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1. ATSDR > Public Health Assessments & Consultations

PUBLIC HEALTH ASSESSMENT

KELLY AIR FORCE BASE
SAN ANTONIO, BEXAR COUNTY, TEXAS

APPENDIX G (Continued)

Attachment A

Initial Cancer Request

After receiving the petition to perform a public health assessment on neighborhoods north and southeast of Kelly Air Force Base, ATSDR requested that the Cancer Registry Division (CRD) of the Texas Department of Health evaluate cancer rates in zip code areas 78211 and 78237. Specifically, incidence (cases) and mortality (deaths) data were evaluated for cancers of the colon, pancreas, lung, prostate, breast, and leukemia for the periods 1985-1992 and 1990-1994 respectively.

In evaluating the cancer incidence data (Tables 1 and 2), the number of cancer cases among both males and female residents was either lower than or within the range expected, with the exception of pancreatic cancer which was elevated among males in zip code area 78211. Evaluation of the mortality data (Tables 3 and 4) in these two zip codes found the number of cancer deaths among both male and female residents to be either lower than or within the range expected with the exception of colon cancer and leukemia, which were elevated among males in zip code area 78237.

Table 1: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78211, 1985-1992

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for California for the period 1988-1992. The SIR has been rounded to the first decimal place.

* Significantly higher ( at the 5% level) than expected.
+ Significantly lower (at the 5% level) than expected.

Table 2: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78237, 1985-1992

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for California for the period 1988-1992. The SIR has been rounded to the first decimal place.

* Significantly higher ( at the 5% level) than expected.
+ Significantly lower (at the 5% level) than expected.

Table 3: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Mortality Ratios, Selected Sites, San Antonio, Texas Zip Code 78211, 1990-1994

Note: The SMR (standardized mortality ratio) is defined as the number of observed deaths divided by the number of expected deaths. The latter is based on race-, sex-, and age-specific cancer mortality rates for Texas, 1990-1994. The SMR has been rounded to the first decimal place.

Table 4: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Mortality Ratios, Selected Sites, San Antonio, Texas Zip Code 78237, 1990-1994

Note: The SMR (standardized mortality ratio) is defined as the number of observed deaths divided by the number of expected deaths. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas, 1990-1994. The SMR has been rounded to the first decimal place.

* Significantly higher ( at the 5% level) than expected.

Attachment B

California Incidence Rates

California was initially chosen as the comparison population due to the availability of cancer incidence rates for the Hispanic population in that state. The number of expected cases presented in Tables 1-3, therefore, was based on race-, sex-, and age-specific cancer incidence rates published by the California Cancer Registry. The initial zip codes of concern were 78211, 78228, and 78237.

During the period 1990-1994, the number of cases observed for cancer of the lung, bladder, kidney, or leukemia was close to the number expected among males and females in zip code 78211 (Table 1). However, a significant excess of liver cancer was observed among the male residents and a significant excess of cervical cancer was observed among females. A higher than expected number of liver cancer cases was observed among females, although it was of borderline statistical significance. In zip code area 78228, the number of cases of lung, bladder, and leukemia cancer observed among males and females was close to the expected number (Table 2). A significant excess of liver cancer among males was observed as was a significant excess of kidney cancer among males. The number of liver and kidney cancer cases were higher than expected among females, although the excesses were of borderline statistical significance. No excess of cervical cancer was observed among females. The number of cases observed for lung, bladder, and kidney cancer, as well as leukemia, was close to the number expected among males in zip code 78237 (Table 3). The number of cases observed of liver and bladder cancer among females in this zip code was also close to the number expected. There was, however, a significant excess of liver cancer observed among the male residents, and a significant excess of cervical and kidney cancer in females. A higher than expected number of leukemia cases and a lower than expected number of lung cancer cases were observed among females, although these excesses were of borderline statistical significance.

Additional Liver Cancer Analysis

Liver cancer incidence data was also examined for 15 additional zip codes in the Kelly AFB area.

The analysis of incidence data using California as the comparison population during the period 1990-1994 indicates a statistically significant excess of liver cancer among males in the 78201, 78204, 78205, 78207 and 78227 zip code areas (Table 4). A higher than expected number of liver cancer cases was observed among males in zip code 78225, although this excess was of borderline statistical significance. Among females in the study area during the same time period, a statistically significant excess of liver cancer was observed in zip code areas 78207, 78212, and 78221.

Discussion

The initial analysis of liver cancer incidence using California rates for comparison found a significant excess of cases among males in all three of the initial zip code areas of concern with a corresponding elevation (although not statistically significant) among females in two zip code areas also. The additional liver cancer analysis using California rates for comparison found a significant excess of cases among males in five of the fifteen zip code areas evaluated and among females in three of the zip code areas.

One of the limitations in using California data for the comparison population is that historically liver cancer rates in Texas have been consistently higher than those in California. This difference in background rates in the Texas and California populations is reflected in the standardized incidence ratios calculated for the zip code areas of concern. Using the California rates as a comparison results in an artificially lower expected number of cases for the San Antonio population and subsequently a higher standardized incidence ratio than if the Texas rates were used. The magnitude of the standardized incidence ratios for both males and females, however, is substantially reduced when using Texas as the comparison population.

Table 1: Number of Observed and Expected New Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78211, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for California during the period 1989-1993.

Bold type indicates an excess of borderline statistical significance
* Significantly higher (at the 5% level) than expected.

Table 2: Number of Observed and Expected New Cancer Cases and Race Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78228, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for California during the period 1989-1993.

Bold type indicates an excess of borderline statistical significance
* Significantly higher (at the 5% level) than expected.

Table 3: Number of Observed and Expected New Cancer Cases and Race Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas, Zip Code 78237, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for California during the period 1989-1993.

Bold type indicates an excess of borderline statistical significance
* Significantly higher (at the 5% level) than expected.

Table 4: Number of Observed and Expected Liver Cancer Cases and Race-Adjusted Standardized Incidence Ratios, San Antonio, Texas, 1990-1994

Table 4 (cont'd): Number of Observed and Expected Liver Cancer Cases and Race-Adjusted Standardized Incidence Ratios, San Antonio, Texas, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for California during the period 1989-1993.

Bold type indicates an excess of borderline statistical significance
* Significantly higher (at the 5% level) than expected.

Attachment C

Additional Liver Cancer Mortality Analysis

When conducting the additional liver analysis, five zip code areas were evaluated in the mortality analysis that were not included in the liver cancer incidence analysis. For the sake of consistency, the results from the same zip code areas were presented in the Health Outcome Data section. The results from the additional zip code areas are presented in Table 1.

Discussion

The additional analysis of liver cancer mortality in five zip code areas did not find a significant excess of cases among males or females in any of the zip code areas.

Table 1: Number of Observed and Expected Liver Cancer Deaths and Race-Adjusted Standardized Mortality Ratios, San Antonio, Texas, 1991-1995

Note: The SMR (standardized mortality ratio) is defined as the number of observed deaths divided by the number of expected deaths. The latter is based on race-, sex-, and age-specific cancer mortality rates for Texas during the period 1990-1995.

Bold type indicates an excess of borderline statistical significance
* Significantly higher (at the 5% level) than expected.

Attachment D

Additional Cancer Analysis

In order to examine cancer incidence in other areas surrounding Kelly Air Force Base, ATSDR requested that the CRD evaluate incidence data for cancer of the liver, lung, cervix, bladder, kidney, and leukemia in the zip code areas 78201, 78204, 78205, 78207, 78221, 78224, 78225, 78226, 78227 and 78242 during the period 1990-1994 (Tables 1-10).

In zip code area 78201, the number of cases observed for cancer of the lung, bladder, kidney, and leukemia was close to the number expected among males and females (Table 1). However, a significant excess of liver cancer was observed among the male residents in this zip code area. In zip code area 78204 (Table 2), 78224 (Table 6), and 78225 (Table 7) the number of cases observed for cancer of the lung, bladder, kidney, and leukemia was close to the number expected among males and females. The number of cases of cancer of the cervix was also close to the number expected for females in these three zip code areas for the time period 1990-1994.

In zip code area 78205 (Table 3), a significant excess of liver cancer was observed among males during this time period and in zip code 78207 (Table 4) a higher than expected number of liver cancer cases were observed among males and females, although the excesses were of borderline statistical significance. In zip code area 78221 (Table 5), a significant excess of lung and kidney cancer was observed among males, as well as a significant excess of kidney cancer among females. A higher than expected number of liver cancer cases was observed among females in this zip code area, although the excess was of borderline statistical significance.

A significant excess of leukemia was observed among males in zip code area 78226 (Table 8) during this time period. In zip code area 78227 (Table 9), a significant excess of liver cancer, bladder cancer and leukemia were observed among males, and a significant excess of lung cancer was observed among females. A higher than expected number of bladder cancer cases was also observed among females in this zip code area, although the excess was of borderline statistical significance. In zip code area 78242 (Table 10), a significant excess of lung and kidney cancer was observed about males during this time period.

Table 1: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78201, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

* Significantly higher ( at the 5% level) than expected.

Table 2 Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78204, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Table 3 Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78205, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected.

Table 4 Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78207, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Bold type indicates an excess of borderline statistical significance

Table 5: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78221, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected.

Table 6: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78224, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Table 7: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78225, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Table 8: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78226, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected.

Table 9: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78227, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected.

Table 10: Number of Observed and Expected Cancer Cases and Race-Adjusted Standardized Incidence Ratios, Selected Sites, San Antonio, Texas Zip Code 78242, 1990-1994

Note: The SIR (standardized incidence ratio) is defined as the number of observed cases divided by the number of expected cases. The latter is based on race-, sex-, and age-specific cancer incidence rates for Texas for the period 1992. The SIR has been rounded to the first decimal place.

Bold type indicates an excess of borderline statistical significance
* Significantly higher ( at the 5% level) than expected.

Attachment H
Fact Sheets

Appendix H. Fact Sheets

The fact sheets and translations will go here when the document is final.

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