Cancer and Demographic COUNTY PROFILE Broward County, Florida

Cancer and Demographic COUNTY PROFILE Broward County, Florida Sylvester Comprehensive Cancer Center Jay Weiss Institute for Health Equity University of Miami Revised Sept. 2016

TABLE OF CONTENTS Page Introduction 2 Broward County Description 3 Broward County Partners 4 Map of Broward County 5 Demographics 6-7 Table 1: Population, Race, Hispanic Origin and Age 6 Table 2: Socioeconomic Measures 7 Cancer Data 8-13 Cancer Incidence Table 3: Average annual number of cases by cancer site 9 Table 4: Age-adjusted incidence rates by cancer site 9 Late Stage at Diagnosis Table 5: Percent of cancers diagnosed at late stage by cancer site 10 Cancer Mortality Table 6: Average annual number of deaths by cancer site 11 Table 7: Age-adjusted mortality rates by cancer site 12 Cancer Prevention Table 8: Cancer screening, tobacco use and skin cancer 13 Appendices Appendix A Summary Tables by County, State of Florida and US 14-18 Appendix B Resources 19 Acknowledgements and References 20 Page 1 Broward County

Introduction The Jay Weiss Institute for Health Equity (JWI) was established in 2013 to support the Sylvester Comprehensive Cancer Center s scientific and programmatic efforts to reduce cancer disparities. The mission of the JWI is to make meaningful progress towards health equity through outreach, community partnerships, research, advocacy, and training. The JWI consists of three inter-related program areas: research, community outreach, and training. In all areas, the JWI collaborates with community partners who offer critical insight regarding risk conditions affecting health and healthcare utilization. This profile is part of a series of reports with demographic and cancer data for South Florida counties that are within the Sylvester Comprehensive Cancer Center catchment area. The profiles present basic information for researchers and community partners to use in planning evidence-based interventions to reduce higher rates of cancer, barriers to routine health care and cancer screening, or other factors that contribute to disparities. We encourage researchers and community partners to work together to use this information for common goals of improving the health status of our community. All reports are available online: http://sylvester.org/jw/community-outreach/data-profiles Please contact us if you have any questions. Erin Kobetz, PhD, MPH JWI Director Senior Associate Dean for Health Disparity and Associate Professor Department of Medicine, UM Miller School of Medicine Associate Director, Disparities and Community Outreach, Sylvester Comprehensive Cancer Center Olveen Carrasquillo, MD, MPH JWI Co-Director Professor, Medicine and Public Health Sciences, UM Miller School of Medicine Director, Division of Health Services Research and Policy, Department of Public Health Sciences Chief, Division of General Internal Medicine. Page 2 Broward County

Broward County Description Broward County is the second most populous county in Florida, with more than 1.8 million residents. There are 31 municipalities in the county. The largest are Fort Lauderdale, Pembroke Pines, and Hollywood. The highest population density is along the Atlantic Ocean and I-95 corridor, and decreasing moving west. The western half of the county (west of State Road 27) is part of the Everglades Wildlife Management Area. Broward County s population is 65% White and 29% Black. Almost one-third (30%) are of Hispanic origin. Broward County also has a significant West Indian community; approximately 16% are from Jamaica and Haiti and other Caribbean countries. For more demographic and socio-economic information, see Tables 1 and 2. Health Care and Cancer Centers Broward County is divided into two health districts, funded by sales tax revenue to provide health care for people without insurance. Broward Health serves the North Broward Hospital District, north of I-595. The South Broward Hospital District is served by the Memorial Healthcare System. Overall, there are a total of 24 hospitals throughout the county. The following hospitals have American College of Surgeons accredited cancer programs: Broward General Medical Center Cleveland Clinic Hospital Holy Cross Hospital Memorial Healthcare System North Broward Medical Center Plantation General Hospital Westside Regional Medical Center Parts of Broward County are medically underserved. Of the 278 Census Tracts in Broward County, 45% are designated as Health Professional Shortage areas, and 34% as Medically Underserved Populations (MUPs). 1 Low income areas within in the following communities are designated as primary care shortage areas: Davie, Hollywood, Dania Beach, Deerfield Beach, Fort Lauderdale, Hallandale, Miramar, Margate, Pompano Beach, and Sunrise. 2 3 Page 3 Broward County

Broward County Partners The Sylvester Comprehensive Cancer Center has four satellite facilities in Broward County that provide cancer screening, diagnosis, treatment, follow-up and social services for cancer patients and their families from the Broward/Palm Beach County area. The following are links to information about those facilities: Deerfield Beach Plantation Hollywood Coral Springs The Sylvester Deerfield Beach facility is also home to The Pap Corps: Champions for Cancer Research, a volunteer organization dedicated to raising funds for cancer research at Sylvester. We also partner with the following organizations for education, research, referral and networking, and as part of the Southeast Florida Cancer Control Collaborative (SFCCC). The Beautiful Gate Cancer Resource Center Florida Health -Broward County Breast and Cervical Cancer Early Detection Program Tobacco Prevention Broward Health Broward Community & Family Health Centers Gilda s Club Health Foundation of South Florida Leukemia & Lymphoma Society, Southern Florida Chapter Sharsheret Susan G. Komen, Miami/Ft. Lauderdale Chapter What s Next for My Life Page 4 Broward County

Map of Broward County Source: Google Maps Page 5 Broward County

DEMOGRAPHICS Tables 1 and 2 present demographic and socioeconomic data for Broward County, Florida and the US. Table 1. Population, Race, Hispanic Origin and Age Broward County Florida Total Population 1,784,889 19,091,156 Number Percent Number Percent Race White 1,129,974 63% 14,568,521 76% Black 484,677 27% 3,056,152 16% Other 170,238 10% 1,466,483 8% Ethnicity Non-Hispanic 1,323,497 74% 14,721,236 77% Hispanic 461,392 26% 4,369,920 23% Country of Origin for Hispanics Cuba 91,641 20% 1,286,325 29% Central America 50,319 11% 482,364 11% South America 159,139 34% 735,600 17% Puerto Rico 80,100 17% 898,953 21% Dominican Republic 30,938 7% 188,024 4% Mexico 30,777 7% 629,945 14% Language Speak language other than English at home 38% 27% Age Percent Age 65+ 15% 19% Source: American Community Survey 2013 5-year estimates, Tables B01003, B02001, B03002, B03001 Page 6 Broward County

Table 2: Socioeconomic Measures Martin County Florida Income, Education and Employment Median household income $49,846 $46,956 High school/ged diploma 26% 30% Age 16+ unemployed 13% 12% Population below the Federal Poverty limit 13% 16% Health Insurance Population under 65 with no health insurance 20% 20% Household and Housing Number of Housing Units 59,891 7,158,980 Average Household Size 2.4 2.6 Owner occupied units 76% 67% Source: American Community Survey 2013 5-year estimates, Tables B19013, B15003, S2301, S1701, S2701, S1601, S1101 Health insurance data US Census & CDC: Small Area Health Insurance Estimates, 2014 Page 7 Broward County

CANCER DATA This profile presents data for all cancer sites combined and for 10 cancer sites: breast (female), cervical, colorectal, leukemia, non-hodgkin s lymphoma, lung, melanoma, prostate, bladder, and oral cancers (oral cavity and pharynx). These sites represent either the most common types of cancer or those for which screening and early detection is available. Age-Adjusted Rates Age-adjusted rates are used to compare areas that have different age distributions. This is important when a disease, such as cancer, is more prevalent in certain age groups. Ageadjusted rates are a weighted average of the age-specific rates where the weights are the proportions of persons by age group in a standard population. Cancer incidence and mortality rates are presented as rates per 100,000 population and are adjusted to the US 2000 Standard Population. For gender-specific cancers, the denominator is the population for that gender, e.g., breast and cervical cancer rates are based on the female population and prostate cancer rates are based on the male population. Comparison to State and US Data Data for each county are compared to data for Florida and the US. Florida is not part of the NCI SEER program, and therefore not reflected in the US rates. Cancer Incidence In Florida, as in all states, cancer is a reportable disease. All newly diagnosed cases in Florida are reported to the Florida Cancer Data System (FCDS), as required by state law. 4 County rates are based on the address of residence at the time of diagnosis. In these profiles, FCDS data from the most recent three-year period, 2010-2013, are presented (2013 rates are provisional). Table 3 shows the average annual number of new cancers in Broward County, Florida, and the US. Table 4 compares age-adjusted incidence rates for Broward County, Florida and the US. County rates that are higher than the State of Florida rate are shown in red. Page 8 Broward County

Table 3: Average annual number of cases by cancer site: Broward County, Florida and US Broward County Florida US Cancer Site Bladder 354 Avg. Annual Number of New Cases 4,813 74,000 Breast 1,305 14,363 231,840 Cervical 93 887 12,900 Colorectal 797 9,147 132,700 Leukemias 233 2,723 54,270 Lung 1,036 15,574 221,200 Melanoma 369 5,208 73,870 Non Hodgkin's Lymphoma 353 4,068 71,850 Oral 259 3,046 45,780 Prostate 873 10,787 220,800 Other Sites 2,780 31,556 519,160 ALL CANCERS 8,452 102,172 1,658,370 Source: County and Florida data from FCDS (2011-2013). US data from ACS Cancer Facts & Figures 2015. Table 4: Age-adjusted incidence rates by cancer site: Broward County, Florida and US Broward County Florida US Cancer Site Bladder 16.2 Age-Adjusted Rate per 100,000 18.1 20.3 Breast 118.0 112.3 124.6 Cervical 9.1 8.4 7.7 Colorectal 37.2 35.9 42.4 Leukemias 11.5 11.4 13.3 Lung 48.2 59.0 58.7 Melanoma 17.5 21.1 21.6 Non-Hodgkin's Lymphoma 17.1 16.5 19.7 Oral 12.0 12.2 11.0 Prostate 86.2 87.2 137.9 ALL CANCERS 400.8 407.3 454.8 Source: County and Florida data from FCDS (2011-2013). US data from SEER (2008-2012). Page 9 Broward County

Late Stage at Diagnosis Stage of disease describes the extent of spread of a cancer at the time of diagnosis, and is based on clinical, imaging, surgical and pathology information. There are several systems of staging. This report uses Summary Staging includes the following categories: in-situ (cancer cells have not spread to surrounding tissue) local (cancer is within the organ of origin) regional (cancer has spread to nearby organs) distant (cancer has spread to other parts of the body) Late stage is defined as regional and distant stage. In-situ and unknown stage cases are excluded from the data presented, with the exception of bladder cancer. Because approximately half of bladder cancer cases are found at the in-situ stage, they are included. The percent of late stage cases can be an indicator of a need to increase early detection if screening tests are available, for example, for breast, colon, and cervical cancers. For systemic cancers such as leukemia, staging is based on different criteria so late stage data are not presented. Table 5 compares the percentage of late stage cancers for Broward County, Florida and the US. County percentages higher than for the State of Florida are shown in red. Table 5: Percent of cancers diagnosed at late stage by cancer site: Broward County, Florida and US Broward County Florida US Cancer Site Bladder 13% Percent Late Stage 12% 11% Breast 37% 35% 38% Cervical 57% 58% 52% Colorectal 61% 60% 59% Lung 79% 78% 83% Melanoma 15% 15% 13% Non Hodgkin's Lymphoma 74% 71% 70% Oral 69% 70% 68% Prostate 17% 16% 16% Source: County and Florida data from FCDS (2011-2013). US data from SEER (2005-2011). Page 10 Broward County

Cancer Mortality Cancer is the second leading cause of death in the Broward County, Florida and the US. 5,6 The cause of death on death certificates is the main source of data on mortality. FCDS links its incidence database with Florida Vital Statistics data to obtain mortality numbers and rates. Table 6 shows average annual number of deaths by type of cancer. Table 7 shows age-adjusted mortality rates for Broward County, Florida, and the US. County rates that are higher than the State of Florida rate are shown in red. Table 6: Average annual number of deaths by cancer site: Broward County, Florida and US Broward County Florida US Cancer Site Bladder 99 Avg. Annual Number 1,208 16,000 Breast 250 2,821 40,290 Cervical 39 334 4,100 Colorectal 325 3,633 49,700 Leukemias 136 1,653 24,450 Lung 809 11,765 158,040 Melanoma 58 765 9,940 Non Hodgkin's Lyphoma 127 1,495 19,790 Oral 49 686 8,650 Prostate 174 2,073 27,540 Other Sites 1,358 15,945 230,930 ALL CANCERS 3,424 42,378 589,430 Source: County and Florida data from FCDS (2011-2013). US data from ACS Cancer Facts & Figures 2015. Page 11 Broward County

Table 7: Age-adjusted mortality rates by cancer site: Broward County, Florida and US Broward Florida US Cancer Site Bladder 4.3 Age-Adjusted Rates per 100,000 4.4 4.4 Breast 11.5 11.1 21.9 Cervix 3.5 32.8 2.3 Colorectal 14.7 13.8 15.5 Leukemias 6.4 6.4 7.0 Lung 37.2 44.2 47.2 Melanoma 2.6 2.9 2.7 Non-Hodgkin's Lymphoma 5.8 5.8 6.2 Oral cancer 2.2 2.7 2.5 Prostate 19.0 17.7 21.4 ALL CANCERS 156.7 161.2 171.2 Source: County and Florida data from FCDS (2011-2013). US data from SEER (2008-2012). Page 12 Broward County

CANCER PREVENTION The Behavioral Risk Factor Surveillance System (BRFSS) provides county-level data for behavioral indicators related to health-related risk behaviors, chronic health conditions, and the use or preventive services. The CDC-based program is based on random telephone surveys conducted in all states. Table 8 shows key indicators for Broward County, Florida, and the US. Data by gender, age-group, race, ethnicity, education level and income for Florida and Florida counties can be found on the Florida CHARTS. For the US, they can be found on the CDC BRFSS web page. Table 8: Cancer screening, tobacco use, and skin cancer: Broward County, Florida and US Broward Florida US Women aged 21 to 65 who had a Pap test in the past 3 years 79% 80% 78% * Women aged 50 to 74 who had a mammogram in the past 2 years 70% 58% 77% ** Adults 50 years of age and older who received a sigmoidoscopy or 65% 69% 67% colonoscopy in the past five years Men ages 50+ who have ever had a PSA test within the past 2 years 67% 73% 45% *** Adults who are current smokers 12% 17% 19% Adults who have ever been told they had skin cancer 6% 9% n/a Source: County and Florida data for 2013 from Florida CHARTS. US data for 2012 from CDC. * Women aged 18+ who have had a pap test within the past three years ** Women aged 50+ who have had a mammogram within the past 2 years *** Men aged 40+ who have had a PSA test within the past 2 years Page 13 Broward County

APPENDIX A Summary Tables by Catchment Area Counties, State of Florida, and US Table 1. Population, Race, Hispanic Origin and Age Broward Miami Dade Monroe Palm Beach Florida Total Population 1,784,889 2,549,075 74,213 1,339,221 19,091,156 Race White 63% 75% 89% 76% 76% Black 27% 19% 7% 18% 16% Other 10% 6% 4% 7% 8% Ethnicity Non-Hispanic 74% 35% 79% 80% 77% Hispanic 26% 65% 21% 20% 23% Country of Origin for Hispanics Cuba 20% 53% 58% 19% 29% Central America 11% 14% 12% 19% 11% South America 34% 17% 8% 22% 17% Puerto Rico 17% 6% 6% 14% 21% Dominican Republic 7% 4% 1% 4% 4% Mexico 7% 3% 13% 18% 14% Language Speak language other than 38% 72% 23% 28% 27% English at home Age Percent Age 65+ 15% 15% 18% 22% 19% Source: American Community Survey 2013 5-year estimates, Tables B01003, B02001, B03002, B03001 Page 14 Broward County

Table 2: Socioeconomic Measures Broward Miami Dade Monroe Palm Beach Florida Income, Education and Employment Median household income $51,251 $43,100 $53,607 $52,432 $46,956 High school/ged diploma 28% 28% 30% 26% 30% Age 16+ unemployed 12% 12% 8% 12% 12% Population below the Federal Poverty limit 14% 20% 14% 15% 16% Health Insurance Population with no health insurance (before the Affordable Care Act) 23% 30% 27% 20% 20% Household and Housing Number of Housing Units 663,458 828,031 28,503 526,007 7,158,980 Average Household Size 2.7 3.0 2.5 2.5 2.6 Owner occupied units 66% 56% 62% 71% 67% Source: American Community Survey 2013 5-year estimates, Tables B19013, B15003, S2301, S1701, S2701, S1601, S1101 Table 3: Average annual number of cases by cancer site Broward Miami Dade Monroe Palm Beach Florida US Cancer Site Avg. Annual Number Bladder 352 409 16 454 4,813 74,000 Breast 1,305 1,612 42 1,149 14,363 231,840 Cervical 93 134 * 57 887 12,900 Colorectal 797 1,203 37 651 9,147 132,700 Leukemias 233 297 * 218 2,723 54,270 Lung 1,036 1,250 52 1,121 15,574 221,200 Non-Hodgkin's Lymphoma 353 494 10 376 4,068 71,850 Melanoma 369 228 29 419 5,208 73,870 Oral 259 279 22 197 3,046 45,780 Prostate 873 1,363 34 813 10,787 220,800 Other Sites 2,782 3,888 127 2,421 31,556 519,160 ALL CANCERS 8,452 11,158 382 7,875 102,172 1,658,370 Source: County and Florida data (2011-2013) from. US data from ACS Cancer Facts & Figures 2015 * <10 cases Page 15 Broward County

Table 4: Age-adjusted incidence rates by cancer site Broward Miami Dade Monroe Palm Beach Florida US Cancer Site Age-Adjusted Rate per 100,000 Bladder 16.2 13.7 14.6 19.4 18.1 20.3 Breast 118.0 103.1 84.9 116.0 112.3 124.8 Cervical 9.1 9.3 9.8 7.3 8.4 7.7 Colorectal 37.2 40.6 34.9 30.9 35.9 42.4 Leukemia 11.5 10.6 7.3 11.0 11.4 13.3 Lung 48.2 41.8 45.4 50.6 59.0 58.7 Melanoma 17.5 7.8 27.0 20.4 21.1 21.6 Non-Hodgkin's Lymphoma 17.1 17.1 10.2 18.3 16.5 19.7 Oral 12.0 9.4 19.0 10.3 12.2 11.0 Prostate 86.2 100.9 53.6 87.4 87.2 137.9 ALL CANCERS 400.8 380.9 352.0 390.3 407.3 460.4 Source: County and Florida data (2011-2013) from FCDS. US data from SEER (2008-2012) NOTE: Rates based on fewer than 10 cases may be unreliable. Table 5: Percent of cancers diagnosed at late stage by cancer site Broward Miami Dade Monroe Palm Beach Florida US Cancer Site Percent Late Stage Bladder 24% 24% 21% 17% 25% 24% Breast 37% 39% 43% 31% 35% 38% Cervical 57% 62% 64% 51% 58% 51% Colorectal 61% 61% 55% 61% 60% 58% Lung 79% 79% 87% 70% 78% 84% Non Hodgkin's Lymphoma 74% 74% 55% 66% 71% 70% Melanoma 15% 21% 16% 17% 15% 13% Oral 69% 69% 75% 70% 70% 68% Prostate 17% 16% 22% 15% 16% 16% Source: County and Florida data (2011-2013) from FCDS. US data from SEER (2005-2011) Page 16 Broward County

Table 6: Average annual number of deaths by cancer site Broward Miami Dade Monroe Palm Beach Florida US Cancer Site Avg. Annual Number Bladder 99 115 * 111 1,208 16,000 Breast 250 311 13 209 2,821 40,290 Cervical 39 48 * 20 334 4,100 Colorectal 325 428 17 258 3,633 49,700 Leukemias 136 166 6 157 1,653 24,450 Lung 809 873 45 821 11,765 158,040 Melanoma 58 43 * 67 765 19,790 Non-Hodgkin's Lymphoma 127 177 4 134 1,495 9,940 Oral 49 54 * 46 686 8,650 Prostate 174 269 * 175 2,073 27,540 Other Sites 1,358 1,692 72 1,266 15,945 230,930 ALL CANCERS 3,424 4,176 182 3,264 42,378 589,430 Source: County and Florida data (2011-2013) from. US data from ACS Cancer Facts & Figures 2015 * <10 cases Table 7: Age-adjusted mortality rates by cancer site Broward Miami Dade Monroe Palm Beach Florida US Cancer Site Age-Adjusted Rates per 100,000 Bladder 4.3 3.8 7.3 4.2 4.4 4.4 Breast 20.6 18.7 24.9 18.6 20.3 21.9 Cervix 3.5 3.2 * 2.3 2.8 2.3 Colorectal 14.7 14.3 15.8 11.3 13.8 15.5 Leukemia 6.4 5.6 6.2 6.7 6.4 7.0 Lung 37.2 29.0 40.5 35.7 44.2 47.2 Melanoma 2.6 1.5 3.2 2.9 2.9 2.7 Non-Hodgkin's Lymphoma 5.8 6.0 3.3 5.6 5.8 6.2 Oral cancer 2.2 1.8 5.3 2.2 2.7 2.5 Prostate 19.0 22.4 17.4 15.7 17.7 21.4 ALL CANCERS 156.7 139.8 169.5 143.2 161.2 171.2 Source: County and Florida data (2011-2013) from FCDS. US data from SEER (2008-2012) NOTE: Rates based on fewer than 10 cases may be unreliable. Page 17 Broward County

Table 8: Cancer screening, tobacco use and skin cancer Broward Miami-Dade Monroe Palm Beach Florida US Women aged 21 to 65 who had a Pap test in the past 3 years 79% 81% 71% 86% 80% 78% * Women aged 50 to 74 who had a mammogram in the past 2 years 70% 78% 68% 84% 58% 77% ** Adults 50 years of age and older who received a sigmoidoscopy or colonoscopy in 65% 59% 67% 74% 69% 67% the past five years Men ages 50+ who have ever had a PSA test within the past 2 years 67% 70% 67% 79% 73% 45% *** Adults who are current smokers 12% 14% 21% 10% 17% 19% Adults who have ever been told they had skin cancer 6% 3% 9% 12% 9% n/a Source: BRFSS County and Florida data from 2013. US data from 2012. * Women aged 18+ who have had a pap test within the past three years ** Women aged 50+ who have had a mammogram within the past 2 years *** Men aged 40+ who have had a PSA test within the past 2 years Page 18 Broward County

APPENDIX B Resources University of Miami Sylvester Comprehensive Cancer Center Jay Weiss Institute for Health Equity Disparities and Community Outreach Core CENSUS DATA U.S. Census Bureau American Community Survey American Fact Finder Maps & Geographic Data Population & Economic Data NATIONAL CANCER INSTITUTE and CDC Surveillance, Epidemiology and End Results (SEER) Center for Disease Control and Prevention - Cancer Data Behavioral Risk Factor Surveillance System FLORIDA DEPARTMENT OF HEALTH Florida Cancer Data System Community Health Assessment Resource Tool Set (CHARTS) BROWARD COUNTY Florida Health Broward County Broward Regional Health Planning Council Broward County 2-1-1 OTHER RESOURCES Community Commons - maps and data by county Community Commons - Community Health Needs Assessments: Health Communities Institute Page 19 Broward County

ACKNOWLEDGEMENTS The County Profiles were prepared by Dorothy Parker, MHS, JWI Manager, Community Outreach Cynthia Lebron, MPH, JWI Community Research Associate Joshua Sznol, MSPH, assisted with census data tables. Florida Department of Health and the Florida Cancer Data System Data from the Florida Cancer Data System used to prepare this report was acquired from the Florida Department of Health, with approval from Department of Health Institutional Review Board and the Bureau of Epidemiology. Florida Cancer Data System Statement The Florida cancer incidence data used in this report were collected by the Florida Cancer Data System under contract with the Department of Health (DOH). The views expressed herein are solely those of the author(s), and do not necessarily reflect those of the contractor of DOH. REFERENCES 1 http://www.broward.org/planningandredevelopment/demographicsandeconomics/pages/quickfacts.aspx 2 http://www.fachc.org/about-floridas-fqhcs.php 3 http://datawarehouse.hrsa.gov/geoadvisor/shortagedesignationadvisor.aspx 4 http://fcds.med.miami.edu/inc/lawsrules.shtml 5 http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm 6 http://www.floridacharts.com/charts/atlas/mortality/2011/leading_cause_age_group_2011.pdf Page 20 Broward County