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.”

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.

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.

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.

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.

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.

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.

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.

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.)

In this post, rates for syphilis, gonorrhea, and chlamydia are examined for the Metro-Detroit area. The Metro-Detroit area includes Detroit, Wayne County, Macomb County, and Oakland County. Detroit data is included in the Wayne County data shown. All rates are based on 100,000 residents and a 95 percent confidence interval. A confidence interval is a range of values that likely includes an unknown population parameter; the range is calculated from a given set of sample data.

Chlamydia rates in Detroit and Wayne, Oakland, and Macomb counties were on the rise from 1999 to 2011, according to the Michigan Department of Community Health. When looking further into data on chlamydia for City of Detroit residents, it can be seen there was a higher rate of females for this sexually transmitted disease (STD) than males. The data also shows the number of chlamydia and gonorrhea cases was highest for those between the ages of 15-24 for all geographical areas examined in the post.

Overall, from 1999 to 2011, the chlamydia rate increased for the state and all four geographical areas examined in this post. However, it increased at a much more rapid pace in the City of Detroit than it did in Oakland and Macomb counties. In 1999, the chlamydia rate in Detroit was recorded at 804 cases per 100,000 residents and in 2010, it reached a peak of 2,561. Note, however it declined in 2011 to 2,279. In Wayne County the rate was recorded at 417 per 100,000 residents in 1999 and 1,109 in 2011. For both Macomb and Oakland counties the chlamydia rate was recorded at 75 cases per 100,000 residents in 1999. By 2011, the rate was recorded at 307 cases per 100,000 residents in Oakland County and 233 in Macomb County.  The state as whole more than doubled across these years to 507 cases per 100,000.

From 1999 to 2011, female Detroit residents consistently had a higher rate of chlamydia infection than Detroit male residents. Between 2006 and 2008, the rate of females infected increased from 1,902 cases per 100,000 female residents to 3,361. In 2011 the rate of females infected was reported to decline to 3,201 cases per 100,000 female residents and the rate of males infected was 1,239 cases per 100,000 male residents.

In 2011, the 15-19 year old age group had the highest rate of females infected with chlamydia, at 17,156 cases per 100,000 female residents. For males, the 20-24 year old age group had the highest rate at 5,472 cases per 100,000 male residents.

No rates are provided for the 45 and older age group in the above chart because the data to calculate a meaningful rate is too broad because of the age range, according to the Michigan Department of Community Health.

Of the three STDs examined in this post, syphilis had the lowest rates of infection for Detroit and Wayne, Macomb and Oakland counties. During the time covered it increased in Detroit and Wayne County then fell dramatically in several jurisdictions. During the time period examined, Detroit had the highest rate of syphilis cases. From 1999 to 2001 there was an increase in Detroit’s rate; the rate peaked  in 2001 at 97 cases per 100,000 residents. Detroit’s rate then decreased, reaching a low of 23 cases per 100,000 residents. Since then, the rate generally increased in Detroit; in 2011, the syphilis rate for Detroit was recorded at 41 cases per 100,000 residents.

Unlike Detroit and Wayne County, the syphilis rates for both Oakland and Macomb counties remained fairly consistent and low  since 1999. However, in recent years, the rates for both counties increased; in 2011, both counties recorded their highest syphilis rates of the examined period: 7 cases per 100,000 residents.

The chart above demonstrates that Detroit males consistently had a higher rate of syphilis than Detroit females. In 2011, there were 66 males  per 100,000 male residents infected with syphilis and 21 females per 100,000 female residents infected.

The above chart shows Detroit males between the ages of 20 and 24 had the highest rate of syphilis infection in 2011. When looking at the 2011 rates for Detroit females only, the 25-29 year old age group had the highest rate.

There is no rate provided for the 15-19 female age group because not enough data was available. Also, no rates are provided for the 45 and older age group in the above chart because the data was too broad because of the age range to calculate a meaningful rate, according to the Michigan Department of Community Health.

Similar to the syphilis rates, residents in Macomb and Oakland counties experienced relatively low and consistent gonorrhea rates from 1999-2011, compared to those in Detroit and Wayne County. In 2011, the gonorrhea rate in Macomb County was 60 cases per 100,000 residents; the rate was 82 per 100,000 in Oakland County. For Wayne County the gonorrhea rate in 2011 was 413 cases per 100,000 residents and it was 906 per 100,000 residents for Detroit. In 2008, a gonorrhea rate of 1,166 was recorded for Detroit residents; this was the peak during the time period examined, and it has declined somewhat since then.

From 1999 to 2000, males had a higher rate of gonorrhea infection than females in Detroit. Between 2001 and 2004, males and females had similar rates. In 2005, the rate of females infected with gonorrhea began to surpass that of males. In 2011, the rate of gonorrhea for females was 1,102 cases per 100,000 and the rate for males was 795 per 100,000.

For Detroit females in 2011, the 15-19 year old age group had the highest rate of gonorrhea infection. For Detroit males, the 20-24 year old age group had the highest rate of infection.

No rates are provided for the 45 and older age group in the above chart because the data was too broad because of the large age range to calculate a meaningful rate, according to the Michigan Department of Community Health.

In this week’s post we examine the death rates for several causes for the Southeastern Michigan area, which consists of Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw and Wayne counties. We also included the City of Detroit in these charts. When comparing all seven counties in the region, a 5-year rolling average was used, as this was the only consistent type of data reporting used by the Michigan Department of Community Health for all the causes of death examined here. When comparing just the tri-county Metro-Detroit region (Macomb, Oakland, and Wayne counties along with the City of Detroit) data was reported on a yearly basis.  Where numbers aren’t reported in the charts it is because the Michigan Department of Community Health did not have sufficient data; this is seen most often with Livingston, Monroe and St. Clair counties. In addition, all death rates were reported per 100,000.

After examining all charts, the reader will see that heart disease has the highest death rate in the area, but has also seen a significant decrease over the last 30 years for the 75 and older population. Death rates related to strokes and flu and pneumonia for the 75 and older population have also been decreasing. Death rates associated with chronic diseases, such as kidney and respiratory diseases, have been increasing for the older population, as have the death rates associated with diabetes and Alzheimer’s disease.

The death rate associated with heart disease is the highest of all the causes of deaths examined in this post. While it has been decreasing since the 1980s in the Southeastern Michigan area; the lowest death rate associated with heart disease is still higher than the death rates associated with cancer for the region. For the five year rolling average of the entire Southeastern Michigan area, Washtenaw County has consistently had the lowest death rate associated with heart disease for those 75 and older.

The four charts above show the cancer death rate for Southeastern Michigan residents age 75 and older and for those 50 and younger. As can be seen by both the data provided for the seven county regions and the tri-county region, the cancer death rate is well over 1,000 points higher for those 75 and older  than those 50 and younger, when comparing the highest rates in the seven county charts. For those 75 and older, Livingston County had the highest five year rolling average cancer death rate of 1,715.5 from 1995-1999.

For those 50 and younger the City of Detroit had the highest rate at 31.9 from 1991-95. For those under the age of 50 in the chart that compares all seven counties in the Southeastern Michigan area, Detroit consistently had the highest rates, while for those 75 and older Detroit only began to have the highest cancer death rate with the 2000-04; this trend has continued. Before then, Livingston and St. Clair counties had the highest rates for those 75 and older.

For the 75 and older population the death rate associated with strokes has been decreasing over time. For example, Washtenaw County started out with the highest death rate caused by strokes when looking at the 1980-84 average; this rate was recorded at 1,179.1. For the 2006-10 average though the rate was recorded at 500.5. Monroe County had the highest death rate average for this population for 2006-10 with a rate of 521.8.

When looking at the data for the 50 and younger population, Detroit had a higher death rate when comparing both the seven county region and the Metro-Detroit area. The 2006-10 average for Detroit was 5.9; this shows how deaths associated with strokes have a much lower rate for the younger population.

When examining the death rates associated with the flu and pneumonia in all four charts there appears to be a downward trend. However, the death rate did spike in the early 1990’s for all charts except the one that shows the five year rolling average for those 75 and older in the Southeastern Michigan region.   For the 75 and older population the death rate ranged from about 300 to 400 in the early 1980s. Those numbers have since decreased, however the overall range has expanded. For example, for the 2006-10 average for the 75 and older population Livingston County had the highest rate at 243.5 while Monroe County had the lowest at 87.7.

When comparing the younger population with the older population, the death rates are much lower for those who are younger. For example, the highest five year average flu and pneumonia death rate recorded for those 50 and younger was in 1992-96 for the City of Detroit; it was recorded at 8.4. The highest rate recorded for those 75 and older was 543.1 for Washtenaw County residents for the 1986-90 average. For the younger population the Michigan Department of Community Health did not have consistent information available for all counties in the Southeastern Michigan region.

The diabetes death rate for those under the age of 50 is highest for the City of Detroit when comparing data at the yearly level for the Metro-Detroit area and for the five year rolling average when looking at all of Southeastern Michigan.  In recent years the diabetes death rate for those 75 and older has been highest and in St. Clair and Monroe counties. St. Clair County has had the highest five year rolling average since 2002-06. Overall, since 1980 for those 75 and older in the seven county regions, Monroe County recorded the highest rate at 402 for the 1998-02 average.

While the rate of deaths caused by chronic liver disease shows an overall downward trend for those 75 and older in the Southeastern Michigan area, the data shows that Monroe County residents are following that trend at an even a slower pace.  Monroe and St. Clair counties both saw a peak in the average number of deaths associated with this disease in the 1997-2001 time frame. However, following that, St. Clair County’s numbers decreased more rapidly than those in Monroe County. For the 2006-10 average Monroe County recorded a rate of 36.4; for those 50 and younger Monroe County residents recorded a rate of about 3.8.

For the younger population, City of Detroit residents had a higher death rates associated with chronic liver disease when looking at both the seven county region and the tri-county area. When examining the seven county region though, the decline in deaths associated with this disease was much more prominent. For the 1985-89 average, the City of Detroit reached a peak of 20.2; that number has since decreased to 3.6 for the 2006-10 average. Starting with the 2000-04 average, St. Clair County moved ahead of the City of Detroit for the death rate associated with chronic liver disease. St. Clair County has remained ahead of Detroit and recorded an average death rate of 4.2 for 2006-10.

The two charts showing data for chronic kidney disease death rates for those 75 and older shows there has been an increasing trend over time. For example, in the City of Detroit, the 1980-84 average was 111.2 and the 2006-2010 average was 216.2. The City of Detroit has recorded the highest death rate for this disease since the 1996-00 five year rolling average was calculated for the elderly population. While the death rate did begin to trend downward for Detroit after the 2001-05 average, the 2006-10 average is still much higher than the 1980-84 average.

The chart showing the chronic kidney disease death rates for those 50 and younger for the City of Detroit and Wayne County shows Detroit’s rate has consistently remained higher. In 2010 Detroit’s rate was recorded at 2 and Wayne County’s was recorded at 1.2. Information for Macomb and Oakland counties with this population wasn’t consistently available on yearly basis; the same goes for the Southeastern Michigan reason with the five year rolling average.

As with trends seen throughout this post though, the death rate for the younger population with this disease is much lower than those 75 and older.

When looking at the death rates associated with chronic respiratory disease the data shows they have been increasing for those 75 and older. However, when looking at the rates for those under the age of 50 there is no evidence of such a prominent increase. Instead, the Metro-Detroit region shows no regular trend and for the information available for the Southeastern Michigan area the trend was less erratic, but this can be attributed to the fact that the data is based on a rolling average. The City of Detroit did have the highest rates for both charts that show the data for those under the age of 50.

The death rate associated with Alzheimer’s Disease has seen an overall upward trend in the Southeastern Michigan area for all ages. Livingston County though saw a large increase from 1994-98 to 1999-03. The five year age death rate associated with this disease was recorded at 27.8 for 1999-03; which was the highest recorded rate for the county and the region. Washtenaw County has had the highest death rate associated with this disease since the early 2000s.For the 2006-10 average it was recorded at 21.9.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Obesity has been documented as a growing problem, not only in Michigan, but across the country. This post will examine the obesity rate for Michigan, particularly its increase over the past few years. According to the Center for Disease Control, a person is considered obese if their Body Mass Index (BMI) is 30 or above while a person is considered overweight if their BMI is between 25 and 29.9.

Michigan’s obesity rate was been increasing since 1990, according to America’s Health Rankings (part of the United Health Foundation). Since 1990 the obesity rate has increased 17.6%. The year 2011 was the highest with 31.7%; in 1990 it was documented at 14.1%.

Of the 11 Midwest states Michigan is ranked the highest for its obesity rate at 31 percent. Indiana is ranked second with an obesity rate at 30.8 percent,  and Missouri came in third at 30.3 percent.

Michigan’s obesity rate was been increasing since 1990, according to America’s Health Rankings (part of the United Health Foundation). Since 1990 the obesity rate has increased 17.6 percent. The year 2011 was the highest with 31.7 percent; in 1990 it was documented at 14.1 percent.

The above chart shows the number of documented conditions, often associated with obesity, in the year 2010.  Hypertension and arthritis had the highest number of document cases, both at 1.9 million; obesity related cancers was the lowest at 150,809.

The above chart shows the percentage of obese children and adolescents according to the most recent studies by various organizations. The 10-17 year old age range, which is the widest range presented in the chart, had the highest obesity rate at 30.6 percent in 2007.

The number of obese Michigan residents with diabetes increased from 1995 to 2007. Then, in 2007 it began to level out. In 1995 35.2 percent of those with diabetes were obese; by 2007 that number reached 58.3 percent, and in 2010 it was 57.7 percent.

In the future, we will examine data about obesity in Detroit and the suburbs.