53.553.5

LungLung 78.0/78.0/70.270.2 94.7/94.7/80.180.1 81.9/81.9/88.888.8

BladderBladder 24.6/24.6/20.620.6 21.2/21.2/17.017.0 24.7/24.7/21.321.3

LeukemiaLeukemia 13.0/13.0/10.810.8 13.8/13.8/11.711.7 14.8/14.8/11.911.9

Pancreas (deaths)(2000/2008)Pancreas (deaths)(2000/2008) 9.9/9.9/9.79.7 10.8/10.8/11.911.9 13.0/13.0/11.211.2

ProstateProstate 159.3/159.3/124.2124.2 188.7/188.7/140.7140.7 137.9/137.9/133.1133.1

Age-adjusted death rates (per/100,000) from Age-adjusted death rates (per/100,000) from diabetes by race for 1998-2000/2006-2008 Rolling diabetes by race for 1998-2000/2006-2008 Rolling

Average in Florida Average in Florida (FDOH CHARTS, 2009)(FDOH CHARTS, 2009)

RaceRace FloridaFlorida EscambiaEscambia Santa RosaSanta Rosa

AllAll 21.3/21.3/20.620.6 28.0/28.0/33.533.5 28.1/28.1/25.525.5

WhiteWhite 18.8/18.8/18.218.2 22.9/22.9/28.928.9 26.8/26.8/24.124.1

BlackBlack 52.6/52.6/43.643.6 59.9/59.9/61.661.6 46.7/46.7/71.871.8

  Diabetes All Races Rolling 3-Year Age- Diabetes All Races Rolling 3-Year Age- Adjusted Death Rate Per 100,000 PopulationAdjusted Death Rate Per 100,000 Population

Diabetes Rolling 3-Year Age-Diabetes Rolling 3-Year Age-Adjusted Death Rate Per 100,000 White PopulationAdjusted Death Rate Per 100,000 White Population

  Diabetes Rolling 3-Year Age-Diabetes Rolling 3-Year Age-Adjusted Death Rate Per 100,000 Black PopulationAdjusted Death Rate Per 100,000 Black Population

Hospitalization rates (per 100,000) from Hospitalization rates (per 100,000) from selected respiratory diseases, rolling three-selected respiratory diseases, rolling three-

year age-adjusted rates 1998-2000/2006-2008 year age-adjusted rates 1998-2000/2006-2008 for Florida for Florida (FDOH CHARTS, 2009)(FDOH CHARTS, 2009)

DiseaseDisease FloridaFlorida EscambiaEscambia Santa RosaSanta Rosa

Asthma Asthma (1(1º/2º)º/2º) 462.4/462.4/708.3708.3 473.2/473.2/829.8829.8 391.7/391.7/854.5854.5

CLRDCLRD (1(1º)º) Includes asthmaIncludes asthma

371.9/371.9/321.4321.4 339.9/339.9/276.4276.4 387.9/387.9/423.0423.0

Adjusted Hospitalization Rate From Asthma Rolling Adjusted Hospitalization Rate From Asthma Rolling 3-Year Age-Adjusted Hospitalization Rate3-Year Age-Adjusted Hospitalization Rate

Adjusted Hospitalization Rate From C.L.R.D. Rolling Adjusted Hospitalization Rate From C.L.R.D. Rolling 3-Year Age-Adjusted Hospitalization Rate3-Year Age-Adjusted Hospitalization Rate

Contact InformationContact Information

John J. Lanza, MD, PhD, MPH, FAAPJohn J. Lanza, MD, PhD, MPH, FAAP

Florida Department of HealthFlorida Department of Health

Escambia County Health DepartmentEscambia County Health Department

850.595.6557850.595.6557

john_lanza@doh.state.fl.usjohn_lanza@doh.state.fl.us

www.EscambiaHealth.comwww.EscambiaHealth.com