Abstract of Environmental Health Study Portions in the Dissertation

Coming to the Surface: The Environment, Health and Culture in Butte Montana

Prepared by:
Stacie Barry, PhD

Abstract of Environmental Health Studies Portion of Dissertation

1. Introduction
This document is an abstract of the environmental health study portions of the
dissertation Coming to the Surface: The Environment, Health and Culture in Butte Montana
(Barry 2012). It is not intended to replace the dissertation or minimize the information contained
within it. It is intended to provide a brief summary of health issues in the Butte area for
interested persons with limited time or little interest in cultural issues or environmental history.
All literature cited in this document is contained in the references section of the dissertation.
This abstract will first provide a brief background of the Butte area, including the extent of
mining and potential cultural influencing factors associated with mining culture. It will then
provide a summary of previous health studies of the Butte area. An overview of the longitudinal
epidemiology study follows this summary and includes a brief abstract of the toxicology of the
chemicals of concern in Butte. The summary of the toxicological information is followed by an
example standardized mortality ratio dataset showing the Butte-Silver Bow compared to United
States mortality rates for 1999-2007. The complete dataset for all years (1979-2007) is presented
in Appendix A. The longitudinal epidemiology study findings are followed by a discussion of
cultural influencing factors. To gain an understanding of the toxicology of the chemicals of
concern, cultural influencing factors (particularly the aspects of mining culture), and an
environmental history of contamination and remediation in the Butte area, please refer to the full
dissertation.
2. Background
Butte is a community of approximately 34,500 people in southwestern Montana, located
in Summit Valley. It is bound on the north and east by the Continental Divide, south by the
Highland Mountain Range, and west by low hills. Silver Bow Creek, a headwater of the Clark
Fork River, begins in Butte and flows westward. The town is named after a butte located in the
western portion of the city, known as Big Butte, and is a part of Silver Bow County. It has a
consolidated city-county government that is known as Butte-Silver Bow. The county covers a
718.31-square-mile area, and 88 % of the occupants reside within Butte city limits (Butte-Silver
Bow Health Department 2011a). The median household income in Butte is 71.6% of national,
due in part to the higher levels of poverty, particularly in the older areas of town. Of the major
counties in Montana, Butte-Silver Bow has the highest crime rate for the seven index crimes:
homicide, rape, robbery, aggravated assault, burglary, larceny, and motor vehicle theft. It also
has a high rate of domestic violence, and the occurrence of severe emotional disturbance in
children between the ages of 9 and 17 is significantly higher than the national rate (Butte-Silver
Bow Health Department 2011a).
The city began as a mining camp in the early 1870s, and the cultural identification as a
mining community is important to this day. The climate in Butte consists of long, cold winters
and brief, cool summers. The average annual precipitation in Butte is approximately 13 inches,
the bulk occurring between May and June (U.S. Environmental Protection Agency 2006a). Harsh
winters are a partial reason for the way neighborhoods clustered on the Butte Hill, near the mine
yards. The steep, rocky terrain made it difficult to travel long distances for work, social
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gatherings, or commerce, and this resulted in a patchwork pattern of houses, churches,

businesses, and social halls interspersed among mine yards and industrial structures-all factors
that contributed to a tight sense of community. Initial settlers typically built homes in close
proximity to one another and property lines were more dependent on the terrain than a typical
settlement of measured lots (NPS 2006).
Mining is very important to the economy, landscape, health, and cultural identity of
Butte. Mining activity began in Butte in the 1870s with the discovery of gold, silver, and copper
deposits. By 1890, copper production approached 113 million concentrated pounds per year, and
Butte soon became the largest North American copper producer. In the early years of Butte
mining (pre-1900), many enterprises employed a process known as heap roasting. In this
process, sulfide ores were slowly burned for two to three weeks in large, layered woodpiles,
often as large as a city block, to remove the sulfur from the ore. The process inundated the Butte
area with metal-bearing smoke, which was often thick enough to immerse the town in darkness
(MacMillan 2000).
Statistically, the city produced more metals than any other mining community in the
United States. Between 1880 and 1993, the mines produced over 20.8 billion pounds of copper,
4.9 billion pounds of zinc, 3.7 billion pounds of manganese, and 855 million pounds of lead
(National Park Service 2006). During the century of large-scale mining operations, over 500
underground mines (entailing 3,000 miles of workings) and several open-pit mines, including the
Berkeley Pit, operated on the Butte Hill. These mines, along with several mills, smelters, and
concentrators created millions of cubic yards of mine waste, which was left in the area. This
waste included mill tailings, slag, waste rock, and dust from aerial deposition. This waste is
often in contemporary residential areas and is mobilized during storm events (U.S. EPA 2005a).
Figure 2-1 provides an example of mine waste in the residential area of Dublin Gulch. The
photograph shows the Never Sweat-Washoe operations in the background and numerous piles of
mine tailings and dumps among the houses. In the forefront of the photograph, children play on
a mine dump as an adult watches.

Figure 2-1. Mine Waste in Residential Areas (Butte-Silver Bow Public Archives Photo
Collection 2010)
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Mining activity continued in the Butte and Anaconda area throughout the 20th Century,
particularly during World Wars I and II, but dwindled at the close of the 20th Century following
the closure of Anaconda Copper Mining Company operations in 1982 (U.S. EPA 2006a).
Currently, Montana Resources runs a large-scale operation adjacent to the old Anaconda
Company workings. Figure 2-2 shows historic and contemporary mining activity in Butte and
illustrates its importance in the landscape. The Anaconda Company controlled the bulk of these
operations and conglomerated the majority of mines, mills, and smelters in the district in the
early 1900s.

Figure 2-2. Historic and Contemporary Mining Activity in the Butte Area (Map by Author)
2.1 Mining Culture
Mining cultures often share several characteristics (Pattinson1999, Critcher 1991, Bulmer
1978), namely:
Physical and/or cultural isolation
Pride in reliance, toughness, and craftsmanship
Strong sense of community and kin networks
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Distrust of institutions, politics, and positions of power

Historic pride and romanticizing of the past
Gender divisions

Buttes mining culture is explored much more deeply in the dissertation, but for the
purposes of this abstract, it is worth highlighting at least one aspect of mining culture because it
potentially has an impact on health issues. Mining cultures value resilience, toughness, strength,
and craftsmanship. The National Summit of Mining Communities logo of Too Tough To Die,
shown in Figure 2-3, and the Yorkshire, England motto, Only the Strong Survive illustrate this
value. Mining is tough, dangerous work that requires skilled labor and miners, and mining
communities value all of these qualities. Figure 2-3 also illustrates several common themes in
the mining landscape. In a dissenting discourse to the American suburban ideal, residential
houses are adjacent to mine waste piles and mining operations, symbolized by the head frame.
This industrial and residential mix is ringed with trees and the area is surrounded by a forest.
This gives the landscape a nontoxic appearance and bucolic setting.

Figure 2-3 National Summit of Mining Communities Logo (National Summit of Mining
Communities 2007)
The dangerous nature of mining work led to a deep sense of work camaraderie and
cooperation. It also often led to a sense of hard work and hard play. During the early years of
the camp, the Butte community styled itself as a wide open town (Brinig 1993, Murphy 1997,
National Park Service 2006). The dangerous nature of underground mining attracted workers
with a high tolerance for uncertainty, physical danger, and uprootedness, men for whom the
prospect of disabling injury or crushing indigence was always present, instilling in them an
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almost religious devotion to the pleasures of the moment(Dobb 1996). Gambling, drinking,
fighting, and prostitution flourished, owing largely to the male-dominated population and a large
working class. In later years, prohibition, a greater number of women in the community, and a
rising middle class did not alter this aspect of the cultural identity (Murphy 1997). Murphy notes
the excessive use of alcohol in Butte and describes early barrooms as theatres of excessive
machismo (Murphy 1997). This machismo often manifested in fighting and translated into
domestic violence away from work and socialization. This is perhaps correlated to the violent
nature of mining. A study of community needs in Butte-Silver Bow describes the city as having
the highest rate of domestic violence in the state and attributes this rate to the mining culture
(Butte-Silver Bow Health Department 2011a). It is worth noting that lead contamination has
also been linked to violent behavior, and lead is one of the contaminants of concern in Butte
(Denno 1990, Needleman 2002, Dietrich 2001, Wright 2008, Stretesky 2001).
2.2 Environmental Impact/Overview
Environmental contamination covers the Butte landscape. Mining operations left
millions of cubic yards of mine waste, including tailings, slag, smelter fall-out, and waste-rock
throughout the city, often in residential and recreational areas. There is no cultural denial of the
source or scale of the contamination. Undisturbed Rocky Mountain forest lands surround the
residential community and provide a natural baseline.
The largest physical reminder of the scale of Butte mining activities is the Berkeley Pit
and its ancillary tailings ponds, mine waste dumps, and leach pads. The Berkeley Pit, shown in
Figure 2-4, is the site of an open-pit copper mine that operated from 1955 to 1982. The
Anaconda Mining Company dewatered the 675-acre, 1.2x1010 cubic-foot pit and associated
underground mines during mining operations, but after mine closure, the company stopped
dewatering operations, and groundwater from underground mine workings flooded the pit (U.S.
EPA 2006a). This groundwater is connected to bedrock and alluvial aquifers and is known to
affect the groundwater flow within the alluvial aquifer (U.S. EPA 2006a).
Figure 2-4 provides an illustration of the landscape surrounding the Berkeley Pit. For
scale, the Berkeley Pit measures approximately 1.2 miles east to west and 1 mile north to south
(Pitwatch 2005). The tailings pond located directly north of the Pit, is known as the Yankee
Doodle Tailings Pond, is approximately 700 feet high and is the largest dam in Montana (State of
Montana, Department of Military Affairs 2010). The EPA designated 100 acres of the area
between the Berkeley Pit and the Yankee Doodle Tailings Pond as historic mining landscape,
and this area will not be reclaimed under Superfund clean-up efforts (BRA 2007a). The area
east of the Berkeley Pit is the location of the Montana Resources contemporary open-pit mining
operations. The pit north of the area labeled terraces in the photograph is known as the
Continental Pit, and it is quickly reaching the size and scope of the Berkeley Pit.
In 1995, 342 snow geese landed on the acidic waters of the Berkeley Pit and died from
burns to their internal organs and oral cavities. In a Harpers Magazine article regarding Butte,
Edwin Dobb stated: In each bird autopsied the oral cavity, trachea, and esophagus, as well as
digestive organs, like the gizzard and intestines, were lined with burns and festering sores. To
even so much as sip from the Pit, it seems, is to risk being eaten alive, from the inside out.
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(Dobb 1996) While community members believed that the birds died as a result of being
poisoned by the pit, ARCO spokespeople claimed that the birds died as a result of eating wheat
fungus (Adams 1995). Subsequent autopsies found that the community members were right
(Curtis 2004).
The main natural water body in the Butte valley is known as Silver Bow Creek. This
creek bisects the landscape and marks the division between uptown and downtown Butte. This
creek is one of the headwaters of the Clark Fork River, which eventually joins the Columbia
River on its way to the Pacific Ocean. Portions of Silver Bow Creek are now referred to as the
Metro Storm Drain. This drain is a man-made water conveyance used to transport storm water,
mine water, and sewage. Historically, the drain was used by the Anaconda Company to convey
wastewater from the Berkeley Pit. Silver Bow Creek currently begins at the confluence of the
Metro Storm Drain and Blacktail Creek and becomes a headwater of the Clark Fork River (U.S.
EPA 2006a). Currently, a group of community members are petitioning the State of Montana to
change the name of the current Metro Storm Drain to the original Silver Bow Creek (Silver Bow
Creek Headwaters Coalition v. State of Montana 2012).

Figure 2-4. Aerial View of Berkeley Pit Area in Butte in 2006 (NASA 2006)
Figure 2-5 illustrates the extent of contamination in Butte.

Figure 2-5. Extent of Major Contamination in Butte (Map by Author)

2.3 Superfund Designation
The EPA designated the Silver Bow Creek area as a Superfund site in September of 1983.
It then expanded the site in 1987, when it became the Silver Bow Creek/Butte Area NPL site.
This expansion did not include new mining activities (Montana Standard 1985b). The site
consists of several operable units, including: Butte Priority Soils (BPSOU), West Side Soils,
Streamside Tailings, Rocker Timber Framing and Treating Plant, and Warm Springs Ponds (U.S.
EPA 2006a). Groundwater, surface water, soils, and inhalable dust pose a threat to human health
and the environment at these sites. There is a general perception held by the community as well
as the EPA and the Potentially Responsible Parties that the extent of contamination is too large,
and consequently too costly, for total remediation or restoration (U.S. EPA 1994, PEER 2005,
BRA 2007a, BRA 2007b, CTEC 2008).

The Record of Decision for the Butte Priority Soils Operable Unit of the Butte Superfund
site (U.S. EPA 2006a) lists the following metals in elevated quantities in Butte soil, air, water,
and/or house dust: aluminum, arsenic, cadmium, copper, iron, lead, mercury, silver, zinc. As part
of the Superfund activities in the region, many soil, sediment, and water samples have been
collected in the Butte and Anaconda area during the past two decades. In particular, the database
submitted as part of the Remedial Investigation report for the BPSOU contains concentrations of
arsenic, cadmium, copper, lead, and zinc measured in approximately 2,700 soil samples collected
in the Butte area. Concentrations as high as 11,900 ppm arsenic; 56,100 ppm cadmium; 217,000
ppm copper; 67,100 lead; and 62,800 ppm zinc were observed (Butte GIS Department 2006).
Overall, areas of maximum environmental impact coincide with the historical mining, milling,
and smelting activities, but some of the samples collected outside of the BPSOU also had
elevated levels of arsenic, copper, lead, and zinc.
It is important to note that there is a second Superfund Site in Butte, the Montana Pole
Plant. This site operated from 1964 to 1984 as a wood-pole treatment plant that employed
pentachlorophenol and other wood preservatives in southwest Butte (MDEQ 2006). The site
contains several polycyclic aromatic hydrocarbons (PAHs), chlorophenols,
dioxin/diobenzofurans, and metals (MDEQ 2006). Chemicals at the site include:

2,3,7,8-tetrachlorodibenzofuran
(TCDF)
2,3,7,8-tetrachlorodibenzo-p-dioxin
(TCDD)
2,4,6-trichlorophenol
2,4-dichlorophenol
2,4-dinitrophenol
2,4-dinitrotoluene
2-chlorophenol
4-chloro-3-methylphenol
Acenaphthene
Anthracene
Arsenic
Benzo(b)fluoranthene
Benzo(ghi)perylene
Benzo(k)fluoranthene
Benzo(e)fluoranthene
Benzo[a]anthracene

Benzo[a]pyrene
Chromium (hexavalent)
Chrysene
Copper
Dibenzo(a,h)anthracene
Dioxins/dibenzofurans
Fluoranthene
Fluorene
Indeno(1,2,3-cd)pyrene
Lead, inorganic
Manganese
Naphthalene
PAH
Pentachlorophenol
Phenanthrene
Pyrene
Zinc

2.4 Risk Assessment Studies

The risk assessments performed for the Butte Priority Soils Operable Unit investigated
risks associated with arsenic and lead and did not investigate the other contaminants of concern.
Importantly, the synergistic, additive, and antagonistic toxicological aspects of the interactions
between the chemicals were never investigated. The BPSOU Superfund Program Cleanup
Proposal states that the highest concentrations of arsenic, lead, and mercury are in attic dust, but
because the attics are not considered living space, they are not considered in the risk assessment
(U.S. EPA 2004). This same document states: Although previous response actions have
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eliminated some exposure pathways in many areas, mining-related contaminants are still present
at concentrations that exceed acceptable risk levels. The document also reports that an
ecological risk assessment has not been performed because the site is in an urban setting (U.S.
EPA 2004). It is worth noting that Butte is in a rural setting in Montana, with numerous
ecological receptors. It is classified as a rural community by the U.S. Census Bureau because it
has a population less than 50,000 (U.S. Census Bureau 1995). Figure 2-6 illustrates the rural
nature of the Butte community.

Figure 2-6. View of Butte from Beef Trail Area, Looking North (Photo by Author)
The preliminary remediation goal of 250 milligrams per kilogram (mg/kg) for residential
arsenic represents a 1 in 10,000 cancer risk. This is significant because government agencies
such as the U.S. EPA and U.S. Food and Drug Administration commonly use 1 in 1,000,000 as
the acceptable risk level or de minimis risk level. Additionally, arsenic action levels in Butte for
commercial/industrial areas and open space areas used for recreational purposes are 500 mg/kg
and 1,000 mg/kg, respectively (U.S. EPA 2004). In a study regarding soil arsenic levels in
Records of Decision at Superfund sites, the average residential exposure ranges from 25.3 mg/kg
to 84.4 mg/kg and the average industrial exposure ranges from 62.5 mg/kg to 272.2 mg/kg,
depending on the target risk level (Davis 2001). The study notes that the demonstration of low
solubility and bioavailability of mine waste in the Anaconda area influenced the regulatory
decision to increase the residential and industrial standards (Davis 2001).
Risk assessments regarding lead were the basis of the current remediation goal of 1,200
mg/kg (ppm) lead in Butte soils. The EPA typically recommends a lead screening level of 800
ppm in soils for adults. The EPA considers lead concentrations over 1200 ppm as a Tier 1
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response level. Lead levels ranging from 400 to 1,200 ppm are considered Tier 2 response levels
(U.S. EPA 2003).
The lead risk assessments used for the Butte Superfund site studied only acute exposures
of 15 days, not the chronic exposure equivalent to Butte residential exposure (U.S. EPA 1993).
The lead remediation goal is based on Uptake Biokinetic (UBK) models that predict blood lead
in children aged 0-6. The preliminary remediation goal study was not based on Butte samples,
but was instead based on interpretations of studies in East Helena, Montana and Midvale, Utah
(U.S. EPA 1993). No actual data from Butte tap water, dust, or air samples were used in these
studies and urban air quality default values were used, even though Butte is a rural community
(U.S. EPA 1993). Additionally, pathways such as exposure from dermal contact, fetal uptake
and newborn uptake from the mother, and ingestion of food from gardens were ignored (U.S.
EPA 1993). The model also assumes that lead paint is the source of lead exposure, not lead in
mine waste (U.S. EPA 1993).
A subsequent bioavailability study in young swine tested lead absorption into organs over
a 15 day period (Casteel1998). While this study did use actual mine waste from Butte, it did not
use residential soils or attic dust. The chief problems with this study were as follows:

The 15-day test period is an acute exposure period

Results were determined based on concentrations found in the internal organs, which are
usually indicative of chronic exposure
The small sample size of 15 pigs made the study statistically insignificant
The high levels of calcium in the samples (16,000 ppm) likely competed with and
reduced lead absorption

Risk assessments evaluating the potential for adverse health effects from arsenic
exposure did not consider dermal pathways or exposure from sediment, surface water, or
groundwater (U.S. EPA 1997a). Bioavailability studies of arsenic in Butte mine wastes were the
basis for the current arsenic action levels. These studies used young swine as an animal model
for oral absorption of arsenic from soils. Casteels study emphasizes that it was meant to be used
as a preliminary estimate, not to set the final action levels and states When reliable data are
available for the bioavailability of arsenic in soil, dust, or other soil-like waste material at the
site, this information can be used to improve the accuracy of exposure and risk calculations at
that site (Casteel 1997). This study exposed 10 groups of 4-5 swine to arsenic-bearing soil for
15 days and then measured the arsenic in urine. The study used smelter slag and Clark Fork
River tailings, not soils from the Butte Priority Soils Operable Unit. The study had fundamental
trouble with the mixing of drinking water and urine samples and a mass balance analysis of
arsenic was able to show only 23-36% recovery. The data for relative bioavailability had
widespread variability, and this limits the reliability of the data (Casteel 1997). A subsequent
bioavailability study by the same researcher performed a similar test for 12 days using composite
soil samples from the Butte Priority Soils Operable Unit. Similarly, drinking water was mixed
with the swine urine samples (Casteel 2003). This study was used to reduce the relative
bioavailability of arsenic in Butte soils to 0.17-0.22 instead of the 0.8 value typically used by the
EPA.

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However, the arsenic was considered bioavailable by the Anaconda Company, who
packaged large quantities of arsenic produced at the Washoe Smelter and sold it as an insecticide
(MacMillan 2000). In 1923, for example, the value of Anacondas arsenic trioxide approached
the value of copper (MacMillan 2000). Figure 2-7 shows the arsenic warehouse in the middle
right portion of the map of the reduction works. The arsenic was obviously bioavailable if it
functioned as an insecticide. Chapter 8 of the dissertation includes a detailed explanation of
arsenic toxicity and associated health effects.

Figure 2-7. Sanborn Map Showing Arsenic Plant at Anaconda Companys Washoe
Smelter (Sanborn 1929)
Additionally, the Montana Pole Plant Superfund Site, located in southwest Butte,
contains several chemicals of concern, including polycyclic aromatic hydrocarbons (PAHs),
chlorophenols, dioxin/diobenzofurans, and metals (MDEQ 2006). Like the metals in the
BPSOU, these chemicals also have additive, synergistic, and antagonistic reactions. The cleanup
levels at the Montana Pole site are based on a 1 in 1,000,000 cancer risk level for recreational
land use at the site for each contaminant of concern for the most susceptible exposure pathway.
The selected remedy states that the area must be prohibited from residential use in the future

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because recreational and industrial cleanup levels are not protective of human health on a
residential basis (U.S. EPA 1993).
3.0 Previous Health Studies
A review of previous health studies helps to understand health issues faced by the Butte
community. These health studies focus on the time period of this study, 1950 forward.
Together, the studies detail elevated rates for several diseases, particularly cancer, and
demonstrate a need for a comprehensive study of disease rates in the city over time. These
studies are summarized in chronological order as follows.
3.1 Mortality from Cardiovascular and Non-Cardiovascular Diseases for U.S. Cities; 19491950, 1959-1961, 1969-1971 with Selected Environmental Descriptions.
This report, authored by the National Heart, Lung, and Blood Institute, Epidemiology
Branch, contains data for Butte showing total mortality counts along with more detailed tables
containing specification of cause, including cardio-vascular-renal, heart, non-cardio-vascularrenal, and cancer for the time periods 1949-1961 and 1969-1971. In an inventory of cities
ranked by cancer mortality rates in 1950, Butte is listed as having the eighth highest mortality
rate from cancer in the country. In this same list for the year 1960, Butte was ranked fifteenth
(National Heart, Lung, and Blood Institute 1971).
3.2 U.S. Cancer Mortality Rates and Trends, 1950-1979
Dr. Wilson B. Riggan compiled a study of cancer mortality rates and trends for the time
period 1950 to 1970. This resource contains three volumes that detail total cancer rates as well
as cancer types, which are further characterized by race and gender on a county level. The study
also provides cancer mortality rates for 1960-1969 and 1970-1979 as wells as percent change for
each type of cancer for the 1960s versus 1950s, 1970s versus 1960s; 1970s versus 1950s; and
1970s rates. The report also highlights any cancer mortality rates that are significantly more
than expected. The cancer mortality rates with this designation for Silver Bow County are
detailed below, separated by time period (Riggan, National Cancer Institute, 1983). Silver Bow
County cancer deaths that occurred at significantly higher rates than expected are as follows:
1950-1959
all cancers in white males
all cancers in white females
cancer of the large intestine in white females
liver and gallbladder cancer in white males
cancer of the trachea, bronchus, and lung in white males
cancer of the trachea, bronchus, and lung in nonwhite females
connective and soft tissue cancer in white females
leukemia in nonwhite males
secondary site and previously unlisted cancers in white males
secondary site and previously unlisted cancers in white females
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1960-1969
liver and gallbladder cancer in white males
cancer of the trachea, bronchus, and lung in white males
1970-1979
all cancers combined in white females
salivary cancer in white females
rectal cancer in white males
liver and gallbladder cancer in white females
pancreatic cancer in white females
cancer of the nose, nasal cavities, middle ear, and accessory sinuses in white
females
cancer of the trachea, bronchus, and lung in white females
connective and soft tissue cancer in nonwhite males
bladder cancer in nonwhite females
kidney cancer in nonwhite males
Hodgkins Disease in white females
multiple myeloma in nonwhite males
This study shows a clear negative health issue in Butte. The cancer rates are significantly
higher than expected in all cancer, internal organ cancers, and in many other sites. The elevated
rates are consistent over time, indicating a chronic cause. It is also seen in both males and
females, indicating that the source does not stem from exposure to work in the mine, which was
almost exclusively done by men.
3.3 Mutagen Screening in an Isolated High Lung Cancer Area of Montana, June 1979
The Montana Department of Health and Environmental Science conducted a mutagen
screening study in Anaconda and Butte in 1979. The study attempted to determine whether the
presence of mutagenic substances in the urine of school children could be correlated with air
pollution in the study areas. The study employed the Ames test to determine mutagenicty. The
study was prompted by high lung cancer death rates in Deer Lodge and Silver Bow Counties
(Montana Department of Health and Environmental Sciences 1979). The introduction refers to
studies performed by the Montana Department of Health and Environmental Sciences and the
National Cancer Institute that show lung cancers in Silver Bow and Deer Lodge counties at twice
the national rate. This study was conducted at the Monroe school in Butte and the Lincoln
school in Anaconda in May and October 1978.
Of the 47 children sampled in Butte in May, seven had significantly high levels of
mutagens. None of the Anaconda children had significantly high levels of mutagens. Butte
children with the highest mutagen levels lived near Front Street. A second study in Butte was
conducted at the Emerson school in October. The Monroe students had higher levels than the
Emerson children at this time, and the four Emerson children who had significantly high
mutagen levels lived relatively close to Front Street. The authors theorize that the Front Street
area is close to the railroad tracks and the tracks could be a source of contamination.

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Researchers also analyzed mutagen levels in filter samples of atmospheric pollutants.

The May 1978 samples indicated that the particulate air pollutants in Butte were more mutagenic
than those in Anaconda.
3.4 Histologic Types of Bronchogenic Carcinoma among Members of Copper-Mining and
Smelting Communities, 1976
This study, authored by Dr. John A. Newman of St. James Community Hospital,
investigated lung cancer rates in Butte and Anaconda. The study found elevated rates of lung
cancer in Butte men and women and in Anaconda men. It also found that the county areas
outside of Butte and Anaconda do not have significantly elevated lung cancer rates for men or
women. Newman states that he based this article on his pathology records at St. James. When
questioned, the hospital would not provide these records.
3.5 Relationship between Human Health and Inhalable Particulates, Montana Air
Pollution Study, 1980
The Montana Department of Health and Environmental Sciences conducted a study of
pulmonary-ability tests in Anaconda, Butte, Missoula, Great Falls, and Billings. There were no
significant findings that correlated directly to Butte. In Anaconda, males tested about average,
the Anaconda females were unusually low (Montana Department of Health and Environmental
Sciences 1980).
3.6 Arsenic and Respiratory Cancer in Humans: Follow-Up of Copper Smelter Employees
in Montana, 1983.
This study is a continuation of a study of workers employed at the Anaconda smelter.
The smelter workers were exposed to varying levels of arsenic trioxide. The study compiled
mortality rates in 8,045 white male workers from the 1938 to 1977 time period to investigate the
role of arsenic in carcinogenesis in humans. The study compared cancer rates of this group to
the white male population in the region.
The mortality rates of the smelter employees were elevated for respiratory cancer and
heart diseases. To better understand the respiratory cancer mortality rates, the study analyzed the
date of mortality with respect to the date of hire, length of employment, and degree of exposure
to arsenic trioxide and sulfur dioxide (Lee-Feldstein 1983). Respiratory cancers were seven to
eight times higher than expected in those first employed prior to 1925 that had heavy or
moderate exposure to arsenic trioxide. The respiratory cancer rates were greater than four times
than expected in those employed from 1925 to 1947 with heavy exposure. The respiratory
cancer mortality rate increased in direct proportion to degree of arsenic trioxide exposure. The
study concluded that inhaled arsenic trioxide is the primary agent associated with the excess
respiratory cancer, with sulfur dioxide perhaps enhancing the effect (Lee-Feldstein 1983).

15

3.7 Cumulative Exposure to Arsenic and its Relationship to Respiratory Cancer among
Copper Smelter Employees, 1976.
This study is a continuation of the epidemiology study of workers employed at the
Anaconda smelter (Lee-Feldstein 1983). This study estimated amounts of arsenic trioxide
exposure. The estimations were based on industrial hygiene reports for various work areas and
the average concentrations in the smelter. Respiratory cancer mortality rates were then analyzed
by time of first employment and maximum lifetime arsenic trioxide exposure. Arsenic trioxide
exposure was estimated with arithmetic means of measured concentrations.
For the cohort employed prior to 1925, respiratory cancer mortality rates increased
linearly with increasing cumulative exposure group, ranging from two to nine times expected
(Lee-Feldstein 1986). For the cohort first employed during the 1925 to 1947 time period,
respiratory cancer mortality rates also increased linearly with increasing cumulative exposure.
3.8 Respiratory Cancer in a Cohort of Copper Smelter Workers: Results from More Than
50 Years of Follow-up, 2000.
In a continuation of the Anaconda smelter cohort, this study investigated white male
workers employed prior to 1957 for greater than 12 months. The mortality statistics for this
study are for the January 1, 1938, through December 31, 1989, time period. At the time of the
article, 62% of the cohort (8,014 men) was deceased, with 446 deaths attributed to respiratory
cancer. The study determined that there were significantly increased standardized mortality
ratios (SMRs) for all causes (SMR = 1.14), all cancers (SMR = 1.13), respiratory cancer (SMR
= 1.55), diseases of the nervous system and sense organs (SMR = 1.31), nonmalignant
respiratory diseases (SMR = 1.56), emphysema (SMR = 1.73), ill-defined conditions (SMR =
2.26), and external causes (SMR = 1.35). While the study concluded that respiratory cancer
was the only cause of death correlated to inhaled arsenic trioxide exposure, it also determined
that there was a significant, linear increase in the excess relative risk of respiratory cancer with
increasing exposure to inhaled airborne arsenic. The estimate of the excess relative risk per
mg/m3-year was 0.21/(mg/m3-year) (95% confidence interval: 0.10, 0.46) (Lubin et. al. 2000).
3.9 An Ecologic Study of Skin Cancer and Environmental Arsenic Exposure, 1992.
This study investigated skin cancer rates in Silver Bow County, Deer Lodge County,
Gallatin County, and Park County. The Silver Bow and Deer Lodge county populations were
assumed to have an increased exposure to arsenic from the mine waste and smelter, and Gallatin
and Park counties were considered controls with no excess arsenic exposure. The study included
the collection of skin cancer incidence rates from dermatologists and pathology services in these
counties and in urban referral areas adjacent to the counties. The study determined that the skin
cancer incidence rates in the control counties were higher than in Silver Bow or Deer Lodge
counties. It also determined that clinical features of the skin cancers in the exposed counties
were not similar to those described for arsenic-related skin cancer (Wong et al. 1992).

16

3.10 An Epidemiological Study to Determine if Heavy Metals are a Factor in the Etiology of
Amyotrophic Lateral Sclerosis, 1995.
This study reported higher rates of Amyotrophic Lateral Sclerosis (ALS), also known as
Lou Gehrigs disease, in Butte on a consistent historical basis, as seen in the Table 3-1 (Satterly
1995). As with standardized mortality ratios (SMR), a ration value greater than one indicates
that there is a greater incidence in Butte than in the United States.
Table 3-1. ALS Incidence Rates in Butte
Cases of ALS in Time Span Total Population
Butte
5
1943-1950
37,000
5
1950-1960
28,000
8
1960-1970
28,000
9
1970-1980
42,000
22
1980-1993
35,000

Butte Incidence vs.

National Incidence Ratio
1.930
1.790
2.857
2.143
4.840

3.11 Health Consultation: Silver Bow Creek/Butte Area, Butte-Silver Bow and Deer Lodge
Counties, Montana, 2002.
This study compares cancer incidences in Silver Bow County to the state of Montana and
to the United States for the years 1979 to 1999. The study investigates six types of cancer
(urinary bladder, kidney, liver, lung, prostate, and skin) because these cancer types are most
often linked to arsenic exposure. The study concluded that Silver Bow County had higher cancer
rates than the rest of Montana, and higher rates than the rest of the U.S., in at least one age group
for all six types of cancer except prostate cancer, which was lower than the national average but
higher than the rest of Montana (Dearwent and Gonzales 2002).
3.12 U.S. National Cancer Institutes of Health State Cancer Profiles, 2004.
In 2004, Silver Bow County was the only county in Montana that was assigned a
Priority 1 index by the National Cancer Institute, in 2004. Priority 1 indicates an area where
the annual death rate from cancer is above the national rate, and an area that also exhibits a rising
trend of deaths from cancer. Table 3-2 summarizes these findings (U.S. National Cancer
Institute of Health 2004).
Table 3-2. Cancer Mortality in Silver Bow County, United States, and Montana 2004
Area
Annual Cancer
Higher or lower
Annual
Rising, Stable, or
Deaths per
than the National
Percent
Declining
100,000 people
Rate?
Change
Trend?
Silver Bow
238.6
Higher
+3.2
Rising
County
Montana
United States

195.0
199.8

Lower

17

-0.6
-1.1

Declining
Declining

3.13 U.S. National Cancer Institutes of Health State Cancer Profiles, 2001-2005
Recent cancer mortality rate information, shown in Table 2-3, indicates that the rate of
cancer mortality continues to increase, but the rate of increase of 12.9% is considered stable by
the National Cancer Institute. It is important to note that the annual percent change for the 2004
data of 3.2% increases to 12.9% for the 2001 to 2005 time period (U.S. National Cancer Institute
of Health 2009).
Table 3-3. Cancer Mortality in Silver Bow County, US, and Montana 2001-2005
Area
Annual Cancer Higher or Lower
Annual
Rising, Stable, or
Deaths per
than the
Percent
Declining Trend?
100,000 people
National Rate?
Change
Silver Bow
205.5
Higher
+12.9
Rising
County
Montana
186.6
Lower
-0.9
Declining
United States

189.8

-1.8

Declining

The National Cancer Institute also provides county-level data for cancer incidence and
mortality. Table 3-4 is a summarization of the information provided in the State Cancer Registry
for 2001-2005. The incidence rates and mortality rates for Silver Bow County are marked in
bold if the rate is higher than national or state rates. The data indicate that there are elevated
incidence rates of total cancer; bladder; kidney and renal pelvis; leukemia; lung and bronchus;
pancreas; prostate; and melanoma of the skin. It also indicates elevated mortality rates for total
cancer; bladder; leukemia; lung and bronchus; pancreas; and prostate cancer.
Table 3-4 Cancer Incidence and Mortality Rates 2001-2005
Cancer Site
Silver Bow County
United States
Total Cancer (Incidence)
417.7
468.2
Total Cancer (Mortality)
205.51
189.8
Bladder (Incidence)
25.4
21.7
Bladder (Mortality)
8.9
4.3
Kidney & Renal Pelvis
12.5
13.9
(Incidence)
Leukemia (Incidence)
13.9
12.3
Leukemia (Mortality)
8.7
7.4
Lung and Bronchus
68.4
69.1
(Incidence)
Lung and Bronchus
65.8
54.4
(Mortality)
Non-Hodgkin Lymphoma
9.1
19.2
(Incidence)
Oral Cavity and Pharynx
9.7
10.6
(Incidence)
Pancreas (Incidence)
9.6
11.3
18

Montana
471.9
186.6
23.8
4.7
12.5
13.6
7.5
66.7
53.3
18.8
10.5
10.3

Pancreas (Mortality)
Prostate (Incidence)
Prostate (Mortality)
Melanoma of the Skin
(Incidence)
Uterus (Incidence)

11.5
163.6
27.2
20.7

10.6
157.0
26.7
17.5

9.9
182.8
29.2
16.7

18.4

23.7

24.7

These health studies show historic elevated rates of cancer and ALS in Butte. This
correlates with community health concerns expressed in the Medical Professionals Survey in
Chapter 7 of the dissertation, and the longitudinal mortality study discussed in the following
section and in Chapter 8 of the dissertation.
4.0 Longitudinal Epidemiology Study
While there are several studies regarding contamination extent and remediation
alternatives in Butte, there has not been an in-depth study of chronic exposure and long-term
health impacts for residents exposed to a mix of contaminants in the soil, air, and water on a
daily basis. Contemporary investigations into other populations that live in areas containing
mine waste have shown elevated adverse health impacts, particularly in children (Hu et al., 2007;
Wright et al., 2006; Mayan et al., 2006; Ferreccio et al., 2006). Of the contaminants present in
elevated quantities in Butte, arsenic is a known carcinogen that can have neurological,
cardiovascular, respiratory, renal, hepatic, dermal, musculoskeletal, and endocrine effects
(Watson et al., 2007; Kapaj et al., 2006; Tchounwou et al., 2006; Tsuji et al., 2004; SzymaskaChabowska et al., 2002). Aluminum, cadmium, chromium, lead, mercury, molybdenum, copper,
zinc, and manganese are also present in Butte. These metals can also have toxic effects on the
neurological, cardiovascular, respiratory, renal, hepatic, dermal, musculoskeletal, and endocrine
systems (Aschner et al., 2007; Bressler et al., 2007; Houston et al., 2007; de Burbure et al., 2006;
Jrup, 2003; Lech, 2002). Butte is well suited for a longitudinal epidemiology study because of
its size and well-defined contamination. Additionally, the current population in Butte is
relatively static, and few residents move out of the area. In fact, many residents are third or
fourth generation residents (Hollis 2011, U.S. Census Bureau 2011a, U.S. Census Bureau
2011b).
It is extremely difficult to track disease occurrence rates, because of the Health Insurance
Portability and Accountability Act (HIPAA) privacy laws, however, so this study instead focused
on mortality rates, which are reported to the Centers for Disease Control (CDC). These data are
reported on a county level. This assures that the data are valid, do not contain bias, and that
personal identities are kept confidential. By determining the mortality rates in Butte and then
comparing these rates to the mortality rates for the State of Montana and the United States as a
whole, it is possible to gain an understanding about the effect living in the Butte area has on the
health of the community. This line of reasoning is consistent with environmental epidemiology
methods that attempt to correlate environmental exposure to disease incidence and mortality
(Merrill 2008). It is important to note that while some conclusions can be made based on
toxicological information, these conclusions are correlations and cannot prove causation.
Cultural influencing factors, also discussed in this section, must be considered as contributing
factors to elevated or decreased mortality rates.
19

The mortality data cover two time periods: 1978-1998 and 1999-2007. In addition to the
general objective of performing a longitudinal mortality analysis, Table 4-1 contains four
practical questions that will be addressed in this project, including the corresponding hypotheses
to be tested.
Table 4-1. Longitudinal Study Questions and Hypotheses
Question
Hypotheses to Be Tested
1. What are the mortality rates in
H0: The majority of mortality rates in Butte are less
the Butte Superfund area and how
than Montana and the United States.
do they compare to Montana and the
United States?
H1: The majority of mortality rates in Butte are greater
than Montana and the United States.
2. Do the two time periods have
H0: Mortality rates in Butte do not fluctuate over time.
different mortality rates in Butte?
H1: Mortality rates in Butte fluctuate over time.
3. Can remediation be correlated to H0: Mortality rates in Butte do not decrease after
a decrease in mortality rates?
remediation.

4. Is there a correlation between the

target systems of concern in Butte
and the cause of mortality?

H1: Mortality rates in Butte decrease after remediation.

H0: Mortality rates in Butte do not correlate with the
target systems of concern.
H1: Mortality rates in Butte do correlate with the target
systems of concern.

4.1 Longitudinal Epidemiology Study Methods

To compile and interpret the mortality statistics in Butte-Silver Bow County, this study
developed standardized mortality ratios (SMR) for all reported diseases. The mortality data for
diseases in Butte-Silver Bow County, the state of Montana, and the United States were obtained
from the Centers for Disease Control (CDC) WONDER database for the years 1978-1998 and
1999-2007. There are two data sets because the Centers for Disease Control began a different
reporting system, ICD 10, in 1996, as a replacement for the ICD9 codes used for the 1978-1998
data. The two data sets also provide a mechanism to understand whether there were changes in
mortality rates after remediation began in the Butte area.
A standardized mortality ratio is calculated by comparing the number of observed deaths
from a specific disease in Butte-Silver Bow County to the number of deaths from the same
specific disease in the United States as a whole. A second set of data was also developed by
comparing the Butte rates to the State of Montana rates. The SMRs were determined by the
following equation (Merrill 2008):
SMR = Observed Mortality Rate Expected Mortality Rate

20

Where the observed rate is the Butte mortality rate. The expected rate was determined by the
following equation, also based on Merrill:
Expected Mortality Rate = Observed Population x Comparison Mortality Rate
Where the observed population is the population of Butte-Silver Bow County and the
comparison mortality rate is the National mortality rate or the State of Montana mortality rate,
depending on which group is serving as the comparison group.
The 95% confidence intervals were developed by using Merrills equation:
/Expected Mortality Rate.

This method was used to answer all four hypotheses of the health study. The SMRs show
whether the mortality rate in Butte is greater than the national average, whether the mortality rate
changes over time, whether the mortality rate decreases after remediation of portions of the Butte
Superfund area, and whether the mortality rates correlate with the target systems of concern.
4.2 Chemicals of Concern
The Record of Decision for the Butte Priority Soils Operable Unit of the Butte Superfund
site (U.S. EPA 2006a) lists the following metals found to be in elevated quantities in Butte soil,
air, water, or house dust: aluminum, arsenic, cadmium, copper, iron, lead, mercury, silver, zinc.
Additionally, the Montana Pole Plant Superfund Site, located in southwest Butte, contains
several polycyclic aromatic hydrocarbons (PAHs), chlorophenols, dioxin/diobenzofurans, and
metals, all listed in table 8-1 (MDEQ 2006). In a study of domestic dogs as biosamplers of
mining contamination in Butte, the following eight elements were identified as elements of
concern (Peterson 2007): aluminum, arsenic, boron, lead, lithium, manganese, molybdenum,
selenium.
To ensure all chemicals of concern in Butte are addressed in this toxicology study, the
author conducted an interview with Butte-Silver Bow Reclamation Manager Tom Malloy in
March of 2008. Mr. Malloy suggested the addition of asbestos and nitrates to the lists of
chemicals of concern. Asbestos is present uptown Butte buildings, structures, and pipelines, and
nitrate contamination occurs in south Butte and Silver Bow Creek (Malloy 2008). The list of
chemicals of concern was then sent to the Butte Health Department and was approved by the
director (Larson 2008). Based on the aforementioned investigations and discussions, the
chemicals in Table 4-2 are considered to have a potential health effect on Butte residents.

21

Table 4-2. Butte Chemicals of Concern

Metals

Polycyclic Aromatic Hydrocarbons

(PAHs)
2,4-dinitrotoluene
Acenaphthene
Anthracene
Benzo(b)fluoranthene
Benzo(e)fluoranthene
Benzo(ghi)perylene
Benzo(k)fluoranthene
Benzo(e)fluoranthene
Benzo[a]anthracene
Benzo[a]pyrene
Chrysene
Dibenzo(a,h)anthracene
Fluoranthene
Fluorene
Indeno(1,2,3-cd)pyrene
Naphthalene
Phenanthrene
Pyrene
Other
Asbestos
Nitrates

Aluminum
Arsenic
Boron
Cadmium
Chromium
Copper
Iron
Lead
Lithium
Manganese
Mercury
Molybdenum
Selenium
Silver
Zinc
Dioxins/dibenzofurans
2,3,7,8-tetrachlorodibenzofuran (TCDF)
2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)
Chlorophenols
2,4,6-trichlorophenol
2,4-dichlorophenol
2,4-dinitrophenol
2-chlorophenol
4-chloro-3-methylphenol
Pentachlorophenol
4.3 Toxicology of the Chemicals of Concern

Toxicology studies in the dissertation describe the effects resulting from chronic
exposure to each of the contaminants of concern. The chemicals are grouped into five
categories: metals, PAHs, dioxins/dibenzofurans, chlorophenols, and others. Toxicity
encompasses adverse impacts such as degeneration, alteration, mutation, or necrosis.
4.4 Target Organs
The target organ is the organ that receives the highest toxic effect or receives severe
damage from a toxicant. A toxicant, or chemical, can have several target organs, and several
chemicals can have the same target organ.

22

4.5 Interactions of the Chemicals of Concern

There is limited information regarding the toxicology of chemical mixtures. However
there is a wide variety of known interactions between the chemicals of concern in Butte.
Typically, chemical compounds elicit an additive effect when administered together. In an
additive interaction, the toxic effects of a mixture are approximately equal to the sum of the
exposure levels, weighted for potency (U.S. Department of Health and Human Services 2004a).
However, synergistic or antagonistic reactions can also occur. In a synergistic interaction, the
effects of the mixture are greater than the effects that would result in an additive interaction. In
an antagonistic interaction, the effects of the mixture are less than the effects expected from an
additive interaction (U.S. Department of Health and Human Services 2004a).
4.5.1 Interaction of Metals
While little is known about the toxicity of chemical mixtures, there have been several
investigations into the toxicology of metals as a group. Recent studies correlated metals
exposure to immune system toxicity (Stejskal 1999, Carey 2006). One of these studies showed a
correlation between metals exposure and immune system toxicity and an increased incidence of
rheumatoid arthritis, ALS (Amyotrophic lateral sclerosis, often referred to as Lou Gehrigs
Disease), and multiple sclerosis (Stejskal 1999). The study points to clusters of multiple
sclerosis in metal-contaminated areas as further incidence of metals correlation to increased
incidence. The paper also describes the effects of chronic low-dose exposure to metals and
suggests that longitudinal studies are the best way to measure these effects. It attributes four
mechanisms in metal-induced toxicity: free-radical formation, local toxic effects, inflammation,
and calcification.
While approximately 10% of ALS cases are attributed to genetic predisposition, the study
also points to environmental factors. An epidemiology study of 170 twin pairs found that only
two pairs had both twins develop ALS, indicating a strong role of environmental factors. Several
other studies have shown ALS disease clusters in metal- contamination areas (Sienko 1990,
Provinciali 1990, Mitchell 1987). An additional study of Parkinsons disease mortality rates in
Michigan showed correlation to metals exposure from industrial processes (Benjamin 2004).
4.6 Toxicology Findings
Based on the toxicology information provided in the dissertation, several adverse health
effects could occur in Butte as a result of environmental exposure to the chemicals of concern.
Table 4-3 lists the adverse health effects associated with the chemical groups. The toxicity noted
in this list includes adverse effects such as degeneration, mutation, necrosis, and cancer.

23

Table 4-3. Health Effects Associated with Butte Chemicals of Concern

Metals
Polycyclic Aromatic Hydrocarbons
(PAHs)
Neurotoxicity
Immune toxicity
Circulatory toxicity
Vascular toxicity
Respiratory toxicity
Dermal toxicity
Hepatic toxicity
Gastrointestinal toxicity
Renal toxicity
Neoplasms
Gastrointestinal toxicity
Dioxins/dibenxofurans
Hematological toxicity
Neurotoxicity
Musculoskeletal toxicity
Renal toxicity
Dermal toxicity
Internal organ toxicity
Immune toxicity
Musculoskeletal toxicity
Endocrine disruption
Hematological toxicity
Neoplasms
Immune toxicity
Diabetes Mellitus
Endocrine disruption
Internal organ toxicity
Neoplasms
Genitourinary System
Genitourinary System
Chlorophenols
Asbestos
Hepatic toxicity
Respiratory toxicity
Leukemia
Gastrointestinal toxicity
Immune toxicity
Immune toxicity
Endocrine disruption
Nitrates
Neoplasms
Circulatory toxicity
Genitourinary System
Hepatic toxicity
By combining the health effects for each group of chemicals, the following list of target
systems associated with toxicity from exposure to the chemicals of concern in Butte is produced:

Circulatory System
Digestive System
Endocrine System
Genitourinary System
Musculoskeletal System
Nervous System
Respiratory System

4.7 Longitudinal Epidemiology Study Results

Because there is a large amount of data, the longitudinal epidemiology study results are
summarized in tables in Appendix A. A brief, pared down sample set of this data is provided in
this section in tables 4-5 to 4-12. The sample shows the SMRs for all diseases for the years 19992007 for the Butte compared to the United States dataset. These tables include the upper and
lower 95% confidence intervals. As seen in tables 4-5 to 4-12, all SMR values fall between the
lower and upper confidence intervals, indicating that they are statistically reasonable values.
24

Because the results show a clear increase in mortality rates for all diseases in both time periods,
the reader is sincerely encouraged to reference the appendix to gain an understanding of the
gravity of the data.
For brevity and because datasets with fewer than 20 data-points deaths are not considered
statistically significant, the following tables were filtered to only show diseases with greater than
20 deaths. To obtain the best quality of data possible, the genders were combined in this data.
By combining the groups, a larger number of cases (Observed N) was possible, making the data
more statistically significant. This is an additional reason for grouping the years together. In a
larger population, a year-by-year epidemiologic study might be possible, but because the Butte
population is relatively small, a statistically sound study showing both genders for yearly data is
not possible. The diseases reported by CDC WONDER that have greater than 20 data points in
Silver Bow County fall under the following classifications:

Circulatory System
Digestive System
Endocrine System
Genitourinary System
Mental and Behavioral Disorders
Musculoskeletal
Neoplasm
Nervous System
Respiratory System

The SMR values that are greater than one, indicating that the mortality rate in Butte-Silver Bow
is higher than Montana or the United States, are shown in bold. In the 1997-1998 dataset, the
SMR values that increased, compared to the 1979-1998 dataset are highlighted.
4.7.1 1999-2007, Butte Compared to the United States, Greater than 20 Data Points
Table 4-5. Diseases of the Circulatory System 1999-2007, Butte Compared to US
Cause of Death
SMR Lower CI Upper CI
Atherosclerotic heart disease
1.59
1.94
1.76
Acute myocardial infarction, unspecified
0.91
0.78
1.06
Stroke, not specified as hemorrhage or infarction
1.55
2.13
1.83
Atherosclerotic cardiovascular disease, so described
1.81
2.51
2.15
Congestive heart failure
2.02
2.84
2.41
Cardiomyopathy, unspecified
1.55
2.85
2.15
Essential (primary) hypertension
1.76
3.50
2.55
Endocarditis, valve unspecified
3.21
7.11
4.97
Intracerebral hemorrhage, unspecified
0.91
2.04
1.42
Atrial fibrillation and flutter
1.12
2.72
1.83

25

Table 4-6. Diseases of Digestive System 1999-2007, Butte Compared to US

Cause of Death
SMR
Lower CI
Other and unspecified cirrhosis of liver
1.24
1.88
Gastrointestinal hemorrhage, unspecified
2.16
3.31
Alcoholic cirrhosis of liver
1.65
2.63
Table 4-7. Diseases of Endocrine System 1999-2007, Butte Compared to US
Cause of Death
SMR Lower CI
Unspecified diabetes mellitus, without complications
1.43
1.80

Upper CI
2.66
4.71
3.84

Upper CI
2.23

Table 4-8. Diseases of Genitourinary System 1999-2007, Butte Compared to US

Cause of Death
SMR
Lower CI
Upper CI
Unspecified renal failure
0.74
1.75
1.19
Urinary tract infection, site not specified
1.56
3.1
2.26
Table 4-9. Mental & Behavioral Disorders 1999-2007, Butte Compared to US
Cause of Death
SMR
Lower CI
Upper CI
Unspecified dementia
0.96
1.60
1.26
Table 4-10. Neoplasms 1999-2007, Butte Compared to US
Cause of Death
SMR
Bronchus or lung, unspecified
1.53
Colon, unspecified
1.95
Breast, unspecified
1.30
Pancreas, unspecified
1.47
Malignant neoplasm of prostate
1.39
Malignant neoplasm without specification of site
1.20
Bladder, unspecified
2.05
Esophagus, unspecified
1.74

Lower CI
1.35
1.57
0.98
1.08
1.01
0.83
1.35
1.10

Upper CI
1.73
2.38
1.67
1.92
1.84
1.65
2.90
2.52

Table 4-11. Diseases of the Nervous System 1999-2007, Butte Compared to US

Cause of Death
SMR
Lower CI
Upper CI
Alzheimer's Disease, unspecified
1.41
2.07
1.72
Parkinson's Disease
0.72
1.71
1.16
Multiple Sclerosis
2.09
6.37
3.94
Table 4-12. Diseases of the Respiratory System 1999-2007, Butte Compared to US
Cause of Death
SMR
Lower CI
Upper CI
Chronic obstructive pulmonary disease, unspecified
2.37
3.00
2.67
Pneumonia, unspecified
0.96
1.55
1.23
Emphysema, unspecified
1.48
2.94
2.15

26

4.8 Interpretation of Health Study Results

To interpret the SMR results, it is worth viewing the data as a complete set first. By
viewing the dataset as a whole, it can be seen that the majority of the diseases have SMR values
over one. This result is as important as the individual disease rates because it points to a
systemic increased incidence of mortality for all causes in Butte-Silver Bow County compared to
both the State of Montana and the United States for both time periods. Clearly, there is an
increased risk of mortality in Butte-Silver Bow County. As noted previously, causation cannot
be proved, but correlation to the toxicity of the contaminants of concern will be examined in this
section.
When compared to Montana rates, all of the diseases of the circulatory system, with the
exception of congestive heart failure and unspecific causes, were greater than 1, indicating a
higher rate of mortality for these causes in Silver Bow County than the State of Montana. The
majority of the SMR values ranged between 1 and 2, with coronary atherosclerosis having
double the State of Montana rate.
Other and unspecified rheumatic heart disease had an SMR value of 3.75. When
compared to the national rates, all of the diseases, with the exception of congestive heart failure,
unspecific causes, and unspecified cerebral artery occlusion were greater than 1. Generalized
and unspecified atherosclerosis, pulmonary embolism and infarction, cerebral atherosclerosis,
and unspecified heart failure had SMR values over double the national rate. Other and
unspecified rheumatic heart disease had an SMR value of 6.14. Toxicology of arsenic shows
an increased incidence of cardiovascular disease in cases of chronic exposure. Exposure to lead,
mercury, and iron can cause cardiovascular toxicity.
The digestive system mortality rates were all greater than 1 when compared to Montana
and national rates. Notably, colon, acute vascular insufficiency of intestine and cirrhosis of the
liver without mention of alcohol were over 2 in the Montana and national comparisons. This is
an important finding because arsenic toxicology indicates that arsenic exposure is correlated to
liver toxicity, including cirrhosis. In the national comparison, hemorrhage of the gastrointestinal
tract and unspecified intestinal obstruction were also over 2. From a cultural perspective, it is
interesting to note that alcoholic cirrhosis of the liver is 1.02 when compared to Montana and
1.12 when compared to national, indicating a potential cultural influencing factor. Arsenic is
also known to be toxic to the gastrointestinal system, as is chromium, lead, mercury, asbestos,
and PAH compounds.
The only disease of the endocrine system with greater than 20 cases is diabetes mellitus,
without mention of complication. Silver Bow County had a rate of 1.65 when compared to the
Montana and 1.61 when compared to national, indicating a consistently higher rate of mortality
from this cause. This is significant because toxicological information for arsenic shows a
correlation between arsenic exposure and an increased risk of diabetes mellitus. Chronic
exposure to elevated levels of iron is also correlated to diabetes mellitus.
The SMRs for the diseases of the genitourinary system differ slightly in the Montana and
national comparisons. In the Montana comparison, urinary tract infection mortality occurs in
27

Silver Bow County at 2.66 when compared to the Montana rate, but renal failure occurs at a
rated that is less than the state rate, with an SMR of 0.98. In the national comparison, urinary
tract infection mortality occurs in Silver Bow County at 1.48 times the national rate, and renal
failure occurs at 1.01 times the national rate. This indicates that the State of Montana has a
slightly higher incidence of renal failure, compared to the United States. Of the contaminants of
concern, arsenic, cadmium, chromium, lead, mercury, and dioxins are associated with renal
toxicity.
The mental and behavioral disorders pre-senile dementia and alcohol-dependence
syndrome are both greater than 1 when compared to Montana and are 3.16 and 2.6, respectively,
when compared to national. The elevated rates of alcohol-dependence syndrome indicate a
cultural influencing factor, particularly considering the elevated alcoholic cirrhosis of the liver
SMRs. Dementia can be associated with neurotoxicity. Aluminum toxicity has been correlated
to dementia, and arsenic, lead, manganese, and mercury are known to be neurotoxic.
The SMR values for rheumatoid arthritis are significantly elevated in both the Montana
(2.79) and national (5.16) comparisons. There is extensive research into causes for rheumatoid
arthritis. Exposure to environmental toxins is suspected of triggering the activation of the
immune system and causing the disease in susceptible individuals. As discussed in the metal
toxicology section, there is correlation between metals exposure and rheumatoid arthritis.
Infectious agents have been suspected, but there is no supporting evidence. It is suspected that
rheumatoid arthritis could be hereditary and this is a broad topic of research. Tobacco use is also
suspected to potentially play a role in causing rheumatoid arthritis.
All of the neoplasm (cancer) SMR values are greater than 1 in both the Montana and
national comparisons, with the exception of unspecified stomach neoplasms. Neoplasms of the
bronchus and lung, colon, breast (female), prostate, ovary, bladder, rectum, multiple myeloma,
brain, esophagus, kidney, and skin had SMRs that ranged between 1 and 2, and larynx was 2.9
when compared to Montana and 2.62 when compared to national. Both chronic and acute
neoplasms were greater than 1 in both comparisons, and chronic was 1.98 in the national
comparison, indicating a significantly elevated rate of chronic neoplasms. This dataset shows an
elevated incidence of cancer in Silver Bow County from the viewpoint of a state and national
comparison. These findings are significant considering the known carcinogenic properties of
arsenic, cadmium, chromium, PAH, dioxin, and asbestos. Specifically, bladder and skin cancer
are known correlates to arsenic exposure.
For diseases of the nervous system, all SMR values are greater than 1 in both the
Montana and national comparisons. Notably, multiple sclerosis had an SMR of 2.25 when
compared to Montana and 4.35 when compared to national. Alzheimers Disease and Motor
Neuron Disease SMR values are both more than double the national rate.
These findings are significant because several of the contaminants of concern are known
to be neurotoxic. Elevated exposure to aluminum has been correlated to an increased risk for
Alzheimers, ALS, and Parkinsons Disease (reported in this table as Paralysis Agitans).
Arsenic, lead, manganese, and mercury are also known to be neurotoxic. It is also an important

28

finding considering previous toxicology studies showing correlations between Parkinsons

Disease, Multiple Sclerosis, and ALS clusters in metal contaminated areas.
All of the disease of the respiratory system had SMR values greater than 1 in the
Montana comparison. In the national comparison, all of the diseases had SMR values greater
than 1, with the exception of bronchopneumonia, which had an SMR of 0.99. The asthma values
are particularly interesting, having rates of 2.21 compared to Montana and 3.16 compared to the
United States. Elevated exposure to chromium is known to have asthma as a potential toxic
effect. Additionally, arsenic, boron, cadmium, and asbestos are also known to elicit pulmonary
toxicity. The increased mortality rate for emphysema (1.19 Montana and 1.43 national) indicates
a potential cultural influencing factor of tobacco use.
The 1999 to 2007 data contain mortality rates for the time in Butte associated with
environmental reclamation throughout the city, particularly on the Butte Hill and Silver Bow
Creek. The majority of these SMR values are also over one.
All of the diseases of the circulatory system have SMR values greater than 1 in the
Montana comparison; in the national comparison, all but unspecified acute myocardial infarction
were greater than 1. In the Montana comparison, cardiomyopathy and essential hypertension had
values over 3, and atherosclerotic cardiovascular disease, atherosclerotic heart disease and
endocarditis had SMR values greater than 2. In the national comparison, endocarditis had an
SMR value of 4.97, and atherosclerotic cardiovascular disease, congestive heart failure,
cardiomyopathy, and essential hypertension had SMR values over 2.
When comparing these rates to the 1978-1998 rates, the majority of the diseases showed
a decreased SMR value. Congestive heart failure rates increased in both the state and national
comparison, as did intracerebral hemorrhage in the national comparison. Atherosclerotic heart
disease, atherosclerotic cardiovascular disease, and cerebral hemorrhage showed an increased
rate in the Butte-to-Montana rate and congestive heart failure and intracerebral hemorrhage
showed an increased rate in the Butte-to-national correlation.
All of the digestive system mortality rates were greater than 1 in when compared to
Montana and National rates. Unspecified cirrhosis of the liver and gastrointestinal hemorrhage
had values greater than twice the Montana rate, and gastrointestinal hemorrhage had an SMR
value over three times the national rate. Alcoholic cirrhosis of the liver had a rate of 1.82 when
compared to Montana and 2.63 when compared to national, indicating a potential cultural
influencing factor. This is a particularly interesting finding because the values increased from
the earlier dataset. It is also important to note that all of the SMRs for the diseases of the
digestive system increased in the 1999-2007 data.
The only disease of the endocrine system with greater than 20 cases is diabetes mellitus,
without mention of complication. Silver Bow County had a rate of 1.72 when compared to the
Montana and 1.82 when compared to national. Both of these rates show a higher incidence in
the 1999-2007 data.

29

Of the genitourinary system diseases, urinary tract infection mortality occurs in Silver
Bow County greater than twice the Montana and national rates. Renal failure occurs at less than
the Montana rate (0.96) but greater than the national rate (1.19). In both cases, the SMRs are
higher in the 1999-2007 data.
Unspecified dementia is the only mental and behavioral disorder with greater than 20
cases in Silver Bow County. It occurred at a lower rate than the state of Montana (0.9) but at a
higher rate than national (1.26). These results show a decrease in SMR values in the 1999-2007
data.
As with the 1979-1998 data, all of the neoplasm SMR values are greater than one, with
the exception of malignant neoplasm without specification of site in the Montana comparison. In
the national comparison this SMR is 2.05. In the Montana comparison, all of the neoplasms
SMRs increased in the 1999-2007 dataset, with the exception of malignant neoplasm without
specification of site. In the national comparison, bronchus or lung, colon, breast, prostate, and
bladder neoplasm rates increased.
In the nervous system dataset, Alzheimers Disease had an SMR greater than 1 in both
the Montana and national comparisons, and the Parkinsons Disease SMRs were less than the
Montana rate (0.97) but greater than the national rate (1.16). When investigating the nervous
system mortality rates, the decision to include Multiple Sclerosis rates, despite there being fewer
than 20 cases, stemmed from a community interest in the disease, as expressed in the medical
community survey. When surveyed about health issues in Butte, several respondents noted an
increased incidence or concern about an increased incidence of Multiple Sclerosis. Because the
number of deaths is less than 20, caution should be taken when interpreting this result because it
is not as statistically significant as a sample size that is greater than 20. The SMR for Multiple
Sclerosis is 1.97 compared to the Montana rate and 3.94 times the national rate. All of the SMR
values for neurological disease decreased in the 1999-2007 dataset.
All of the diseases of the respiratory system had SMR values greater than one in both the
Montana and national comparisons. Of these, chronic obstructive pulmonary disease and
emphysema showed increased mortality rates in both the Montana and national comparisons in
the 1999-2007 dataset.
4.9 Correlation to Target Systems
As seen in the previous SMR tables, the majority of the mortality rates in Butte-Silver
Bow County are greater than the Montana and national rates for disease in all of the target
systems. Table 4-14 provides a visual interpretation of these results, with the addition of mental
and behavioral disorders because they correlate to the nervous system and were reported by the
CDC separately. The highlighted Xs indicate that the mortality rates increased from the 19791998 dataset.

30

Table 4-13. Standardized Mortality Rates

Target System
SMRs over 1
SMRs over 1
Butte
Butte
Compared to
Compared to
Montana
National
1979-1998
1979-1998
Cardiovascular
X
X
Digestive
X
X
Endocrine
X
X
Genitourinary
X
X
Mental &
X
X
Behavioral
Musculoskeletal
X
X
Neoplasm
X
X
Nervous
X
X
Respiratory
X
X

SMRs over 1
Butte
Compared to
Montana
1999-2007
X
X
X
X

SMRs over 1
Butte
Compared to
National
1999-2007
X
X
X
X
X

Fewer than 20
X
X
X

Fewer than 20
X
X
X

4.10 Validity of Data

Appendix A contains the full set of data for the summarized results presented in the
previous sections. These tables contain the number of observed mortality cases, expected
number of cases, and the upper and lower 95% confidence intervals. Confidence intervals
provide the range of reasonable values in which the population of data resides. In other words,
the value of the SMR should fall between the lower and upper confidence interval to be
considered a reasonable value. The tables in this section and in Appendix A show that this is the
case for all of the data in this study. Additionally, the datasets are statistically significant because
each of the individual diseases have greater than 20 data points. Diseases with less than 20 cases
were collected and analyzed, as were mortality rates for both genders, but will not be reported as
a part of this report in order to ensure statistical significance in the dataset.
4.11 Inference on the Efficacy of Remediation
The data are presented in two time periods primarily because that is the way they are
reported by the CDC. To attain the highest sample size (and validity) possible for the Butte
population, these two groups are looked at as a whole, rather than on a year-by-year or gender
basis. This allows for an investigation into whether the rates change over time. This is an
interesting opportunity because the second set of data occurs well after remediation began in
earnest in Butte.
This dataset shows a decrease in mortality rates for mental and behavioral disorders,
potentially correlating to the lead remediation program. It also shows a decrease in neurological
disease rates. This could potentially correlate to the remediation of metals, including the
neurotoxins arsenic, aluminum, lead, manganese, and mercury. It also showed a decrease in
several cardiovascular diseases. It should be noted, however, that some of the cardiovascular
diseases for the 1999-2007 data do not correlate because of the change in ICD coding by the
CDC.
31

Unexpectedly, the dataset shows an increase in mortality rates for several diseases. All of
the diseases of the digestive system in both the Montana and national comparisons show an
increase in mortality rates. Diabetes mellitus also shows an increase in both cases. Unspecified
renal failure shows an increase in both cases also, but in the comparison of the Butte rate to the
Montana rate the SMR is less than one.
The neoplasm, or cancer, data is perhaps most interesting. In the Butte to Montana
comparison, all cancer mortality rates increase, with the exception of malignant neoplasm
without specification of site. In the Butte to national comparison, pancreas, esophagus, and
malignant neoplasm without specification of site mortality rates also decreased. All other rates
increased. This would indicate that remediation activities have not had an impact on cancer
mortality rates. This is important because several of the contaminants, including arsenic,
cadmium, chromium, PAH, dioxin, and asbestos are carcinogenic. The 1999-2007 respiratory
disease rates show a decrease in pneumonia mortality in both the state and national comparisons
but show an increase in chronic obstructive pulmonary disease and emphysema.
Overall, these results show a potential positive impact for several diseases but do not
indicate that remediation has had a positive impact on mortality rates. Table 4-14 contains a
summary of findings in the longitudinal epidemiology study, based on the original study
hypotheses.
Table 4-14. Longitudinal Study Questions and Hypotheses Accepted
Question
Hypotheses Accepted
1. What are the mortality rates in the Butte H1: The majority of mortality rates in Butte
Superfund area, and how do they compare are greater than Montana and the United
to Montana and the United States?
States.
2. Do the two time periods have different
H1: Mortality rates in Butte fluctuate over
mortality rates in Butte?
time.
3. Can remediation be correlated to a
decrease in mortality rates?
4. Is there a correlation between the target
systems of concern in Butte and the cause
of mortality?

Mortality rates in Butte both decrease and

increase after remediation.
H1: Mortality rates in Butte do correlate with
the target systems of concern.

4.12 Cultural Influencing Factors

There are several cultural influencing factors to consider as potential mechanisms of
influence when interpreting the longitudinal epidemiology data. A Behavioral Risk Factor
Surveillance system collected for the state of Montana showed that Butte-Silver Bow has a high
rate of overweight people but a lower number of obese people and a higher number of smokers
and heavy drinkers than the rest of the state (Butte-Silver Bow Health Department 2011a).
These findings could correlate with elevated rates of diabetes mellitus and emphysema.
However, Butte-Silver Bow has the same diabetes rate as the state of Montana.
32

The Behavioral Risk Factor System also reported that Butte has a higher rate of drug
abuse, including alcohol, and this could correlate to the elevated rates of alcoholic cirrhosis of
the liver. According to the Butte Community Needs Assessment, authored by the local hospital
and Butte-Silver Bow Health Department, The culture of alcohol abuse is well known among
Butte citizens and the communitys reputation throughout Montana as a hard drinking town is
not without merit.The DUI crime rate was 20% higher than the rate for Montana overall
perhaps the most alarming is that 35% of those convictions are repeat offenders (Butte-Silver
Bow Health Department 2011a).
In a further description of substance abuse, this needs assessment correlated substance
abuse to the mining culture of Butte. Butte-Silver Bow has a deeply rooted culture of substance
abuse that presents a risk to public health. This culture must be understood within Buttes origins
as a mining camp its mining legacy lives on. For many, over eighty years of economic
depression have resulted in multi-generational poverty that is highly entrenched and seemingly
intractable. In addition, values and behaviors known to evolve in mining settlements continue to
be woven into the social fabric of Butte, not the least of which is cultural acceptance of alcohol
abuse (Butte-Silver Bow Health Department 2011a).
A 2011 report from the State of Montana Department of Health and Human Services
Addictive and Mental Disorders Division listed the number of clients in treatment in Butte-Silver
Bow and statewide (Montana Department of health and Human Services 2011). There were 106
in treatment for alcohol addiction in Butte and 5,009 statewide. There were two in treatment for
amphetamine in Butte and 51 statewide; there were three in treatment for cocaine/crack in Butte
and 80 statewide. There were 29 in treatment for MDMA/ecstasy and 1,557 statewide, and there
were 23 in treatment for methamphetamine and 569 statewide. There were 12 in treatment for
other opiates or synthetics and 688 statewide (Montana Department of health and Human
Services 2011). Overall, this does not paint the picture of Butte-Silver Bow as having a
disproportionate amount of drug addiction.
In a table of key indicators of public health included in the Community Needs
Assessment, which compared Butte-Silver Bow to Montana, there is a higher number of disabled
persons in Butte Silver Bow. Importantly, there is a lower number of persons with health
insurance (79.7% in Butte-Silver Bow and 84.65% in Montana). This could correlate to a lack of
medical care and early diagnosis as well as potential for negative health effects.
Like the SMR data, the key indicators of the public health table also shows an increased
incidence of asthma in Butte-Silver Bow (11% compared to 8.8% in Montana). While this is not
a cultural influencing factor, it is important to restate the elevated incidence of this disease rate
because there are also elevated mortality rates for this disease.
This study also shows a lower cancer incidence rate in Butte-Silver Bow (321.9 per
100,000) compared to Montana (455.5 per 100,000). This is an interesting finding because the
majority of mortality rates for Butte-Silver Bow are higher than Montana rates. This could
indicate a difference in community members seeking health care, aggressiveness of cancer, a
difference in patient care, or a future decrease in Butte-Silver Bow cancer mortality rates.

33

There is a higher suicide rate in Butte than Montana but a lower motor vehicle
unintentional death rate. Of these, Butte had a higher percentage of motor vehicle crashes that
involve alcohol. One disturbing finding is the elevated non-motor vehicle unintentional death
rate of 84.3 per 100,000 compared to six per 1000,000 in Montana. No explanation is given for
this rate in the report. It is potentially related to Butte-Silver Bow having the highest crime rate
of all of the major counties in Montana. There is also a potential correlation between lead
exposure and violent crimes. As discussed in the toxicology section, lead exposure has been
correlated to increased incidence of violent crime, including murder, juvenile delinquency, and
antisocial behavior, including alcohol and drug use.
There is a perception that the majority of the population in Butte is geriatric. In fact,
16.5% of the population is senior citizens, indicating that 83.5% are not elderly. The ButteSilver Bow population average 41.6 years of age, which is higher than the Montana average of
36.7. This increase in age could correlate to an increased rate of geriatric disorders, such as
Alzheimers disease.

34

Appendix A. Health Data, Genders Combined, with Greater than 20 Data Points

35

BUTTE COMPARED TO MONTANA GREATER THAN 20 CASES, 1979-1998

Table A-1. Diseases of the Circulatory System 1979-1998, Butte Compared to MT
Cause of Death
Observed Expected SMR Lower Upper
N
CI
CI
Acute myocardial infarction
1114
620.9
1.69
1.90
1.79
Coronary atherosclerosis
664
331.05
1.86
2.16
2.00
Acute, but ill-defined,
379
262.65
1.30
1.6
1.44
cerebrovascular disease
Chronic ischemic heart disease,
281
176.86
1.40
1.78
1.59
unspecified
Cardiovascular disease, unspecified
199
136.57
1.26
1.67
1.46
Cardiac arrest
182
115.82
1.35
1.80
1.57
Generalized and unspecified
145
79.22
1.54
2.14
1.83
atherosclerosis
Congestive heart failure
95
124.5
0.76
0.62
0.92
Other primary cardiomyopathies
58
33.16
1.33
2.23
1.75
Pulmonary embolism and
56
29.73
1.42
2.41
1.89
infarction
Aortic valve disorders
54
27.37
1.48
2.53
1.97
Intracerebral hemorrhage
54
40.55
1.00
1.7
1.3
Cerebral thrombosis
44
28.01
1.14
2.07
1.57
Cerebral atherosclerosis
41
20.62
1.42
2.64
1.99
Heart failure, unspecified
31
29.38
0.72
1.46
1.05
Other and unspecified rheumatic
29
7.73
2.51
5.24
3.75
heart diseases
Unspecified
28
33.52
0.83
0.55
1.17
Abdominal aneurysm, ruptured
27
22.17
0.80
1.72
1.21
Cerebral artery occlusion,
26
20.32
0.83
1.82
1.28
unspecified
Unspecified
26
16.32
1.04
2.26
1.59
Other specified forms of chronic
23
19.21
0.76
1.74
1.2
ischemic heart disease
Table A-2. Diseases of Digestive System 1979-1998, Butte Compared to MT
Cause of Death
Observed Expected SMR
Lower
N
CI
Cirrhosis of liver without mention of
58
28.10
1.57
2.06
alcohol
Hemorrhage of gastrointestinal tract,
37
20.28
1.28
1.82
unspecified
Acute vascular insufficiency of
32
15.64
1.40
2.05
intestine
36

Upper
CI
2.63
2.46
2.82

Alcoholic cirrhosis of liver

Colon
Unspecified intestinal obstruction

26
23
21

25.39
8.94
11.30

1.02
2.57
1.86

0.67
1.63
1.15

1.46
3.73
2.74

Table A-3. Diseases of Endocrine System 1979-1998, Butte Compared to MT

Cause of Death
Observed Expected SMR Lower Upper
N
CI
CI
Diabetes mellitus without mention
158
95.79
1.40
1.92
1.65
of complication
Table A-4. Diseases of Genitourinary System 1979-1998, Butte Compared to MT
Cause of Death
Observed Expected SMR Lower
Upper
N
CI
CI
Urinary tract infection, site not
42
15.76
1.91
3.53
2.66
specified
Renal failure, unspecified
32
32.43
0.98
0.67
1.35
Table A-5. Mental & Behavioral Disorders 1979-1998, Butte Compared to MT
Cause of Death
Observed N
Expected
SMR Lower CI Upper CI
Presenile dementia
42
24.53
1.23
2.27
1.71
Alcohol dependence syndrome
35
19.55
1.25
2.43
1.79
Table A-6. Diseases of the Musculoskeletal System 1979-1998, Butte Compared to MT
Cause of Death
Observed N
Expected
SMR
Lower CI Upper CI
Rheumatoid arthritis
23
8.25
1.79
4.04
2.79
Table A-7. Neoplasms 1979-1998, Butte Compared to MT
Cause of Death
Observed
Expected
N
Bronchus and lung, unspecified
405
327.44
Colon, unspecified
174
110.49
Breast (female), unspecified
128
106.67
Malignant neoplasm of prostate
108
103.66
Pancreas, part unspecified
105
69.47
Other
99
82.74
Ovary
58
36.09
Other lymphomas
46
42.06
Bladder, part unspecified
44
32.56
Rectum
36
21.31
Multiple myeloma
33
23.84
Stomach, unspecified
32
32.39
Brain, unspecified
29
26.89
Esophagus, unspecified
27
21.44
37

SMR

Lower CI

Upper CI

1.24
1.57
1.20
1.04
1.51
1.20
1.61
1.09
1.35
1.69
1.38
0.99
1.08
1.26

1.12
1.35
1.00
0.85
1.24
0.97
1.22
0.80
0.98
1.18
0.95
0.68
0.72
0.83

1.36
1.82
1.42
1.25
1.81
1.44
2.05
1.43
1.78
2.29
1.90
1.36
1.51
1.78

Kidney, except pelvis

Larynx, unspecified
Melanoma of skin, site
unspecified
Chronic
Acute

27
26
23

26.38
8.98
16.97

1.02
2.90
1.36

0.67
1.89
0.86

1.45
4.12
1.97

20
20

11.60
15.38

1.72
1.30

1.05
0.79

2.56
1.93

Table A-8. Diseases of the Nervous System 1979-1998, Butte Compared to MT

Cause of Death
Observed N
Expected
SMR Lower CI Upper CI
Alzheimer's disease
95
55.80
1.38
2.06
1.70
Paralysis agitans
32
24.66
0.89
1.79
1.30
Motor neuron disease
24
12.42
1.24
2.78
1.93
Multiple sclerosis
22
9.79
1.41
3.28
2.25
Table A-9. Diseases of the Respiratory System 1979-1998, Butte Compared to MT
Cause of Death
Observed Expected SMR Lower
Upper
N
CI
CI
Chronic airway obstruction, not
395
247.06
1.45
1.76
1.60
elsewhere classified
Pneumonia, organism unspecified
241
165.95
1.27
1.64
1.45
Emphysema
63
53.14
0.91
1.50
1.19
Asthma, unspecified
39
17.66
1.57
2.96
2.21
Postinflammatory pulmonary fibrosis
27
18.86
0.94
2.02
1.43
Obstructive chronic bronchitis
22
9.97
1.38
3.23
2.21
Bronchopneumonia, organism
21
18.00
0.72
1.72
1.17
unspecified
BUTTE COMPARED TO NATIONAL GREATER THAN 20 CASES, 1979-1998
Table A-10. Diseases of the Circulatory System 1979-1998, Butte Compared to US
Cause of Death
Observed Expected SMR Lower
N
CI
Acute myocardial infarction
1114
720.01
1.46
1.55
Coronary atherosclerosis
664
494.13
1.24
1.34
Acute, but ill-defined, cerebrovascular
379
240.88
1.42
1.57
disease
Chronic ischemic heart disease,
281
198.81
1.25
1.41
unspecified
Cardiovascular disease, unspecified
199
200.87
0.99
0.86
Cardiac arrest
182
92.50
1.69
1.97
Generalized and unspecified
145
57.70
2.12
2.51
atherosclerosis
Congestive heart failure
95
98.62
0.96
0.78
Other primary cardiomyopathies
58
51.02
0.86
1.14
38

Upper
CI
1.64
1.45
1.74
1.58
1.13
2.26
2.94
1.17
1.45

Pulmonary embolism and infarction

Aortic valve disorders
Intracerebral hemorrhage
Cerebral thrombosis
Cerebral atherosclerosis
Heart failure, unspecified
Other and unspecified rheumatic heart
diseases
Unspecified
Abdominal aneurysm, ruptured
Cerebral artery occlusion, unspecified
Unspecified
Other specified forms of chronic
ischemic heart disease

56
54
54
44
41
31
29

27.77
21.92
53.81
32.48
16.74
12.95
4.72

2.02
2.46
1.00
1.35
2.45
2.39
6.14

1.52
1.85
0.75
0.98
1.76
1.63
4.11

2.58
3.16
1.29
1.78
3.26
3.31
8.58

28
27
26
26
23

63.76
18.15
28.05
13.65
32.31

0.44
1.49
0.93
1.90
0.71

0.29
0.98
0.60
1.24
0.45

0.62
2.10
1.32
2.71
1.03

Table A-11. Diseases of Digestive System 1979-1998, Butte Compared to US

Cause of Death
Observed Expected SMR Lower
N
CI
Cirrhosis of liver without mention of
58
36.06
1.22
1.61
alcohol
Hemorrhage of gastrointestinal tract,
37
16.39
1.59
2.26
unspecified
Acute vascular insufficiency of intestine
32
12.44
1.76
2.57
Alcoholic cirrhosis of liver
26
23.14
0.73
1.12
Colon
23
8.75
1.66
2.63
Unspecified intestinal obstruction
21
8.30
1.56
2.53
Table A-12. Diseases of Endocrine System 1979-1998, Butte Compared to US
Cause of Death
Observed Expected SMR Lower
N
CI
Diabetes mellitus without mention of
158
97.91
1.37
1.61
complication

Upper
CI
2.05
3.04
3.54
1.60
3.81
3.73

Upper
CI
1.88

Table A-13. Diseases of Genitourinary System 1979-1998, Butte Compared to US

Cause of Death
Observed Expected SMR Lower CI Upper CI
N
Urinary tract infection, site not
42
28.41
1.07
1.96
1.48
specified
Renal failure, unspecified
32
31.78
0.69
1.39
1.01
Table A-14. Mental & Behavioral Disorders 1979-1998, Butte Compared to US
39

Cause of Death
Observed N
Presenile dementia
42
Alcohol dependence syndrome
35

Expected
13.29
13.49

SMR
3.16
2.60

Lower CI Upper CI
2.28
4.19
1.81
3.53

Table A-15. Diseases of the Musculoskeletal System 1979-1998, Butte Compared to US

Cause of Death
Observed N
Expected
SMR
Lower CI Upper CI
Rheumatoid arthritis
23
4.45
3.27
7.49
5.16
Table A-16. Neoplasms 1979-1998, Butte Compared to US
Cause of Death
Observed N
Expected SMR Lower CI Upper CI
Bronchus and lung, unspecified
405
372.84
0.98
1.19
1.09
Colon, unspecified
174
123.27
1.21
1.63
1.41
Breast (female), unspecified
128
116.80
0.91
1.29
1.10
Malignant neoplasm of prostate
108
84.08
1.05
1.54
1.28
Pancreas, part unspecified
105
67.42
1.27
1.87
1.56
Other
99
83.40
0.96
1.43
1.19
Ovary
58
34.88
1.26
2.12
1.66
Other lymphomas
46
41.66
0.81
1.45
1.10
Bladder, part unspecified
44
29.61
1.08
1.96
1.49
Rectum
36
18.76
1.34
2.60
1.92
Multiple myeloma
33
24.30
0.93
1.86
1.36
Stomach, unspecified
32
38.06
0.84
0.57
1.16
Brain, unspecified
29
26.38
0.74
1.54
1.10
Esophagus, unspecified
27
26.84
0.66
1.42
1.01
Kidney, except pelvis
27
26.74
0.66
1.43
1.01
Larynx, unspecified
26
9.91
1.71
3.73
2.62
Melanoma of skin, site
23
15.33
0.95
2.18
1.50
unspecified
Chronic
20
10.12
1.20
2.94
1.98
Acute
20
15.15
0.80
1.96
1.32
Table A-17. Diseases of the Nervous System 1979-1998, Butte Compared to US
Cause of Death
Observed N
Expected
SMR
Lower CI Upper CI
Alzheimer's disease
95
33.86
2.27
3.40
2.81
Paralysis agitans
32
20.73
1.06
2.12
1.54
Motor neuron disease
24
9.91
1.55
3.49
2.42
Multiple sclerosis
22
5.05
2.72
6.36
4.35
Table A-18. Diseases of the Respiratory System 1979-1998, Butte Compared to US
Cause of Death
Observed N Expected SMR Lower
Upper
CI
CI
Chronic airway obstruction, not
395
168.21
2.12
2.59
2.35
elsewhere classified
40

Pneumonia, organism unspecified

Emphysema
Asthma, unspecified
Postinflammatory pulmonary fibrosis
Obstructive chronic bronchitis
Bronchopneumonia, organism
unspecified

241
63
39
27
22
21

159.75
43.94
12.34
14.77
6.12
21.26

1.51
1.43
3.16
1.83
3.59
0.99

1.32
1.10
2.25
1.20
2.25
0.61

1.71
1.81
4.23
2.58
5.25
1.46

BUTTE COMPARED TO NATIONAL GREATER THAN 20 CASES, 1999-2007

Table A-19. Diseases of the Circulatory System 1999-2007, Butte Compared to MT
Cause of Death
Observed N Expected SMR Lower
Upper
CI
CI
Atherosclerotic heart disease
380
165.69
2.07
2.53
2.29
Acute myocardial infarction,
158
140.74
0.95
1.30
1.12
unspecified
Stroke, not specified as hemorrhage or
154
99.28
1.32
1.81
1.55
infarction
Atherosclerotic cardiovascular disease,
146
50.00
2.47
3.41
2.92
so described
Congestive heart failure
132
90.85
1.22
1.71
1.45
Cardiomyopathy, unspecified
42
12.67
2.39
4.39
3.31
Essential (primary) hypertension
33
10.57
2.15
4.28
3.12
Endocarditis, valve unspecified
25
9.52
1.70
3.76
2.63
Intracerebral hemorrhage, unspecified
24
17.60
0.87
1.96
1.36
Atrial fibrillation and flutter
20
14.88
0.82
2.00
1.34

Table A-20. Diseases of Digestive System 1999-2007, Butte Compared to MT

Cause of Death
Observed Expected SMR Lower
N
CI
Other and unspecified cirrhosis of liver
27.00
12.38
1.44
2.18
Gastrointestinal hemorrhage,
26.00
11.41
1.49
2.28
unspecified
Alcoholic cirrhosis of liver
22.00
12.06
1.14
1.82
Table A-21. Diseases of Endocrine System 1999-2007, Butte Compared to MT
Cause of Death
Observed Expected SMR Lower
N
CI
Unspecified diabetes mellitus, without
78.00
45.33
1.36
1.72
complications
Table A-22. Diseases of Genitourinary System 1999-2007, Butte Compared to MT
41

Upper
CI
3.08
3.24
2.67

Upper
CI
2.12

Cause of Death
Unspecified renal failure
Urinary tract infection, site not
specified

Observed
N
21.00
33.00

Expected SMR
21.91
12.20

0.96
2.70

Lower
CI
0.59
1.86

Upper CI
1.41
3.71

Table A-23. Mental & Behavioral Disorders 1999-2007, Butte Compared to MT

Cause of Death
Observed N
Expected
SMR
Lower CI Upper CI
Unspecified dementia
61
67.602
0.90
0.69
1.14
Table A-24. Neoplasms 1999-2007, Butte Compared to MT
Cause of Death
Observed N Expected SMR
Bronchus or lung, unspecified
Colon, unspecified
Breast, unspecified
Pancreas, unspecified
Malignant neoplasm of prostate
Malignant neoplasm without
specification of site
Bladder, unspecified
Esophagus, unspecified

247.00
90.00
56.00
47.00
43.00
33.00

172.06
46.71
41.86
33.60
39.21
34.54

1.44
1.93
1.34
1.40
1.10
0.96

Lower
CI
1.26
1.55
1.01
1.03
0.79
0.66

27.00
23.00

15.71
16.04

1.72
1.43

1.13
0.91

Upper
CI
1.62
2.35
1.71
1.83
1.45
1.31
2.43
2.08

Table A-25. Diseases of the Nervous System 1999-2007, Butte Compared to MT

Cause of Death
Observed N Expected
SMR
Lower CI Upper CI
Alzheimer's disease, unspecified
106
76.04
1.141
1.67
1.39
Parkinson's disease
21
21.62
0.97
0.600
1.43
Multiple sclerosis
13
6.59
1.046
3.19
1.97
Table A-26. Diseases of the Respiratory System 1999-2007, Butte Compared to MT
Cause of Death
Observed N Expected SMR Lower
Upper
CI
CI
Chronic obstructive pulmonary disease,
277.00
153.42
1.60
2.02
1.81
unspecified
Pneumonia, unspecified
67.00
59.13
0.88
1.42
1.13
Emphysema, unspecified
33.00
21.33
1.06
2.12
1.55
BUTTE COMPARED TO NATIONAL GREATER THAN 20 CASES, 1999-2007
Table A-27. Diseases of the Circulatory System 1999-2007, Butte Compared to US
Cause of Death
Observed N Expected SMR Lower Upper
CI
CI
Atherosclerotic heart disease
380
215.99
1.59
1.94
1.76
Acute myocardial infarction, unspecified
158
173.00
0.91
0.78
1.06
42

Stroke, not specified as hemorrhage or

infarction
Atherosclerotic cardiovascular disease,
so described
Congestive heart failure
Cardiomyopathy, unspecified
Essential (primary) hypertension
Endocarditis, valve unspecified
Intracerebral hemorrhage, unspecified
Atrial fibrillation and flutter

154

84.28

1.83

1.55

2.13

146

67.92

2.15

1.81

2.51

132
42
33
25
24
20

54.80
19.56
12.93
5.03
16.96
10.94

2.41
2.15
2.55
4.97
1.42
1.83

2.02
1.55
1.76
3.21
0.91
1.12

2.84
2.85
3.50
7.11
2.04
2.72

Table A-28. Diseases of Digestive System 1999-2007, Butte Compared to US

Cause of Death
Observed N Expected SMR Lower
CI
Other and unspecified cirrhosis of
27
14.35
1.24
1.88
liver
Gastrointestinal hemorrhage,
26
7.84
2.16
3.31
unspecified
Alcoholic cirrhosis of liver
22
8.36
1.65
2.63
Table A-29. Diseases of Endocrine System 1999-2007, Butte Compared to US
Cause of Death
Observed Expected SMR Lower
N
CI
Unspecified diabetes mellitus, without
78
43.26
1.43
1.80
complications

Upper
CI
2.66
4.71
3.84

Upper
CI
2.23

Table A-30. Diseases of Genitourinary System 1999-2007, Butte Compared to US

Cause of Death
Observed N Expected SMR Lower CI Upper CI
Unspecified renal failure
21
17.65
0.74
1.75
1.19
Urinary tract infection, site not
33
14.60
1.56
3.1
2.26
specified
Table A-31. Mental & Behavioral Disorders 1999-2007, Butte Compared to US
Cause of Death
Observed N
Expected
SMR
Lower CI Upper CI
Unspecified dementia
61
48.35
1.26
0.96
1.60
Table A-32. Neoplasms 1999-2007, Butte Compared to US
Cause of Death
Observed N Expected SMR
Bronchus or lung, unspecified
Colon, unspecified
Breast, unspecified
Pancreas, unspecified
Malignant neoplasm of prostate

247
90
56
47
43
43

161.31
46.09
43.00
32.00
30.88

1.53
1.95
1.30
1.47
1.39

Lower
CI
1.35
1.57
0.98
1.08
1.01

Upper
CI
1.73
2.38
1.67
1.92
1.84

Malignant neoplasm without

specification of site
Bladder, unspecified
Esophagus, unspecified

33

27.46

1.20

0.83

1.65

27
23

13.16
13.23

2.05
1.74

1.35
1.10

2.90
2.52

Table A-33. Diseases of the Nervous System 1999-2007, Butte Compared to US

Cause of Death
Observed N
Expected
SMR Lower CI Upper CI
Alzheimer's disease, unspecified
106
61.56
1.41
2.07
1.72
Parkinson's disease
21
18.14
0.72
1.71
1.16
Multiple sclerosis
13
3.30
2.09
6.37
3.94
Table A-34. Diseases of the Respiratory System 1999-2007, Butte Compared to US
Cause of Death
Observed N Expected SMR Lower Upper
CI
CI
Chronic obstructive pulmonary disease,
277
103.61
2.37
3.00
2.67
unspecified
Pneumonia, unspecified
67
54.27
0.96
1.55
1.23
Emphysema, unspecified
33
15.37
1.48
2.94
2.15

44