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HEALTH CONSULTATION

LIBBY ASBESTOS SITE
LIBBY, LINCOLN COUNTY, MONTANA


TABLES 1 - 6

Population Estimates
Geographic Regions of Analysis Area (in Square Miles) Population (1990 Census)
Libby City Limits 1.1 2,532
Extended Libby Boundary 2.2 3,694
Air Modeling 16.0 4,300
Medical Screening 25.0 6,072
Libby Valley 65.0 8,617
Central Lincoln County 314.0 9,521
Montana (Reference) 145,556.0 799,065
U.S. (Reference) 3,597,693.0 248,790,925


Table 2.

Libby Study Population Sizes
Number of Libby Area Decedents
Libby Area Decedents Number
Initial Study Population 435
After Review of Libby Care Center Records 419
After Georeferencing 413
Decedents Falling within the Following Geographic Areas of Analysis
Central Lincoln County 400
Libby Valley 398
Medical Screening 328
Air Modeling 289
Extended Libby Boundary 278
Libby City Limits 237


Table 3.

Crude Mortality Rates for Libby, Montana, 1979-1998*
  Areas of Analysis
Underlying Causes of Mortality State Central Lincoln County Libby Valley Medical Screening Extended Libby Boundary Libby City Limits
Lung Cancer
[ICD-9 160-165] † 		998
(8,223/823,838)

840
(80/9,521)

928
(80/8,617)

1,021
(62/6,072)

1,326
(49/3,694)

1,540
(39/2,532)
Non-Malignant Respiratory Diseases [ICD-9 460-519] 1,745
(14,373/823,838)

1,229
(117/9,521)

1,346
(116/8,617)

1,614
(98/6,072)

2,274
(84/3,694)

2,883
(73/2,532)
Digestive Cancer
[ICD-9 150-159] 		912
(7,512/823,838)

546
(52/9,521)

592
(51/8,617)

708
(43/6,072)

975
(36/3,694)

1,106
(28/2,532)
Diseases of Pulmonary Circulation
[ICD-9 415-417]		 102
(842/823,838)

137
(13/9,521)

151
(13/8,617)

165
(10/6,072)

244
(9/3,694)

356
(9/2,532)
Cerebrovascular Disease
[ICD-9 430-438]		 1,268
(10,449/823,838)

977
(93/9,521)

1,079
(93/8,617)

1,285
(78/6,072)

1,895
(70/3,694)

2,449
(62/2,532)
Breast Cancer
[ICD-9 174] 		306
(2,518/823,838)

221
(21/9,521)

244
(21/8,617)

329
(20/6,072)

487
(18/3,694)

592
(15/2,532)
Prostate Cancer
[ICD-9 185] 		297
(2,444/823,838)

147
(14/9,521)

162
(14/8,617)

198
(12/6,072)

325
(12/3,694)

395
(10/2,532)

*Rates are reported per 100,000 persons and are not age-adjusted.
†ICD: International Classification of Diseases.


Table 4. Standardized Mortality Ratios by Areas of Analysis Using theMontana Population as a Reference, 1979-1998

Malignant Neoplasm of Digestive Organs and Peritoneum [ICD-9 150-159]
Area of Analysis Observed Expected SMR* Lower 95% CI† Upper 95% CI
Libby City Limits 28 34.4 0.8 0.5 1.2
Extended Libby Boundary 34 41.4 0.8 0.6 1.1
Air Modeling 36 50.0 0.7 0.5 1.0
Medical Screening 43 61.1 0.7 0.5 0.9
Libby Valley 52 78.7 0.7 0.5 0.9
Central Lincoln County 53 84.1 0.6 0.5 0.8

Malignant Neoplasm of Esophagus, Stomach, Small Intestine, Colon, and Rectum [ICD-9 150-154]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 20 22.6 0.9 0.5 1.4
Extended Libby Boundary 24 27.1 0.9 0.6 1.3
Air Modeling 26 32.7 0.8 0.5 1.2
Medical Screening 29 40.0 0.7 0.5 1.0
Libby Valley 36 51.5 0.7 0.5 1.0
Central Lincoln County 37 55.0 0.7 0.5 0.9


Malignant Neoplasm of Pancreas [ICD-9 157]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 8 7.6 1.0 0.5 2.1
Extended Libby Boundary 8 9.2 0.9 0.4 1.7
Air Modeling 8 11.2 0.7 0.3 1.4
Medical Screening 9 13.7 0.7 0.3 1.2
Libby Valley 10 17.8 0.6 0.3 1.0
Central Lincoln County 10 19.0 0.5 0.3 1.0

Malignant Neoplasm of Respiratory and Intrathoracic Organs, Excluding Nasal Cavities and Accessory Sinuses [ICD-9 161-165]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 39 35.2 1.1 0.8 1.5
Extended Libby Boundary 49 43.4 1.1 0.8 1.5
Air Modeling 56 53.5 1.0 0.8 1.4
Medical Screening 62 67.1 0.9 0.7 1.2
Libby Valley 82 88.4 0.9 0.7 1.2
Central Lincoln County 82 95.0 0.9 0.7 1.1

Malignant Neoplasm of Trachea, Bronchus, and Lung [ICD-9 162]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 37 34.0 1.1 0.8 1.5
Extended Libby Boundary 47 41.9 1.1 0.8 1.5
Air Modeling 54 51.6 1.0 0.8 1.4
Medical Screening 60 64.7 0.9 0.7 1.2
Libby Valley 80 85.3 0.9 0.7 1.2
Central Lincoln County 80 91.6 0.9 0.7 1.1

Malignant Neoplasm of Female Breast [ICD-9 174]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 15 10.6 1.4 0.8 2.3
Extended Libby Boundary 18 13.3 1.4 0.8 2.1
Air Modeling 18 16.2 1.1 0.7 1.8
Medical Screening 20 20.5 1.0 0.6 1.5
Libby Valley 22 27.2 0.8 0.5 1.2
Central Lincoln County 22 29.4 0.7 0.5 1.1

Malignant Neoplasm of Prostate [ICD-9 185]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 10 12.3 0.8 0.4 1.5
Extended Libby Boundary 12 14.2 0.8 0.4 1.5
Air Modeling 12 16.9 0.7 0.4 1.2
Medical Screening 12 19.8 0.6 0.3 1.1
Libby Valley 14 24.4 0.6 0.3 1.0
Central Lincoln County 14 25.8 0.5 0.3 0.9

Diseases of Pulmonary Circulation [ICD-9 415-417]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 9 3.9 2.3¶ 1.1 4.4
Extended Libby Boundary 9 4.7 1.9 0.9 3.7
Air Modeling 10 5.6 1.8 0.9 3.3
Medical Screening 11 6.8 1.6 0.8 2.9
Libby Valley 14 8.7 1.6 0.9 2.7
Central Lincoln County 14 9.3 1.5 0.8 2.5

Cerebrovascular Disease [ICD-9 430-438]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 63 55.5 1.1 0.9 1.5
Extended Libby Boundary 71 62.7 1.1 0.9 1.4
Air Modeling 72 73.4 1.0 0.8 1.2
Medical Screening 79 83.6 0.9 0.7 1.2
Libby Valley 94 101.4 0.9 0.7 1.1
Central Lincoln County 94 106.6 0.9 0.7 1.1

Diseases of Respiratory System, Excluding Upper Respiratory Tract Infections[ICD-9 480-519]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 72 72.0 1.0 0.8 1.3
Extended Libby Boundary 84 83.0 1.0 0.8 1.3
Air Modeling 83 98.4 0.8 0.7 1.0
Medical Screening 98 115.1 0.9 0.7 1.0
Libby Valley 116 142.5 0.8 0.7 1.0
Central Lincoln County 117 150.8 0.8 0.6 0.9


Chronic Obstructive Pulmonary Disease [ICD-9 490-496]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 33 37.5 0.9 0.6 1.2
Extended Libby Boundary 42 44.3 0.9 0.7 1.3
Air Modeling 39 53.3 0.7 0.5 1.0
Medical Screening 48 64.0 0.7 0.6 1.0
Libby Valley 59 80.9 0.7 0.6 0.9
Central Lincoln County 60 86.1 0.7 0.5 0.9

Asbestosis (Represents all Pneumoconioses)[ICD-9 501]

Asbestosis (Represents all Pneumoconioses)[ICD-9 501]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 5 0.1 40.8¶ 13.2 95.3
Extended Libby Boundary 7 0.1 47.3¶ 18.9 97.5
Air Modeling 8 0.2 44.3¶ 19.1 87.2
Medical Screening 9 0.2 40.6¶ 18.5 77.1
Libby Valley 11 0.3 38.7¶ 19.3 69.2
Central Lincoln County 11 0.3 36.3¶ 18.1 64.9


Other Diseases of the Respiratory System [ICD-9 510-519]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 9 4.9 1.9 0.8 3.5
Extended Libby Boundary 10 5.7 1.7 0.8 3.2
Air Modeling 10 6.8 1.5 0.7 2.7
Medical Screening 13 8.1 1.6 0.8 2.7
Libby Valley 15 10.3 1.5 0.8 2.4
Central Lincoln County 15 10.9 1.4 0.8 2.3

*SMR: Standardized mortality ratio.
†CI: Confidence interval.
¶Statistically significant elevated SMRs.


Table 5. Standardized Mortality Ratios by Areas of Analysis Using the U. S.Population as a Reference, 1979-1998

Malignant Neoplasm of Digestive Organs and Peritoneum [ICD-9 150-159]
Area of Analysis Observed Expected SMR* Lower 95% CI† Upper 95% CI
Libby City Limits 28 37.5 0.7 0.5 1.1
Extended Libby Boundary 34 45.1 0.8 0.5 1.1
Air Modeling 36 54.6 0.7 0.5 0.9
Medical Screening 43 66.8 0.6 0.5 0.9
Libby Valley 52 86.1 0.6 0.5 0.8
Central Lincoln County 53 92.0 0.6 0.4 0.8

Malignant Neoplasm of Esophagus, Stomach, Small Intestine, Colon, and Rectum [ICD-9 150-154]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 20 25.2 0.8 0.5 1.2
Extended Libby Boundary 24 30.3 0.8 0.5 1.2
Air Modeling 26 36.7 0.7 0.5 1.0
Medical Screening 29 44.8 0.6 0.4 0.9
Libby Valley 36 57.7 0.6 0.4 0.9
Central Lincoln County 37 61.7 0.6 0.4 0.8

Malignant Neoplasm of Pancreas [ICD-9 157]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 8 7.6 1.0 0.5 2.1
Extended Libby Boundary 8 9.2 0.9 0.4 1.7
Air Modeling 8 11.2 0.7 0.3 1.4
Medical Screening 9 13.8 0.7 0.3 1.2
Libby Valley 10 17.8 0.6 0.3 1.0
Central Lincoln County 10 19.0 0.5 0.3 1.0

Malignant Neoplasms of Respiratory and Intrathoracic Organs, Excluding Nasal Cavities and Accessory Sinuses [ICD-9 161-165]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 39 39.7 1.0 0.7 1.3
Extended Libby Boundary 49 49.2 1.0 0.7 1.3
Air Modeling 56 60.6 0.9 0.7 1.2
Medical Screening 62 76.3 0.8 0.6 1.0
Libby Valley 82 100.8 0.8 0.6 1.0
Central Lincoln County 82 108.4 0.8 0.6 0.9

Malignant Neoplasms of Trachea, Bronchus, and Lung [ICD-9 162]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 37 38.4 1.0 0.7 1.3
Extended Libby Boundary 47 47.6 1.0 0.7 1.3
Air Modeling 54 58.6 0.9 0.7 1.2
Medical Screening 60 73.8 0.8 0.6 1.0
Libby Valley 80 97.4 0.8 0.7 1.0
Central Lincoln County 80 104.8 0.8 0.6 1.0

Malignant Neoplasm of Female Breast [ICD-9 174]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 15 11.7 1.3 0.7 2.1
Extended Libby Boundary 18 14.6 1.2 0.7 2.0
Air Modeling 18 17.8 1.0 0.6 1.6
Medical Screening 20 22.5 0.9 0.5 1.4
Libby Valley 22 29.9 0.7 0.5 1.1
Central Lincoln County 22 32.3 0.7 0.4 1.0

Malignant Neoplasm of Prostate [ICD-9 185]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 10 10.3 1.0 0.5 1.8
Extended Libby Boundary 12 11.9 1.0 0.5 1.8
Air Modeling 12 14.2 0.8 0.4 1.5
Medical Screening 12 16.7 0.7 0.4 1.3
Libby Valley 14 20.7 0.7 0.4 1.1
Central Lincoln County 14 21.9 0.6 0.3 1.1

Diseases of Pulmonary Circulation [ICD-9 415-417]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 9 3.7 2.4 1.1 4.6
Extended Libby Boundary 9 4.5 2.0 0.9 3.8
Air Modeling 10 5.4 1.8 0.9 3.4
Medical Screening 11 6.7 1.7 0.8 3.0
Libby Valley 14 8.6 1.6 0.9 2.7
Central Lincoln County 14 9.2 1.5 0.8 2.6

Diseases of Respiratory System, Excluding Upper Respiratory Tract Infections [ICD-9 480-519]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 72 62.2 1.2 0.9 1.5
Extended Libby Boundary 84 72.0 1.2 0.9 1.4
Air Modeling 83 85.2 1.0 0.8 1.2
Medical Screening 98 99.9 1.0 0.8 1.2
Libby Valley 116 124.0 0.9 0.8 1.1
Central Lincoln County 117 131.2 0.9 0.7 1.1

Chronic Obstructive Pulmonary Disease [ICD-9 490-496]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 33 27.5 1.2 0.8 1.7
Extended Libby Boundary 42 32.6 1.3 0.9 1.7
Air Modeling 39 39.1 1.0 0.7 1.4
Medical Screening 48 46.9 1.0 0.8 1.4
Libby Valley 59 59.4 1.0 0.8 1.3
Central Lincoln County 60 63.2 1.0 0.7 1.2

Asbestosis (Represents all Pneumoconioses) [ICD-9 501]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 5 0.1 63.5¶ 20.5 148.3
Extended Libby Boundary 7 0.1 74.9¶ 30.0 154.4
Air Modeling 8 0.1 71.0¶ 30.6 139.9
Medical Screening 9 0.1 66.1¶ 30.2 125.5
Libby Valley 11 0.2 63.7¶ 31.7 114.0
Central Lincoln County 11 0.2 59.8¶ 29.8 107.0

Other Diseases of the Respiratory System [ICD-9 510-519]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 9 5.0 1.8 0.8 3.4
Extended Libby Boundary 10 5.9 1.7 0.8 3.1
Air Modeling 10 7.1 1.4 0.7 2.6
Medical Screening 13 8.6 1.5 0.8 2.6
Libby Valley 15 10.9 1.4 0.8 2.3
Central Lincoln County 15 11.6 1.3 0.7 2.1

*SMR: Standardized mortality ratio.
†CI: Confidence interval.
¶Statistically significant elevated SMRs.


Table 6. Gender Specific Standardized Mortality Ratios by Areas of AnalysisUsing the Montana Population as a Reference, 1979-1998

Asbestosis (Represents all Pneumoconioses) -- Male [ICD-9 501]
Area of Analysis Observed Expected SMR* Lower 95% CI Upper 95% CI
Libby City Limits 5 0.1 52.0¶ 16.8 121.4
Extended Libby Boundary 7 0.1 55.4¶ 22.2 114.2
Air Modeling 8 0.2 49.3¶ 21.2 97.2
Medical Screening 8 0.2 38.7¶ 16.6 76.2
Libby Valley 10 0.3 36.4¶ 17.4 67.0
Central Lincoln County 10 0.3 34.1¶ 16.3 62.7

Asbestosis (Represents all Pneumoconioses) -- Female [ICD-9 501]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 0 0.1 0 - -
Extended Libby Boundary 0 0.2 0 - -
Air Modeling 0 0.2 0 - -
Medical Screening 1 0.2 4.6 0.1 25.7
Libby Valley 1 0.3 3.7 0.0 20.5
Central Lincoln County 1 0.3 3.5 0.0 19.2

*SMR: Standardized mortality ratio.
¶Statistically significant elevated SMRs.


Table 7. Gender Specific Standardized Mortality Ratios by Areas of AnalysisUsing the U.S. Population as a Reference, 1979-1998

Asbestosis (Represents all Pneumoconioses) -- Male [ICD-9 501]
Area of Analysis Observed Expected SMR* Lower 95% CI Upper 95% CI
Libby City Limits 5 0.1 76.5¶ 24.6 178.5
Extended Libby Boundary 7 0.1 82.7¶ 33.1 170.3
Air Modeling 8 0.1 74.7¶ 32.1 147.1
Medical Screening 8 0.1 59.4¶ 25.6 117.0
Libby Valley 10 0.2 56.7¶ 27.2 104.3
Central Lincoln County 10 0.2 53.1¶ 25.4 97.7

Asbestosis (Represents all Pneumoconioses) -- Female [ICD-9 501]
Area of Analysis Observed Expected SMR Lower 95% CI Upper 95% CI
Libby City Limits 0 0.0 0.0 - -
Extended Libby Boundary 0 0.0 0.0 - -
Air Modeling 0 0.0 0.0 - -
Medical Screening 1 0.0 161.2¶ 2.1 897.0
Libby Valley 1 0.0 131.7¶ 1.7 732.7
Central Lincoln County 1 0.0 124.2¶ 1.6 691.3

*SMR: Standardized mortality ratio.
¶Statistically significant elevated SMRs.


FIGURES 1 - 3

Figure 1. Aerial Photography


Figure 1a. Downtown Area


Figure 1b. Mining Area


Figure 1c. Distribution Area


Figure 1d. Exfoliation Area

Figure 2. Geographic Areas of Analysis


Figure 2a. General Vicinity


Figure 2b. Central Lincoln County


Figure 2c. Libby Valley


Figure 2d. Medical Screening


Figure 2e. Air Modeling


Figure 2f. Extended Libby Boundary


Figure 2g. Libby City Limits

Figure 3. Standardized Mortality Ratio Graphs of Asbestosis

Standardized mortality ratios (SMRs) are presented as point estimates (diamonds) alongwith 95% confidence intervals (bands). The geographic areas of analysis progress fromthe smallest region (Libby City Limits) to the largest region (Central Lincoln County).



APPENDICES 1 - 2

Appendix 1.

International Classification of Diseases - 9th Revision
ICD-9 Codes Description of Underlying Cause of Death
150-159 Malignant neoplasm of digestive organs and peritoneum
   150-154 Malignant neoplasm of esophagus, stomach, small intestine, colon, and rectum
   157 Malignant neoplasm of pancreas
161-165 Malignant neoplasms of respiratory and intrathoracic organs, excluding nasal cavities and accessory sinuses
   162 Malignant neoplasms of trachea, bronchus, and lung
174 Malignant neoplasm of female breast
185 Malignant neoplasm of prostate
199 Malignancy without specification to site
415-417 Diseases of pulmonary circulation (acute cor pulmonale, pulmonary embolism and infarction, pulmonary hypertension)
430-438 Cerebrovascular disease
480-519 Nonmalignant diseases of the respiratory system, excluding upper respiratory tract infections
   490-496 Chronic obstructive pulmonary disease
   500-505 Pneumoconioses
   501 Asbestosis
   510-519 Other disease of respiratory system (emphysema, pleurisy, pneumothorax, pulmonary congestion, pulmonary collapse, respiratory failure)


Appendix 2. Montana Death Certificate



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