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Forsyth County, North Carolina: environmental and disease records

Cancer mortality in Forsyth County is 158.7 deaths per 100,000 people per year against a U.S. rate of 143.2, a statistically significant excess. The strongest disease signals are Liver & bile duct deaths at 1.2 times the U.S. rate and Lung & bronchus deaths at 1.2 times the U.S. rate. Federal databases place 1,275 regulated facilities, sites and hazards inside the county, led by NPDES wastewater discharge permit (706), Rail grade crossing (161), Gas station (mapped facility) (109). EPA AirToxScreen estimates a lifetime cancer risk from outdoor air toxics of 30 in a million, driven mainly by formaldehyde.

Rates are age-adjusted per 100,000 people. A cancer signal is marked significant when the lower bound of its 95 percent confidence interval is above the U.S. rate. Facility counts use active federal records located inside the county boundary. Approximate county center: 36.1169, -80.2602.

How this county ranks in North Carolina

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Cancer deaths and new cases versus the United States

Source: NCI and CDC State Cancer Profiles, both sexes, all ages. Sorted by the ratio of the county rate to the U.S. rate.

Cancer rates for Forsyth County compared with the United States
Cancer	Measure	County rate	U.S. rate	Times U.S.	95% interval	Years
Liver & bile duct	Deaths	8.2	6.6	1.24xSignificant	7.1 to 9.5	2020-2024
Lung & bronchus	Deaths	36.8	30.2	1.22xSignificant	34.4 to 39.3	2020-2024
Lung & bronchus	New cases	60.7	51.8	1.17xSignificant	57.7 to 64	2019-2023
Pancreas	Deaths	13.2	11.3	1.17xSignificant	11.8 to 14.8	2020-2024
Brain & nervous system	Deaths	5.1	4.4	1.16x	4.2 to 6.1	2020-2024
Leukemia	New cases	16.8	14.5	1.16xSignificant	15.1 to 18.6	2019-2023
Kidney & renal pelvis	New cases	20.6	17.9	1.15xSignificant	18.8 to 22.6	2019-2023
Bladder	Deaths	4.7	4.1	1.15x	3.9 to 5.7	2020-2024
All cancer	Deaths	158.7	143.2	1.11xSignificant	153.6 to 163.9	2020-2024
Pancreas	New cases	15.4	13.9	1.11x	13.9 to 17.1	2019-2023
Liver & bile duct	New cases	9.5	8.7	1.09x	8.3 to 10.8	2019-2023
Leukemia	Deaths	6.1	5.7	1.07x	5.1 to 7.2	2020-2024
Bladder	New cases	20	18.7	1.07x	18.2 to 21.9	2019-2023
All cancer	New cases	484.1	453.4	1.07xSignificant	475.1 to 493.3	2019-2023
Kidney & renal pelvis	Deaths	3.5	3.4	1.03x	2.8 to 4.3	2020-2024
Brain & nervous system	New cases	6.1	6.2	0.98x	5 to 7.2	2019-2023
Melanoma of the skin	New cases	23.4	23.8	0.98x	21.4 to 25.5	2019-2023
Non-Hodgkin lymphoma	Deaths	4.6	4.8	0.96x	3.8 to 5.6	2020-2024
Melanoma of the skin	Deaths	1.9	2	0.95x	1.3 to 2.5	2020-2024
Non-Hodgkin lymphoma	New cases	17.5	18.5	0.95x	15.8 to 19.4	2019-2023
Esophagus	New cases	4.2	4.6	0.91x	3.4 to 5.1	2019-2023
Stomach	New cases	6	6.6	0.91x	5.1 to 7.2	2019-2023
Stomach	Deaths	2.3	2.7	0.85x	1.7 to 3	2020-2024
Esophagus	Deaths	2.9	3.7	0.78x	2.3 to 3.7	2020-2024
Childhood cancer (under 15)	New cases	11.1	16.4	0.68x	7.9 to 15.2	2019-2023
Thyroid	New cases	8.7	13	0.67x	7.4 to 10.1	2019-2023

Mortality measures versus the U.S. county median

Source: County Health Rankings, built from CDC National Vital Statistics System death records. The comparison value is the median of all U.S. counties.

Mortality measures for Forsyth County
Measure	County	U.S. median	Difference	Unit
Premature death	9,571.3	9,842.6	-3%	years of life lost before age 75 per 100,000
Life expectancy	75.8	75.3	+1%	years
Child mortality	67.9	59.8	+14%	deaths under age 18 per 100,000
Infant mortality	8.8	6.2	+41%	deaths under age 1 per 1,000 live births
Injury deaths	98.7	96.9	+2%	deaths per 100,000
Drug overdose deaths	39.7	28.6	+39%	deaths per 100,000

Air toxics and air quality

EPA AirToxScreen 2020

Lifetime cancer risk from outdoor air toxics: 30 in a million. EPA treats 100 in a million as the upper end of acceptable risk and 1 in a million as the goal.

Formaldehyde23.45 per million
Carbon Tetrachloride2.9 per million
Acetaldehyde2.4 per million
Benzene1.49 per million

EPA Air Quality Index 2025

Monitored on 365 days: 232 good, 0 unhealthy for sensitive groups or worse. Median AQI 45, peak 100.

Regulated facilities, sites and hazards by type

1,275 active records inside the county from EPA ECHO, TRI, Superfund, Brownfields, NPDES, EIA, FAA, FRA and corrections data.

NPDES wastewater discharge permit706
Rail grade crossing161
Gas station (mapped facility)109
Air permit holder (minor source)76
Small hazardous waste generator56
Auto repair or body shop (mapped facility)39
Toxic chemical release facility (TRI)27
Large hazardous waste generator21
TRI reporting facility21
Brownfield property19
Major air pollution source10
Dry cleaner (mapped facility)8
EPA air quality monitor3
Large greenhouse gas emitter3
Hazardous waste transporter3
Landfill (mapped facility)3
Biomass power plant3
Heliport2
Solar power plant2
Public airport1
Commercial airport1
Wastewater plant (mapped facility)1

Highest-severity records

The 25 records with the highest Envyrofax severity in the county, with the agency identifier to cite in a records request.

Ingredion Winston Salem, Winston-Salem
TRI reporting facility. Penalties $29,500.
EPA FRS registry ID 110000861032 (U.S. EPA ECHO) Agency record
Severity 10
Ardagh Metal Beverage Usa Inc Re: Winston Salem Plant, Winston Salem
Toxic chemical release facility (TRI). Chemicals: Certain glycol ethers, n-Butyl alcohol, Hydrogen fluoride, Manganese and 1 more. Reports carcinogens. 2,426,427 lbs released over 5 years.
TRI facility ID 27107STRHC4000O (U.S. EPA Toxics Release Inventory)
Severity 9.4
Ingredion Inc - Winston Salem Plant, Winston Salem
Toxic chemical release facility (TRI). Chemicals: Hydrochloric acid (acid aerosols including mists, vapors, gas, fog, and other airborne forms of any particle size), Acetaldehyde, Lead compounds, Lead And Lead Compounds and 1 more. Reports carcinogens. 334,088 lbs released over 5 years.
TRI facility ID 27107CRNPR4501O (U.S. EPA Toxics Release Inventory)
Severity 8.7
R. J. Reynolds Tobacco Co. Whitaker Park, Winston Salem
TRI reporting facility. Penalties $7,500.
EPA FRS registry ID 110000345332 (U.S. EPA ECHO) Agency record
Severity 8.7
Tex-Tech Coatings Llc, Kernersville
Toxic chemical release facility (TRI). Chemicals: Toluene, N,N-Dimethylformamide. Reports carcinogens. 244,942 lbs released over 5 years.
TRI facility ID 27284HGHLN215DR (U.S. EPA Toxics Release Inventory)
Severity 8.6
Structural Steel Of Carolina, Winston Salem
Toxic chemical release facility (TRI). Chemicals: Nickel, Manganese, Chromium. Reports carcinogens. 25,272 lbs released over 5 years.
TRI facility ID 27107STRCT1725V (U.S. EPA Toxics Release Inventory)
Severity 7.9
Ingredion Winston Salem, Winston-Salem
Major air pollution source. Penalties $29,500.
EPA FRS registry ID 110000861032 (U.S. EPA ECHO) Agency record
Severity 7.5
Ardagh Metal Packaging Usa Corp., Winston-Salem
TRI reporting facility.
EPA FRS registry ID 110000345458 (U.S. EPA ECHO) Agency record
Severity 7.3
R. J. Reynolds Tobacco Co. Whitaker Park, Winston Salem
Major air pollution source. Penalties $7,500.
EPA FRS registry ID 110000345332 (U.S. EPA ECHO) Agency record
Severity 7.3
Highland Industries Incorporated, Kernersville
TRI reporting facility. Penalties $1,200.
EPA FRS registry ID 110000345966 (U.S. EPA ECHO) Agency record
Severity 7.1
John Deere Kernersville Llc, Kernersville
Toxic chemical release facility (TRI). Chemicals: Manganese, Polycyclic aromatic compounds, Ethylene glycol, Lead. Reports carcinogens. 2,761 lbs released over 5 years.
TRI facility ID 27285DRHTC1000D (U.S. EPA Toxics Release Inventory)
Severity 7.1
Ingredion Winston Salem, Winston-Salem
NPDES wastewater discharge permit. Penalties $29,500.
EPA FRS registry ID 110000861032 (U.S. EPA ECHO) Agency record
Severity 7
Triseal Opco Llc - Polo Road Complex, Winston Salem
Toxic chemical release facility (TRI). Chemicals: N-Methyl-2-pyrrolidone. 87,211 lbs released over 5 years.
TRI facility ID 27105RCLFL22EPL (U.S. EPA Toxics Release Inventory)
Severity 6.8
R. J. Reynolds Tobacco Co. Whitaker Park, Winston Salem
Large hazardous waste generator. Penalties $7,500.
EPA FRS registry ID 110000345332 (U.S. EPA ECHO) Agency record
Severity 6.8
R. J. Reynolds Tobacco Co. Whitaker Park, Winston Salem
NPDES wastewater discharge permit. Penalties $7,500.
EPA FRS registry ID 110000345332 (U.S. EPA ECHO) Agency record
Severity 6.8
Clarios Llc, Kernersville
Toxic chemical release facility (TRI). Chemicals: Lead And Lead Compounds, Arsenic And Arsenic Compounds, Antimony And Antimony Compounds, Nonylphenol. Reports carcinogens. 851 lbs released over 5 years.
TRI facility ID 27102JHNSN2701W (U.S. EPA Toxics Release Inventory)
Severity 6.7
American Snuff Co Llc Taylor Brothers Div, Winston Salem
Toxic chemical release facility (TRI). Chemicals: Nicotine and salts. 76,430 lbs released over 5 years.
TRI facility ID 27103TYLRB2415S (U.S. EPA Toxics Release Inventory)
Severity 6.7
R J Reynolds Tobacco Co Tvill, Tobaccoville
Toxic chemical release facility (TRI). Chemicals: Nicotine and salts, Ammonia, 2,2-Dichloro-1,1,1-trifluoroethane (HCFC-123). 69,105 lbs released over 5 years.
TRI facility ID 27050RJRYN7855A (U.S. EPA Toxics Release Inventory)
Severity 6.7
Ingredion Winston Salem, Winston-Salem
Large greenhouse gas emitter. Penalties $29,500.
EPA FRS registry ID 110000861032 (U.S. EPA ECHO) Agency record
Severity 6.5
R J Reynolds Tobacco Company, Tobaccoville
TRI reporting facility.
EPA FRS registry ID 110000345225 (U.S. EPA ECHO) Agency record
Severity 6.5
Cres Tobacco Co Inc, King
Toxic chemical release facility (TRI). Chemicals: Nicotine and salts, Ammonia. 23,256 lbs released over 5 years.
TRI facility ID 27021CRSTB3BIGA (U.S. EPA Toxics Release Inventory)
Severity 6.4
R J Reynolds Tobacco Co Whitaker Park, Winston Salem
Toxic chemical release facility (TRI). Chemicals: Nicotine and salts. 22,552 lbs released over 5 years.
TRI facility ID 27105RJRYN1101R (U.S. EPA Toxics Release Inventory)
Severity 6.3
Tri-Seal Opoc, Llc, Winston-Salem
TRI reporting facility.
EPA FRS registry ID 110025316815 (U.S. EPA ECHO) Agency record
Severity 6
Siemens Energy Winston Service Center, Rural Hall
Toxic chemical release facility (TRI). Chemicals: Copper, Nickel, Chromium. Reports carcinogens. 55 lbs released over 5 years.
TRI facility ID 27105WSTNG3050W (U.S. EPA Toxics Release Inventory)
Severity 5.8
Alliance One N.A. - Recon Facility, Winston Salem
Toxic chemical release facility (TRI). Chemicals: Nicotine and salts. 4,282 lbs released over 5 years.
TRI facility ID 2710WLLNCN11REY (U.S. EPA Toxics Release Inventory)
Severity 5.8

Correctional facilities

Prisons, jails and corrections operations with an EPA facility record, and the drinking water and wastewater compliance attached to them.

No correctional facility with an EPA record is located in this county.

Discovery / public records

Records to request for Forsyth County

North Carolina state cancer registry
Cancer incidence counts by census tract or ZIP code, by cancer type and year (de-identified). Any cancer cluster inquiries or investigations in Forsyth County, and their findings.
North Carolina vital statistics office
Death certificate counts by cause of death and residence tract or ZIP code, and the years behind the mortality measures above.
North Carolina health department, environmental epidemiology
Health consultations or assessments by ATSDR or the state health department covering the county, and any exposure investigations.
North Carolina environmental agency and the U.S. EPA regional office
Compliance history, inspection reports, notices of violation, penalties and enforcement actions for each facility above, cited by EPA FRS registry ID.
North Carolina drinking water program
Violation notices, sampling results and sanitary surveys for the public water systems serving the county, including any system serving a correctional facility.
Department of corrections or county sheriff
Water testing, grievances and environmental health inspections for the correctional facilities listed above.

Each Envyrofax address report includes a printable records request worksheet with the custodian and the exact request wording per finding.

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