Follow-up on Spring
Valley Health Study
Community Briefing
July 24, 2013
Johns Hopkins Study Team
Mary Fox, PhD, MPH
Beth Resnick, MPH, CPH
Keeve Nachman, PhD, MHS
Patti Truant, MPH
Meghan McGinty, MBA, MPH
Jennifer Le, MPH
Thomas Burke, PhD, MPH
2
Agenda
• 2013 Follow-up Study Background and Objectives
• Summary of Findings
• Data and Results
• Community Health Assessment
• Community Survey
• Environment Assessment
• Discussion and Recommendations
3
© 2013, Johns Hopkins University. All rights reserved.
2013 Study builds on 2007 Findings
•2007 Health Findings:
 Community health is good compared to the nation
• Mortality rates low
• Cancer rates are lower than the nation; however, some arsenicrelated cancer rates are slightly higher in Spring Valley than
Chevy Chase
 No association found between DC Cancer Registry cases and site-related
contamination areas
•2007 Environment Findings (Soil Sampling):
 Reflect dual nature of contamination
• Dispersed low-level contamination
• Disposal areas with higher levels of contamination
4
© 2013, Johns Hopkins University. All rights reserved.
2013 Follow-up Study Components and
Objectives
• Community Health Assessment
• Update community mortality and selected cancer statistics
• Extend 2007 study with literature search for data on other similar
FUDS
• Community Survey and Outreach
• Gather and report health conditions and community concerns
• Maintain open communication and dialogue
• Environment Assessment
• Develop community environmental portraits
• Extend 2007 scoping study with assessment of site-related water
sampling plans and data
5
© 2013, Johns Hopkins University. All rights reserved.
Follow-up Study Approach
• Compare rates, trends and survey responses across
geographic areas: Spring Valley, Chevy Chase, DC, US
• Consider findings from community health, environment, and
survey components
• Offer public health recommendations, as indicated by findings
6
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2013 Study Framework
7
© 2013, Johns Hopkins University. All rights reserved.
Summary of Findings
• Community health in the Spring Valley and Chevy Chase study
areas continues to be very good.
• Mortality rates for the major causes of mortality are lower or similar to US rates
• Incidence and mortality rates for selected cancers are mostly lower than US rates
• Some cancer rate time trends were found to be increasing in the study areas
• Survey respondents reported better health overall than the national
average
• Respondents across the study areas reported a common set of concerns about
chronic health conditions, air and water quality, nutrition/obesity
• Respondents residing inside the FUDS area continue to be concerned about siterelated exposures
• Environment: overall air and water quality are good
• Air quality concerns are common to US cities
• No increased risk was estimated from contact with surface water on the site
• Although the methods and approaches being used in the site-related water study
are appropriate, some aspects could be strengthened
8
Community Health Assessment
Data and Results
9
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Community Health Assessment Components
• Population demographics, 2006-2010
– US Census and American Community Survey
• Age-adjusted rates for Top 15 causes of mortality, 2004-2010
– Data from DC Department of Health (DCDOH), Division of Vital Records
• Age-adjusted rates for selected cancer incidence and mortality,
2005-2009
– Bladder, kidney & renal pelvis, liver & bile duct, lung & bronchus,
leukemias, lymphomas, melanoma
– Data from DCDOH, Vital Records and Cancer Control Registry
• Literature search for other similar FUDS investigations
– Peer-reviewed literature databases, Agency for Toxic Substances and
Disease Registry (ATSDR) reports
10
© 2013, Johns Hopkins University. All rights reserved.
Demographic comparisons, 2006-2010
Population
Characteristics
Total Population
Spring Valley
Chevy Chase
D.C.
U.S.
24,762
16,766
617,996
311,591,917
% White
84.3
81.8
38.5
63.7
% Black
4.4
8.7
50.7
12.6
% Hispanic
7.4
6.5
9.1
16.3
% Other
4.0
3.1
1.7
7.4
$139,724
$132,773
$ 58,526
$ 51,914
82
82
49
28
Median Household
Income
% College Degree
11
© 2013, Johns Hopkins University. All rights reserved.
Demographic comparisons, 2006-2010
Age Distribution
Spring
Valley
Chevy Chase
D.C.
U.S.
% Age < 20
24.3
21.5
20.5
26.9
% Age 20 – 39
33.8
21.2
38.6
26.8
% Age 40 – 59
22.6
29.8
24.6
27.8
% Age 60 – 79
15.3
19.8
13.1
14.8
4.0
7.7
3.3
3.7
% Age 80 and up
12
© 2013, Johns Hopkins University. All rights reserved.
Spring Valley and Chevy Chase
Census Tracts
ZIP Codes
Census Tracts:
Demographics
Cancer Data
Air Toxics
13
Zip Codes:
Mortality
Survey
Environmental Portrait
© 2013, Johns Hopkins University. All rights reserved.
Top Causes of Death - #1 to 7, 2004-2010
300.00
*
200.00
SV 04-10
CC 04-10
DC 2007
US W 2007
US 2007
150.00
100.00
*
Age-Adjusted Rate per 100,000
250.00
50.00
0.00
Cancers
Stroke
Chronic
Respiratory
Accidents
*
*
Heart Disease
Diabetes
Mellitus
Influenza and
Pneumonia
*Statistical differences between Spring Valley and Chevy Chase areas
14
© 2013, Johns Hopkins University. All rights reserved.
Top Causes of Death - #8 to 15, 2004-2010
30.00
Age-adjusted Rate per 100,000
25.00
20.00
15.00
SV 04-10
CC 04-10
10.00
DC 2007
*
5.00
US 2007
0.00
*
*Statistical difference between Spring Valley and Chevy Chase areas
15
US W 2007
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Selected cancers – Incidence, 2005-09
70
Age-adjusted Rate per 100,000
60
50
SV
CC
DC
US ’07 Whites
US 2007
40
30
*
20
10
0
Bladder
Kidney and
Renal Pelvis
Leukemias
Liver and
Intrahepatic
Bile Duct
Lung and
Bronchus
Lymphomas
Skin
*
*Statistical difference between Spring Valley and Chevy Chase areas
16
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Selected cancers – Mortality, 2005-09
60
Age-adjusted Rate per 100,000
50
40
SV
CC
30
DC
US W 2007
US All 2007
20
10
0
Bladder
17
Kidney and
Renal Pelvis
Leukemias
Liver and
Intrahepatic
Bile Duct
Lung and
Bronchus
Lymphomas
© 2013, Johns Hopkins University. All rights reserved.
Skin
Cancer trends, 1994 – 2009
• Annual trends were examined for cancers where differences
compared to US trends were observed in aggregated data
and where “numbers” were adequate (≥1 case/year)
• Findings:
– Year by year rates are highly variable
– Spring Valley annual trends:
» Small increasing trends found for bladder and lung and bronchus incidence, and lymphoma
mortality;
» Moderate, statistically significant increasing trend found for lung and bronchus mortality
– Chevy Chase annual trends:
» Small increasing trends found for lung and bronchus and lymphoma mortality
18
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Cancer trends, 1994 – 2009
80.0
• Lung and Bronchus
Cancer Incidence
Rate per 100,000
70.0
60.0
Incidence
50.0
SV Lung and
Bronchus
CC Lung and
Bronchus
US Lung and
Bronchus
40.0
30.0
20.0
10.0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
0.0
Year
19
– US: steady decreasing
trend
– Spring Valley: small
increasing trend
– Chevy Chase: small
decreasing trend
© 2013, Johns Hopkins University. All rights reserved.
Cancer trends, 1994 – 2009
• Lung and Bronchus
Cancer Mortality
70
60
Rate per 100,000
50
Mortality
SV Lung and
Bronchus
40
30
CC Lung and
Bronchus
20
US Lung and
Bronchus
10
– US: steady decreasing
trend
– Spring Valley:
moderate increasing
trend
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
0
Year
20
© 2013, Johns Hopkins University. All rights reserved.
– Chevy Chase: small
increasing trend
Lessons learned from other FUDS
•Little peer-reviewed literature on community health near other
FUDS
•Only Former Camp Sibert in Alabama has contamination
issues similar to Spring Valley. However, the exposure
potential, population and community health are quite different.
–Not heavily residential, under development only in recent years
–Population not comparable to Spring Valley
•Lower income, lower educational attainment, more diverse ethnicity, older
–Poorer community health in Former Camp Sibert area than Spring
Valley area
•Total mortality and cancer mortality rates higher than US rates
21
© 2013, Johns Hopkins University. All rights reserved.
Community Health Assessment - Summary
• Community health in the Spring Valley and Chevy Chase, DC
areas continues to be very good.
• Mortality rates for major causes of death are lower than US
rates for most causes in both areas
• Cancer incidence and mortality rates for selected cancers are
lower than US rates for most causes
– Increasing rate trends for bladder, lung and bronchus cancer
incidence (Spring Valley) and lung and bronchus and lymphoma
mortality (Spring Valley and Chevy Chase)
22
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Community Survey
Data and Results
23
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Survey Objectives
• Characterize residential, work & study history in 3 geographic
areas:
• 20015
• 20016 Inside FUDS
• 20016 Outside FUDS
• Describe overall health status
• Report specific health conditions
• Identify public health and community concerns
• Report other concerns and comments
24
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Survey Implementation
• Survey available on-line and in hard copy for 9 weeks in Fall
2012
• All current and former residents, students and workers in
20015 and 20016 Zip Code areas were eligible to complete
the survey
• Participants could respond for members of their household
(including children and former household members who live in
other locations or are deceased)
• Outreach to news and social media, community listservs,
distribution of flyers at polling stations and community venues
25
Community Survey Response
• 865 total respondents
~79% - 20016
~12% - 20015
~ 9% - Both 20016 and 20015
20016
20015
Both
Ever live, work or study in 20016 or 20015
26
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Community Survey Response
• 757 ever live, work or study in 20016
~ 52% Inside FUDS
~ 35% Outside FUDS
~ 10% Inside and Outside FUDS
~ 2% Unsure
Inside FUDS
Outside FUDS
Inside and
Outside FUDS
Unknown
Ever live, work or study in 20016
27
© 2013, Johns Hopkins University. All rights reserved.
Survey Respondent Demographics
Gender
Male
Female
Ethnicity
White/Caucasian
Black/African-American
Hispanic/Latino
Asian
Native American/Alaska Native
Other
Age
Under 20
20-39
40-59
60-79
80 and older
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All Survey
Respondents
(N=865)
U.S. 2010 Census Data combined
for 20015 and 20016
393 (46%)
467 (54%)
45%
55%
800 (92%)
18 (2%)
18 (2%)
41 (5%)
1 (0%)
10 (1%)
83%
7%
7%
5%
0.2%
2%
179 (24%)
129 (17%)
234 (31%)
172 (23%)
32 (4%)
27%
27%
28%
15%
4%
© 2013, Johns Hopkins University. All rights reserved.
Length of Residence
Inside
FUDS
n=403
Outside
FUDS
n=259
n=126
n (%) / Avg. Age
n (%) / Avg. Age
n (%) / Avg. Age
0 to 5 years
96 (24%) /
67 (26%) /
23
40 (32%) /
23
6 to 17 years
143 (35%) / 40
103 (40%) / 36
47 (37%) /
33
18 or more years
164 (41%) / 58
89 (34%) /
39 (31%) /
60
Time Resided
29
28
59
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20015
Self-Reported Personal Health Status
•
Survey respondents in all 3 geographic areas reported equal
or better overall health status than the general U.S.
population
•
Only in the case of residents living in 20016 inside the FUDS
for 18 or more years was the proportion of those reporting
fair/poor health slightly higher (17%) than the national
average (13%)
30
© 2013, Johns Hopkins University. All rights reserved.
Self-Reported Health Conditions Caveats
• “Self-reported” (many respondents reported for other family
members)
• Respondents asked if they (or family member) were “ever
diagnosed”
31
Self-Reported Health Conditions
•
•
•
•
•
•
•
•
•
•
•
•
32
Cancer
Hypertension
Skin Disease
Respiratory Disease
Thyroid Disease
Heart Disease
Learning Disability
Mental Illness
Peripheral Neuropathy
Diabetes
Kidney Disease
Other (please specify)
Self-Reported Health Conditions –
Compared to US
• Most were reported at percentages below US national averages
• Some were reported at greater frequency than US statistics:
– 20016 Inside FUDS: Learning Disability, Thyroid Disease
– 20016 Outside FUDS: Learning Disability, Peripheral Neuropathy,
Thyroid Disease
– 20015: Hypertension, Learning Disability, Heart Disease, Peripheral
Neuropathy, Respiratory Disease, Thyroid Disease
33
Self-Reported Health Conditions Comparing
Study Areas Only
• In all three geographic areas, reporting of health conditions
increased with age and correspondingly length of residence, as
long-term residents on average were older
• Patterns of higher reporting within study areas (over at least 2
residence durations)
– 20016 Inside FUDS: diabetes, learning disability, peripheral neuropathy
– 20016 Outside FUDS: had no consistent pattern of higher reporting
– 20015: hypertension, mental illness, respiratory disease, thyroid disease
34
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Top 5 Reported Health Concerns
Inside FUDS
Outside FUDS
20015
n=403
n=259
n=126
#
%
#
%
mean age =
mean age =
mean age =
44.3
39.4
36.7
1. Cancer
62 15% 1. Cancer
36 14% 1. Hypertension
2. Hypertension 53 13% 2. Skin Dis.
35 14% 2. Skin Dis.
3. Skin Dis.
44 11% 3. Hypertension 28 11% 3. Cancer
4. Thyroid Dis.
29 7% 4. Thyroid Dis.
20 8% 4. Resp. Dis.
5. Resp. Dis.
27 7% 5. Resp. Dis.
19 7% 5. Thyroid Dis.
35
#
20
18
17
17
11
%
16%
14%
13%
13%
9%
Public Health and Community Concerns
Concerns
20016 Inside FUDS
20016 Outside FUDS
20015
Drinking Water
Quality
√
√
√
Chronic Conditions
√
√
√
Nutrition/Obesity
√
√
√
Outdoor Air Quality
√
√
√
Site-related chemical
contamination
√
Causes of cancer
√
36
Survey Conclusions
•
All three geographic areas are overall healthy compared to
the nation
•
Personal health status and most health conditions reported were
better than or equal to the national average (similar to the findings
from the community health assessment)
•
There was consistency in concerns across all respondent
groups on drinking water, chronic conditions, outdoor air
quality and nutrition/obesity.
•
Inside FUDS area respondents expressed additional
concerns related to the FUDS, causes of cancer and
possible environmental contamination.
37
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Environment Assessment
Data and Results
38
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Environment Assessment Components
• Community environmental health portraits, 2005-2012
– Data from DDOE, EPA, Washington Aqueduct
• Exposure pathway evaluation, Spring Valley FUDS
– Data from EPA and Army Corps of Engineers reports
• Water monitoring plans and data evaluation, Spring Valley
FUDS
– Includes available data from Army Corps of Engineers and URS, 2005
– May 2012
39
© 2013, Johns Hopkins University. All rights reserved.
Environmental Portrait
Industrial Facilities and Air and Water Quality
•20016 ZIP Code has a greater density of facilities that report to EPA
than 20015
•Air quality in the D.C. area has improved over the past 10 years
– Ozone is the only criteria air pollutant found above national standards in
the Washington, D.C. area
•Exposures and risks from air toxics in the study areas and DC overall
are typical of US urban areas (higher than US average)
– Potential for adverse respiratory outcomes due to air toxics
•Both the 20016 and 20015 ZIP Codes are served by the public water
system
– Water supply meets existing standards for arsenic and perchlorate
40
© 2013, Johns Hopkins University. All rights reserved.
DC Air Monitors Map
41
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Exposure Analysis and Water Study Review
• Assessment of Site- Specific Exposure Pathways
• Completed exposure pathways identified by JHSPH and USACE
were similar, with two exceptions:
– JHSPH included and evaluated a landscaper worker and residents’
particulate inhalation (2007 Scoping Study)
• No increased risks were indicated from incidental and recreational
exposure to surface water evaluated for all contaminants detected
in sampling
Evaluation of water study plans
• The types of data and general approaches developed for the water
study are adequate to address the stated objectives
– Gaps identified: rationale for well location, role of biogeochemical
processes, potential for groundwater seepage to surfaces
42
© 2013, Johns Hopkins University. All rights reserved.
Environment Assessment Summary
• Ambient Air
– Ozone concentrations are above national standards in DC area
– Air toxics concentrations in the study areas and DC overall are typical
of other US cities
• Drinking water meets existing standards for arsenic and
perchlorate
• No increased risks from exposure to surface water sampled
on site
• US Army Corps of Engineers water study
– Methods adequate to address objectives
– Gaps identified: rationale for well location strategy, biogeochemical
processes, groundwater seepage
43
© 2013, Johns Hopkins University. All rights reserved.
Discussion and Recommendations
44
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2013 Study Key Findings (1)
• Community Health
– Community health in the Spring Valley and Chevy Chase areas
continues to be very good
– Mortality rates are lower than US rates for most major causes
– Cancer incidence and mortality rates for most of the selected cancers
are lower than US rates
– Some cancer rate trends are increasing in both study areas where US
rates are decreasing
45
© 2013, Johns Hopkins University. All rights reserved.
2013 Study Key Findings (2)
• Survey
– Reports of personal health status were better than or equal to the national
average
– Most health conditions in all geographic areas were reported with less
frequency than general US population statistics
– All respondent groups reported concerns about drinking water, chronic
conditions, outdoor air quality and obesity
– Respondents inside the FUDS area expressed additional concerns
related to the FUDS, causes of cancer and possible environmental
contamination
46
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2013 Study Key Findings (3)
•Environment
– Exposures and risks from air toxics in DC including the study areas are
higher than the US average but typical of US urban areas
– Air quality in the Washington, D.C. area has improved over the past 10
years.
– Ozone is found above national standards in D.C. area.
– No increased risk was indicated from exposure to surface water on site
– Types of data and general approaches developed for the water study
adequate to address the stated objectives
– Areas highlighted for further documentation/evaluation: well location strategy; role
of biogeochemical processes; potential for groundwater seepage on surfaces
47
© 2013, Johns Hopkins University. All rights reserved.
Integrated Findings – Health
Health
Outcome
Community Survey
20015
20016: inside & outside FUDS
Community Health
Assessment
20015 & 20016
Cancer
Among top 5 concerns for all study
areas
Overall rates lower than
national average, some
rate trends increasing
Diabetes
20016 Inside FUDS had higher
reporting than other study areas (but
lower than US statistics)
Mortality rates lower
than US
Hypertension
20015 had higher reporting than US
and other study areas
Mortality rates lower or
on par with US
Learning
Disability
20016 Inside FUDS had higher
reporting than US and other study
areas
Respiratory
Disease
20015 had higher reporting than US
and other study areas
48
Mortality rates lower
than US
© 2013, Johns Hopkins University. All rights reserved.
Environment
Assessment
20015 & 20016
Air toxics cancer risks
low
Ozone, air toxics typical
of urban air, potential for
increased respiratory
disease risk
Integrated Findings - Environment
Issue
49
Community Survey
20015
20016: inside & outside
FUDS
Environment
Assessment
20015 & 20016
Air Quality
All respondent groups
reported concerns about
outdoor air quality
Ambient ozone, air toxics
typical of urban air
Drinking Water
Quality
All respondent groups
reported concerns about
drinking water quality
Meets national standards,
perchlorate levels below
existing standards
Site-related Exposure
Respondents of 20016
Inside the FUDS area
expressed additional
concerns related to the
FUDS, causes of cancer and
possible environmental
contamination
No increased risks
estimated for surface
water exposure
© 2013, Johns Hopkins University. All rights reserved.
Community Health Recommendations
•Develop a complete profile of cancer incidence and mortality
including rates and time trends for all major cancers, as well as
cancers selected for site-related or other community concerns.
• Monitor health conditions that were reported more frequently
than national average in the study areas:
– Heart Disease, Hypertension, Learning Disability, Peripheral
Neuropathy, Respiratory Disease, Thyroid Disease
50
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Community Outreach Recommendations
• Monitor and report environment and health status and trends
• Findings should be publicly available and disseminated on a regular
basis in user-friendly formats, such as neighborhood profile reports
and/or interactive websites.
• Maintain transparency and communication with the
community regarding Spring Valley FUDS remediation
activities and potential health risks, as well as FUDS related
health concerns.
• Engage with the communities to identify opportunities for
communication, education and evaluation of reported topics of
concern (drinking water quality, chronic conditions, outdoor air
quality and nutrition/obesity).
51
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Water Study Recommendations
•US ACE water study methods and approaches were found to
be adequate to achieve stated objectives
•Recommend further documentation and evaluation on:
• Strategy for well location
• Role of biogeochemical processes on contaminant fate and transport
• Potential for groundwater seepage onto surfaces
52
© 2013, Johns Hopkins University. All rights reserved.
2013 Study Challenges and Strengths
• Challenges
–
–
–
–
Time lag approaching 100 years since AUES activity
Lack of exposure data
Disease latency
High mobility of population particularly in 20016
• Strengths
– Integrated assessment considering
• Community input via survey
• Health data
• Environment data
– Consistency of health findings across 2007 and 2013 studies
– Strong agreement between community survey reporting and health
data analysis findings
53
Conclusions
•We found that the study areas continue to have good health
•We recommend:
–Regular monitoring and reporting on health outcomes and
environmental issues of concern
–Maintaining transparency and engagement with the community on
Spring Valley FUDS activities, potential health risks, and health
concerns
54
© 2013, Johns Hopkins University. All rights reserved.
Thank you!
Questions? Comments?
Report available:
www.jhsph.edu/springvalley
55
© 2013, Johns Hopkins University. All rights reserved.