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Knox County, Tennessee: environmental and disease records

Cancer mortality in Knox County is 153.5 deaths per 100,000 people per year against a U.S. rate of 143.2, a statistically significant excess. The strongest disease signals are Melanoma of the skin deaths at 1.5 times the U.S. rate and Lung & bronchus deaths at 1.2 times the U.S. rate. Federal databases place 1,835 regulated facilities, sites and hazards inside the county, led by NPDES wastewater discharge permit (965), Rail grade crossing (248), Gas station (mapped facility) (179). EPA AirToxScreen estimates a lifetime cancer risk from outdoor air toxics of 40 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: 35.9902, -83.8977.

How this county ranks in Tennessee

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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 Knox County compared with the United States
Cancer	Measure	County rate	U.S. rate	Times U.S.	95% interval	Years
Melanoma of the skin	Deaths	2.9	2	1.45xSignificant	2.3 to 3.7	2020-2024
Lung & bronchus	Deaths	37.3	30.2	1.24xSignificant	35.1 to 39.6	2020-2024
Lung & bronchus	New cases	63.7	51.8	1.23xSignificant	60.9 to 66.7	2019-2023
Bladder	Deaths	5	4.1	1.22xSignificant	4.2 to 5.9	2020-2024
Thyroid	Deaths	0.6	0.5	1.2x	0.4 to 1	2020-2024
Esophagus	New cases	5.5	4.6	1.2xSignificant	4.7 to 6.5	2019-2023
Kidney & renal pelvis	Deaths	4	3.4	1.18x	3.3 to 4.8	2020-2024
Esophagus	Deaths	4.3	3.7	1.16x	3.6 to 5.1	2020-2024
Kidney & renal pelvis	New cases	19.8	17.9	1.11xSignificant	18.2 to 21.6	2019-2023
Melanoma of the skin	New cases	25.9	23.8	1.09xSignificant	24.1 to 27.9	2019-2023
All cancer	Deaths	153.5	143.2	1.07xSignificant	149 to 158.1	2020-2024
Brain & nervous system	Deaths	4.6	4.4	1.05x	3.9 to 5.5	2020-2024
Non-Hodgkin lymphoma	Deaths	5	4.8	1.04x	4.2 to 5.9	2020-2024
All cancer	New cases	460.7	453.4	1.02x	452.7 to 468.8	2019-2023
Pancreas	Deaths	11	11.3	0.97x	9.9 to 12.3	2020-2024
Brain & nervous system	New cases	6	6.2	0.97x	5.1 to 7.1	2019-2023
Leukemia	Deaths	5.5	5.7	0.96x	4.6 to 6.4	2020-2024
Bladder	New cases	18	18.7	0.96x	16.5 to 19.7	2019-2023
Thyroid	New cases	12.3	13	0.95x	10.9 to 13.7	2019-2023
Liver & bile duct	New cases	8.1	8.7	0.93x	7.1 to 9.2	2019-2023
Liver & bile duct	Deaths	6.1	6.6	0.92x	5.3 to 7.1	2020-2024
Pancreas	New cases	12.7	13.9	0.91x	11.4 to 14.1	2019-2023
Leukemia	New cases	12.4	14.5	0.86x	11.1 to 13.8	2019-2023
Non-Hodgkin lymphoma	New cases	15.8	18.5	0.85x	14.3 to 17.3	2019-2023
Childhood cancer (under 15)	New cases	13.9	16.4	0.85x	10.6 to 18	2019-2023
Stomach	New cases	5.3	6.6	0.8x	4.5 to 6.2	2019-2023
Stomach	Deaths	1.9	2.7	0.7x	1.4 to 2.4	2020-2024

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 Knox County
Measure	County	U.S. median	Difference	Unit
Premature death	11,096.3	9,842.6	+13%	years of life lost before age 75 per 100,000
Life expectancy	74.2	75.3	-1%	years
Child mortality	55.9	59.8	-6%	deaths under age 18 per 100,000
Infant mortality	5.9	6.2	-5%	deaths under age 1 per 1,000 live births
Injury deaths	140.3	96.9	+45%	deaths per 100,000
Drug overdose deaths	86.1	28.6	+201%	deaths per 100,000

Air toxics and air quality

EPA AirToxScreen 2020

Lifetime cancer risk from outdoor air toxics: 40 in a million. EPA treats 100 in a million as the upper end of acceptable risk and 1 in a million as the goal.

Formaldehyde24.68 per million
Carbon Tetrachloride2.88 per million
Acetaldehyde2.6 per million
Naphthalene1.54 per million

EPA Air Quality Index 2025

Monitored on 365 days: 230 good, 1 unhealthy for sensitive groups or worse. Median AQI 46, peak 156.

Regulated facilities, sites and hazards by type

1,835 active records inside the county from EPA ECHO, TRI, Superfund, Brownfields, NPDES, EIA, FAA, FRA and corrections data.

NPDES wastewater discharge permit965
Rail grade crossing248
Gas station (mapped facility)179
Air permit holder (minor source)149
Auto repair or body shop (mapped facility)73
Small hazardous waste generator46
Brownfield property42
Toxic chemical release facility (TRI)24
Scrapyard (mapped facility)23
TRI reporting facility22
Large hazardous waste generator13
Dry cleaner (mapped facility)11
Heliport8
Major air pollution source7
EPA air quality monitor6
Wastewater plant (mapped facility)5
Public airport4
Hazardous waste transporter3
Large greenhouse gas emitter2
Commercial airport1
Crematorium (mapped facility)1
Landfill (mapped facility)1
Gas power plant1
Superfund (NPL) site1

Highest-severity records

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

Smokey Mountain Smelters, Knoxville
Superfund (NPL) site. Hazard Ranking System score 50. NPL Site.
EPA site ID TND098071061 (U.S. EPA Superfund (SEMS/NPL)) Agency record
Severity 10
Explore Industries Usa Inc, Knoxville
Toxic chemical release facility (TRI). Chemicals: Styrene, Dichloromethane, Dimethyl phthalate. Reports carcinogens. 2,944,796 lbs released over 5 years.
TRI facility ID 37914SRYBT2601S (U.S. EPA Toxics Release Inventory)
Severity 9.5
Rohm & Haas Chemicals Llc - Knoxville Site, Knoxville
Toxic chemical release facility (TRI). Chemicals: m-Xylene, Ammonia, Ethyl acrylate, Methyl methacrylate and 4 more. Reports carcinogens. 189,275 lbs released over 5 years.
TRI facility ID 37921RHMND730DA (U.S. EPA Toxics Release Inventory)
Severity 8.6
Cemex Construction Materials Atlantic Llc, Knoxville
TRI reporting facility. Penalties $9,000.
EPA FRS registry ID 110009789318 (U.S. EPA ECHO) Agency record
Severity 8.5
Cmc Steel Tennessee, Knoxville
Toxic chemical release facility (TRI). Chemicals: Zinc compounds, Manganese compounds, Lead compounds, Manganese And Manganese Compounds and 4 more. Reports carcinogens. 89,983 lbs released over 5 years.
TRI facility ID 37921FLRDS1919T (U.S. EPA Toxics Release Inventory)
Severity 8.3
Leisure Pools And Spas Manufacturing Na, Inc., Knoxville
TRI reporting facility. Penalties $23,773.
EPA FRS registry ID 110000373435 (U.S. EPA ECHO) Agency record
Severity 8.3
Nyrstar- Immel Mine, Mascot
Toxic chemical release facility (TRI). Chemicals: Zinc compounds, Lead And Lead Compounds, Lead compounds, Mercury compounds and 1 more. 6,217,766 lbs released over 5 years.
TRI facility ID 37806SRCNC2160I (U.S. EPA Toxics Release Inventory)
Severity 8.2
Darling Ingredients Inc. (Fka Valley Protein Fka Cbp Resources Inc), Strawberry Plains
TRI reporting facility. Penalties $10,660.
EPA FRS registry ID 110006690928 (U.S. EPA ECHO) Agency record
Severity 8.1
Nystar - Young Mine & Mill, Strawberry Plains
TRI reporting facility. Penalties $1,500.
EPA FRS registry ID 110000590147 (U.S. EPA ECHO) Agency record
Severity 8
Cmc Steel Tennessee, Knoxville
TRI reporting facility.
EPA FRS registry ID 110000373480 (U.S. EPA ECHO) Agency record
Severity 7.6
Mplx Terminals Llc - Knoxville Tn Lp Terminal, Knoxville
Toxic chemical release facility (TRI). Chemicals: n-Hexane, Toluene, Benzene, Xylene (mixed isomers) and 4 more. Reports carcinogens. 11,621 lbs released over 5 years.
TRI facility ID 37921MRTHN261KN (U.S. EPA Toxics Release Inventory)
Severity 7.6
Cemex Construction Materials Atlantic Llc, Knoxville
Toxic chemical release facility (TRI). Chemicals: Ammonia, Lead compounds, Mercury, Chromium and 1 more. 136,867 lbs released over 5 years.
TRI facility ID 37914DXCMN6212C (U.S. EPA Toxics Release Inventory)
Severity 6.9
Nyrstar Tennessee Mines - Strawberry Plains Llc, Mascot
TRI reporting facility.
EPA FRS registry ID 110006615225 (U.S. EPA ECHO) Agency record
Severity 6.9
Exedy America Corp, Mascot
Toxic chemical release facility (TRI). Chemicals: Copper, Manganese, Lead, Ammonia. Reports carcinogens. 696 lbs released over 5 years.
TRI facility ID 37806DKNDR2121H (U.S. EPA Toxics Release Inventory)
Severity 6.7
Rohm And Haas Chemicals Llc, Knoxville
TRI reporting facility.
EPA FRS registry ID 110000373514 (U.S. EPA ECHO) Agency record
Severity 6.3
Lambcon Ready Mix, Knoxville
Toxic chemical release facility (TRI). Chemicals: Xylene (mixed isomers), Benzene, Toluene, Chromium and 3 more. Reports carcinogens. 140 lbs released over 5 years.
TRI facility ID 3792WLMBCN621RU (U.S. EPA Toxics Release Inventory)
Severity 6.1
Darling Ingredients Knoxville Facility, Strawberry Plains
Toxic chemical release facility (TRI). Chemicals: Nitrate compounds (water dissociable; reportable only when in aqueous solution). 12,635 lbs released over 5 years.
TRI facility ID 37871VLLYP9300J (U.S. EPA Toxics Release Inventory)
Severity 6.1
Cemex Construction Materials Atlantic Llc, Knoxville
Major air pollution source. Penalties $9,000.
EPA FRS registry ID 110009789318 (U.S. EPA ECHO) Agency record
Severity 6
Energizer Personal Care, Knoxville
TRI reporting facility.
EPA FRS registry ID 110000590192 (U.S. EPA ECHO) Agency record
Severity 5.8
First U.D. Knox Co.-Turkey Cr, Knoxville
NPDES wastewater discharge permit.
EPA FRS registry ID 110006367706 (U.S. EPA ECHO) Agency record
Severity 5.8
Kuwahee Wastewater Treatment Plant, Knoxville
NPDES wastewater discharge permit.
EPA FRS registry ID 110009492307 (U.S. EPA ECHO) Agency record
Severity 5.8
Hallsdale-Powell U.D.-Granny Bright Spring, Knoxville
NPDES wastewater discharge permit.
EPA FRS registry ID 110010813478 (U.S. EPA ECHO) Agency record
Severity 5.8
Schick Manufacturing Inc, Knoxville
Toxic chemical release facility (TRI). Chemicals: Ammonia, Chromium. 3,261 lbs released over 5 years.
TRI facility ID 37914MRCNS2820M (U.S. EPA Toxics Release Inventory)
Severity 5.7
Mplx Knoxville Lp Terminal, Knoxville
TRI reporting facility.
EPA FRS registry ID 110001856938 (U.S. EPA ECHO) Agency record
Severity 5.6
Cemex Construction Materials Atlantic Llc, Knoxville
NPDES wastewater discharge permit. Penalties $9,000.
EPA FRS registry ID 110009789318 (U.S. EPA ECHO) Agency record
Severity 5.5

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 Knox County

Tennessee 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 Knox County, and their findings.
Tennessee vital statistics office
Death certificate counts by cause of death and residence tract or ZIP code, and the years behind the mortality measures above.
Tennessee health department, environmental epidemiology
Health consultations or assessments by ATSDR or the state health department covering the county, and any exposure investigations.
Tennessee 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.
Tennessee 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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