PRELIMINARY PUBLIC HEALTH ASSESSMENT
10TH STREET SITE
(a/k/a COLUMBUS PUBLIC WATER SUPPLY)
COLUMBUS, PLATTE COUNTY, NEBRASKA
The U.S. Environmental Protection Agency has developed plans toconduct a Remedial Investigation and Feasibility Study (RI/FS)for the Tenth Street Superfund Site in Columbus, Nebraska. Thefirst task for this RI/FS was to prepare a project scoping reportto define the limits of the investigation. This task wascompleted by Sverdrup consultants in January, 1990. Sverdrupwill also conduct the remainder of the tasks for this RI/FS. TheRI/FS will fill the data gaps related to the groundwater and thephysical setting of the site. This will include the installationof monitoring well clusters to identify the aquifers ad directionof groundwater flow and to fully characterize the nature andextent of the contamination. Site boundaries and identificationof the potential release sources will be delineated through theuse of soil sampling. This site is currently on the Update 10list proposed for inclusion on the National Priorities List ofSuperfund sites.
The subject site is located in the business district of the Cityof Columbus and may be the source of contamination of several of the City's municipal supply wells. The major site contaminantsare trihalomethanes (THM), trichloroethylene (TCE) andtetrachloroethylene (PCE). Contributors to the sitecontamination are speculated to be four dry cleaningestablishments, a radiator repair/machine shop, and an unpavedparking lot that previously was a scrap metal yard.
At this stage of investigation, data regarding site contaminationare limited. Indicators of site contamination are PCE, TCE, andTHM in the City's municipal wells. For individual municipalsupply wells, prior to being mixed for distribution,concentrations of TCE and PCE have been found ranging up to 34and 25 parts per billion (ppb) respectively. Chloroform has beendetected at levels ranging from none detected up to 240 ppb atthe supply well.
Water from several municipal wells is mixed prior to distributionto the community. Average PCE concentrations in this distributedwater ranged from 1 to 5 ppb; average TCE concentration rangedfrom 6 to 18 ppb. Both PCE and TCE concentrations meet or exceedthe Maximum Contaminant Level (MCL) for these chemicals indrinking water. THMs in the distributed water have been reportedas "well below" the MCL of 100 ppb.
The City reduced contamination in distributed water by taking themost heavily contaminated individual supply wells off-line. Thishas helped; however contamination is still detectable and for TCEhas exceeded the MCL (6.3 ppb).
On-site soil gas measurement has demonstrated the presence of a plumeof TCE and PCE underlying the site. Options under consideration byEPA and the city of Columbus for long-term remediation and mitigationinclude abandonment of the existing contaminated well-field anddevelopment of a new, more remote well-field, treatment of municipalwater to reduce contamination levels, and remediation of the suspectedsource site to reduce contamination of the well field.
The city is continuing monitoring of the municipal wells for theidentified contaminants to follow trends in the concentrations. EPAis presently conducting the RI to further characterize the groundwaterand the contamination of the ground water and to delineate the sourcesof the groundwater contamination. It is difficult to assess possibleimpacts from exposures that may have occurred prior to thecontaminants of concern being detected in 1984. There have been noparticular health concerns expressed by the community specificallyrelated to the site or the low-level contamination in the watersupply.
A review of the 10 leading causes of death indicates an increased rateof death from diseases of the kidney (nephritis/nephrosis) in the cityof Columbus when compared to the county and state rates. While thekidney is a target organ for these compounds, this elevated ratecannot be attributed to exposure to the low levels seen in the watersupply. This may represent a subpopulation with increased sensitivityto the effects of exposure that must be considered. These healthparameters should be investigated further to identify possible risk factors.
Until such time that the RI/FS is completed by EPA, water monitoringshould be continued to prevent consumption of contaminated water. Thelong-term human health effects resulting from chronic exposure to low-levels of these substances is not known at present. Twenty-twopercent of the population in the city of Columbus are either underfive years of age or over sixty-five years of age. These age groupsare potentially more sensitive to the effects of exposure. Thepopulation in the city is relatively stable, suggesting the potentialfor long-term exposures. In view of the potential for long-termexposure, the presence of potentially sensitive subpopulations, andthe lack of data on the effects of chronic exposure to low levels ofthese substances, this site is considered to be an indeterminatepublic health hazard.
This site has been reviewed by the ATSDR Health ActivitiesRecommendation Panel. While there is evidence that individuals areexposed to low levels of trichloroethylene and tetrachloroethylene,data at this point are very limited. Further information as providedby the site remedial investigation will assist ATSDR in determiningany public health actions for the community in the future. ATSDR willreview the remedial investigation information as it becomes available.
In November 1983, the city of Columbus, Nebraska discoveredtrihalomethanes (THMs) in the drinking water supply. It is notknown whether this was the first time that such compounds wereanalyzed in the drinking water or the first time that thecontaminants actually migrated into the drawdown zone ofcontaminated municipal wells. Trichloroethylene (TCE) andtetrachloroethylene (also known as perchloroethylene, PCE) weredetected in the wells in the following year. These contaminantscontinue to be detected in the wells and distributed water. TheU.S. Environmental Protection Agency (EPA) identified theprobable source of ground water contamination in 1988. Soil gasstudies conducted by EPA indicated the plume of contaminationoriginated in the city block bounded by Tenth and EleventhStreets on the south and north, respectively and 24th and 25thAvenues on the east and west, respectively. Possiblecontributors to the site contamination include four dry cleaners,a radiator repair/machine shop, and a former scrap-metal yardthat is presently used as an unpaved, municipal parking lot.
The site, known as the Tenth Street Site, is located in thecentral business district of Columbus, Nebraska. Columbus servesas the County seat of Platte County, Nebraska, and is locatedapproximately 75 miles west of Omaha in the eastern half of theState. The Loup River, which is located just south of the mainportion of the city, flows in a general eastward direction. Nearby, and south of the Loup River is the Platte River whichalso flows eastward and joins the Loup River several miles eastand south of the City. [See Appendix A (figures 1,2,3) or mapsof the area.] Seven of the City's nine active production wellsused for the municipal water supply are located within 2,000 feetof the site, with the closest at approximately 900 feet from thesite. All but one of the seven wells is due west of the site. Well number 2 is west-southwest of the site at a distance of1,200 feet. (See figure 4 in Appendix A)
To date no site remediation (i.e., clean-up activity) has takenplace. Options considered by the EPA and the city of Columbus,for future implementation include abandonment of the existingmunicipal wells, treatment of the municipal water to reducecontamination levels, and remediation of the suspected sourcesite to reduce contamination of the existing wells. In theinterim, the city is restricting use of the contaminated wellsand mixing water from the various wells to meet drinking watercriteria.
Personnel from the Agency for Toxic Substance and DiseaseRegistry (ATSDR) received a tour of the site and near-bybusinesses from an employee of the city water department on May4, 1990. ATSDR visitors included Dr. Virginia Lee and Mr. HarveyRogers from the Atlanta office and Mr. David Parker from theRegion 7 office. The tenth Street site currently shows no overtsigns of contamination or continued disposal activities. Therewere no odors or visible residues or vegetation damage apparentduring our visit.
The City of Columbus reported that EPA conducted a well survey todetermine the number of private wells near the site. No privatewells were reported according to the municipal public worksemployee conducting the site tour; however, he was not sure sincethe survey was not done by his department. It was noted indriving in the direction of the well field from the Tenth Streetsite that at least one residential yard appeared to have a wellpump on site.
The Tenth Street site did not have restricted access. Thephysical hazards present are those associated with a one storybuilding in a business district.
The day before the site visit, the ATSDR staff met with officialsfrom the Nebraska Department of Health and the Department ofEnvironmental Control to review site records and data. Most ofthe information available had already been reflected in the EPA"Scope Report" previously furnished to ATSDR. We discussed newground-water sampling data taken in February, 1990.
The business district is largely north of the site, withresidential areas located in the other directions. Noagricultural activity occurs in the immediate vicinity of thesite; however, home gardening in the area is possible.
The population of the city in 1986 was 18,610, which is over 60%of the entire county population. The county is primarilyagricultural with 605 of its 669 square miles being utilized byagriculture. There is one 81-bed hospital in the city. (1)
Vital statistics information has been obtained from the NebraskaDepartment of Health for the city of Columbus and for the stateof Nebraska for the year 1988. Census information for thecommunity from the 1980 U.S. Census has been reviewed.
The Riggans Mortality Database have been reviewed to obtainbackground cancer mortality information for Platte County and theState of Nebraska.
Discussions with state and local officials did not reveal anyspecific community concerns about the water supply. The ATSDRRegional Representative attended a public meeting in the summerof 1990 for the site. No major community health concerns wereraised at that time.
The only on-site contamination data were developed for the EPA in1988 by Ecology and Environment/FIT in a soil-gas investigation. Soil-gas measurements were taken at depths ranging from 3 to 9feet, with the most of the higher values being found at the 5foot depth. Soil-gas concentrations for PCE ranged up to about146,000 nanogram per liter (ng/L) on-site (at 5 feet below thesurface). Soil-gas concentrations of TCE were not reported inthe data supplied to ATSDR; however, they are reported to beabout 1/100th of the PCE concentrations and cover about one thirdto one fourth as much land area. The soil-gas contaminationappears to be spreading southward; although there is somecontamination in all directions from the highest level of on-sitecontamination. Soil-gas contamination does extend westward intothe municipal well-field.
In addition to the above-mentioned soil-gas study which addressedboth on and off-site soil-gas contamination, the city hascollected samples of both individual municipal supply wells anddistributed water after blending from the wells. Table 1summarizes the reported off-site contamination data. This datarepresents seven years of data collected from 1984 through 1990. Of 79 positive results for organic compounds in the wellssampled, 19 were above the Maximum Contamination Level (MCL) of 5parts per billion set by EPA for trichloroethylene andtetrachloroethylene. Of 45 positive results for organiccompounds found in the water distribution system (after blendingof the well water), 9 were above the MCLs mentioned above. Thetotal number of sampling events was not described.
|Contaminant||Supply Well||Distribution Water|
| Trichloroethylene (TCE) |
| 34 ppb* |
| 18 ppb |
* - parts per billion. (The MCL for both TCE and PCE is 5 ppb.)
** - no numerical value given, reported as well under 100 parts per billion
Other contaminants, including cis-1,2-dichloroethylene, toluene,and 1,2-dichloroethane, have also been reported in water samples atlevels below 5 ppb.
In order to identify other facilities that could contribute togroundwater contamination in the area of concern, ATSDR searchedthe 1987 and 1988 Toxic Chemical Release Inventory (TRI). TRI isdeveloped by EPA from chemical release (air, water, soil)information provided by certain industries. No sites in the nearvicinity of the Tenth Street site reported releases of site relatedchemicals in Columbus, Nebraska.
The EPA, the Nebraska Department of Health, and the City ofColumbus did not provide quality assurance and quality control(QA/QC) information for the data reviewed for this PreliminaryHealth Assessment. The validity of ATSDR's findings depends uponthe reliability and accuracy of the data provided and reviewed inthis health assessment.
The Tenth Street Site serves primarily as a municipal parking lotand does not contain any unusual physical hazards.
Groundwater is the major environmental pathway of concern at the Tenth Street site. Based upon on-site soil-gas analysis, groundwater underlying the site is probably contaminated with TCE, PCE and THMs. This conclusion is supported by off-site soil-gas results and concurrent observation of the same contaminants in the municipal wells located west and southwest of the subject site.
Groundwater underlying the site tends to flow east-southeast at adownward slop of approximately 10 feet of drop per mile toward theLoup River. The well-field is located generally west of the site;however, it is believed that the pumping of the wells creates agradient (downward slope in the surface of the groundwater zone) inthe direction of the well-field that results in the wells'contamination.
Because of limited data, it is difficult to evaluate trends ingroundwater contamination. Well number 4 has been taken out ofservice because of the apparent continuing raise of TCE levels inthat particular well.
Soil and Sediment
Except for EPA's soil gas data, no other data characterizes soilcontamination on or off site. It appears that there is a zone ofcontaminated soil underlying the subject site. Since dumpingactivities occurred over several years, TCE, PCE, and THMs haveleached into subsurface soils and are now reflected in the soil gasmeasurements. Surface soils probably contain little to nocontaminants because the remaining chemicals at the surface easilyevaporate to the air.
The site is largely level with no major drainage channels. Surfacewater from heavy rains would percolate through the site soils. More information is needed to better characterize this potentialpathway.
There are little data available that characterizes the air above ornear the Tenth Street Site that would address known sitecontaminants. It is anticipated that in its present undisturbedcondition the level or organic air pollution coming from the sitewould be negligible or unmeasurable. Excavation of the site duringfuture site use or cleanup activities could release measurableamounts of PCE and TCE to the air and should be addressed in theplanning stages of any future activities involving the site. Soil-gas is contaminated on or near the site at depths that could seepinto nearby basements. This potential pathway needs furtherevaluation.
City water used to water gardens would normally be exposed to theair through sprinkling where it might be expected that most of theTCE, PCEW or THMs would be released to the atmosphere.
The other potential food chain pathway would be throughcontaminated groundwater migrating to the Loup River and hencepossibly contaminating fish found in the river. Volatile organiccompounds do not tend to accumulate in the food chain. Thispathway would not be a problem.
The major human exposure pathway from this site is drinking VOC-contaminated city water. Showering or bathing with VOC-contaminated city water would also provide an opportunity for direct contact with the contaminants. Also, VOCs could be released to the air and inhaled during showering or bathing. Finally, contaminated soil gases could seep into basements near the Tenth Street site and be inhaled by site occupants.
The levels of tetrachloroethylene (PCE) in the water at the pointof distribution to individual households are low (maximum 5 ppb). The Safe Drinking Water Act (SDWA) established drinking waterregulations to protect the public health. These regulations applyto public water systems. These regulations include maximumpermissible levels of contaminants (MCLs) in water that isdelivered to the user of the public water system. The proposed MCLfor PCE is 5 ppb. Tetrachloroethylene has been detected in manydrinking water systems in the United States. The EPA GroundwaterSurvey of 945 water supplies that used groundwater sources found 8%of the supplies had detectable levels of PCE. The median levels atthese 75 water supplies were ˜0.75 ppb and the maximum levelreached 69 ppb. The long-term health effects to humans fromingesting low levels in water supplies have not been identified. (3,4) The estimated level of exposure through ingestion of waterwith the maximum levels seen at this site is below that level thathas been determined to be the minimal risk level (MRL). MRLs arean estimate of daily human exposure to a chemical that is notlikely to produce any harmful (non-carcinogenic) effects over aspecified duration of exposure. (5) The levels found in thedrinking water should not pose a significant risk to the publichealth at the present time.
Trichloroethylene (TCE) is widespread in the environment. The mostcommon means of exposure to low levels in the general population isthrough the concentrations found in breathable air. TCE has alsobeen detected in many water supplies in the United States. The EPAGroundwater supply Survey found TCE in 91 of the waters surveyed. The median level in these 91 waters was ˜1 ppb. One system had asingle high maximum value of 130 ppb. The maximum level oftrichloroethylene found at the distribution water was 18 ppb. While this value exceeds the MCL of 5 ppb, there is no data on theconcentrations at the tap to which people would be exposed. Thetap levels should be lower than at the distribution point so peopleshould not be exposed to levels that would harm their health. Thecentral nervous system, liver, and kidney are the primary organsaffected by exposure to TCE; however, effects on these organs occurat much higher levels of exposure than would be seen at this site.(4,5)
Chloroform and other trihalomethanes have been found in variousconcentrations in over 99 percent of the water supplies surveyed inthe EPA National Organics Reconnaissance Survey and the EPANational Organic Monitoring Study. The main source of chloroformin these water supplies is the chlorination of the naturallyoccurring humic materials. Many water supplies (primarily surfacewater) are chlorinated to prevent the occurrence of waterborneinfectious diseases that were a major public health problem earlyin this century in the United States. The levels oftrihalomethanes reported at this site are below the 100 ppb MCL.(4,6,7,8). These chemicals have not been identified to date atconcentrations in the drinking water that should cause asignificant risk to health in the general public. (9,10,11).
Census information was obtained and reviewed for the county and the city. The 1986 county population was 29,500. Sixty-three percent or 18,610 persons reside in the city of Columbus. The racial make-up of the population is over 99 percent white. (1) Appendix B contains a tabular summary of the census information.
Children under five years of age comprise 8.4 percent of theoverall population. Children may represent a more sensitivepopulation than adults to exposures from these compounds. Thelevels are not such that they are expected to create a threat tochildren's health.
Platte County Residents in 1975 (From 1980 Census): (13)
Population over age five: 15,904
Population living in same house in 1980: 8,321 (52.3%)
Population living in same county in 1980: 4,346 (27.3%)
The majority of persons in Platte county have lived in the samehouse for at least 5 years. This indicates a stable population inthe city of Columbus with long-terms use of the municipal water bythe individuals.
Summary Tables of vital statistics information are provided inAppendix B. The number of births in Columbus have remainedrelatively stable over the years of 1986 to 1988. The percent ofbirths in Platte County with birth defects is not significantlyhigher than the range one would expect when compared to the ratesfor the state of Nebraska.
The slightly higher rate for infant death in Platte county whencompared to the state may reflect the larger percent of very lowbirth weight infants born during that time period. Thetoxicological implications of the compounds and the levels seen atthis point do not indicate a relationship between the site and therate of very low weight births.
A review of the 10 leading causes of death indicates an increasedrate of death from diseases of the kidney (nephritis/nephrosis) inthe city of Columbus when compared to the county and state rates. While the kidney is a target organ for these compounds, thiselevated rate cannot be attributed to exposure to the low levelsseen in the water supply. This may represent a subpopulation withincreased sensitivity to the effects of exposure that must beconsidered. These health parameters should be investigated furtherto identify possible risk factors.
This site presents an indeterminate public health hazard. There isevidence that the general population is and has been exposed toTCE, PCE, and THMs in the drinking water at very lowconcentrations. The concentrations presently are at a level thathas not been demonstrated to result in adverse health effects. Because the major route of exposure is the municipal water supply,concern exists over potentially increasing concentrations of thesubstances that could exceed EPA's MCL. Continued well watermonitoring, combined with proper blending of supplied water, shouldkeep the contaminant concentrations below levels of public healthconcern. In addition to exposures through the drinking water, thepotential exists for soil-gas VOC levels to contaminate indoor airof nearby buildings and lead to an inhalation exposure.
Water quality data for the years prior to 1984 were not available;therefore, conclusions regarding the duration of exposure cannot bemade at present.
A review of vital statistics data yielded no clearly identifiablehealth effects relatable to this site. Elevated death rates fromkidney diseases, compared to state and county death rates, wouldnot be explained by exposure to the low levels of contaminationattributed to this site.
Since a remedial investigation has not yet been completed for thissite, there are a number of data gaps that must be filled to allowthe conduct of a more thorough public health assessment. Some ofthe more important data gaps include understanding potential soil-gas migration pathways with respect to nearby building basements,characterization of volatile gas release and migration potentialduring site remediation activities, and boundaries and migrationrates off the contaminated groundwater plume. Other data gaps,such as surface water drainage patterns through the site, surfacesoil contamination levels, and ultimate fate of contaminantsmigrating to the Loup River through the groundwater, areanticipated to be minor with respect to potential for adverseimpact on human health. This is because the volatile nature of thecontaminants in the surface soils would suggest that they areprobably no longer present in the upper soil levels andconsequently would not contaminate surface water flowing throughthe site. Also, volatile organic compounds migrating to the LoupRiver would not concentrate in fish and consequently would notimpact the food chain.
The direct relationship of the site to the presence oftrihalomethanes in the water supply is not evident at this point.
- Municipal supply wells should be monitored monthly and thosewells that exceed EPA's MCL for PCE, TCE, and THMs should beconsidered for removal from service. Remedial actions areneeded to prevent further contamination of the municipalsupply wells and the aquifer. Other options that protectpublic health such as water treatment to remove volatilecontaminants and the provision of an alternate water supplyshould also be investigated.
- Appropriate respiratory protection should be worn by remedialworkers during clean-up activities that disturb thecontaminated subsurface soils. Control methods to prevent therelease of volatile organic compounds should also be addressedin planning clean-up activities to assure that the nearbypopulations are not exposed to these compounds.
- A formal survey of private wells should be conducted in thearea of the site to verify that there are no additional directhuman exposure routes to contaminated groundwater throughingestion.
- Indoor air measurements for the volatile of concern,particularly PCE, should be taken in the basements ofbuildings in zones where high soil-gas concentrations aredemonstrated.
- Further monitoring data, as supplied from additional monitoring wells would be helpful to define the boundaries and migration rates of the contamination in the water supply well-field and to assist in setting the limits of the well survey recommended above.
This site has been reviewed by the ATSDR Health ActivitiesRecommendation Panel. While there is evidence thatindividuals are exposed to low levels of trichloroethylene andtetrachloroethylene, data at this point are very limited. Further information as provided by the site remedialinvestigation will assist ATSDR in determining any publichealth actions for the community in the future. ATSDR willreview the remedial investigation information as it becomesavailable.
Additional public involvement was sought during theperiod of public comment on the preliminary public healthassessment. There were no comments received during thecomment period.
ATSDR in cooperation with the Nebraska Department ofHealth will conduct a closer evaluation of the rate ofbirths of very low weight infants and the deaths fromdiseases of the kidney is indicated to identify riskfactors associated with these parameters.
When indicated by public health needs, and as resourcespermit the evaluation of additional relevant healthoutcome data and community health concerns, if available,is recommended.
Remedial Programs Branch
Division of Health Assessment and Consultation
Federal Programs Branch
Division of Health Assessment and Consultation
ATSDR Regional Representative
- U.S. Bureau of Census.County & City Data Book, 1988. U.S. Government Printing Office, 1988.
- Sverdrup. Scope Report for the RemedialInvestigation/Feasibility Study at the Tenth StreetSuperfund Site, Columbus, Nebraska. January 1990.
- ATSDR. Toxicological Profile for Tetrachloroethylene January 1990.
- Sittig, M. Handbook of Toxic and Hazardous Chemicals andCarcinogens. Noyes Publications: Park Ridge, N.J., 1985.
- ATSDR. Toxicological Profile for Trichloroethylene. October 1989.
- ATSDR. Toxicological Profile for Chloroform. January 1989.
- Jolley, RL et al eds. Water Chlorination: EnvironmentalImpact and Health Effects, Vol. 5. Ann Arbor, Michigan: Ann Arbor Science Publishers, Inc., 1985.
- Munson, AE et al. "Toxicology of Organic Drinking WaterContaminants: Trichloromethane, Bromodichloromethane,Dibromochloromethane, and Tribromomethane." EnvironmentalHealth Perspectives Vol. 46: 117-126, 1982.
- Crump, KS and HA Guest. "Drinking Water and Cancer: Reviewof Recent Epidemiological Findings and Assessment of Risks." Annual Review of Public Health 3:339-357, 1982.
- Shy, CM. "Chemical Contamination of Water Supplies." Environmental Health Perspectives Vol. 62: 399-406, 1985.
- LaDou J. "The Clinical Significance of Water Pollution." Western Medical Journal 148:192-196, 1988.
- U.S. Bureau of Census. 1980 Census of Population: Chapter B - General Population Characteristics: Part 29 - Nebraska. U.S. Department of Commerce. Issued July 1982.
- U.S. Bureau of Census. 1980 Census of Population: ChapterC - General Social and Economic Characteristics: Part 29 - Nebraska. U.S. Department of Commerce. Issued July 1983.
- Nebraska Department of Health. 1988 Vital StatisticsReport. Division of Health Data Systems.
|Under 5 years||1,451||702||749|
|5 to 9 years||1,352||690||662|
|10 to 14 years||1,301||664||637|
|15 to 19 years||1,583||776||807|
|20 to 24 years||1,527||730||797|
|25 to 34 years||2,749||1,355||1,394|
|35 to 44 years||1,759||848||911|
|45 to 54 years||1,637||797||840|
|55 to 64 years||1,576||719||857|
|Over 65 years||2,393||892||1,501|
|Year||Nebraska||Platte County||Columbus City|
|Rate per 1000 Pop.||14.9||17.2||17.3|
|Percent of 1988 Births||2.3||3.3|
|Percent of 84-85 Births||2.5||2.4|
|1988 Less than 1500 grams Rate per 1000 Live Births||9.5||11.5|
|1988 Less than 2500 grams Rate per 1000 Live Births||55.3||57.5|
|1984-1988 Less than 1500 grams Rate per 1000 Live Births||8.9||7.1|
|1984-1988 Less than 2500 grams Rate per 1000 Live Births||54.4||39.7|
|Year||Nebraska||Platte County||Columbus City|
|1988 Crude Death Rate||9.3||7.7||8.3|
|1988 Infant Death Rate per 1000 Live Births||9.0||11.5||6.1|
|84-88 Infant Death Rate per 1000 Live Births||9.4||9.8||11.2|
|1988 Neonatal Death |
Rate per LB
|84-88 Neonatal Death |
Rate per 1000 LB
LB = Live Births
|Cause||Nebraska Rate*||Platte Rate*||Columbus Rate*|
* Age-Adjusted Rate per 100,000 Population