Archive for the ‘Health’ Category

More affluent school districts in Southeastern Michigan have higher immunization waiver rates

January 26, 2015

In recent weeks news has broken about outbreaks of diseases many have thought were eradicated. From a mumps outbreak in the NHL to a measles outbreak at Disney World-which has since traveled to at least seven different states-to whooping cough outbreaks and a measles outbreak much closer to home in Grand Traverse and Leelanau counties, we are seeing that these diseases are indeed making a comeback. Many believe these are outbreaks are because of the growing number of children not being immunized.

While there have been no such outbreaks as mentioned above, immunization rates do vary in Southeastern Michigan, with some school districts having rates lower than the minimum thresholds needed to prevent the spread of disease. This is problematic, as low immunization rates threaten herd immunity and puts both vaccinated and non-vaccinated individuals at risk.

What is herd immunity?

The phrase “herd immunity” refers to protecting a community from disease by having a critical mass of its population immunized. Rather than just protecting the person vaccinated, vaccines can protect the entire community by breaking the chain of an infection’s transmission. However, for this to be successful, a certain number of people have to be vaccinated.

Epidemiologists have determined a basic threshold for infectious disease transmission by calculating both a “basic reproduction number” (R0), which represents how many people in an unprotected population one infected person can pass the disease along to – basically, a single person with mumps can pass it along to between 4 and 7 non-vaccinated people, while a single person with the measles could pass it along to between 12 and 18. The higher this R0 value is, the higher the percentage of vaccinated people in the population has to be, in order to prevent the spread of these illnesses. Therefore, in order to prevent an outbreak of measles, for instance, in a school district, 89-94% of students would have to be immunized.

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Photo credit © Tangled Bank Studios; data from Epidemiologic Reviews, 1993.

Furthermore, it is important for the population to be immunized in order to protect the health of those who cannot be vaccinated, such as infants and people with weakened immune systems. When large chunks of the community are not protected against these diseases, it is these groups of people whose health with be the most affected.

What are the immunization rates in Southeast Michigan schools?

Rates vary from well above minimum threshold numbers for even the most contagious diseases (Hazel Park and Southfield schools both have rates of 98%) to far below the threshold for any sort of protection (Madison Public Schools has the lowest, at only 70% vaccinated). However, it is important to note that not all school districts track vaccination rates uniformly – Inkster Public Schools, for instance, is reporting a 100% vaccination rate, but that’s based on an interview with a very small sample of students and may not be accurate.

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Note: Data unavailable for Willow Run Schools (white area), as it was absorbed into Ypsilanti Schools this year.

One interesting trend present in the map is how more affluent districts seem to have lower vaccination rates than their less affluent counterparts, suggesting that non-vaccination is more of a trend in middle- to upper-income communities (although this certainly does not hold true for all). One important fact about herd immunity is that being vaccinated yourself (or vaccinating your children) matters less when the population isn’t immunized. For example, an unvaccinated student in Hazel Park would have less of a chance of catching a vaccine-preventable illness than a vaccinated student in neighboring Madison Heights, since it would be exceedingly difficult for disease to spread in a population that is nearly universally protected against it.

What is Michigan doing to boost vaccination rates?

As of January 1, 2015, the Michigan Department of Community Health changed their rules on obtaining an exemption waiver for vaccinations. Starting this year, parents will still have the right to refuse inoculations, but first they have to be educated by a local health worker about vaccines and the diseases they are intended to prevent, and sign a universal state form that includes a statement of acknowledgement that they understand they may be putting their own children and others at risk by refusing shots.

Currently, Michigan is one of 20 states that allow such an exemption. With this being the case, it was still easier to obtain a waiver here than it is elsewhere – for instance, Arkansas and Minnesota require a waiver form to be notarized, and Vermont requires parents who opt out to renew their waiver each year, instead of just for kindergarten, sixth grade, and in the event of a school transfer.

There is a definite correlation between the ease of getting an exemption waiver for vaccinations and the percentage of students who obtain waivers, as one study (Blank, Caplan & Constable, 2013) found that states with an easier process had waiver rates twice as high as those with more complicated ones. Therefore, by tightening these restrictions, Michigan’s vaccination waiver rates may decrease, and vaccination rates may increase.

Sources

http://www.pbs.org/wgbh/nova/body/herd-immunity.html
http://www.mlive.com/news/index.ssf/2014/12/vaccination_rule_change_propos.html
Blank, N.R., Caplan, A.R. & Constable, C. (2013) Excempting schoolchildren from immunizations: States with few barriers had highest rates of nonmedical exemptions. Health Affairs 32(7): 1282-1290. http://content.healthaffairs.org/content/32/7/1282.abstract

Reported lead releases into the environment up dramatically from 2002 to 2012 in Southeast Michigan

December 9, 2013

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A number of national and international environmental incidents in the early 1980s led to the federal Emergency Planning and Community Right-to-Know Act (EPCRA) in 1986. EPCRA mandates all facilities that handle or produce at least 10,000 pounds of any of 650 chemicals known to be harmful to humans or the environment annually report any releases into the environment This information is made available to the public via the Toxic Release Inventory (TRI).

In this post we will examine releases of two of those 650 chemicals – lead and lead-based compounds. By releases the EPCRA means releases into the air, water or land. Federal law designates landfilling as a form of release as well, even though the lead may be buried. Below is a map showing the location of the 2012 reporters and releases of lead and lead-based compounds in the Southeast Michigan area.

In this post we will examine releases of two of those 650 chemicals – lead and lead-based compounds. For those interested in learning the effects of lead please click here.

Below is a map showing the location of the 2012 releases of lead and lead-based compounds in the Southeast Michigan area.

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In Southeast Michigan, 38 of 87 reporting facilities indicated they had no on-site releases into the land, water or air (These are 0’s on the map). The largest releases Southeast Michigan was Wayne Disposal, in Belleville, which reported more than 52,000 pounds of lead or lead-based compounds. How much of this stays in landfills versus gets released by air or water is not reported. This facility is a landfill that receives toxic waste, including being the only recipient of polychlorinated byphenols (PCBs) in the State of Michigan. In addition to skilled waste handlers, power generation is another top contributor to lead releases, with DTE and other generating plants along rivers and lakes releasing large quantities of lead and lead-based compounds, well over 60,000 pounds.

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Wayne Disposal, the region’s largest reporter of releases lead and lead-based-compounds (52,318 pounds), is located in Wayne County, along with about 35 other facilities. It may be reasonable to assume that the vast majority of this went into their landfill, but no data is provided about the specifics beyond the amounts. There are a total of 36 facilities reporting in Wayne County; altogether these facilities reported releasing a total of 54,366.91 pounds in 2012, as shown on the map below. There is a concentration of facilities reporting releases of lead and lead-based-compound in and near Southwest Detroit. However, the largest reported releases in Detroit were from the GM Detroit-Hamtramck Assembly Plant, which is bisected by the southern border of Hamtramck and Detroit.

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Releasing just over 455 pounds of lead-based compounds into the air in 2012, the GM Detroit-Hamtramck Assembly Plant is large, as well as near areas of dense settlement. Using software developed by the U.S. Military and adapted for use by the Environmental Protection Agency, we used dominant weather conditions to determine the approximate area in which these compounds, emitted from on-site stacks, may fall. The result is shown on the map below. The tri-color cone is the area most likely to be impacted because of dominant weather conditions (Winds 10 mph, 58oF, partly cloudy). The circle includes areas impacted by changing wind directions. Additional clouds, wind or precipitation could create a wider pattern of impact. Within the circle, live 5,963 people in 1,997 housing units (2010 Census). There are also three schools (Hanley, Holbrook and Oakland International) and one park with athletic facilities (Veterans in Hamtramck). Oakland International Academy falls under the cone of dominant exposure.

This set of estimates are based on a centroid in the northern area of the site, near cooling towers, but the results could vary depending on the specific location on the site where releases occur. There appear to be several large stacks and many small stacks on the site.  Some stacks are located further east on the site, which would yield estimates that cover more residential areas in Detroit.

Releasing just more than 455 pounds of lead-based compounds in 2012, the GM Detroit-Hamtramck Assembly Plant is large, as well as near areas of dense settlement. Using software developed by the U.S. Military and adapted for use by the Environmental Protection Agency, we used dominant weather conditions to determine the approximate area in which these compounds, emitted from on-site stacks, may fall. The result is shown on the map below. The tri-color cone is the area most likely to be impacted because of dominant weather conditions (Winds 10 mph, 58oF, partly cloudy). The circle includes areas impacted by changing wind directions. Additional clouds, wind or precipitation could create a wider pattern of impact. Within the circle, live 5,963 people in 1,997 housing units (2010 Census). There are also three schools (Hanley, Holbrook and Oakland International) and one park with athletic facilities (Veterans in Hamtramck). Oakland International Academy falls under the cone of dominant exposure.

NOTE:The software Aloha and Marplot were used to used to estimate the spread of lead pollution in the area.  In Aloha lead pollution can not be estimated so mercury was used as a proxy. The weight of lead per cubic inch is 0.39 lbs; the weight of mercury is 0.49 lbs. per cubic inch.

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To better understand the increase in lead pollution, we examined how lead was released into Wayne County. TRI documents releases into all mediums of the environment, breaking them down into details. Aggregating the categories into the three major environmental mediums – air, water and land, we can see that which methods of lead pollution has changed dramatically over the decade. In 2002, air pollution was the predominant medium, accounting for 99 percent of all lead pollution (455 pounds in total from stack releases and fugitive emissions). Since 2002, this amount has increased in aggregate (1,453 pounds in 2012, a 319 percent increase); however, the proportion of reported lead releases into the air has decreased in relation to the total, from 99 percent in 2002 to 3 percent in 2012.

The dramatic increase in reported lead releases has come from land releases – or that stored in landfills or otherwise held on site. In 2012, 96 percent of the total emissions for the region came from a single facility – Wayne Disposal, a toxic waste facility located on the Wayne/Washtenaw border near Belleville. As explained earlier, a facility must report if it handles more than 10,000 pounds of a toxic chemical, whether or not the facility releases the chemical or handles it without a release. Opened in 1997, Wayne Disposal was not handling enough lead or lead-based compounds in 2002 to require TRI reporting. By 2004, Wayne Disposal was handling enough to trigger reporting requirements. Eight years later, it is the largest single reporter in the region, reporting more than 52,000 pounds of lead or lead-based compounds. In future posts we plan to investigate the sources of the lead maintained at the facility. In general, we expect to find that most of the lead is from lead-based paint that is part of demolition debris from older houses in the metropolitan area.

Mortality related to Disease:Region below average for Alzheimer’s mortality

November 25, 2013

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This post portrays regional mortality rates related to disease, in particular, cancer, heart disease and Alzheimer’s disease.

The cancer mortality rate for those above the age 75 was the highest of the three diseases presented below. Alzheimer’s disease was the only illness presented below where none of the counties in Southeastern Michigan has a mortality rate above the state average. From 2006-2010, the rolling average mortality rate related to Alzheimer’s disease for the State of Michigan was  recorded at 22.7 deaths per 100,000 residents. Macomb was highest in the region at 20.9.

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The mortality rate for those 75 or older with cancer is about 150 times higher than those below the age of 50. For example, in the City of Detroit the mortality rate for those above the age of 75 with cancer was 1,512 per 100,000 residents from 2006 to 2010. For those below the age of 50 the mortality rate was 27.1 per 100,000 residents for the City of Detroit during the same time frame.

On all three maps, Oakland County was below the state average for the mortality rate related to cancer. Mortality rates related to cancer for the City of Detroit, however, were consistently above the state average, across age group and time.

The Michigan Department of Community Health did not document cancer mortality rates for those between the age of 51 and 74.

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Heart disease is another illness where Detroit was again above the state average, but in this case lower than Wayne County as a whole. In 2010, according to the Michigan Department of Community Health (MDCH), there were 236 deaths related to heart disease in the State of Michigan. In comparison, MDCH reported 316 deaths in Detroit and 988 deaths per 100,000 residents in Wayne County related to heart disease in 2010.  Washtenaw County was on the opposite end of the spectrum with a mortality rate related to heart disease recorded at 138.2 per 100,000 residents.

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Of the three types of diseases presented, Alzheimer’s disease had the lowest mortality rates. According to MDCH, the state average was 22.7 Alzheimer’s related deaths per 100,000 residents from 2006-10. None of the areas presented on the map were at or above the state average. Macomb County had the highest rate at 20.9 while Detroit had the lowest at 10 deaths per 100,000 residents.

Information for Livingston and Washtenaw counties was not available because the state reported it had not collected enough data to determine an accurate rate.

Lead and Housing Age: Homes Built Before 1980

August 8, 2013

In the following post we will examine the percent of homes built before 1980 for the city of Detroit and Wayne, Oakland and Macomb Counties to examine the risk of lead poisoning among children. Prior to 1978 there was no ban on the use of lead based paint, and 1980 is the closest available Census data on housing age. The older the homes and the higher percentage of older homes, the higher the risk that lead based paint was used in the homes.

Detroit has the highest percent of homes built before 1980 of all the areas examined. Since Detroit has such a high percentage of older homes (a majority of the Census tracts in Detroit have 86 percent or higher of the homes built before 1980), the Detroit map uses different breakpoints in the legend than the County maps presented below.

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There are only three Census tracts in Detroit where none of the homes in the city were built before 1980. These are locations such as Belle Isle and the Coleman A. Young International Airport, which generally do not have housing stock, though some people were found to have taken up residence in these areas.

One of the especially interesting features of this map is that much of the younger housing is located in the inner core where housing demolition and replacement has been intense since the 1940s and 1950s.

Much of the city is covered in dark brown, which represents Census tracts where between 96 and 100 percent of the homes were built before 1980.

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According the maps presented above, Wayne County has the highest number of Census tracts with homes built before 1980; in total 84.4 percent of the county is made up of homes built before 1980.

A closer look shows that majority of these Census tracts fall within the Detroit City limits and the inner suburbs, such as Redford and Lincoln Park. According to the legend, between 84.1 and 100 percent of the homes in the darkest shade of brown, in areas like Detroit and Lincoln Park, were built before 1980. Inner suburbs of Oakland and Macomb such as Ferndale and Eastpointe, respectively, follow this same pattern. This means these inner suburbs are at substantial risk of lead poisoning of children, particularly when older housing stock is not fully maintained.

In Oakland and Macomb counties though there are far fewer Census tracts where over 84 percent of the homes were built before 1980. For example, Macomb Township, which has seen the highest population growth in the last two years, is mainly made up of Census tracts where 0-20 percent of the homes were built before 1980. In total, 62.1 percent of Macomb County is made up of homes built before 1980 and 64 percent of Oakland County is made up of homes built before 1980.

 

A pocket of Detroit’s downtown exhibits most number of falls

July 1, 2013

This post examines the number of fall-related calls placed to Detroit EMS from January 1, 2010 to August 26, 2012 . Both the frequency and distribution of these calls are examined, along with the type and number of injuries suffered from the falls. All information obtained was from Detroit EMS. Overall, the post shows that the city’s downtown, predominantly in the area between M-10 and I-375, is where the highest number of falls occurred. The most frequent type of fall was one where the victim fell from less than six feet and suffered no injuries. The most common reported reason for falls was an altered state of consciousness, which could range from an inability to focus to a concussion. In addition to examining fall-related calls for the entire City of Detroit, three neighborhood areas are also highlighted at the end of this post. These three areas (North End and Crossman, Osborn, and Southwest) are highlighted because they are CLEARCorps target areas for the Green and Healthy Homes-Detroit Initiative, which aims to reduce housing related health-risks through “comprehensive home-based assessments and interventions, public outreach and education, and local partnerships.”

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The above maps show the frequency and distribution of fall-related calls Detroit EMS personnel responded to from January 1, 2010 to August 26, 2012. In total, EMS responded to 4,853 calls in that time frame, most of which were concentrated along the city’s downtown near the Detroit River between M-10 and I-375. In that area there are six Census tracts with the highest range of calls (over 67 calls); no other Census tract in the city received more than 67 calls during that time period. For the Census tracts in dark purple there were a total of 767 fall related calls.  There was also a concentration of falls around Woodward Avenue.

In the second map, which shows the distribution of falls in the city, one dot is equal to one fall related call. This remains true in all other distribution maps in this post.

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The above map shows the distribution of EMS calls reporting falls associated with the victim having altered consciousness following the incident. In total there were 750 such calls. Similar to the first frequency map of all falls, this map shows the highest concentration of such falls was located downtown, along the Detroit River and down Woodward Avenue.

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In the time frame examined in this post, there were 350 calls where the victim of a fall had difficulty breathing following the incident. As can been seen, these type of fall-related EMS calls did not occur as often as other types of fall-related calls and were less concentrated in the downtown area of the City of Detroit.

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Of the type of fall calls to EMS examined in this post, there were 1,653 instances where a person fell less than six feet and suffered no injuries. These made up 34 percent of the fall calls received by Detroit EMS during the time period examined. There was a heavy concentration of these calls received in the city’s downtown, between M-10 and 375. There was also a string of such incidents just west of I-94, between I-75 and I-96.

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There were 612 calls to the Detroit EMS from January 1, 2010 to August 26, 2012 related to a person falling and being non-alert following the incident. Aside from the concentration of such falls in the city’s downtown between M-10 and I-375, these calls are fairly evenly distributed throughout the city.

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Between January 1, 2010 and August 26, 2012 Detroit EMS responded to 1,488 calls where the injured person was paralyzed or had no sense of feeling following the incident.

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The Green and Healthy Homes-Detroit Initiative aims to reduce housing related health-risks through “comprehensive home-based assessments and interventions, public outreach and education, and local partnerships.” Through this initiative, ClearCorps is targeting three neighborhoods for housing hazard identification and remediation.  These neighborhoods are the North End and Crossman area (the center target area), the Osborn area (the north target area) and the Southwest area. The map above shows that none of these target areas had Census tracts were Detroit EMS responded to more than 67 falls. All three areas did have at least one Census tract with the second highest range (31-67) of fall-related calls.

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In the North End and Crossman area there were about 70 total fall-related calls made to Detroit EMS from January 1, 2010 to August 26, 2012. Of those calls, the following types of fall-related calls were responded to:

(The categories below are not mutually exclusive.)

•Altered consciousness: 27
•Difficulty breathing: 9
•A fall from less than 6 feet with no injury: 45
•No alert: 18
•Paralyzed/loss of feeling: 41
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In the Osborn area there were about 80 total fall-related calls made to Detroit EMS from January 1, 2010 to August 26, 2012. Of those calls, the following types of fall-related calls were responded to:

(The above categories are not mutually exclusive)

•Altered consciousness: 25
•Difficulty breathing: 13
•A fall from less than 6 feet with no injury: 60
•No alert: 30
•Paralyzed/loss of feeling: 48

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In the Southwest area there were about 60 total fall-related calls made to Detroit EMS from January 1, 2010 to August 26, 2012. Of those calls, the following types of fall-related calls were responded to:

(The categories are not mutually exclusive)

•Altered consciousness: 19
•Difficulty breathing: 20
•A fall from less than 6 feet with no injury: 40
•No alert: 21
•Paralyzed/loss of feeling: 40

911 data show show breathing and wheezing calls dot Detroit

April 21, 2013

There were few places in the City of Detroit where Detroit EMS did not respond to a call related to breathing and wheezing problems between January 1, 2010 and August 26, 2012.  there were about six neighborhoods in the western portion of the city and six other neighborhoods throughout the city that exhibited a high frequency of breathing and wheezing-related EMS calls. Aside from these 12 areas, the majority of the city exhibited a fairly low frequency of breathing and wheezing related calls.

Breathing and wheezing problems can be brought on from asbestos, mold and moisture, Volatile Organic Compounds, carbon monoxide, and tobacco smoke, amongst other health issues. Asthma can also bring on breathing and wheezing problems; this was examined in an earlier Drawing Detroit post.

The information used in this post was collected and provided by the City of Detroit. It was analyzed as part of the ongoing efforts of the Green and Healthy Homes Initiative-Detroit to identify hazards and health challenges emerging from housing problems.  The Green and Healthy Homes Initiative-Detroit (GHHI) aims to reduce housing related health-risks through “comprehensive home-based assessments and interventions, public outreach and education, and local partnerships.” Three GHHI target areas—CLEARCorps’ North End and Crossman area, Osborn and Southwest–are examined in this post. Of these three, the Osborn neighborhood had the highest frequency of breathing/wheezing related calls, while the Southwest target area had lower frequencies. locations.

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Please click all maps to enlarge them

The map above shows the frequency of all Detroit EMS calls about wheezing and difficulty breathing made between January 1, 2010 and August 26, 2012. Areas north of Michigan Avenue and east of Gratiot appear to have more challenges. One area with the highest frequency is just across the river from Belle Isle (306, 152, 202). There is also a string of Census tracts near downtown that have particularly high numbers of calls (Counts of 911 calls:202, 306, 330) .

The next six maps below show in more detail the distribution and frequency of calls made to the Detroit EMS regarding breathing and wheezing in the target areas for the Detroit Green and Healthy Homes Initiative (GHHI). For each area a dot map of locations (To preserve privacy, the precise addresses are not shown.) followed by a map shaded to reflect frequencies for Census tracts.

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The CLEARCorps target area above is located in Detroit’s north end/central Woodward neighborhood; it is  bordered by Linwood (west), Webb/Woodland (north), I-75 (east), and  Grand Boulevard (south). In this target area, there was one Census tract neighborhood with the highest frequency of calls (167) and two with the second highest frequency rating (150 and 130). The remainder of the target area is comprised of locations with a lower frequency of calls.

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The Osborn area has a high frequency of calls. This area, which is in the upper east side of the city, contains two Census tracts (with frequencies of 164 and 163) with a very high frequency of breathing/wheezing related calls. Almost every other tract in the Osborn neighborhood was in either either the second or third highest category for frequency of calls. The only exception was a Census tract in the middle of the area, which had a low frequency (38).

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The Southwest target area has no tracts with the highest frequency of breathing/wheezing related calls, though some areas have over 100 calls. The entire area is shaded in the low and middle portion of the frequency spectrum.

Dealing with the challenges

The challenges identified in these maps are partly the result of exterior and interior hazards though age of residents or disease processes are also likely to explain part of these numbers. Outside the home, dust, pollution and pollen can create breathing problems. Inside the home, mold, insects, pets and smoke are among the most important risk factors. GHHI concentrates on removing these hazards from home to make them safe for vulnerable populations, typically children and the elderly.

 

Detroit EMS receives high number of burn calls associated with structure fires

April 14, 2013

From January 1, 2010 to August 26, 2012 there were about 400 calls received by the Detroit EMS related burns associated with structure fires. In that same time there were only 15 calls related to electrical fire burns.

This post exams the distribution and frequency to which Detroit EMS responded to burn related calls. In addition to showing the overall frequency and distribution of burn related EMS calls, this post also breaks down the calls by the following types:

•Burns related to structure fires: 394 calls
•Small Burns: 262 calls
•An adult with over 18 percent of his or her body covered in burns: 219 calls
•A child with over 10 percent of his or her body covered in burns: 94 calls
•Burns where a person was not alert: 56 calls
•A person with burns and difficulty breathing: 35 calls
•Burns related to electrical fires: 15 calls

This information was obtained and analyzed as part of the ongoing efforts of the Green and Healthy Homes Initiative-Detroit . While these calls presented in this post are not mutually exclusive, each call in the time frame presented was assigned to one of the above categories.

While this information was made available for GHHI purposes, the City of Detroit only publically presents information related to the number of fire calls responded to by the City of Detroit Fire Department for 2006 on their website. According to that data, in 2006 the fire department responded to 33,441 fires and 131,481 medical emergencies. According to the same website, there was an average of 47 people in the city who die each year from residential fire deaths.

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The above map shows, by Census tract data, where Detroit EMS assisted burn victims, and the frequency at which they assisted, from January 10, 2010 to August 26, 2012. During this period, there were 1,075 burn calls throughout the city. While much of the City of Detroit was in the mid to low range (2-5 calls per Census tract) for the frequency of burn calls, there were several pockets that had high numbers of EMS calls, according to the legend. The dark green areas have the highest frequency of calls; these areas range from 9 to 12 calls. For the highest frequency areas there is no trend associated with where they are located in the city; there were 11 Census tract locations in the high frequency range. There was however a diagonal string of Census tract areas in the central/ south-central area of the city that had between 6 and 9 EMS burn calls from January 2010 to August 2012.

There were 21 Census tract locations where zero burn related calls were made to the Detroit EMS in this time frame; some of these locations include Palmer Park, Rouge Golf Course, Eliza Howell Park, and Belle Isle; all of which are parks/recreation areas in the city.

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This map provides a different picture on where Detroit EMS responded to burn related situations. As mentioned above there is no trend to where the high frequency areas are located in the city, and areas with between 2 to 5 calls seemed to dominate the city.

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The above seven maps are a breakdown of the EMS burn calls,  by dispatcher-assigned category, within the City of Detroit. Of the 1,075 total burn calls during this time, 394 were categorized as related to structure fires. The second highest frequency category was small burn related calls.

There were 15 calls to Detroit EMS between January 1, 2010 to August 26, 2012 for burns related to electrical fires, 35 calls related to a person having burns and difficulty breathing, and 56 where a person was burned and not alert. There were far fewer EMS calls in those three categories than EMS calls related to burns and structure fires (394), small burns (262) and children (94) and adults (219) with burns that covered a certain portion of their body.

When the total number of burn related calls were broken down in the seven categories the maps showed there were no clear geographic trends of concentration in certain areas of the city, per category.

Mortality rates for Detroit and Michigan

February 2, 2013

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According to the Center for Disease Control and Prevention, the mortality rate is defined as “a measure of the frequency of occurrence of death among a defined population during a specified time interval.” The above chart shows the mortality rates from 2010 for each of the seven counties that make up Southeastern Michigan. Of these counties, St. Clair County had the highest mortality rate in 2010 at 1,007.1 per 100,000 residents; Wayne County had the second highest rate at 985.2. Washtenaw County had the lowest rate at 581.2.

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The above chart shows the mortality rates for the City of Detroit, the State of Michigan, and the United States. The rates from Michigan and the United States cover the time span of 1970 to 2010, while the rate for the City of Detroit only covers 1990 to 2010, the only years for which this data was available.

As can be seen, the mortality rate in the City of Detroit remained higher than the rates in Michigan and the United States from 1990 to 2010. The mortality rate in Detroit had a decreasing trend from 1995 to 1997. In 1997, the mortality rate was 9.9 per 1,000 residents, and in 1998 it increased to 10.1. Since then, the mortality rate in the city has ranged from 10.2 to 10.8. In 2010, it was recorded at 10.5.

For Michigan and the United States, the mortality rate trends over time are much smoother.  Although they were declining from 1972 to 1979, the rates increased in 1980 and remained fairly constant until 2001. From 2001 to 2010, the mortality rate for the United States began to decline while the rate in Michigan began to increase. In 2010, Michigan’s mortality rate was 8.9 per 1,000 residents, and the rate in the United States was 8.

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In 2010, the mortality rate, per 100,000 residents, in the City of Detroit was highest for those individuals 85-years-old and older; it was recorded at 13,081.2. The age bracket for individuals 75-84 years old had the second highest rate at 5,710.9. The age bracket with the lowest rate was 1 to 14-year-olds with a rate of 31.7. There was a gradual progression of increasing rates as the age groups became older, with the exception of the under 1 year old age group. For this group, there was a mortality rate of 1,423.2 per 100,000 residents in 2010. For more information on infant mortality rates, please see our previous post here.

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The above chart shows that in 2010, the mortality rate for males was consistently higher than the rate for females in every age category in the City of Detroit. For example, in the 85 and over age group, the mortality rate for males was 14,350 per 100,000 residents,  while the mortality rate for females was 12,506.

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The above chart shows the top 10 leading causes of death for Detroit and Michigan residents in 2010, according to the Michigan Department of Community Health. Heart disease had the highest mortality rate per 100,000 residents for both the City of Detroit and the State of Michigan. However, that rate was 80 deaths per 100,000 residents higher in Detroit (316) than the state (236).

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The above slide shows the death rate for each one of the counties that make of Southeastern Michigan for heart disease, which is the leading cause of death for all the above counties. Wayne County has the highest rate at 988.1. St. Clair County has the second highest rate 296.8. The rate for St. Clair County is closer to Washtenaw County’s rate of 138.2, which is the lowest of the seven counties, than it is to Wayne County.

In an upcoming post we will explore how the top 10 leading causes of death for each county in Southeastern Michigan and how they have changed over time.

Infant mortality rates in Detroit and Michigan

January 27, 2013

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The above chart shows the infant mortality rate for 2010 and the five year rolling average for the infant mortality rate from 2006 to 2010 for the counties in Southeastern Michigan. Wayne County has the highest infant mortality rate: in 2010, it was 9.7 per 1,000 live births and the five year rolling average was 10.2. When looking at the rolling average rates, Washtenaw County is the lowest with 5.3. In 2010, St. Clair County had the lowest infant mortality, with a rate of 4.7.

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The above chart shows that the infant mortality rate for the City of Detroit has consistently been higher than the rate for the State of Michigan from 1970 through 2000. While the rates have been decreasing for both the city and the state, Michigan has a smooth decreasing trend, whereas Detroit’s rate has been unstable. Part of the smoothness of the Michigan curve is simply the larger number of cases.  Detroit’s lowest infant mortality rate was 13.4 in 2006 while the state’s lowest rate was 7.1 in 2010. Detroit’s infant mortality rate was 13.5 in 2010.

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According to both the charts above, in both the state and the City of Detroit, black children had the highest infant mortality rate from 1990 to 2010. In Michigan, the highest rate among that race was 22.1 in 1992; that rate decreased to 14.2 in 2010. For the white race the highest rate was 7.9 in 1990 and the lowest rate was 5.4 in 2004; it was 5.5 in 2010.

The instability of a constant decline, or increase, is pronounced in the white race in the City of Detroit, again, probably because of a smaller number of cases.  In 1990 the rate of infant mortality for whites in the City of Detroit was 8.7 and in 2010 it was 8.5. During this 20-year period, it reached a high of 11.5 (2003) and a low of 3.4 (1996). For blacks, the infant mortality high was recorded at 23.3 in 1992 and has since decreased to 14.4 in 2010.

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The above chart shows the three-year rolling average rate of infant mortality from 2008 to 2010 by cause of death. The Michigan Department of Community Health only tracked these causes per 10,000 live births, as opposed to the rates based on 1,000 live births above, because they are grouped into broader categories when being coded. Premature birth/low birth weights and congenital abnormalities  were the two highest causes of infant death, according to the Michigan Department of Community Health. The rate for premature birth/low birth weights was 16.7 per 10,000 and the rate for congenital abnormality related deaths was 15.2. The cause with the lowest rate was birth trauma with a rate of 0.

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The above chart compares the infant mortality rates of Detroit and Michigan to the highest and lowest international rates and the four countries with rates closest to Detroit. As can be seen, in 2010, Angola had the highest infant mortality rate of 178.3 and Monaco had the lowest with 1.78. The countries closest to Detroit 2010 infant mortality rate of  13.5 were Aruba and Turks and Caicos, which were just below the city’s rate, and the Bahamas and British Virgin Islands, which were just above it. The 2010 infant mortality rate for the U.S. is lower than both Detroit’s and Michigan’s rates.

The HIV epidemic in the Detroit Metropolitan Area

December 16, 2012

In this post, we will examine the HIV/AIDS epidemic in Michigan with particular emphasis on the Detroit Metropolitan Area. The Michigan Department of Community Health (MDCH) considers the Detroit Metropolitan Area (DMA) to include the counties of Wayne, Oakland, Macomb, St. Clair, Monroe, and Lapeer. Michigan has the 13th highest number of persons living with HIV in the United States. According to the 2012 Epidemiological Profile of HIV in Michigan, 15,753 persons were known to be infected with HIV in Michigan by the end of 2011. All told, 63% of all persons living with HIV in Michigan reside in the Detroit Metropolitan Area where 43% of the state’s population lives.

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The state separately reports data for the City of Detroit and the balance of Wayne County. As can be seen in the following graph, in 2011, HIV infection was concentrated in Wayne and Oakland counties. Over half of the persons living with HIV in the DMA resided in the City of Detroit, with 16% in the balance of Wayne County and 18% in Oakland County.

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HIV continues to disproportionally impact African Americans. In Michigan, the rate of infection is 10 times higher among black males than white males and 25 times higher among black females than white females.  Within the DMA, the infection rate among black persons is higher than for the general population. When the information is broken down by gender and race it shows there is a higher prevalence of HIV in both black males and females. According to data on the DMA, by 2011 approximately 64% of males diagnosed with HIV  and 81% of diagnosed females were black.

 

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As shown in the graph below, almost a third of persons living with HIV were between 30 and 39 years old at the time of diagnosis. The next highest number of cases occurs with persons who were diagnosed between 20-24 years or 40-49 years old, both of which were reported at 18%. This information shows the percent of those diagnosed with HIV was highest for those in the 20-29 age group, which the MDCH epidemiologist breaks down into two groups to emphasize the differences in HIV rates, especially in trend analyses. Trend data calculated by MDCH from 2006 to 2010 indicates the rate of new HIV diagnosis increased an average of 11% per year among persons 20-24 years of age and an average of 8% per year among those persons 25-29 years of age.

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HIV/AIDS is transmitted through contact with specific bodily fluids: blood, semen, vaginal secretions and breast milk (CDC, 2012).  In the U.S., HIV is most commonly transmitted through specific sexual behaviors (e.g., anal or vaginal sex) or by sharing needles or injection drug equipment with an infected person. Less common transmission routes are through oral sex, transfusions, or an HIV-infected woman passing the virus to her baby.

According to the MDCH HIV/STD/VH/TB Epidemiology Section of the Bureau of Disease Control, Prevention and Epidemiology, nearly half, 49%, of people infected engaged in “man who has sex with a man” (MSM) behavior. However, keep in mind  not all those in the MSM category are MSMs. MSM is a broad category that also includes transgenders and bisexuals; these groups would argue they are not MSMs.

Exposure through unprotected heterosexual sex constitutes 17% of HIV cases; 11% were exposed through injection drug use.

In terms of the 18% with no identified risk, this means it is too difficult to determine the exact route of exposure for such reasons as there can be at least three months or longer lag between exposure and a positive diagnosis. With such a time frame, many people are not sure of the exact cause, which is why it is listed as “no identified risk.” Also, some do not get diagnosed until they have symptoms, which could be 20 years post exposure.  Also all exposure data is, by necessity, self-reported, and some don’t acknowledge having any risks.

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More detailed information about the epidemiologic profile of HIV/AIDS in Michigan and the DMA can be found at http://www.michigan.gov/mdch/0,4612,7-132-2940_2955_2982_46000_46003-36307–,00.html

To find a free or low cost confidential HIV or STD testing location you can check the website http://hivtest.cdc.gov/Default.aspx to find free testing sites in your area. Just enter your ZIP code. Testing is confidential.