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Data Snapshot on Health in Detroit: May 2018 1. A Look at Disparities in Infants and Children Infant Mortality Table 1.1 Three-Year Moving Average Infant Death Rates in Wayne County (including Detroit) (Per 1,000 Live Births), 2004-2015 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15 Overall 10.6 10.5 10.4 10.4 10.2 9.8 9.9 9.7 9.6 9.3 White 5.0 5.4 5.6 5.6 5.4 5.5 5.9 6.3 6.4 6.4 Black 16.7 15.9 15.3 15.3 15.1 14.5 14.5 14.0 13.8 13.1

Note: (1) Infant deaths is the deaths occurring to individuals less than 1 year of age. (2)The infant death rate is the number of resident infant deaths divided by total resident live births X 1,000. Source: 2014-2015 Michigan Death Certificate Registries. 2004-2015 Geocoded Michigan Birth Certificate Registries. Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services. Link: https://www.mdch.state.mi.us/pha/osr/Chi/Indx/frame.asp Caption: Figure 1.1 shows the three-year average infant death rate by race in Wayne county from 2004 to 2015. Overall, there has been a slight decline in infant death rate in the county during this period. The trend differs between Black and White. There has been a decline in Black American infant death rate while there has been an increase in White American infant death rate.

2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15Overall 10.6 10.5 10.4 10.4 10.2 9.8 9.9 9.7 9.6 9.3White 5.0 5.4 5.6 5.6 5.4 5.5 5.9 6.3 6.4 6.4Black 16.7 15.9 15.3 15.3 15.1 14.5 14.5 14.0 13.8 13.1

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Figure 1.1 Three-Year Average Infant Death Rates in Wayne County (including Detroit) by Race, 2004-2015

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Table 1.2 Three-Year Moving Average Infant Death Rates in Detroit City (Per 1,000 Live Births), by Race, 2014-2015 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15

Detroit 15.0 14.7 14.3 14.8 14.4 13.6 13.6 13.6 13.9 13.5

White 4.9 5.5 5.2 5.5 5.8 6.5 9.9 10.1 11.3 9.9

Black 16.8 16.2 15.8 16.5 15.9 15.0 14.7 14.8 15.0 14.7

Note: (1) Infant Deaths is the deaths occurring to individuals less than 1 year of age. (2) The infant death rate is the number of resident infant deaths divided by total resident live births X 1,000. Source: 2014-2015 Michigan Death Certificate Registries. 2004-2015 Geocoded Michigan Birth Certificate Registries. Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services. Link: https://www.mdch.state.mi.us/pha/osr/Chi/Indx/frame.asp Caption: Figure 1.2 shows the three-year average infant death rate in the city of Detroit from 2004 to 2015. Overall, there has been a decline in infant death rate in Detroit. However, this rate has been increased in White Detroit residents.

2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13 2012-14 2013-15Detroit 15 14.7 14.3 14.8 14.4 13.6 13.6 13.6 13.9 13.5White 4.9 5.5 5.2 5.5 5.8 6.5 9.9 10.1 11.3 9.9Black 16.8 16.2 15.8 16.5 15.9 15 14.7 14.8 15 14.7

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Table 1.3 Three-Year Average Infant Death Rates in Michigan, Wayne County (excluding Detroit), Detroit City (Per 1,000 Live Births), 2013-2015 Michigan Wayne County (excluding Detroit) Detroit Overall 6.8 6.2 13.5 White 5.4 6.1 9.9 Black 13.6 8.1 14.7

Source: 2014-2015 Michigan Death Certificate Registries. 2004-2015 Geocoded Michigan Birth Certificate Registries. Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services. Link: https://www.mdch.state.mi.us/pha/osr/InDxMain/WtCoTbl.asp Caption: Figure 1.3 shows that the infant death rates were higher in Black than it is in White in Michigan, Wayne county, and Detroit. Overall, the infant death rate was 6.8 per 1,000 live births in Michigan; it was 5.4 per 1,000 live births while it was 13.6 per live births. The infant death rates were higher in Detroit both for White and for Black.

Michigan Wayne County (excluding Detroit) DetroitOverall 6.8 6.2 13.5White 5.4 6.1 9.9Black 13.6 8.1 14.7

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Figure 1.3 Three-Year Average Infant Death Rates in Michigan, Wayne County(excluding Detroit), Detroit, 2013-2015

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Teen Fertility Table 1.4 Fertility Rates in Females Aged 15-19 Years in Michigan, Wayne County (excluding Detroit), Detroit City, by Race, 2016

Fertility Rates (Births per 1,000

Females Aged 15-19 Years) Michigan (White) 13.5 Michigan (Black) 35.0 Wayne Excluding Detroit (White) 11.9 Wayne Excluding Detroit (Black) 32.6 Detroit (Black) 37.8

Note: *Fertility rate for White females was not available in Detroit. Source: 2016 Michigan Resident Live Birth Files, Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services. Population Estimate, National Center for Health Statistics, U.S. Census Populations with Bridged Race Categories. Link: https://www.mdch.state.mi.us/osr/Abortion/PregTrdTeen15-19.asp Caption: Figure 1.4 shows that there were significant difference on teen fertility rate between White and Black in Michigan. In 2016, fertility rate in White was 13.5 births per 1,000 females aged 15-19 years while in Black it was 35.0 births per 1,000 females aged 15-19 years. The similar trend showed in Wayne county and the city of Detroit although fertility rate for White females was not available.

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Figure 1.4 Fertility Rates in Females Aged 15-19 Years in Michigan, Wayne County (excluding Detroit), Detroit, by Race, 2016

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Preterm Births Table 1.5 Three-year Average Rates of Preterm Birth by Age Groups, Michigan, Wayne County (including Detroit), Detroit (Per 100 Live Births), 2014-2016 Age Group Michigan Wayne County (including Detroit) Detroit City Total 9.9 11.1 14.0 15 – 19 10.5 11.8 12.9 20 – 24 9.7 11.3 13.3 25 – 29 9.2 10.4 13.2 30 – 34 9.7 10.8 15.2 35 – 39 11.3 11.8 16.9 40 and over 14.6 15.9 19.2

Note: Preterm birth means infants born prior to 37 completed weeks of gestation. Source: 2014-2016 Geocoded Michigan Birth Certificate Registries Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services Link: https://www.mdch.state.mi.us/pha/osr/Chi/births14/frameBxChar.html Caption: Data of the three-year average preterm birth rates by age group from 2014-2016 indicated that there was a higher preterm birth rate in the city of Detroit than it was in Wayne county and Michigan (Figure 1.5). Data in Figure 1.5 indicated that in Detroit, women aged more than 30 years old or above had an increased preterm birth rates when ages increase.

0.02.04.06.08.0

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Michigan, Wayne County (including Detroit), Detroit City, 2014-2016

Total15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 and over

6

Table 1.6 Three-year Average Rates of Preterm Birth by Race among Mothers at All Age in Michigan, Wayne County (including Detroit), Detroit (per 100 Live Births), 2014-2016 Michigan Wayne County (including Detroit) Detroit City White 9.0 8.6 10.3

Black 14.0 14.1 14.9

Note: Preterm birth means infants born prior to 37 completed weeks of gestation Source: 2014-2016 Geocoded Michigan Birth Certificate Registries Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services Link: https://www.mdch.state.mi.us/pha/osr/Chi/births14/frameBxChar.html Caption: Data of the three-year average preterm birth rates from 2014-2016 also indicated that Black mothers had higher preterm rates than their White counterparts in Michigan, Wayne county, and Detroit.

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Figure 1.6 Three-year Average Rates of Preterm Birth by Race in All Mothers, 2014-2016

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Low Birth Weight Table 1.7 Three-year Average Rates of Low Birth Weight in Michigan, Wayne County (including Detroit), Detroit among Mothers at All Age (per 1,000 Live Births), 2014-2016 Michigan Wayne County (including Detroit) Detroit Overall White Black Overall White Black Overall White Black Total 8.5 7.0 14.3 10.8 7.4 14.5 14.2 9.4 15.3

Note: Low Birth Weight means live births weighing less than 2,500 grams. Source: 2014-2016 Geocoded Michigan Birth Certificate Registries Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services Link: https://www.mdch.state.mi.us/pha/osr/Chi/births14/frameBxChar.html Caption: Figure 1.7 showed that Detroit had a higher low birth rates in mothers than the low birth rates in The three-year average low weight birth rates in Black mothers were higher than White mothers in Michigan, Wayne County, and Detroit City.

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8

Children with Elevated Blood Lead Levels Table 1.8 Percentage of Tested Children under Age Six with Elevated Blood Lead Levels (EBLL) (≥5 μg/dL) in Michigan, 1998-2015

Percentage of tested children under age six with elevated blood lead levels (≥5 μg/dL) (%)

Number of children under age six tested for lead

Changed number of kids tested

1998 42.7 73643 0 1999 35.1 79063 5420 2000 30.5 78040 -1023 2001 30.4 87875 9835 2002 25.5 92767 4892 2003 20.0 100181 7414 2004 18.4 125417 25236 2005 17.1 132913 7496 2006 14.3 141011 8098 2007 13.0 149449 8438 2008 9.8 153248 3799 2009 8.5 154291 1043 2010 6.3 155847 1556 2011 5.0 151867 -3980 2012 4.6 149046 -2821 2013 3.9 147879 -1167 2014 3.5 143123 -4756 2015 3.4 140857 -2266

Source: MDHHS Data Warehouse Link: https://www.michigan.gov/documents/lead/2015_annual_report_2_7_17_551735_7.pdf Caption: Long-term exposure to lead, a naturally occurring metal used in everything from construction materials to batteries, can cause serious health problems. Although the blood lead level in children declined over years, it is still a health concern. This table and graph show the percentage of lead tested kids who were positive for elevated lead blood levels (along with the quantity and change in quantity) from 1998-2015.

42.7

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Figure 1.8 Percentage of Tested Children under Age Six with Elevated Blood Lead Levels (≥5 μg/dL) in Michigan, 1998-2015

9

Table 1.9 Percentage of Tested Children under Age Six with Blood Lead Levels ≥ 5 µg/dl in Michigan, Wayne County (excluding Detroit), Detroit, 2015 Percent Detroit City 6.1 Wayne County Excluding Detroit City 1.1 Michigan 1.8

Source: MDHHS Data Warehouse Link: https://www.michigan.gov/documents/lead/2015_annual_report_2_7_17_551735_7.pdf Caption: This table and graph show the percentage of lead tested kids who were positive for elevated lead blood levels for the city of Detroit, Wayne county excluding Detroit, and the state of Michigan. The percentage for the city of Detroit is higher than the state of Michigan and Wayne county.

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Figure 1.9 Percentage of Tested Children under Age Six with Blood Lead Levels ≥ 5 µg/dl in Michigan, Wayne County (excluding Detroit), Detroit, 2015

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2. A Look at Health Disparities in Chronic Conditions General Health Table 2.1 Behavioral Risk Factor Surveillance: Overall Health and Well-being, 2014-2016 Fair or Poor

General Health (%)

Poor Physical Health on at Least 14 Days in the Past Month

(%)

Poor Mental Health on at Least 14 Days in the Past Month

(%)

Activity Limitation on at Least 14 Days in the Past Month

(%) Michigan 17.5 16.3 16.2 9.2 Wayne County (excluding Detroit)

18.2 16.9 16.8 8.7

Detroit 27.5 18.5 18.8 13.5

Source: Michigan Behavioral Risk Factor Surveillance System (Michigan BRFSS), 2014-2016 Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf; http://www.michigan.gov/mdhhs/0,5885,7-339-71550_5104_5279_39424_39426-211229--,00.html Caption: This table and graph show the average percentage of general health indicators for a three-year span (2014-2016) for the state of Michigan, the city of Detroit, and Wayne County (excluding Detroit).

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Figure 2.1 Behavioral Risk Factor Surveillance: Overall Health and Well-being 2014-2016

Michigan Wayne County (excluding Detroit) Detroit

11

Leading Causes of Death

Table 2.2 Age-adjusted Mortality Rates for Ten Leading Causes of Death, Detroit City, Wayne County, Michigan and United States (per 100,000 Population), 2015

Detroit City Wayne County (excluding Detroit) Michigan 1. Heart Disease 296.6 228.7 195.5 2. Cancer 190.8 179.5 164.9 3. Chronic Lower Respiratory Diseases 38.8 50.4 46.7 4. Stroke 48.9 35.7 36.8 5. Unintentional Injuries 63.7 53.3 42.9 6. Alzheimer's Disease 20.6 28.5 29.7 7. Diabetes Mellitus 33.3 23.7 22.2 8. Kidney Disease 26.5 17.5 15.4 9. Pneumonia/Influenza 21.3 17.7 15.0 10. Intentional Self-harm (Suicide) 6.1 13.4 13.6

Note: Rates are per 100,000 population. The causes of death are listed in order of the 10 leading causes of death for Michigan residents in 2015. Source: 2015 Michigan Death Certificate Registry. Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services Link: https://www.mdch.state.mi.us/pha/osr/CHI/deaths/frame.asp. Caption: This chart and graph show the rates (per 100,000 people) of the top 10 leading causes of mortality (adjusted for age) in the state of Michigan along with the city of Detroit and Wayne county excluding Detroit).

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Diabetes Table 2.3 Proportion of Adults Ever Told Diabetes, in Michigan, Wayne County (excluding Detroit), Detroit City, 2014-2016 Combined Ever Told Diabetes (%) Detroit City 13.1 Wayne County (excluding Detroit) 11.3 Michigan 10.8

Note: The proportion of adults who reported that they were ever told by a doctor that they have diabetes. Women who had diabetes only during pregnancy and adults who were diagnosed with pre-diabetes were considered to not have been diagnosed with diabetes. Source: Michigan Behavioral Risk Factor Surveillance System (Michigan BRFSS), 2014-2016 Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf Caption: This chart and graph show the percentage of patients who were ever told that they have diabetes for the city of Detroit, Wayne county (excluding Detroit), and the state of Michigan.

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Figure 2.3 Proportion of Adults Ever Told Diabetes, in Michigan, Wayne County (excluding Detroit), Detroit City, 2014-2016 Combined

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Table 2.4 Age-Adjusted Diabetes Mellitus Death Rates in Michigan by Race, 2010-2015 2010 2011 2012 2013 2014 2015 Michigan 23.9 24.2 23.0 23.8 23.6 22.2 White 22.2 22.4 21.6 21.7 21.5 20.1 Black 36.0 35.7 33.9 38.8 38.9 37.6

Note: Age-adjusted death rates are based on age-specific death rates per 100,000 population in specified group. Age-adjusted death rates are computed by the direct method, using as the standard population the age distribution of the total population of the United States for the year 2000. Source: Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services; Population Estimate (latest update 9/2014), National Center for Health Statistics, U.S. Census Populations With Bridged Race Categories Link: https://www.mdch.state.mi.us/pha/osr/CHI/deaths/frame.asp Caption: This chart and graph show the age-adjusted death rate due to Diabetes Mellitus from 2010-2015 in the state of Michigan (divided by race). The rates have fluctuated by race and throughout the state of Michigan.

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Asthma Table 2.5 Respiratory Health in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

Ever Told Have Asthma (%) Ever Told COPD, Emphysema or Chronic Bronchitis (%)

Detroit 20.9 12.3 Wayne County (excluding Detroit) 15.3 8.9 Michigan 15.8 8.5

Source: Michigan BRFSS, 2014-2016 Combined, 2014-2016 Michigan BRFS Regional & Local Health Department Estimates December 12, 2017 Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf Caption: This table shows the percentage of how many patients were ever told that they have a respiratory health problem and if they still have asthma in the city of Detroit, Wayne county (excluding Detroit), and the state of Michigan.

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Figure 2.5 Respiratory Health in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

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Table 2.6 Current Asthma Prevalence among Adults in Michigan by Ethnicity, 2013-2015 Ethnicity Percent Michigan 10.9 White 10.3 Black 13.4 Hispanic 12.7 American Indian 20.3 Arab 10.9 Asian 3.2 Other 16.5

Source: Michigan Behavioral Risk Factor Survey, 2013‐2015 Link: http://www.michigan.gov/documents/mdhhs/Asthma_in_Michigan_by_Race_and_Ethnicity_600961_7.pdf Caption: This chart and graph show asthma prevalence by percent in the state of Michigan (divided by race).

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Figure 2.6 Current Asthma Prevalence among Adults in Michigan by Ethnicity, 2013-2015

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Cardiovascular Disease Table 2.7 Cardiovascular Health in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

Ever Told Heart Attack

Ever Told Angina or Coronary Heart Disease

Ever Told Stroke

Ever Told Any Cardiovascular Disease

Detroit 5.5 4.6 6.0 11.4 Wayne County (excluding Detroit) 3.0 4.9 3.6 10.2 Michigan 4.9 5.0 3.4 9.7

Source: Michigan BRFSS, 2014-2016 Combined; 2014-2016 Michigan BRFS Regional & Local Health Department Estimates December 12, 2017. Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf Caption: This table and graph show the percentage of how many patients were ever told that they have a cardiovascular health problem in the city of Detroit, Wayne county (excluding Detroit), and the state of Michigan.

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Figure 2.7 Cardiovascular Health in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

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Hypertension Table 2.8 Ever Told They Have High Blood Pressure among Adults in Michigan, Wayne County (excluding Detroit), Detroit, 2013-2015 Percent Detroit 44.9 Wayne County (excluding Detroit) 35.4 Michigan 34.3

Source: Michigan Behavioral Risk Factor Surveillance System (MiBRFSS) Link: http://www.michigan.gov/documents/mdch/WEB-High_Blood_Pressure_P-7-LHD_482106_7.swf Caption: This table and graph shows the percentage of how many patients were ever told that they have hypertension (high blood pressure) in the city of Detroit, Wayne county (excluding Detroit), and the state of Michigan.

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Figure 2.8 Prevalence of High Blood Pressure among Adults in Michigan, Wayne County (excluding Detroit), Detroit 2013-2015

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Table 2.9 Prevalence of High Blood Pressure among Adults (Michigan vs. the United States), 2003-2015

Year Prevalence of High Blood Pressure among

Michigan Adults by Year (%) Prevalence of High Blood Pressure among adults by year United States Median (%)

2003 26.8 24.8 2005 27.8 25.5 2007 28.6 27.5 2009 29.7 28.6 2011 34.2 30.8 2013 34.6 31.4 2015 33.1 30.9

Note: Due to Changes in Data Collection, Michigan Data from 2011 and Later Cannot be Directly Compared to Data from 2010 and Earlier. Source: Michigan Department of Health and Human Services Link: http://www.michigan.gov/documents/mdch/WEB-High_Blood_Pressure_P-7-LHD_482106_7.swf

Caption: This chart and graph compares the prevalence of high blood pressure between the state of Michigan and the United States.

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Figure 2.9 Prevalence of High Blood Pressure among Adults (Michigan vs. the United States), 2003-2015

Prevalence of High Blood Pressure among Adults in Michigan by Year

Prevalence of High Blood Pressureamong Adults in the United States (Median) by Year

19

Alzheimer’s Disease/Dementia Table 2.10 Age-Adjusted Alzheimer's Disease Death Rates in Michigan, Wayne County (excluding Detroit), Detroit (per 100,000 Population), 2010-2015 2010 2011 2012 2013 2014 2015 Detroit City 12.6 16.4 14.3 16.4 21.0 21.2 Wayne (excluding Detroit) 21.1 23.8 27.3 34.7 34.6 36.1 Michigan 27.7 29.1 31.0 32.6 33.7 37.5

Notes: Rates are per 100,000 estimated population. Source: 1980 - 2015 Michigan Resident Death Files. Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services. Link: https://www.mdch.state.mi.us/osr/deaths/AlzheimersCrudeRatesTrends.asp

Caption: This chart and graph show the age-adjusted death rate due to Alzheimer’s from 2010-2015 in the state of Michigan, Detroit, and Wayne county excluding Detroit. It has increased throughout the state of Michigan.

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3. A Look at Disparities in Health Behaviors Healthy Weight Table 3.1 Weight Status in Adults Aged 18 years and Older in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016 Obese (%) Overweight (%) Healthy Weight (%) Detroit 37.2 33.2 31.9 Wayne County (excluding Detroit) 31.5 33.6 32.7 Michigan 31.4 35.0 31.9

Source: Michigan BRFSS, 2014-2016 Combined, 2014-2016 Michigan BRFS Regional & Local Health Department Estimates December 12, 2017. Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf

Caption: This chart and graph show weight status as a percent over a three-year span for the city of Detroit, Wayne county (excluding Detroit), and the state of Michigan.

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Figure 3.1 Weight Status in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

Michigan

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Detroit City

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Physical Activity and Eating Habit Table 3.2 Physical Activity, Health Behavior in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016 No Leisure Time Physical Activity* Adequate physical activity** Michigan 24.9 19.5 Wayne County (excluding Detroit) 25.1 19.1 Detroit City 34.7 17.9

Note: * Data from Michigan BRFSS, 2014-2016 Combined; ** Data from Michigan BRFSS 2013-2015 combined Source: Michigan BRFSS, 2014-2016 Combined, 2014-2016 Michigan BRFS Regional & Local Health Department Estimates December 12, 2017. Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf http://www.michigan.gov/documents/mdch/WEB-Physical_Activity_P-2-LHD_482080_7.swf Caption: This chart and graph show physical activity status as a percent over a three-year for the city of Detroit, Wayne county (excluding Detroit), and the state of Michigan.

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Figure 3.2 Physicial Activity, Health Behaviors in Michigan, Wayne County (excluding Dettroit), Detroit, 2014-2016

Michigan

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Detroit City

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Table 3.3 Prevalence of Fruit and Vegetable Consumption (5+ times/day), in Michigan, Wayne County (excluding Detroit), Detroit, 2013-2015 Percent Michigan 14.9 Wayne County (excluding Detroit) 16.0 Detroit 15.8

Note: Prevalence assessed using the percentage of people eating fruits or vegetables or both five or more times per day. Source: Michigan Coordinated Chronic Disease Prevention and Health Promotion Indicators Link: http://www.michigan.gov/documents/mdch/WEB-Fruits_Veggies_P-1-LHD_482078_7.swf Caption: This chart and graph show adequate fruit & vegetable consumption status as a percent for the city of Detroit, Wayne county (excluding Detroit), and the state of Michigan. Wayne county and the city of Detroit have slightly higher adequate fruit & vegetable consumption than the state average.

14.214.414.614.815.015.215.415.615.816.016.2

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Figure 3.3 Prevalence of Fruit and Vegetable Consumption (5+ times/day), in Michigan, Wayne County (excluding Detroit), Detroit, 2013-2015

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Places in Distress Table 3.4 The 10 Cities with the Largest Number of People in Distressed

City Population in Distressed Proportion of Population in Distressed (%)

Ratio of City Distressed Population Share to Total Population Share

New York, NY 1,328,870 15.90 0.85 Chicago, IL 1,064,510 39.20 2.09 Houston, TX 712,140 32.80 1.75 Detroit, MI 688,080 98.90 5.28 Philadelphia, PA 669,990 43.30 2.31 Los Angeles, CA 661,170 17.10 0.91 Phoenix, AZ 456,310 30.60 1.63 Memphis, TN 437,090 66.60 3.55 San Antonio, TX 403,640 29.10 1.56 Baltimore, MD 344,080 55.30 2.95

Source: CITYLAB. Link: https://www.citylab.com/equity/2016/02/mapping-distressed-communities-in-the-us/471150/ Caption: This chart and graph show the top 10 cities of distressed populations along with their percentages.

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Figure 3.4 Percentage of Population in Distressed Area

24

STD Infection Table 3.5 Prevalence of Gonorrhea and Chlamydia in Michigan (per 100,000 Population), 2016 Gonorrhea Chlamydia

White 32.6 191.7 Black 464.5 1135.1 Hispanic 67.2 331.2 Asian or Pacific Islander 16.8 108.8 Native American 53.8 292.8

Note: Rate of STDs was based on 2016 NCHS bridged-race estimates. Source: Division of Communicable Disease Epidemiology, Michigan Department of Health & Human Services. Link: http://www.michigan.gov/documents/mdhhs/2015_Michigan_STD_Statistics_542411_7.pdf Caption: This chart and graph show the rate of Gonorrhea and Chlamydia by race in the state of Michigan in 2016.

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Figure 3.5 Prevalence of Gonorrhea and Chlamydia in Michigan, 2016

White

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25

HPV Vaccination Table 3.6 Prevalence of HPV Vaccination Coverage in Adolescents Aged 13-17 Years in Michigan, and the United States, 2013 Michigan (%) United States (%) Girls ≥ Doses 66.0 57.3 3 Doses 34.5 37.6 Boys ≥ Doses 30.0 34.6 3 Doses 7.7 13.9

Source: CDC Human Papillomavirus (HPV) Vaccination Report: Michigan, Working Together to Reach National Goals for HPV Vaccination. Link: https://www.michigan.gov/documents/mdch/MichiganHPVReport_479144_7.pdf Caption: This chart and graph compares HPV vaccination dose percentage by sex and whether they got at least one dose or three doses for the state of Michigan and the United States.

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Figure 3.6 HPV Vaccination Coverage in Michigan Adolescents Aged 13-17 Years, 2013, and the United States

Michigan

National

26

Vaccinations for Elderly Table 3.7 Immunizations among Adults Aged 65 Years and Older in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016 Had Flu Vaccine in Past Year (%) Ever Had Pneumonia Vaccine (%) Detroit 43.9 53.0 Wayne County (excluding Detroit) 61.8 69.8 Michigan 57.1 71.3

Source: Michigan BRFSS, 2014-2016 Combined 2014-2016 Michigan BRFS Regional & Local Health Department Estimates December 12, 2017. Link:http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf Caption: This chart and graph show the percentage of vaccinations for the elderly (age 65 or above) in the state of Michigan, the city of Detroit, and Wayne county excluding Detroit.

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Figure 3.7 Immunizations among Adults Aged 65 Years and Older in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

Michigan

Wayne County (excluding Detroit)

Detroit City

27

Oral Health Table 3.8 Oral Health Care Access in Michigan 2014-2016 No Dental Visit in Past Year (%) * 6+ Teeth Missing (%) ** Detroit 49.6 25.0 Wayne County 29.6 10.9 Michigan 30.7 15.7

Note: * The proportion of adults who reported that they had not visited a dentist or dental clinic for any reason in the past year; ** The proportion of adult s who reported that they were missing 6+ teeth due to tooth decay or gum disease. This excludes teeth lost for other reasons, such as injury or orthodontics Source: Michigan BRFSS, 2014-2016 Combined, 2014-2016 Michigan BRFS Regional & Local Health Department Estimates December 12, 2017. Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf Caption: This chart and graph show oral health status as a percent in the state of Michigan, the city of Detroit, and Wayne county excluding Detroit.

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Figure 3.8 Oral Health Care in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

Detroit City

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Michigan

28

Health Care Access Table 3.9 Health Care Access in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

Had No Routine Checkup in Past Year (%)

Had Mammogram in Past Two Years (%)

Had Appropriately Timed Pap Test (%)

Had PSA Test in Past Year (%)

Appropriate Colorectal Cancer Screening (50+ years) (%)

Ever Had an HIV Test (%)

Detroit 24.3 73.4 75.0 34.2 65.6 68.3 Wayne County (excluding Detroit) 26.0 71.9 72.1 43.9 69.5 42.1 Michigan 27.7 74.9 73.7 43.4 71.0 41.0

Source: Michigan BRFSS, 2014-2016 Combined, 2014-2016 Michigan BRFS Regional & Local Health Department Estimates December 12, 2017. Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf Caption: This chart and graph show health care and health test status as a percent in the state of Michigan, the city of Detroit, and Wayne county excluding Detroit.

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Figure 3.9 Health Care Access in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

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29

Tobacco, Alcohol and Drug Use Table 3.10 Tobacco and Alcohol Use in Michigan Adults, 2016

Current smoking (%)

Current E-Cigarette Use (%)

Current Hookah Use (%)

Heavy Drinking (%)

Binge Drinking (%)

Michigan 20.4 5.0 4.1 7.0 19.1 White 19.6 5.2 3.7 7.5 20.1 Black 25.0 3.7 6.3 3.5 14.9

Source: Michigan Behavioral Risk Factor Survey 2016. Life Course Epidemiology and Genomics Division, Bureau of Epidemiology and Population Health, Michigan Department of Health and Human Services. Link: http://www.michigan.gov/documents/mdhhs/2016_MiBRFS_Race_Tables_608881_7.pdf Caption: This tables and graph show alcohol and tobacco use by percentage by Michigan adults in 2016. They are divided by general smoking use, smoking types, and alcohol extremities by race.

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Figure 3.10 Tobacco and Alcohol Use in Michigan Adults, 2016

Michigan

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Table 3.11 Three-year Average Percentage of Adults with Risk Behaviors in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

Current Smoking (%)

Any Alcohol in Past Month (%)

Heavy Drinking (%)

Binge Drinking (%)

Michigan 20.8 57 6.7 18.8 Wayne County (excluding Detroit) 21.9 57.6 5.6 17.1 Detroit City 32.8 52.7 6.4 18.6

Source: Michigan Behavioral Risk Factor Surveillance System (Michigan BRFSS) 2014 – 2016 Link: http://www.michigan.gov/documents/mdhhs/2014-2016_MiBRFSS_Reg__LHD_Tables_608878_7.pdf Caption: This chart and graph show the average alcohol and tobacco use by percentage by Michigan adults (grouped by Michigan state, city of Detroit, and Wayne county excluding Detroit) over a three-year span (2014-2016).

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Figure 3.11 Three-year Average Percentage of Aadults with Risk Behaviors in Michigan, Wayne County (excluding Detroit), Detroit, 2014-2016

Michigan

Wayne County (excluding Detroit)

Detroit City

31

4. A Look at Health Disparities in Cancer Cancer Table 4.1 Age-adjusted Incidence (per 100,000 Population) in Michigan, 2010-2014

Prostate Gland

Lung and Bronchus Breast

Colon and Rectum

All Others Total

Michigan 58.4 66.7 65.6 40.3 233 464.1 Wayne County (excluding Detroit) 65.9 76.6 73.7 45.3 256.7 518.2 Detroit City 81.7 82.3 69.7 52.8 225.6 512.0

Note: Age-adjusted rates are per 100,000 population. Age-adjusted rates are computed by the direct method, using as the standard population the age distribution of the total population of the United States for the year 2000. Adding and subtracting the number shown after the ± symbol from the rate creates a confidence interval indicating that the true rate lies between the lower and upper bounds of this interval with 95 % statistical confidence. Average number is the number of new invasive cancer cases diagnosed in the period, divided by the number of years in the period. Source: Michigan Resident Cancer Incidence File. Updated with cases processed through November 30, 2016. Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services. Link: https://www.mdch.state.mi.us/osr/Chi/Cancer/frame.asp Caption: This chart and graph show the incidence rates of age-adjusted cancers for the city of Detroit, Wayne county (excluding Detroit), and the state of Michigan.

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Figure 4.1 Age-adjusted Cancer Incidence in Michigan, Wayne County (excluding Detroit), Detroit, 2010-2014

Michigan

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Detroit City

32

5. A Look at Disparity in Crime and Violence Violence Table 5.1 Reported Annual Violence Rates (per 100,000 Residents) in Detroit, Michigan, the United States The United States Michigan Detroit Murder 5.3 6.0 45.2 Rape 40.4 71.8 86.5 Robbery 102.8 71.7 439.2 Assault 248.5 309.5 1475.7

Source: areavibes, Detroit, MI Crime. Link: http://www.areavibes.com/detroit-mi/crime/ Caption: This chart and graph show the reported violent crime rate (per 100,000 residents) for the city of Detroit, the state of Michigan, and the United States.

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Figure 5.1 Reported Annual Violence Rates in Detroit, Michigan, the United States, 2016

The United States

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Detroit

33

Table 5.2 Violence Rate (per 100,000 Residents) in Detroit, 2002-2016

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Murders 41.80 39.40 42.10 39.30 47.30 45.80 33.80 40.20 34.50 48.20 54.60 45.20 43.50 43.80 45.20

Rapes 73.60 87.70 78.60 65.40 67.00 39.60 36.40 36.90 45.00 59.90 62.40 88.30 81.40 78.70 86.50

Robberies 653.60 627.00 596.20 757.00 818.60 763.70 675.10 650.90 615.70 695.70 684.90 682.10 521.40 513.50 439.20

Assaults 1303.80 1264.00 1023.50 1495.90 1486.00 1440.00 1178.80 1238.90 1192.20 1333.60 1321.00 1256.80 1342.40 1123.50 1475.60

Burglaries 1496.80 1519.80 1334.50 1698.70 2050.30 2063.60 1967.10 2090.70 1900.10 2242.40 1907.50 1679.40 1340.30 1161.60 1312.10

Note: City-data.com crime rate counts serious crimes and violent crime more heavily. It adjusts for the number of visitors and daily workers commuting into cities. Source: City-Data.com. Link: http://www.city-data.com/crime/crime-Detroit-Michigan.html Caption: This chart and graph show the year over year reported violent crime rate (per 100,000 residents) from 2002-2016 in the city of Detroit. There has been an overall fluctuation for all types of violent crime.

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Figure 5.2 Violence Rates in Detroit, 2002-2016

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34

Homicide

Table 5.3 Homicide Rate in Michigan, Wayne County (excluding Detroit), Detroit City (per 100,000 Population), 2014 all ages Under 5 years 5-14 years 15-24 years 25-44 years 45-64 years ≥65 years Michigan 5.9 4.6 0.9 11.2 10.3 3.8 2.7 Wayne County (excluding Detroit) 10.4 0.1** 0.1** 25.3 17.5 5.6 5.1 Detroit City 33.0 0.1** 5.4 56.5 59.0 25.6 9.3

Note: Zero deaths are shown by a "—". Rates are per 100,000 population for the specified age and sex group in the geographic area. Adding and subtracting the number shown after the ± symbol from the rate creates an interval indicating that the true rate lies between the lower and upper bounds with 95% statistical confidence. "*" indicates the number of cases is too small (5 or less) to calculate a statistically reliable rate. "**" indicates rate is greater than 0.0 but less than 0.1. Source: Michigan Resident Death Files, Division of Vital Records and Health Statistics, Michigan Department of Health and Human Services. Link: https://www.mdch.state.mi.us/pha/osr/chi/FATAL/FRAMETT1.HTM Caption: This table shows the homicide rate by age group in Detroit, the state of Michigan, and Wayne county excluding Detroit. This graph shows the homicide rate in Detroit, the state of Michigan, and Wayne county excluding Detroit.

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Figure 5.3 Homicide Rate in Michigan, Wayne County (excluding Detroit), Detroit City, 2014

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Suicide Table 5.4 Suicide Rate in Michigan, Wayne County (excluding Detroit), Detroit (per 100,000 Population), 2014 all ages Under 5 years 5-14 years 15-24 years 25-44 years 45-64 years ≥65 years Michigan 13.6 * 1.6 13.0 17.3 18.0 13.5 Wayne County (excluding Detroit) 15.3 - ** 21.7 22.2 19.6 8.3 Detroit City 7.1 - ** 8.2 8.9 9.3 7.0

Note: Zero deaths are shown by a "-". Rates are per 100,000 population for the specified age and sex group in the geographic area. Adding and subtracting the number shown after the ± symbol from the rate creates an interval indicating that the true rate lies between the lower and upper bounds with 95% statistical confidence. "*" indicates the number of cases is too small (5 or less) to calculate a statistically reliable rate. "**" indicates rate is greater than 0.0 but less than 0.1. Source: Michigan Resident Death Files, Division of Vital Records and Health Statistics, Michigan Department of Health and Human Services. Link: https://www.mdch.state.mi.us/pha/osr/chi/FATAL/FRAMETT1.HTM Caption: This table and graph shows the suicide rate in Detroit, the state of Michigan, and Wayne county excluding Detroit.

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Figure 5.4 Suicide rate in Michigan, Wayne County (excluding Detroit), Detroit, 2014

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Opioid or Heroin Deaths Table 5.5 Death Rate Due to Drug Poisoning Deaths in Michigan, Wayne County (including Detroit) (per 100,000 Population), 2006-2016 2006-2012 2012-2014 2013-2015 2014-2016 Michigan 13 16 18 20 Wayne County 16 21 27 32

Source: University of Wisconsin Population Health Institute. A Robert Wood Johnson Foundation Program. Link: http://www.countyhealthrankings.org/app/michigan/2015/measure/factors/138/data Caption: This table and graph shows the death rate (per 100,000 people) by drug poisonings for the state of Michigan and Wayne county. The rates are addressed by a three-year moving rate except for 2006-2012. There has been an increase in the death rate.

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Figure 5.5 Death Rate Due to Drug Poisoning Deaths in Michigan, Wayne County (including Detroit), 2006-2016

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37

Intimate and Sexual Violence against Women Table 5.6 Lifetime Prevalence of Rape, Physical Violence, and/or Stalking by an Intimate Partner by Gender in Michigan compared with the United States, 2010 Type of Violence United States (Weighted %) Michigan (Weighted %) Women Men Women Men Rape by an Intimate Partner 9.4 0.3* 25.6 0.3* Physical Violence by an Intimate Partner 32.9 28.2 0.3* 0.3* Rape, physical violence and or stalking by an intimate partner 35.6 28.5 41.8 23.0 Rape by any Perpetrator 18.3 1.4 25.6 0.3* Sexual Violence by any Perpetrator 44.6 22.2 45.2 22.5 Stalking by any perpetrator 16.2 5.2 18.2 0.3* Note: “0.3*” means data are not available. Source: Tables 2.1-2.2, Tables 4.1-4.6, 7.1-7.5 in National Intimate Partner and Sexual Violence Survey 2010 Summary Report Link: http://www.cdc.gov/ViolencePrevention/pdf/NISVS_Report2010-a.pdf

Note: “0.3*” means data are not available. Source: Tables 2.1-2.2, Tables 4.1-4.6, 7.1-7.5 in National Intimate Partner and Sexual Violence Survey 2010 Summary Report Link: http://www.cdc.gov/ViolencePrevention/pdf/NISVS_Report2010-a.pdf

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perpetrator

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Figure 5.6 Lifetime Prevalence of Rape, Physical Violence, and/or Stalking by an Intimate Partner by Gender in Michigan compared with the United States, 2010

United States (Weighted %)

United States (Weighted %)

Michigan (Weighted %)

Michigan (Weighted %)

38

Table 5.7 Lifetime Prevalence of Sexual Violence Victimization by Gender in Michigan and the United States, 2010-2012 Type of Violence United States (Weighted %) Michigan (Weighted %) Women Men Women Men Contact Sexual Violence 36.3 17.1 37.6 14.3 Rape by an Intimate Partner 19.1 1.5 22.7 0.3* Completed or attempted forced penetration 14.4 1.0 15.4 0.3* Completed alcohol/drug facilitated penetration 9.0 0.8 11.5 0.3* Made to penetrate 0.5 5.9 0.3* 0.3* Unwanted sexual contact 27.5 11.0 29.0 10.1 Non-contact unwanted sexual experiences 32.1 13.2 30.4 12.6 Sexual Coercion 13.2 5.8 13.6 0.3* Contact Sexual Violence by Current/Former Intimate Partner 45.1 1.0 46.0 0.3* Contact Sexual Violence by Acquaintance 49.6 48.9 53.5 72.3 Contact Sexual Violence by Stranger 19.1 18.6 22.2 0.3* Stalking 15.8 0.3* 16.1 0.3* Any Contact Sexual Violence,1 Physical Violence, and/or Stalking Victimization by an Intimate Partner

37.3 30.9 36.1 25.8

Contact Sexual Violence by an Intimate Partner 16.4 7 17.3 0.3* Physical Violence by an Intimate Partner 32.4 28.3 31.3 23.3 Any Psychological Aggression by an Intimate Partner 47.1 18.2 51.9 15.2 Any Expressive Aggression by an Intimate Partner 39.3 9.5 43.0 9.6 Any Coercive Control by an Intimate Partner 39.7 15.4 44.1 11.6 Note: Contact sexual violence includes rape, being made to penetrate someone else, sexual coercion, and/or unwanted sexual contact. “0.3*” means data are not available. Source: Tables 3.1, 3.5. 3.9, 3.12a, 3.14, 4.11, 5.9, 5.13, 5.16 in National Intimate Partner and Sexual Violence Survey 2010-2012 State Report. Link: https://www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf

39

Note: Contact sexual violence includes rape, being made to penetrate someone else, sexual coercion, and/or unwanted sexual contact. “0.3*” means data are not available. Source: Tables 3.1, 3.5. 3.9, 3.12a, 3.14, 4.11, 5.9, 5.13, 5.16 in National Intimate Partner and Sexual Violence Survey 2010-2012 State Report. Link: https://www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf

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Figure 5.7 Lifetime Prevalence of Sexual Violence Victimization by Gender in Michigan and the United States, 2010-2012

United States (Weighted %) United States (Weighted %)

Michigan (Weighted %) Michigan (Weighted %)

40

Table 5.8 Michigan Domestic Violence Perpetrators by Age Age Groups Domestic Violence (%) Under 10 years 0.7 10-19 years 7.0 20-29 years 36.4 30-39 years 30.4 40-49 years 19.1 50+ years 6.6 Source: Table 3 in 2006 Michigan Uniform Crime Reports; Executive Report of the Michigan Domestic and Sexual Violence Prevention Steering Committee Link: https://www.michigan.gov/documents/mdch/MIIPSVPreventionPlan-shortened_390773_7.pdf

Source: 2006 Michigan Uniform Crime Reports; Executive Report of the Michigan Domestic and Sexual Violence Prevention Steering Committee Link: https://www.michigan.gov/documents/mdch/MIIPSVPreventionPlan-shortened_390773_7.pdf

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(%)

Figure 5.8 Michigan Domestic Violence Perpetrators by Age

41

Table 5.9 Michigan Sexual Violence by Age Age Groups Sexual Violence Victims (%) Under 10 years 14.7 10-14 years 24.0 15-19 years 31.3 20-24 years 10.6 25-34 years 9.9 35-44 years 5.5 45+ years 3.5 Source: Table 4 in 2006 Michigan Uniform Crime Reports; Executive Report of the Michigan Domestic and Sexual Violence Prevention Steering Committee Link: https://www.michigan.gov/documents/mdch/MIIPSVPreventionPlan-shortened_390773_7.pdf

Source: Table 4 in 2006 Michigan Uniform Crime Reports; Executive Report of the Michigan Domestic and Sexual Violence Prevention Steering Committee Link: https://www.michigan.gov/documents/mdch/MIIPSVPreventionPlan-shortened_390773_7.pdf

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Figure 5.9 Michigan Sexual Violence by Age