1. New Iowa Cancer Maps and Other Related Tools to Support Cancer Prevention and Control Initiatives
Mary Charlton & Amanda kahl
Iowa Cancer Registry
University of Iowa college of public health, Department of epidemiology

2. IOWA CANCER REGISTRY
Iowa Cancer Registry (ICR) has been a NCI-funded Surveillance, Epidemiology and End Results (SEER) Registry since 1973 and consistently recognized for its extremely high quality data
Designated agent to collect data on cancer patients for the state of Iowa
Best statewide resource for determining the burden of cancer on the Iowa population and assessing trends in the occurrence of cancer over time

3. New & improved website New tools New cancer burden statements
(Coming soon!)
We recently re-designed our entire website

4. Burden Statements
Provide Iowa-specific statistics and information about the most common cancers or cancer risk factors impacting Iowans.
2014 Burden Statements

5. Iowa Health Fact Book http://iowahealthfactbook.org/
Biennial publication starting
Updated annually since 2015
Collaboration between the University of Iowa College of Public Health and the Iowa Department of Public Health
County compared to state data
Data available for a wide variety of topics

6. What information does the Iowa Health Fact Book have?
Demographics
County populations
Social Determinants of Health
High school graduation rates, Poverty levels, % Uninsured
Marriages & Dissolutions
Health Behaviors
IBRFSS, Iowa Youth Survey, Drug & Alcohol Treatment Admissions
Prenatal & Infant Health
Births, Birth Weights, Deaths
Young Mothers, maternal smoking
Congenital & Inherited disorders
Infectious Disease
STI and selected infectious diseases
Cancer
Incidence & mortality for select cancers
Mortality
Injury, youth injury, other
Health Care Providers & Facilities
Types of providers & size of facilities
Environmental Health Indicators
Blood lead levels for ages < 6yrs
What information does the Iowa Health Fact Book have?

7. Why use the Iowa Health Fact Book?
Provides counts, rates, ranks for each county
Easily compare counties to each other
Charts and graphs generated for most data
Easily download information to excel files

8. Iowa Cancer Data Tool Developed by Kentucky Cancer Registry
Counts, incidence and mortality rates for specific cancer sites by
Year of diagnosis, age, gender, race, county
Data can be displayed in
Tables
Maps
Bar charts
Iowa Health Fact Book is great at providing the most current incidence and mortality rates for the top cancers in Iowa.
If you want to look at different cancers or years then the Iowa Cancer Data Tool is the place to go.

9. Lung
Cancer

10. Iowa Cancer Data Tool
When examining areas with low rates of certain types of cancer, it may be necessary to lump several years together to get the tool to show you a rate. A minimum of 10 cases are required to calculate a stable age-adjusted rate.

11. Iowa Cancer Data Tool
Years grouped together to get stable rates

12. Why use these resources compared to others?
Iowa Health Fact Book
Quickly and easily find information to a variety of health topics
Easy to compare multiple counties to one another
Iowa Cancer Data Tool
Easily generate rates by variety of cancer sites, years of diagnosis, gender, race, county
Generate tables, figures, charts
If you are looking for county level health data or want to compare data between counties then the Iowa Health Fact Book is a great starting point.
You can quickly and easy find information on a variety of health topics
You can easily compare numbers between counties
Look at counties similar in size, in the same region, or
Generate figures and charts
Download tables
Once you have this information you can dive deeper using the Iowa Health Tracking Portal to look at rates by age group, sex, different years; Community Commons, or County Health Ranking & Roadmaps to look at more county level social determinants and health behaviors.
If you are looking at cancer data and want to look at different sites or years than what the Iowa Health Fact Book Provides then the Iowa Cancer Registry’s data tool is the place to go.
Easy to use and you can quickly find the information you are looking for

13. The Need for New Tools
Iowa Cancer Consortium and IDPH voiced a need for maps of incidence and mortality at a smaller area level for selected cancers that can be prevented or detected early through public health interventions
Iowa’s rurality and small population throughout many areas of the state posed significant challenges to creating reliable GIS maps, namely the ability to produce reliable estimates, as well as the ability to ensure confidentiality of health data

14. New Cancer Maps
Statistical smoothing methods are one approach to creating estimates for smaller geographic areas such as ZIP codes
Bayesian disease mapping statistical models were used to create small area estimates using spatial and temporal smoothing → produced reliable estimates even in the context of small numbers
Borrows information from nearby ZIP codes and similar time periods
Spatial Correlation:
ZIP codes nearer to each other are more likely to have similar rates than ZIP codes that are further apart from each other
Temporal Correlation:
ZIP codes will have more similar rates in contiguous years (2012 and 2013) than in years that were further apart (2004 and 2014)

15. New Cancer Maps

16. New Cancer Maps Breast Cervical Colorectal Liver Lung
Non-Hodgkin Lymphoma (NHL)
Prostate
Melanoma
Incidence
Late Stage
Mortality
We mostly selected cancers that can be prevented or detected early through public health interventions

17. New Cancer Maps - Types Persistence Maps:
Display standardized incidence ratios or mortality ratios based on the overall time period: – 2015
Time Period Maps:
Display standardized incidence ratios or mortality ratios by individual time period:

18. Quick Review of Terms Incidence = Mortality =
Number of new cases of a disease occurring in the population during a specified time period
Number of persons at risk of developing the disease during that period of time
Number of deaths from a disease occurring in the population during a specified time period
Number of persons in the population
Population: Based on 2010 Census data for Iowa
Incidence =
Mortality =
We chose 2010 because it was the midpoint of the years included

19. Quick Review of Terms Standardized Incidence Ratio =
Observed number of new cancer cases in the time period
Expected number of new cancer cases in the time period
Standardized Incidence Ratio =
*referred to as Relative Risk (RR) in the maps
Observed number of cancer deaths in the time period
Expected number of cancer deaths in the time period
Standardized Mortality Ratio =
*referred to as Relative Risk (RR) in the maps
Expected Number of cases/deaths:
Statewide averages applied to the age-gender distributions of individual ZIP codes
Same for each time period to allow us to monitor change over time

20. Relative Risk
Most RR’s displayed on the maps fall in between 0.75 and 1.25
0.5
0.25
0.75
1.25
1.5
1.75
2.0
2.25
1.0
State
Average for Developing Cancer
RR = 0.75 means that people residing in that ZIP have a 25% lower likelihood of developing cancer than people residing in a ZIP that has a RR = 1.0
RR = 1.25 means that people residing in that ZIP have a 25% greater likelihood of developing cancer than people residing in a ZIP that has a RR = 1.0
There was not a great deal of variation when we based the maps on these relative risks because there is not a lot of wide variation - most were between 0.75 and 1.25.

21. Risk → Probability
One goal of the project was to better locate areas in need of interventions/resources
Rather than focus on risk where the range of values differed per cancer, we can look at a probability where every cancer is displayed on the same scale
Gives an informative value of whether the ZIP code was worse than the state average
Allows us to better see contrasts between the zip codes

22. Probability Scale 0% 100% 50% Minimum Maximum RR = 1.0
RR of any ZIP in the State
100%
Maximum
RR of any ZIP in the State
Less Likely to Develop Cancer than State Average
50%
RR = 1.0
State Average for Developing Cancer
More Likely to Develop Cancer than State Average

23. ZCTA: 50112
City: Grinnell
Risk Probability: 0.91
Relative Risk: 1.16
ZCTA: 50049
City: Chariton
Risk Probability: 0.93
Relative Risk: 1.18

24. Colorectal Cancer Incidence
The incidence of colorectal cancer is decreasing, so it was expected that the maps would go from mostly red to mostly blue, but we can still see some areas that have higher than expected risk of developing CRC.

25. ZCTA: 50112 City: Grinnell Risk Probability: 0.56 Relative Risk: 1.07
City: Chariton
Risk Probability: 0.75
Relative Risk: 1.21
Late stage (III/IV) may be of interest to public health practitioners working on CRC screening initiatives. Similar areas show up as the ones in the incidence maps. But in this one, Grinnell does not appear to have a higher risk of late stage CRC, but Chariton still does.

26. Colorectal Cancer – Late Stage

27. ZCTA: 50112 City: Grinnell Risk Probability: 0.76 Relative Risk: 1.31
City: Chariton
Risk Probability: 0.75
Relative Risk: 1.31
Mortality is another measure that people involved in CRC screening initiatives since all recommended forms of CRC screening reduce mortality. Here we see that both Grinnell and Chariton have higher than average risk of dying from CRC. They have nearly identical risk which was a little bit surprising since the Chariton ZIP had higher risk of late stage CRC, but likely due to the small numbers issues, the models had to borrow data from other ZIPs so that could potentially explain why Chariton did not have greater risk of death than Grinnell.

28. Colorectal Cancer Mortality

29. ZCTA: 52003 City: Dubuque Risk Probability: 0.79 Relative Risk: 1.25
City: Cedar Falls
Risk Probability: 0.65
Relative Risk: 1.1
The persistence map is less helpful in a cancer like melanoma where the rates are increasing steeply across the state. Public health professionals may not care which ZIP codes had high rates across all time periods—they want to know where the problem is now.

30. Skin Melanoma Incidence
With the exception of Denison and a few others, most of the state has higher than average probability of developing melanoma because the rates of melanoma are increasing so much, so this map doesn’t really narrow it down much. Essentially the entire state could benefit from preventive initiatives to slow the rate of increase in melanoma incidence.
ZCTA: 51442
City: Denison
Risk Probability: 0.2
Relative Risk: 0.91
ZCTA: 52003
City: Dubuque
Risk Probability: 1.67
Relative Risk: 0.91

31. Skin Melanoma Mortality
It may be of interest, and more helpful in focusing in on certain geographic areas, to examine where people have a greater probability of dying from melanoma. These areas could potentially benefit from initiatives focused on melanoma awareness and early detection.

32. ZCTA: 52806 City: Davenport Risk Probability: 0.99 Relative Risk: 1.19
City: Little Sioux
Risk Probability: 1.00
Relative Risk: 2.14
ZCTA: 52501
City: Ottumwa
Risk Probability: 0.99
Relative Risk: 1.17
There were a number of more urbanized areas that had higher risk, but were not surrounded by areas with higher risk: Davenport, Newton, Des Moines, Burlington, Cedar Rapids, Waterloo

33. Lung Cancer Incidence

34. ZCTA: 51239 City: Hull Risk Probability: 0.00 Relative Risk: 0.51
City: Little Sioux
Risk Probability: 1.00
Relative Risk: 2.15
Lung cancer had a wider spread in risk than most. We provide these tables for each set of maps so you can see the distribution of relative risk values.

35. We Would Love Your Feedback!
Please let us know if you have any feedback, suggestions, issues, concerns, etc. with the maps
We plan to update them regularly and would love to hear about your experience with using them so we can make improvements and meet your data needs

36. Thank you