Cancer Incidence (Hunterdon & Mercer County)
Hunterdon and Mercer County Demographics
Hunterdon and Mercer Counties are located in Western-Central New Jersey.
Hunterdon County is the 8th largest county within New Jersey consisting of 429.96 square miles. According to the US Census State and County 2012, Hunterdon County is home to 126,319 residents, which is an increase of 4.4% from 2000 levels. This makes it the 8th largest county within New Jersey. Hunterdon County’s population is comprised of 92.2% White, 3.5 % Asian, 2.9% African American, 0.2% American Indian and Alaska Native and 0.1 Other. Persons of Hispanic or Latino Origin make up 5.7% of the population.
In 2013, the US Census estimated that there were 370,414 people residing in Mercer County. This is an increase of 8% from the population in 2010. The resulting population density of 1,632.2 people per sq. mile is higher than both the Hunterdon County population density and the state average. Although the poverty rates for Mercer County are slightly higher than the state average, this figure varies greatly between municipalities. For example, the poverty rate for individuals in Trenton, which is a dense urban population, is 26.6%.
MAP – Hunterdon County
In 2005-2009, among NJ women ages 20 or older, about 400 were diagnosed with and 120 died of invasive cervical cancer each year. Nearly all invasive cervical cancer can be prevented by a combination of Papanicolaou (PAP) screening and Human Papilloma Virus (HPV) vaccination. The three significant areas accounted for 14% (n=296) of the cases and had relative risks ranging from 1.9 to 2.6: northeast (primarily Newark and Elizabeth), central (primarily Trenton, n = 35, RR = 2.6), and south (primarily Camden). The Trenton invasive cervical cancer case demographics were primarily African-American women without insurance or receiving Medicaid health coverage. Cervical cancer prevention, screenings and HPV vaccination education is much needed in Trenton. Coalition efforts are also needed to educate Mercer County, particularly Trenton healthcare providers, on the importance of HPV vaccinations, series completion and reducing cervical cancer rates.
MAP – Mercer County
Epidemiological Profile of the Cancer Burden
All incidence and mortality rates cited here in are per 100,000 and age-adjusted to the 2000 U.S. population standard. All incidence rates are average annual rates during 2005-2009. All mortality rates are average annual rates during 2003-2007 (which is the latest data available).
Overall, Hunterdon County ranks 15th out of 21 counties in overall cancer incidence (500.2), and 21st out of 21 counties in overall cancer mortality (164.0).
Mercer County ranks 8th out of 21 counties in overall cancer incidence
(527.9) and 14th out of 21 counties in overall cancer mortality (179.5). Only
Mercer County’s overall cancer incidence is higher than state average (508.3).
There are a few specific types of cancers within each county that exceed the state average incidence rates.
In Hunterdon County some of these include:
1) breast (81.8 vs. 71.1 for NJ); and 2) melanoma (38.2 vs. 21.4 for NJ).
When comparing Hunterdon County’s incidence rates and gender specific rates to those of the other twenty counties in New Jersey, Hunterdon ranks 2nd highest for melanoma in both men and women, highest for breast cancer in women, and 3rd highest for oral cavity and pharynx cavity cancers in women.
In Mercer County, cancers whose incidence rates exceed state average include: 1) oral cavity and pharynx (10.5 vs. 10.0 for NJ); 2) colon and rectum (51.2 vs. 49.4 for NJ); 3) prostate (190.1 vs. 172.0 for NJ); and 4) breast (73.5 vs. 71.1 for NJ).
For some cancers, certain genders and/or races have higher-than-average incidence rates. For instance, females in Mercer County of all races have a higher-than-average colorectal cancer incidence rate. For men, the colorectal cancer incidence rate is higher than average in the black non-Hispanic population (70.8 vs 61.5 for NJ).
American Cancer Society Cancer Burden Profiles
Hunterdon County Cancer Burden
According to the ACS 2011 Hunterdon County Cancer Burden Profile, each week, 13 residents are diagnosed with cancer and 4 die from cancer.
In Hunterdon County, 49.6% of all new cancer cases and 49.4% of all new cancer deaths can be attributed to four cancers:
1) Lung/bronchus (10.7% of new cancer incidence, 23.5% of new cancer mortalities)
2) Prostate (13.0% of new cancer incidence; and 6.4% of new cancer mortalities)
3) Female Breast (17.0 of new cancer incidence; 9.0% of all cancer mortalities)
4) Colorectal (8.9% of all new cancer incidence; 10.5% of new cancer mortality)
Mercer County Cancer Burden
Mercer County’s cancer burden follows a similar pattern to Hunterdon County. According to the ACS 2011 Mercer County Cancer Burden Profile, 52.0% of all new cancer cases and 48.4% of all new cancer deaths can be attributed to the aforementioned cancers –
1) Lung/bronchus (12.2% of new cases, 24.7% of new cancer deaths)
2) Prostate (15.7% of new cases, 5.0% of new cancer deaths)
3) Female Breast (14.0% of new cases, 8.6% of new cancer deaths)
4) Colorectal (10.1% of new cases, 10.0% of new cancer deaths)
In contrasting the cancer burdens within Hunterdon and Mercer Counties, the difference between burdens of the two counties comes in percentage of cases detected at an early stage. In Hunterdon County, only 39.8% of colorectal cancer cases in men and 40.1% of colorectal cancer cases in women are detected at an early stage, while in Mercer County, the early detection rate for men and women is 48.0% and 46.5%, respectively.
Trenton, Mercer County Cervical Cancer Burden
In 2005-2009, among NJ women ages 20 or older, about 400 were diagnosed with and 120 died of invasive cervical cancer each year. Nearly all invasive cervical cancer can be prevented by a combination of Papanicolaou (PAP) screening and Human Papilloma Virus (HPV) vaccination. The three significant areas accounted for 14% (n=296) of the cases and had relative risks ranging from 1.9 to 2.6: northeast (primarily Newark and Elizabeth), central (primarily Trenton, n = 35, RR = 2.6), and south (primarily Camden).
The Trenton invasive cervical cancer case demographics were primarily African-American women without insurance or receiving Medicaid health coverage. Cervical cancer prevention, screenings and HPV vaccination education is much needed in Trenton. Coalition efforts are also needed to educate Mercer County, particularly Trenton healthcare providers, on the importance of HPV vaccinations, series completion and reducing cervical cancer rates.
Other Disease Burden
Other chronic diseases have risk factors in common with cancer. For instance, tobacco users have a higher incidence of not only cancer (especially lung cancer), but also heart disease and chronic lung diseases such as chronic obstructive pulmonary disease, asthma, emphysema, and chronic bronchitis. In New Jersey, the age-adjusted death rate due to diseases of the heart from 2004-2008 (the last year for which data is available) was 204.7 per 100,000. Mercer County’s death rate for this cause was 206.0, while Hunterdon County’s death rate due to heart disease was 148.9.
Senior citizens are also more vulnerable to poverty and therefore in need of affordable care options. According to the 2013 Hunterdon County Community Health Assessment, the elderly population increased in Hunterdon County from 10% in 2000 to 13% in 2010, and the percentage of adults 45-64 years of age is much higher than the state average. It is projected that by 2030, County residents 65 years and over will make up 24% of Hunterdon County’s population. Seniors aged 65 and over are considered the fastest-growing age cohort in Mercer County. This group is expected to increase in population in Mercer County by 49% from 46,347 seniors in 2010 to a projected 69,200 in 2028. More importantly, the growth in the senior population is outpacing general population growth, in that seniors are expected to encompass a larger proportion of the general population in the future, a trend expected to be mirrored nationally. As seen in Figure 5, currently seniors aged 65 or more years old make up 12.6% of Mercer County’s population, whereas in 2028, they are expected to comprise 17.2%. Since prevalence of chronic conditions increases with age, it is imperative to focus prevention and healthy lifestyle initiatives in this population now to prevent or minimize healthcare challenges later.
Racial and Ethnic Diversity
Hunterdon County has a growing number of Latinos that are not assessed by traditional strategies such as the Census or BRFSS. Recent needs assessments conducted on Latinos have clearly indicated that significant health inequities exist within Hunterdon County. These findings are especially true for Latinos living in the municipalities of Flemington, Lambertville, and Clinton. According to the U.S Census Bureau, Hunterdon County’s Latino population increased by 103% between 2000 and 2010. A recent survey conducted by the United Way of Hunterdon County revealed that this growing population experiences significantly more health disparities compared to the general population. Sixty percent (60%) have no health insurance. This lack of access to health care was reflected in self-reported health status. Seventy percent (70%) of Latinos surveyed reported they are overweight, obese or morbidly obese compared to 55% of the general population. Forty-two percent (42%) reported that their health was fair or poor, compared to 8% of the general population.
Overall, the non-White population in Mercer County is approximately 45%, which reflects the region’s diversity as discussed in focus groups and interviews from the Greater Mercer Partnership for Health. This diversity varies across the County. According to the US Census, Mercer County has a significantly higher minority population than Hunterdon County with African-American/Black (21%), Hispanic/Latino (16%) and Asian alone (10%). West Windsor and Trenton have the most substantial diversity although their populations differ. Trenton’s population is over one half Black and one third Hispanic/Latino while West Windsor’s population is over one third Asian.
The changing demographics in Hunterdon County have resulted in an increase in the number of low-income residents. The number of residents living at or below 199% of the Federal Poverty Level is at 4%, a rise from 2.6% in 2007. Hunterdon County experienced a 281% surge in the number of children receiving food stamps (SNAP). National data shows that low-income, food- insecure families tend to be at a higher risk for obesity, because they try to stretch their budgets with cheaper, energy dense foods that have low nutritional content, such as fast food. According to the 2013 Hunterdon County community Health assessment, “In a location such as Hunterdon where the cost of living is higher than average, the above numbers actually underestimate the level of poverty. “Hidden Poverty” was a term used by the 2013 Hunterdon County Community Health Assessment focus group participants to refer to individuals who were financially well off, but are now experiencing financial difficulties. Many of them are either too embarrassed to ask for assistance or do not know where to go for assistance, as they never had to do so before.
In Mercer County, there are stark contrasts by income within very wealthy to less affluent municipalities, with pockets of residents struggling during the economic recession. According to the 2006-2010 American Community Survey, Mercer County communities have poverty rates above the state (11.4%) and national (13.8%) averages, such as almost one quarter of Trenton’s individuals had incomes below the federal poverty line (24.5%). Poverty has also been increasing over the past decade. The percentage of individuals below the poverty line in Mercer County increased 1.5%, a change greater than for the state as a whole (0.6%).
Behavioral Risk Factor Prevalence
Nutrition and Healthy Lifestyle
According to the 2013 Hunterdon County Community Health Assessment, 6% of Hunterdon County residents experience both financial and geographical barriers to accessing healthy foods such as fresh fruits and vegetables. According to the 2012 Health County Rankings, 3% of the Mercer County population report limited access to healthy foods; however, 50% of the population in Mercer County report having access to fast food, which equals the NJ data but is 25% higher than the national benchmark. In Hunterdon County, it is interesting that the BMI data is considerably higher with objective data recorded in the Electronic Medical Record during an office visit (31%) than the self-reported data from the BRFSS (18.8%). In Mercer County, according the 2012 County Health Rankings and Roadmaps, adult obesity rate was reported at 25%, equal to state average and national benchmarks. Hunterdon County is slightly below the national benchmark for physical inactivity at 19% while in Mercer County is slightly above the national benchmark at 25%.
Certain behavioral risk factors for two of the four cancers identified in the ACS Cancer Burden Profiles, lung/bronchus and colorectal, contribute to both risk of contracting the disease and the stage of diagnosis. The chief behavioral risk factor for lung cancer is tobacco use. According to the 2010 Hunterdon County BRFSS, 8.7% of residents reported smoking cigarettes every day or some days. The 2012 County Health Rankings reports an adult smoking rate of 15% for Hunterdon County and 14% for Mercer County. Relying on the County Health Rankings report, both counties are below the New Jersey adult smoking rate of 17%. Secondhand-exposure to tobacco smoke can also increase risk of contracting myriad of tobacco-related diseases, including cancer, coronary heart disease and chronic lung diseases. The Indoor Clean Air Act has eliminated many non-residential sources of environmental tobacco smoke; however individuals of all ages can still be exposed to environmental tobacco smoke at outdoor public recreation facilities. Global Advisors Smoke-free Policy (GASP) reports that eight of Mercer County’s thirteen towns have some version of tobacco use ordinance on the record. These municipalities include: East Windsor, Hamilton, Hightstown, Lawrence Township, Pennington Boro, Princeton Boro, Washington Township, and West Windsor. Of these eight municipalities, only one (Princeton Boro) has an ordinance pertaining to the outdoor use of tobacco products near public parks and recreational facilities. Collaboration with the ACS and UMDNJ’s Tobacco Free for a Healthy New Jersey, the coalition was able to pass an outdoor tobacco use ordinance in Princeton for the FY 2013. Continued support would allow for additional ordinances in progress to be enacted in the FY 2014. Furthermore, only four of Hunterdon County’s twenty six municipalities have an outdoor tobacco use ordinance on the record. These municipalities include: Clinton Township, Flemington Boro, Lambertville City, and Raritan Township. Three of these four municipalities do cover use in public parks and recreational facilities. Increasing the number of municipalities in both counties with comprehensive outdoor tobacco use bans can increase the health and safety of residents and decrease dangerous exposure to environmental tobacco smoke.
Colorectal Cancer Screening
Colorectal cancer risk is associated with high fat diet, and low consumption of fruits and vegetables. In addition, obesity plays a critical role in colorectal cancer risk. Part of a healthy lifestyle can include appropriate screening for cancer and other diseases. In the case of colorectal cancer, removal of polyps during a colonoscopy or flexible sigmoidoscopy can prevent the polyp from becoming cancerous and can allow for the detection of early-stage disease. However, colonoscopy and flexible sigmoidoscopy are not the only accepted screening methods and the public should be aware of this. In 2009, the Hunterdon County Colorectal Prevention Workgroup conducted a needs assessment study that revealed opportunities for colorectal cancer prevention/education within primary care provider offices in Hunterdon. Specifically, messaging is needed to encourage healthcare consumers to discuss colorectal cancer screenings with their healthcare providers. Healthcare provider offices also offer an opportunity to increase colorectal cancer screening rates. The 2013-2014 Hunterdon and Mercer County Regional Chronic Disease Coalition Grant focused on increasing Colorectal screening through physician and patient education and appropriate messaging using motivational interviewing. As a result of those interventions, as well as improving the data integrity in the medical records, we saw a 45% increase in colorectal screening documentation within the three Hunterdon County practices.
Sunscreen use and Sunburn Frequency
Melanoma incidence and mortality rates in Hunterdon County are some of the highest in NJ. Fair-skinned endo-Europeans (German, Irish, Polish, and English) account for greater than 67% of the ethnicity of Hunterdon County residents. Ultraviolet radiation exposure in youth creates the greatest risk for melanoma in young, middle and late adulthood. According to the 2010 Hunterdon County BRFS results, 39% of Hunterdon County residents reported having been sunburned within the past 12 months. Furthermore, only 37.6% of Hunterdon County Residents report “always” or “nearly always” wearing sunscreen when going outside on a sunny day for more than an hour. The Hunterdon and Mercer County Regional Chronic Disease Coalition has continued to provide ongoing sun safety educational programs in numerous elementary schools within both counties. Including direct education and train-the-trainer sessions, we provide resources and incentives for the participating students to promote and maintain good sun safety behaviors.
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