North C.1rolina Dep .:lrtment of Health .1nd Human $en-ices Di\ision of Publi c Health P;.t~kCmy .-\Iden. Z. \'.'c;, l-.:D . Alllhm .ict (Ret : S,;m,tay DKHS GC\"i'.JllCf D .nitl sttlt 1· .-\:tiug Di.-i;i.:u Dire~tr'r Reporton StandardIncidenceRatiofor Unal Melanoma Cases Mecklenblll'g County,KorthCarolina !\fay2015 Preparedby Chr\!tiauKlam, Ga1yLeung aud Ch211drika Rao North CarolmaCffltralCancerRegistry(NC. CCR) Backgl.'ound Tue midena of Hunter3,ille-Coruelius 2reaexpreued cone~ about thehigh incidenceofUveal Mel21Joma iu their neighborhoodto the North C2rolinaCrutral C:!llcerRegi1t1y.Tue initfalinmtigatiou usingmudard incidence ratio, (Sffi)did uot ftud my exceu cam ofUvea! Mehuowa in MecklenburgCouuty.At lhe reque3tofreiident:3 fromHuntersvilleaud ComeHu1,a.i well ai other state health official!,s1211dard incidenceratios(Sffi) wereuied to further ex2111iue whethertherew:u unum:illyhigh illcideuceofUve-alMelanomain the area ofHuntmvilleComeliu1. Sundard incidence ratios have beeu widelymed to e\'alu21~wheth~ the incidi!llceof disei!le,suchI!.! cancer,i1 unurn:illyhigh for one selectedarea, rnclu.s a county, over a period of time, suchas l Oy~i!!!. It is asmsed by calculatingthe ratio of the observedlllllil.b'erof casl!Sover the expectedmunbu ofcasesiu the selectedarea during the itudy period. The expectednumber ofcam is e,timatedby multLplyiug NorthCarolinaage.ipecilicincidence ntei of the di3eaie2l!dthe denominatorpopulaliouof the area during the srudy~iod. This1;based 011the :mumptionthat t!te State rate of the diseaseii wh~twouldbe the averagerate expectedthroughoutthHtate. Thus, we C2ll"expect"a certainUUlllbetof cases iu the ;elected~ea by U3ingthe Stateratesa. a stmd;rd. Tue mud2rd incidenc~ratio is c21culatedto compareihe obsenedand the expectednumberofcasesin the area.If the sWJ.d!!!d incidenceratiois gre~tertb2nOlle, theu the obser..-edincidenceof diseasemay notbe ''llonni" for the2rea Mate1iaJandMethod Da!asollJ'ce Data used for thi, Ul\'eitig2tio11 were bas~ ou cam diagnosed during 2000- 2013:!lldreportedto the North CarolinaCaitr21CancerRegiitry (N.C. CCR) as ofl\-iarch201:i for p2tient. whoieaddrm at the timeof diagnosis wai in North Carolina Ca.m were selected baied ou diagnosi1codes as refl~~d in the pathology:md ruedk-al reportl reportedfromthe hospit2132l!dfacilitie,. Further, ca.es dfagnosedOlliofthestate aud countrybut th:!!may be receiviug treattnentiu faciliti~siu NorthCarolinawereuot includedas they tte not required to be repomd to the N.C. CCR.The N.C. CCRr~u ives caucerdiaguoiil aud treatmentinfOflllationfromho1pit2h211dotherfacilitieiat lea.Itsi., month!2fterthe diagnoii3.Tu~rea.ou for this ii that GeneralStatuteB0A-209requiresfacilitiesto report completefint courseof IIeatruentdata aud ru211y ca3e3 have au ei."tend ed periodoffl!'stcour1eoft!eallllmt Tue p:!tientmay have surgE:t)',followedby multiple coll!m ofchclllotherapy,followedby r2diationtherapy.Iu orderto obtaincomplete2lldaccur~tedatafromthe facilitiel thereii a lag tiru~ of at leait si.,months. For somecam, N.C. CCRreceivei multiplereporti from differait facilitie3,which l)If revfrwed audcomoliditedon 2ll ongoingbasii . N.C. CCRcontinues to receiverepom from the ho3pitah forca.m diaguo3edm2013, 2014md prior yean. Therefore, there may be c.ale, diagnosedthat ha~·e uot beai reported illldiucludtdin thi; report. 1nw.-.u~dhh;._g,:\" • ,,,.,,. ~.,:.publ:ic haltl:. rcc-.g~ -, •.•. ., r~~•:; ..;c:.sc~c·•·F:.x ;:; ..s~~·-48~9 Lc~aiw : 56S5Six Fcrkl R,;d • Rtl;-igh, XC ~76"'., ~1:~iliu_g Add!tB : ~;3: ti'!:.il S::1Y i::~ Ca.tt er • Rtl~igh: ;\C~;6;;.:;3: Au E;u~ Oppcrtuuit;· A:tullisti;-e A~ticu Empk:·;o· 20 ~ ,; rt:'1(.';11c-lru l'11l·l .:l l1 ;!1; , Sele,ctioncriiei-iaforobserw1dU\'ealJfelamma cases Per CDC'sguidelinesOil investigati.ugsuspectedcauc<:tclll.!teu,county-leveldataareoftenusedto calculate standardincidenceratios (SIR). However,au inYe.tigationfocmed on three different:ireai,Huntenville-Coruelim, Hunter3ville-only and C-0111clim-only, was reque.ted. In thi3investigation,threedelineatioll3of the itudy areawere used: 1) Huntenville-Cornelius:the 43 BlockGroupsfrom the 2010 Cemus thatencompa.i 3 thecurrentmunicipal boundaryofHuntersville-Omielius2rea;2) Huntenville-ollly:the 26 BlockGroups.fromth~2010 Censusthat encompassthe currentmunicipalboundaryof Huntersville;and 3) C<>mclim-only: the I 7 BlockGroupsfromthe 20l OCensusthat e.ucompa.uthe currentmunicipalboundaryof Cornelius. Ba;Mon the studyarea., obstrvedcam wereidentifiedand expectedcases wereestimated.Observedcam of UvealMelanomaselectedfor this investigationwerediaguosedbetween2000aud 2013 in this area of North Carolina.In thi1investigation,Uveal Mclauoruawas defmedasprimary site C69 with histologycode 8720..87SO. Estimationo/expeciedcases In order to e3tiruateexp&."ted Uve21Melanomacam between2000 and 2013forthe three3tudyareal,HuntenvilleCornelim,Huntersville2lld Cornelius,North C2rolina2000--2013 age-!p~cific(in 10--year intervali)incidencerates for Uveal1\,Manomaweremed. It shouldbe noted that theincidenceratesmaybeunderestimat,JJ;u; BlockGroups,for each age groupmultipliedby the time periodof study.For Huntersville-onlyarea, thedenominatorpopulationwasthe 2010 Ceiuuspopulationof Huntenville, ba.iedon the aforE:lllentioned CensusBlock Group,, for eachage groupmultipliedby the timeperiodof study. For Cornelius-onlya:rea,the denominatorpopulationwa., the 2010 Censuspopulationof Comelim,basedon the ~orem-elltionedCen.u; BlockGroup,,for each age groupmultipliedby thetimeperiodohtudy .1 Data were 2llalyzedming fomiufa-basedcalculatiomwith l\-1icrosoftExcel.Thefo1mulasm-ed in thi3reyo1twe.re based on thoseli3tedon the NationalCruicerlmtitute websitefor the standardincidenceratio, and ~act confidence 1 i1ll1iU. Denominatorpopulationof au age group: The area of Huntenville-Comeliu,,Huntem:ille-onlyor Cornelim-only,b:md -Oil Cenrn3BlockGroupi, 2-010C~ms populationfor~clt age groupx 14 fapec:tednlllllberof ca3e..i of an age group: N.C. :ige-3pecificUJcidencerate (per 100,-0GIO) x Denominatorpopulation Stand:irdincidenceratio (SIR): Obser,;ednllillberof c<1,es / Sumof expectednumber of ca;;esfrom all2gegroups faact 95% Confidence Inten•al: . Lowerlimit \Vhere X · l-.,~ UpperLimit- 2x (#Expected) X h:=o~= -~+1).1·" 1 2x(#Expe:cted) ii the 1OOc . percentileof thechi-squaredi3tributionwith" degreesof freedomand a is 0.05. The 95% confidence int<1rvru indicate, that the"true" v:!lueof the .tmdard incidenceratio wouldbe withinthe interval95 pE:!·~e.ut of the time, and ii cakulated to indie.atewhether the st211d&d incidence ratiois statiuically 1iguificant, i.e., the upperand lower bounddoesnot includethe value of one. 21 Rernlts Betw~-..ll 2000and 2013, therewere 7 ob,ervedcam of Uve21Melanomawho)ind in theset of 43Cenrni Block Group3encompas;ingthe area of Hunteuville-C-0meliu1 at the time of diagnosiswhilethe e,.-pected numberof ca1esfor thi; areain thi, periodwa19. The ,tandardincideuceratio w:13Je~sthi!llone, indicatingthatthe incidence of Uve21Melanomabetween2000and 2013in Hunteriville-ComeliU3 areaw:13nothigherthan e:,-pected. (See Table 1). Toe confidenceintl!!\·als fw1herconfirmedthat ob1ervednWllberof cam forUvealMelanomawerenot significantlydifferentthan the expectednumberof cam a.iconfidenceiutm,21includedone. However,tl!erewerefewerthan 5 obiervedcase, of UvealMelanomadiaguoiedin Huntenville-onlyareaa3 well ai in C-0.ruelius-ouly area.Per NC CCR protocol,aggregareddab with fewerthan 5 cam cannotbe released;thu,, the st211dard incidenceratio, as w~ as the coufidtnceinteI'l'al,werenot eitiruared(Se?Table1). In orderfor the Haudardincidenceratioi to be signiftcru.it, the minimumuumben of obser\·edcam ne:dedaie 11 in HUlltenvilleolllyarea and S in Comeliu,--only area. Table I Una.J MelanomaObmnd and f.xpected Cues, 2000-2013 Obserred Expected SIR 95%CI 7 9 0.8 (0.3-1.6) HUlltsersville 5 N:'A N/A Coruclim 3 Na\ N.:A Hunter;ville-C-0rncliu i *Datamppm,eddue to lowcoUlll.3 , i.e.,fewerthan 5. Note:E.--qmted Cale, :lie e,timates:!lldmay not addup due to rollllding. Conc1uilons The standardiucideuceratioswere eltiruatedfor UvealMcl2lloniato investigatewhethf'.! the incideuceof Urntl Melanomaw:!3 w1Usu:illyhigh in the :!feaofHUllter1ville-C-0t11~ius betw~.n2000aud2013.As of March2015,the remit ofthe 211a!y,ii failedto indicJ!tea higherth!llle.•q1ected numberof Uveal Melanomacam in Huntem,jlle. Coruel.i\uarea duringthfatimeperiod. Howenr, !he !taudardincidenceratio couldnotbe cakula:ed for Huntenville-olllyareaor Corneliiu-ollly areadue to low obiem~dnumbm. A1 of March2015,theremitof thean:!lyaildid not indicatea higherthi!llexpected numberofUvealMelanom1ca.m in theie two 2reaiduringthistimeperiod. There 2re;ever21Jilllitation,to this inve;tigatiou. Fint, 211 ca.ie&dfagnoiedin 2014maynot be included due to the Jagtime in reporting. Second,the ,tudy areaii ba;ed ou C<:nsuiBlock Groupsthit encompa,1 the municipal boundarie1ofHunter1ville-Corncliu1, HUlltem,ille andCoruelim. Therefore,it mayincludenon-incorporated:irea.i of the :iurroUllding county. TI1ird,the KC CCRdoe. not haveaccurateiufornntionou individm.b' hi!toriesof mide.uti:!laddmm or occupation!.Therefore , cam :irenot pre1eutin the inveitigationif the individu:!ls had previomlylived in theseareal but not at the time of diagno;ii. In addition,individu:!l.1 who\\'Orkintheseareaibut are not midents ~e not included,a3 Haudardanl!lyseiareb:uedon midence. Lair,thepopulationof tl!e3tudy:!!ea ii not availableon a ye~ly baiii. The popuJ9tion is basedou 2010 Cemus. Toe estima tion of expect:dcam is ba.iedonthe a; 1umptionth~tthe populationii statico\·erthe 14-yearperiod. Therefore,the mults fromthii inve,tigation1houldbe u;ed withcaution. Reference.s 1. US Cenrn. Bureau:2010 Cen.m of Population andHouiiug, SummaryFile I. Wa.ihiugton , DC, US Dep:irtmentof CommerceEconomic,and Suthtics Administration; 2015.URL hm,1:iiwwwcen3U!.l!O\'.D1P,.\vwwlcardecennitl ceusm 2010.-·sUDIDt:ltV ftle I 1.btllll. 2. Standardized Incid~ce Ratio and ConfidenceLiruits.Toe NationalCancerInstitute: SUtveill ance, Epidemiologyand EndRe3Ult!.URL: httjl:i/seer.caucer.11:ov/ ,eentat-'WebHelp,:S1and:2!'djzed J.ncideuceRatio and ConfidenceLLmi n.htm Accme d on March27, 2015. 3. InvestigatingSu,pe.."led Cmcer Clmtm andReipondingto CommunityConc<:111, : GuidelinesfromCDCand the Councilof Sute and Territori21Epidemiologisu: httu:/.\-v,\ 'W.cdc.e:ov,'nllllwr,'pt:e\·itw.-illmwrhtmJ..'rr 62083l .htm. 22