Preliminary Analysis of Area-Level Drinking Water Arsenic and Bladder Cancer Incidence

Rates in New Mexico, 1988-2002

Second Annual National Environmental Public Health Tracking Conference

Atlanta, April 2005

Len Flowers M.S., New Mexico Department of Health (NMDOH)Will Athas Ph.D., University of New Mexico, Department of Family & Community Medicine

Orrin Myers Ph.D., University of New Mexico, Division of Epidemiology & BiostatisticsShirley Baros B.S., University of New Mexico, Earth Data Analysis Center (EDAC)

Funded by CDC Cooperative Agreement U50/CCU623291-02

OVERVIEWNew Mexico Drinking Water Arsenic and Cancer

Incidence Linkage Demonstration Project

Study Design: Ecologic, aggregate data linkage

Geographic Level: Census tract (2000 US Census, N=456)

Time Frame: 1988-2002

Health Outcomes: Bladder, lung, kidney, liver (primary) Other cancers (secondary)

Arsenic Exposure: Municipal water systems (primary)Private wells (secondary)

Data Management: Geographic information system (GIS)

Data Analysis: Exposure-stratified incidence rates and rate ratios, Poisson regression

New Mexico

33 Counties

456 Census Tracts (2000)

Main Cities/Towns

Albuquerque 448607

Las Cruces 74267

Santa Fe 62203

Rio Rancho 51765

Roswell 45293

South Valley 39060

Farmington 37844

Alamogordo 35582

Clovis 32667

Hobbs 28657

Carlsbad 25625

Gallup 20209

Racial/Ethnic Distribution of New Mexico Population 2000 US Census

Total 1819046 100.0 Not Hispanic or Latino 1053660 57.9 White alone 813495 44.7 Black or African American alone 30654 1.7 American Indian or Alaska Native alone 161460 8.9 Asian, Native Hawaiian, Other Pacific Islander alone 19249 1.1 Some other race alone 3009 0.2 Two or more races 25793 1.4 Hispanic or Latino 765386 42.1 White alone 400758 22.0 Black or African American alone 3689 0.2 American Indian or Alaska Native alone 12023 0.7 Asian, Native Hawaiian, Other Pacific Islander alone 1509 0.1 Some other race alone 306873 16.9 Two or more races 40534 2.2

RACIAL/ETHNIC GROUP Count (%)

⇒⇒

⇒

Arsenic (ppb)<1.01.0 – 10.010. 1 - 30.0

30.1 - 50.0

>50.0

Data Sources for Drinking Water Arsenic Exposure Assessment

Arsenic in Municipal Water Supplies

NMED Drinking Water Bureau

Qualitative Data Source for Drinking Water Arsenic Exposure Assessment

Private Wells in New Mexico

Office of State Engineer

Well UseDomestic

Other

Geologic Factors Affecting Exposure to Arsenic

Volcanic Geology & Hot Springs

Data Sources for Cancer Case Numerator and Population Denominator Data

• New Mexico Tumor Registry- NCI/SEER registry since 1973- Statewide, population-based - 1988-2002: N~ 94,000 case records

→ All invasive cancers→ Non-invasive (in-situ) breast cancers→ Benign brain tumors (1996-2002)

• US Census Bureau- Age, gender, racial/ethnic specific counts

→ 1990 Census (385 census tracts)

→ 2000 Census (445 census tracts)

SEER= Surveillance, Epidemiology, & End Results

Geocoding Case Address at Diagnosis(Coordinate location, census block group, census tract)

Geocoding Resources- Road network - City of Albuquerque

- Road network - StreetMap 2000

- DynaMap

- 2000 TIGER roads

- Zipcodes - StreetMap 2000

- Zipcodes ESRI Data 2002

Initial Geocoding Results (N=93,908 records)- Street Address Match 74578 (79.4%)

- Zip Code Centroid (PO Boxes, etc.) 19005 (20.2%)

- Unmatched – no address 325 (<1%)

38.05

8.01

37.21

38.07

9404

12

3637.20

37.34

7.10

34

5

38.03

3

38.06

40.01

37.31

35.01

37.3237.22

7.11

7.14

38.04

18

17

29

7.07

20

1.07

37.29

37.15

7.08

37.23

47.16

1.25

1.22

7.04

1.21

6.04

2.07

1.234.01

7.13

37.07

35.02

6.01

37.27

1.12

1311.01

2.08

9.03

37.3037.12

4.02

37.33 37.19

16

37.25

37.17

9.04

1.24

15

37.14

9.01

6.03 7.12

37.26

1.112.06

1.16

1.18

37.24

37.28

1.29

1.14

1.10

1.28

2.04

1.26

19

1.15

1.20

1.27

1.13

1.17

2.05 1.19

1.09 1.082.0337.18

11.02

32.01

32.02

21

87111

87122

87123

87008

87059

87116

87106

87109

87113

87110

87112

87107

87108

8704787114

87102

87048

870XX

87118

871XX

87043

871XX871XX

87105

87004

870HH

Development of 1988-2002 Age, Sex, and Racial/Ethnic Specific Census Tract Population Denominator Data

University of New Mexico Bureau of Business & Economic Research (UNM/BBER)

• 1990 to 2000 Census Tract Correspondence- Reconcile 1990 population data into 2000 tract boundaries

• 2000 to 1990 Racial/Ethnic Bridging - Reconcile 2000 multiple races data into 1990 racial/ethnic groups

• Non-Hispanic White• Hispanic

Multiple Races → → → • American Indian• Black• Asian/Pacific Islander

• Intercensal/post-censal estimates: linear interpolation

Number of Census Tracts (2000 Census) Per County in New Mexico

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150Catron

DeBacaGuadalupe

HardingMora

UnionHidalgoColfaxSierra

LosQuay

RooseveltLincoln

TorranceLuna

SocorroTaosSan

GrantCibolaCurry

Rio ArribaEddy

ChavesLea

OteroMcKinleyValencia

San JuanSandoval

Dona AnaSanta FeBernalillo

Number of Census Tracts

The US Census Bureau defined 456 census tracts in New Mexico for the 2000 Census, of which 141 (31%) are located in Bernalillo County, the state’s most populous and urban county. The state has 33 counties, of which 6 counties include only a single census tract.

Preliminary Linkage and Analysis of Drinking Water Arsenic and Bladder Cancer Incidence in New Mexico, 1988-2002

• Descriptive epidemiology of bladder cancer in New Mexico - Person, place, time

• Methods

- Drinking water arsenic exposure assessment

- Characteristics of 1988-2002 bladder cancer cases

• Preliminary Results

- Linkage of bladder cancer incidence data with preliminary census tract drinking water arsenic

Age-Specific Pattern of Bladder Cancer Incidence in New Mexico, 1997-2001

Age-Specifc Incidence of Bladder Cancer by Sex, New Mexico, 1997-2001

0

50

100

150

200

2500-

4

5-9

10-1

4

15-1

9

20-2

425

-29

30-3

4

35-3

940

-44

45-4

950

-54

55-5

9

60-6

465

-69

70-7

4

75-7

980

-84

85+

Age at Diagnosis (Years)

Rat

e pe

r 100

,000

MaleFemale

Gender and Racial/Ethnic Pattern of Bladder Cancer Incidence in New Mexico, 1997-2001

Average Annual Age-Adjusted (2000 US) Bladder Cancer Incidence Rates by Sex and Race/Ethnicity,

New Mexico, 1997-2001 (NHW= Non-Hispanic White)

0

5

10

15

20

25

30

35

40

NHW HISPANIC ASIAN/PI BLACK NATIVE AM

Rat

e pe

r 100

,000

MALEFEMALE

Temporal Pattern of Bladder Cancer Incidence in New Mexico Hispanics and Non-Hispanic Whites, 1992-2001

Five-Year Moving Average Annual Age-Adjusted (2000 US) Bladder Cancer Incidence Rates, New

Mexico, 1992-2001

0

5

10

15

20

25

30

35

40

1994 1995 1996 1997 1998 1999Diagnosis Year (Mid-point of 5-yr moving average)

Rat

e pe

r 100

,000 NHW Male NHW Female

HISPANIC Male HISPANIC Female

Distribution of 1988-2002 Bladder Cancer Cases by Sex and Race/Ethnicity

No. % No. % No. %Non-Hispanic White 2278 60.8 761 20.3 3039 81.1Hispanic 499 13.3 166 4.4 665 17.8Black 27 0.7 8 0.2 35 0.9Asian/Pacific Islander 7 0.2 0 0.0 7 0.2All Race/Ethnicities 2811 75.0 935 25.0 3746 100.0

Distribution of 1988-2002 New Mexico Bladder Cancer Cases by Sex and Race/Ethnicity

** Excludes 43 Native American cases

Male Female BothRace/Ethnicity

Geocoding Results for 1988-2002 Bladder Cancer Cases

No. % No. % No. %Non-Hispanic White Male 1839 80.7 439 19.3 2278 100.0 Female 632 83.0 129 17.0 761 100.0Hispanic Male 358 71.7 141 28.3 499 100.0 Female 124 74.7 42 25.3 166 100.0

Distribution of 1988-2002 New Mexico Hispanic and Non-Hispanice White Bladder Cancer Cases by Geocoding Results

Address Match Zipcode Centroid TotalRace/Ethnicity

Distribution of 1988-2002 Bladder Cancer Cases by Census Tract at Diagnosis

Frequency Distribution of Bladder Cancer Cases Per Census Tract (403 Tracts)

0

20

40

60

80

100

120

140

160

1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45

Number of Cases Per Tract

Num

ber o

f Tra

cts

Geographic Distribution of New Mexico Census Tracts According to Drinking Water Arsenic

Tract Arsenic (ppb)No Data0.1 - 0.91.0 - 10.010.1 - 30.0>30.0

Arsenic (ppb)<1.01.0 – 10.010. 1 - 30.030.1 - 50.0

>50.0

Geographic Distribution of Albuquerque Census Tracts According to Drinking Water Arsenic

Tract Arsenic (ppb)No Data0.1 - 0.91.0 - 10.010.1 - 30.0>30.0

Arsenic (ppb)<1.01.0 – 10.010. 1 - 30.030.1 - 50.0

>50.0

Preliminary Bladder Cancer Incidence Rates by Sex, Race/Ethnicity and Drinking Water Arsenic Levels

New Mexico, 1988-2002

Average Annual Age-Adjusted (2000 US) Bladder Cancer Incidence Rates by Sex, Race/Ethnicity, and Grossly

Estimated Census Tract Drinking Water Arsenic Concentrations

New Mexico, 1988-2002

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Non-Hispanic WhiteMale

Hispanic Male Non-Hispanic WhiteFemale

Hispanic Female

Rat

e pe

r 100

,000

<1.0 ppb1.0-10.0 ppb10.1-30 ppb>30.0 ppb

Preliminary FindingsGeocoding cancer data requires significant effort to resolve non-address level records, but provides the level of resolution needed for geospatial data linkage

Estimating exposure concentrations of arsenic in drinking water requires finer geographic resolution than the census tract in many New Mexico tracts

Once these tools are developed they can easily be adapted to other drinking water and cancer studies