Loading...
HomeMy WebLinkAboutMINUTES - 05171988 - 2.2 a.a THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on May 17, 1988 by the following vote: AYES: Supervisors Powers, Fanden, Torlakson, Schroder NOES: None ABSENT: Supervisor McPeak ABSTAIN: None ------------------------------------------------------------------ ------------------------------------------------------------------ SUBJECT: Report on Public and Environmental Health Activities The Board received the attached reports from Mark Finucane, Health Services Director, and Wendel Brunner, MD, Public Health Director, relative to various projects in which the Health Services Department is involved. IT IS BY THE BOARD ORDERED that receipt of the attached reports is ACKNOWLEDGED. 1 hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervis rs on the date shown. ATTESTED: '�7•/,(_ /,*/ PHIL BATCHEL , Clerk of the Board cc• County Administrator of Supervisors and County Administrator • Health Services Director By �" , Deputy CONTRA COSTA COUNTY n HEALTH SERVICES DEPARTMENT To: Board of Supervisors Date: May 3, 1988 via Phil Batchelor County Administrat r From: Subject: Mark Finucane, Dire for REPORT ON PUBLIC AND Health Services Department ENVIRONMENTAL HEALTH By: Wendel Brunner, M.D. G.� .J- ACTIVITIES Director of Public Health 4 The Health Services Department has been involved in several projects in public and environmental health at the specific request of the Board of Supervisors. We are taking this opportunity to update you on the progress of some of these projects and indicate the future directions which we anticipate these projects will take. GBF Hazardous Waste Site and GBF Task Force The GBF hazardous waste site in Antioch stopped receiving hazardous materials in 1974 and was closed as a hazardous waste site in 1978 under a plan approved and monitored by the State Department of Health Services. In August, 1986 the .Central Valley Regional Water Quality Control Board discovered that the site had leaked to chemicals into the groundwater. When our Health Services Department became aware of that information, we undertook a series of tests of public water systems, existing groundwater wells, Marklee Creek, and ambient air both up and downwind from the site for toxic chemicals. From those tests we ascertained that there was no current exposure to hazardous chemicals from the site to people or animals, and no imminent threat to public health. Beginning in 1986 the Health Services Department coordinated activities and information about GBF with the Regional Water Quality Control Board, State Health Services Department Toxics Control and Epidemiological Studies Sections, Bay Area Air Quality Management District, and the Solid Waste Management Board. At the direction of the Board of Supervisors on January 20, 1987 that coor- dination was formalized as the GBF Task Force, staffed by the Health Services Department, and including community representation and elected officials as well as the various regulatory agencies. The purpose of the Task Force is to coor- dinate the activities of the regulatory agencies and to inform the public and elected officials about the GBF site in order to facilitate the timely charac- terization of the leakage of toxic substances and to promote the expeditious cleanup of the site. Since that time the GBF Task Force has held four meetings. The Task Force was instrumental in encouraging the Potentially Site Responsible Parties (PRP's) to proceed with the characterization of the site even before all the legal issues regarding liability were resolved. A-41 3J81 Board of Supervisors -2- May 3, 1988 The State Department of Health Services issued a Remedial Action Order in September 25, 1987 which requires all the identifiable PRP's to develop a plan and then proceed with characterization and cleanup. The Remedial Action Order also lays the legal groundwork for accessing State Superfund monies for cleanup, should that be necessary. The Environmental Protection Agency is also con- sidering the GBF site for possible Federal Superfund monies. Building on the groundwork of the GBF Task Force, the Contra Costa Health Services Department is developing a contract with the State Department of Health Services to maintain community input into the management of the GBF site. This will be the first time the Toxics Substances Control Division of the State Department of Health Services has ever contracted with a local health department to provide the mandated community relations activities during site mitigation. On April 19, a.community meeting was orqanized by Health Services Department staff to bring neighbors and other concerned citizens up to date on the investi- gations and plans for the site. The completion of the remedial actions at that site will take several years, and it is the primary goal of the Health Services Department to assure continued public health protections and community involve- ment during that interval . I. T. Hazardous Waste Treatment Facility and I. T. Task Force I.T. Corporation announced the intention to modernize its waste treatment faci- lity at Vine Hill near Martinez on September 16, 1986. The Board of Supervisors directed the Health Services Department to convene and staff a Task Force to coordinate the permit applications with all the various regulatory agencies and to ensure that the public health is protected by all the agencies throughout the process, whatever the eventual outcome of the permit applications. On March 8, 1988, I.T. Corporation announced that it was withdrawing its applica- tions for modernizing the Vine Hill facility, and that it would end its involve- ment in the hazardous waste disposal business. Subsequently, I.T. Corporation announced that it no longer intended to participate in the I.T. Task Force. The I.T. Task Force continues to function, although its original goals have been modified. I.T. Corporation is required under existing law to deinventory its ponds at Vine Hill and Baker (remove the liquid from the ponds) by January 1, 1989. In addition, I.T. is required to close the Vine Hill and Baker sites, i .e., clean and cover the waste sites. Closure is expected to cost some tens of millions of dollars. The State Health Services Department is responsible for ensuring that I.T. has the financial resources to carry out site closure under State regulations. The I.T. Task Force will monitor the deinventory of the ponds and facilitate the closure process, to ensure that site closure occurs in an expeditious and appropriate manner and that public health and the environment are protected. Board of Supervisors -3- May 3, 1988 One of the activities resulting from the I.T. Task Force is the forum held on April 26, 1988 on "Alternative Technologies for Hazardous Waste Disposal ", jointly sponsored by Contra Costa County and the State Department of Health Services. Approximately 160 persons attended representing industry, small busi- ness generators, community agencies, and elected officials. The Health Services Department will be preparing a summary of the proceedings of the conference as a guide to the further development and use of alternative technologies in Contra Costa. Study of Cancer Rates in North Richmond In 1987 representatives from several community organizations in Richmond approached the Health Services Department with concerns that industrial air pollution was causing excess cancer and other diseases in their neighborhoods. In October, 1987 these concerns were further presented to the Bay Area Air Quality Management District (BAAQMD) in the course of public hearings. The BAAQMD began sampling for toxic air contaminants at several sites in North Richmond, and requested the County Health Services Department to survey the North Richmond and Parchester Village areas to determine the degree of air toxics related disease and cancer in those areas. The Board of Supervisors followed with a specific request to the Health Services Department to evaluate the extent of air toxics related disease in Richmond. There is a widespread public perception that Richmond has "the highest rate of cancer in the Bay Area", although that allegation has never even been investi- gated, much less confirmed. We are working with the California Department of Health Services Cancer Prevention Unit to analyze Tumor Registry (1978 to 1982) and census (1980) data in order to compare cancer incidence in communities of public concern in Richmond with control areas in both Alameda and Contra Costa Counties. The objective of this analysis is to identify whether there are measurable increased cancer rates in the neighborhoods in the vicinity of petrochemical facilities. Analysis of cancer incidence for six comparison communities will help identify variations in cancer incidence rates which may be due to socio- economic status (SES), urban/suburban/rural variables, and/or proximity to petrochemical facilities. The comparison communities comprise areas selected on the basis of 1980 census data from West Oakland, Brentwood and Discovery Bay, Pt. Richmond, El Cerrito and Richmond hills, and Tassajara and Danville. We have made it clear to community organizations in a series of public meetings that this cancer study will not answer the question of whether industrial pollu- tion contributes to cancer in the industrial area of Contra Costa County. This limited analysis is not a substitute for the kind of extensive Prospective Cancer Study that would be required to seriously address that question. However, Board of Supervisors -4- May 3, 1988 this study will determine whether the cancer rates in North Richmond are signi- ficantly higher than other areas in the Bay Area. Most important, this study begins to give us a look at cancer rates in a variety of different kinds of com- munities in Contra Costa and the East Bay. This approach broadens our view of cancer and its causes and leads to a regional perspective for analysis of cancer trends and the development of effective cancer prevention strategies. . Bay Area Regional Cancer Summit (BARCS) Approximately a year and a half ago updated epidemiological data from the Bay Area Tumor Registry indicated increased cancer rates throughout the Bay Area. At the inititative of the Board of Supervisors, the Health Services Department has promoted a Cancer Prevention Summit to develop further data analysis and initiate regional action strategies to address cancer prevention. The BARCS Conference is scheduled for May 18 and 19 at the Henry J. Kaiser Family Foundation new conference center in Menlo Park. While Contra Costa County has been a catalyst for this effort, outstanding sup- port has been generated by many local health departments, the California Department of Health Services, key community agencies including the American Cancer Society, and academic institutions including the Stanford Health Promotion Resource Center and the U.C. at Berkley School of Public Health. Funding has been secured from the Kaiser Family Foundation, the Northern California Cancer Center, the Western Consortium for Health Professions, and the California Public Health Foundation. Speakers at the Summit are both regional and national experts, including a senior representative from the National Cancer Institute. The Cancer Summit is the first of its kind in the nation and will serve as a model for other regions concerned about cancer prevention or other regional health issues. BARCS is more than a single conference; it is an ongoing organi- zation involving key agencies in the Bay Area to implement long-term cancer pre- vention strategies. WB:rm =,r CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT To: Board of Supervisors Date: May 11 , 1988 r From:Mark FinucanC irector Subject: REPORT ON CANCER RATES IN Health Services Department �� NORTH RICHMOND AND SELECTED 6 By: Wendel Brunner, M.D., ' ec or AREAS OF CONTRA COSTA AND Public Health ALAMEDA Enclosed is a report prepared by the Health Services Department on cancer rates in North Richmond and selected areas of Contra Costa and Alameda Counties. This report was initiated at the request of several community organizations in Richmond who were concerned that industrial air pollution was causing excess cancer and other diseases in their neighborhoods . The Bay Area Air Quality Management District and the Contra Costa Board of Supervisors also specifically requested the Health Services Department to evaluate the extent of air toxic related disease in Richmond . .We have made it clear to community organizations in a series of public meetings that this Cancer Study will not answer the question of whether industrial pollution contributes to cancer in the industrial area of Contra Costa County. The purpose of this Study is to determine if Richmond has a cancer rate which is significantly different from the rest of Contra Costa and the Bay Area, and also to begin to evaluate the cancer rates in various communities throughout our County and the Bay Area. The Health Services Department identified three census tracts of greatest concern in Richmond through a series of meetings with representatives of com- munity groups . For comparison, we selected three census tracts in West Oakland which are comparable to North Richmond in ethnic distribution, income, and housing type, but are removed from petro-chemical industry. Four additional areas in Contra Costa County were selected for comparison, representing different kinds of communities throughout our County. The cancer rates were determined for the years 1978-82 by the California Tumor Registry, maintained by the State Health Services Department. Confidence intervals were also calculated to facilitate determination of statistical significance of any differences observed . The results show that the North Richmond census tracts have a cancer rate which is not significantly different from the cancer rates of Alameda or Contra Costa Counties as a whole. The North Richmond rate is not signifi- cantly different from the rates most of the other Contra Costa communities sampled. The cancer rate in the West Oakland census tracts appears to be significantly higher than the rate in most Contra Costa communities , including higher than the rate in North Richmond. The Brentwood/Discovery Bay area, a rural area in Contra Costa, appears to have a significantly lower rate than the County as a whole . A-41 3/81 . -2- This report, although limited in scope, shows that the cancer problem is not just confined to a few regions in Contra Costa, and validates the regional approach to cancer prevention being developed by Bay Area health departments and others through the Bay Area Regional Cancer Prevention Summit (BARCS) . This 'study was not expected to answer the question of the health impacts of toxic air pollution. The possible effects of environmental pollution on local cancer rates are very difficult to detect by environmental epidemiolo- gic studies of this kind. We know, however, that toxic constituents of air po-llu•tion-can-pose.- a threat--to human-health . -Even in the absence of defini- tive epidemiologic evidence of disease, it is important for the health of the public to continue an aggressive campaign to control toxic air con- taminants. We would like to acknowledge the assistance of the California Department of Health Services, particularly Dr. Peggy Reynolds and staff of the California Tumor Registry, and Susan Ferguson of the California Birth Defects Monitoring Program. Epidemiologists and others from the Tumor Registry con- sulted with us on the design of the Study, developed the cancer incidence data, provided the statistical analysis and consulted with us on the interpretation of the results . Susan Ferguson generated the birth defects data and statistical analysis . Without the above assistance, this report could not have been produced. The Contra Costa Health Services Department, however, takes final responsibility for the design of the survey and the conclusions presented. MF:WB:cbc _ . Encs . cc: Phil Batchelor CANCER RATES IN NORTH RICHMOND AND SELECTED AREAS OF CONTRA COSTA AND ALAMEDA COUNTIES Background In 1987 representatives from several community organizations in Richmond approached the Health Services Department with concerns that industrial air pollution was causing excess cancer and other diseases in their neighborhoods. In October, 1987 these concerns were further presented to the Bay Area Air Quality Management District (BAAQMD) in the course of public hearinqs. The BAAQMD began sampling for toxic air contaminants at several sites in the North Richmond area under AB2588, and requested the County Health Services Department survey the North Richmond and Parchester Village areas to determine the degree of air toxic related disease and cancer in those areas. The Contra Costa County Board of Supervisors followed up with a specific request to the Health Services Department to evaluate the extent of air toxic related disease in Richmond. Although asthma and other respiratory diseases were discussed by the community organizations both with the Health Services Department and in the public testi- mony at BAAQMD hearings, the major concern was about the possible excess rates of cancer in the Richmond area. The existence of a very complete tumor registry covering the Bay Area counties facilitates the determination of cancer rates. Other disease indicators are difficult to quantify because there is no existing data, or registry. The Health Services Department has therefore focused on eva- luating the rates of cancer. Selection of Census Tracts for Evaluation Cancer data is available by census tract from the State Health Services Department Tumor Registry. The Health Services Department identified three cen- sus tracts of greatest concern in Richmond through a series of meetings with representatives of community groups. At the same time the Health Services Department has been promoting a regional approach to cancer evaluation and pre- vention, the Bay Area Cancer Summit (BARCS). This regional approach suggested the importance of comparing cancer rates in Richmond with cancer rates in simi- lar communities located elsewhere in the Bay Area, and also with the cancer rates of various communities in Contra Costa County. Such comparisons aid ana- lyses of the data. For the most direct comparison with North Richmond, three census tracts in West Oakland were selected. West Oakland is comparable to North Richmond in racial distribution, income, and housing type. West Oakland is also similar to North Richmond in that it contains largely single family homes or small apartments with a stable population that has lived in the area for years or decades; however, West Oakland is removed from any major petro-chemical industry. Other areas included for comparison are Point Richmond, which differs from North Richmond in racial composition and in income but shares its proximity to petro- chemical industry; the El Cerrito/Richmond hills; Danville, a predominantly white, upper income area; and the Brentwood/Discovery Bay area, a rural farminq community. These areas were selected to represent different kinds of com- munities, without any prior knowledge of their cancer incidence rates. Table 1 presents the census tracts evaluated along with their populations, ethnic break- down, and mean incomes. Data Evaluation The numbers of cancer cases in each census tract are available from the Tumor Registry for the years 1972 through 1985. In order to calculate cancer inciden- ces, however, data is required on the total population i.n the census tracts and the population age, sex and racial distributions. The 1980 U.S. Census Report provides this data. To calculate a more accurate indication of the cancer inci- dence rates, cases from a number of years in each census tract have been com- bined. The rates reported here are determined from combining all the cases from each census tract for the five years of 1978 throuqh 1982. The population data was taken from the 1980 census, which is the midpoint of that interval . Age adjusted rates per 100,000 population were calculated for male, female, black, white, other and total based on the 1970 U.S. population age distribution, and reported for each group of census tracts. -2- Confidence Intervals Standard errors were calculated for each group of census tracts and presented as 95% confidence intervals. These confidence intervals mean there is a 95% chance that the actual cancer rate of the population lies somewhere within the inter- val . Confidence intervals are important when comparing the calculated cancer rates of two areas or populations. If the confidence intervals of the cancer rates of two areas overlap, no particular significance can be ascribed to the difference in calculated cancer rates, even if the specific calculated rates of the two areas differ. That is because the difference in calculated rates may be due to chance alone, and not reflect any real underlying difference in the actual cancer rates of the two populations. Even when the confidence interval for cancer rates of two areas do not overlap, one must be cautious about ascribing real significance to the difference. That caution comes from certain statistical problems associated with calculating the statistical significance of multiple comparisons. Limits to Data Evaluation The accuracy of the calculated cancer rates for each census tract and population sub-group (male, female, etc. ) depend upon the number of cancer cases observed in the sub-group. The more cancer cases observed, the more likely the calcu- lated rate will be close to the actual cancer rate for the population. If there are only a few cancer cases observed in a population, a chance variation of one or two cancer cases during the observed period will have a major effect on the calculated cancer rates. We can increase the accuracy of the calculated rates by combining cancer cases over a number of years or over a wider geographic area. Because we are looking for localized cancer effects, we have chosen not to expand the geographic areas considered beyond several census tracts. Combining cancer cases for over five years, however, does allow greater preci- sion in calculating the cancer rates. The limitations in the data analysis may mask some real differences in the cancer rates. Even though we cannot pinpoint statistical differences in the -3- cancer rates between some communities, there may in fact be important differen- ces which cannot be detected. Results Table 2 shows the age-adjusted cancer incidence rates for North Richmond and comparison areas, along with the 95% confidence intervals. Figures 1 through 3 show the same data presented graphically. The hatched bars represent the calcu- lated cancer rates; the white bars indicate the associated confidence intervals. The confidence intervals for the rates of most of the different census tract groupings overlap, indicating that no particular siqnificance can be ascribed to the dif- ferences in calculated rates. The highest calculated total rate of cancer, and highest calculated rate of cancer in males, is observed in the West Oakland cen- sus tracts. The confidence intervals between the West Oakland and North Richmond cancer rates do not overlap, indicating that the calculated rates may reflect a real increase in the rate of cancer in West Oakland as compared to North Richmond. The cancer rate in North Richmond overlaps with the rate in the other reported areas except for the Brentwood/Discovery Bay region. That region appears to have a lower rate of cancer than North Richmond. The pattern seen for the total cancer incidence rates also appears when cancer rates among males alone is considered (Figure 2) . The cancer rate for West Oakland males does not overlap with the male cancer rate in North Richmond, and the North Richmond rate is again greater than the Brentwood/Discovery Bay rate. For females (Figure 3) Point Richmond shows the highest calculated cancer rate; however, its large confidence interval overlaps with all the other cancer rates and therefore no significance can be ascribed to any of the differences in the female cancer rates. Birth Defects Indicators Several community organizations also requested an evaluation of the rate of birth defects in West County. Birth defects are monitored by the State Health -4- Services Department through the California Birth Defects Monitoring Program. The data for birth defects is maintained by zip code, rather than census tract. Table 3 presents the birth defect rates for 1,000 live births and fetal deaths for Contra Costa County, zip code 94801, and zip code 94806 in West County, along with the associated 99% confidence intervals. Figure 4 is a map showing the location of the zip code areas in West County. There is no statistical difference detected in the birth defect rates for Contra Costa County as a whole and for the locations in West County. The very wide confidence intervals in the zip code areas, 11.51 to 37.28 for example, reflects the difficulty in making any kind of precise comparisons of birth defect rates in zip code areas. Discussion The Health Services Department and the community organizations involved understood, prior to initiatinq this evaluation, that this limited study would be unable to answer the question of whether industrial pollution contributes to the cancer burden in North Richmond. This study indicates some of the limita- tions in evaluating concerns about cancers clustered in a small geographic area. If one considers cancer rates in a small area, the small number of cases leads to very large confidence intervals around the calculated rate, so that a local cancer rate cannot be compared to county or Bay Area norms with any degree of statistical confidence. If larger geographic areas are considered to encompass more cancer cases, there is greater precision in the calculated rates. However, the effects of a possible localized cluster are lost statistically in the greater number of cases of the larger geographic region. Citizens For A Better Environment estimated in 1987 that toxic air pollution accounts for approximately ten cancer cases per year throughout the Bay Area. That estimate was based on a risk-assessment using the concentrations of ambient air toxics measured by the Bay Area Air Quality Management District at their 17 Bay Area monitoring stations. If that estimate were accurate, the ten cases would be lost in the thousands of annual cancer cases that occur from other -5- causes in the region, and we would be unable to detect air pollution induced cancers statistically in this or similar studies. The Bay Area Air Quality Management District has been monitoring toxic air contaminants in North Richmond through a special monitoring program this year. Although a final report of those studies has yet to be released, a preliminary report presented in Richmond on December 15, 1987 indicated that the air toxic concentrations in North Richmond are comparable now to the rest of the Bay Area. The purpose of this study has been to find out if Richmond has a cancer rate which is significantly different from the rest of Contra Costa and the Bay Area, and also to begin to evaluate the cancer rates in various communities throughout our county and the Bay Area. This study shows that there are no detectable dif- ferences in the cancer rate in North Richmond compared to the cancer rates in Contra Costa and Alameda Counties as a whole and the rates in most of the selected communities in Contra Costa. The cancer rate in Brentwood/Discovery Bay appears to be lower than the rate in North Richmond. The cancer rate in West Oakland indicates that there are areas of high cancer incidence probably throughout the Bay Area. In fact, the true cancer rate in West Oakland may be higher than the rate in North Richmond, although problems associated with multiple statistical comparisons require caution about such sta- tements. Although the numbers are too small for statistical analysis, much of the cancer rate in both North Richmond and West Oakland is associated with lung cancer. Conclusions This survey of cancer rates in various communities is quite limited in scope. The communities included are a small sample of the various communities around the Bay Area, and this study does not represent a systematic or thorough eva- luation of regional cancer rates. However, even these preliminary results do validate the regional cancer approach beinq developed by the Bay Area Regional Cancer Prevention Summit (BARCS). In order to understand the causes of cancer in our communities, it is clearly necessary to look at more than one part of a -6- single county. We should define the areas of high and low cancer rates across the Bay Area, identify the common determinants of cancer in those communities, and develop innovative, regional prevention strategies to address those causes. The possible effects of environmental pollution on local cancer rates are very difficult to detect by environmental epidemiologic studies of this kind. In addition to the problems discussed above, there is the further problem of defining the toxic exposures of the population. The levels of toxic air con- taminants measured this year in Richmond by the Bay Area Air Quality Management District are probably much different than the levels of 20 or 30 years ago, when some of the cancers counted in this survey might have been induced. The toxic constituents of air pollution can pose a threat to human health. Even in the absence of definitive epidemiologic evidence, it is important for the health of the public to continue an aggressive campaign to control toxic air contaminants. -7- TABLE 1 RICHMOND CENSUS TRACTS Richmond Point Hills Richmond 3760 3650.01 3650.02 3610 3620 3780 Total Persons 4727 1260 3331 630 42 2082 Av. Age 36.0 29.9 26.4 35.9 40.5 35.1 Pop>65 526 141 446 #Blacks 3827 1211 2825 75 94 #Hispanics 541 21 191 40 7 107 %H.S. Grads 43.7 52 28.8 74.1 100.0 87.3 Income Median Family 8338 14000 6881 33228 35182 20070 Mean Family 11216 15763 11243 41190 32339 26666 Per Capita 4100 5187 4770 11908 12304 13396 TABLE 1 (Continued) WEST OAKLAND CENSUS TRACTS 4018 4021 4022 Total Persons 1735 1738 1538 Av. Age 31.7 23.8 32.2 Pop>65 265 150 275 #Blacks 1562 1639 1407 #Hispanics 29 30 73 U.S. Grads 42.5 49.9 36.7 Income Median Family 6581 4990 6458 Mean Family 8940 7706 10210 Per Capita 3899 3070 3943 TABLE 1 (Continued) DANVILLE EL CERRITO Sample Census Tract Arlington Area Census Tracts 3451.05 3851 3852 Total Persons 5674 2310 1548 Av. Age 32.4 44.3 44.4 Pop>65 216 296 254 #Blacks 33 212 129 #Hispanics 207 57 41 U.S. Grads 95.2 93.6 87.8 Income Median Family 36534 37362 30239 Mean Family 38368 41387 35529 Per Capita 11755 15543 12701 TABLE 1 (Continued) RURAL CONTRA COSTA COUNTY CENSUS TRACTS Brentwood and Surrounding Area Discovery Bay Tassajara 3031 3032 3040 3551.03 Total Persons 4712 3422 2944 2012 Av. Age 29.1 32.0 33.8 30.6 Pop>65 460 363 210 26 #Blacks 5 2 31 70 #Hispanics 1745 1006 399 121 % H.S. Grads 53.5 30.9 38.6 90.2 Income Median Family 18713 18150 26402 37367 Mean Family 20603 22521 27147 42304 Per Capita 6595 7675 9346 12185 ..woo �•.-1v ..gym .�� .�� �Z D I wwr-+= wwDa wwf-+r wo .A�rn wwwo i ootnm cn4:b(na WMC') 1%4" ootn Vulul= m I awn= cry--Asch W= NI--'-i cmmm-I D I (DI-AO-1 P-A03m CD--i Noo 000s •.I : ter- *-o o �• -�4 m0 Oovr- W=CD wv»vm wwv" F-+ �7� NF-•�t•-+ D I o••<v D\ wm -i c-) or w \, Unm=CD NOO NOH\ 3 I-,Z 3 I L4 v v cn N N W W Ln W I w ON. 00 O 4:b D I 00 w U l 00 V cn -4 i m I w V N 4�ii V Ch00-1% 001% 10IN OWIIA 00"N CD F-A N N N .A N -i I m t0 00 V V N tD � D I Z O� Ch O .A N W t0 r l O D Ln I v 00 V o\o I L+ N W w Un tJl W n I t!) V On O to to to O O t,0 V w Ln m t31 i s ... .� `. .. ... .. I V z z N N W V :t3 I Co cn cn .AA N w M D I m 00 V O to -1 20 � m I V 00 m a% W ( 00 n l-4 ---- ---- ---- -- --- ---- — I N O Z N F•� N N tJl W D I �"� O W Q1 W . V V rl D v 4:11 00 V W W t0 m I 7o m • <.Tt N I F-� Z I o m w .A Un 00 cn c-) I z w o 00 00 cn I Q1 V iTt ..00 I D D 00 cn I m m %.. ---- ---- ---- -- --- ---- — —I to 00 to to .A cM D I W N W N O N •--1 I m cm N V F-i W Vt I N m l N Ln 00 W N O 31 00 V Q1 to V O to D I • cry r I N 0\0 m l V) N W W Ln W c") I m V Ln Ln W N 00 W w V F--► co 0 00 I IAO •�' Cl 0 s ICA-or rd � tl o 4'4. °� �► . cn C C, w,o 03 0 o to 0 0 n �= n S W 0 �Q LO o o a3 © �? n Co o ,c , CA Q..0-:3:3 D ci 4- ` 4 O � � 0 a N � � n a o o n th N o co 030 � In Ln0 Q 0 p �. CS -n tr �Q G) c p0 a rn to a o n o a n n c� rn o o o Z -a o cz� 70 ,' • o Q a L Cp a a Q 0 p J � a Q N �• :3 ^' n o CL © © > n N C:) 03 C Q -TJ(4 N c1t Q a > o cpa �SIR cl - v_y Q N N LO J N © o cn 3 rn p p a I-U a t4 m Ud n ry © (Q O r-+ (D tD 0 O Z O O � ci w ° CL a v ° CL CL c� LD Q o ) p CL C) > a � �a pCl A o UI N O O to til. c �q 3 ca g m © coo a � c� r-- c� rn o a -- o TABLE 3 Overall Case Rate 1983 - 1984 for Contra Costa County and Zip Code Areas 94801 and 94806 Rates per 1,000 Livebirths and Fetal Deaths Military Hospital Births Not Included Area Number of Cases Denominator Rate 99% C.I.* Contra 528 20,222 26.11 23.34-29.18 Costa County 94801 20 955 20.94 11.51-37.28 94806 40 1,466 27.28 17.98-40.98 *Confidence Interval This table shows three very similar rates of overall birth defects in the areas studied. Small denominators in the two zip code areas cause the confidence intervals around those rates to be large. This means that the rate estimate for these two small areas is relatively imprecise with only two years of data. The addition of more years of data will allow for more precise comparisons. At this time our data shows no indication of any unusual pattern in birth defects rates in the west side of Contra Costa County compared to the County as a whole. 00, 1 00 O n i CJI .ia�+M��_. ��� ' � \ • SAY ✓'i,. •a-t,rv'rU _ ' , .a ; � « i t .. rri,} iCr�l,` ..".r-�— `,'...`• � ^Y0. r •'� 'r �� ' r ,� +.+4.t�: ,i os,. M1 }.�o i I i `'�``yJ•• i� �.r"'r �•~ .���� S� ..� '! u _ A4 . �A .3 t iF t, f}d- � ({y v ._ A i4� �' ���a""tp... � -'' /��111 .::'���"° � ��'•• S '�' tl {�••%' �!sj ��1 `d�}+.4l,1lk .i�'',,Jt �.s'i.�j. ' d� +�1•�.M '� :�. ��ij.}, .= F a ll(aR t11 •:fi ���,,,. � � ', Yom. ,',�, �i S 11 A co / i fix � r -lir+1 d sG `•��.t .�84 �. a ,� �="'� �i'�a� y~, '�' a '� �"�� Y. ',' ,}$`C�:.'`'> "`r•r'� �� .,i � .!� • ,¢.'; :; (Ry, S' �.,'.-� to=� �t' ,.� �` tia y, i��ty ,,5�„ �K � ';y;?1r� 'w�f. /°°• `a '�il'i f \`� 'k�,r r`'•y, � `1� -`/9•,' �� tltii� ���• ,��•''�'j i�:l` . t, / CD