Transcript The Picture in Cleveland - Department of Epidemiology

The Local Problem
Natalie Colabianchi, Ph.D.
Chris Kippes, M.S.
Mireya Diaz-Insua, Ph.D.
Alfred Rimm, Ph.D.
Jessica Diggs
In cooperation with:
Cuyahoga County Board of Health
Cleveland Department of Public Health
Background
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Lead poisoning may be the most significant
environmental problem facing our children
Nationally and locally, lead levels in children
have been decreasing dramatically over the
past 20 years
– Much of the decline is due to the removal of lead
from gasoline
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
Rates remain high in urban areas and in
poor communities
Steep rates of decline not likely to continue
Ohio compared to 18
other states
Cuyahoga County relative
to other counties in Ohio
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Cuyahoga
Hamilton
Franklin
Lucas
Mahoning
Summit
EBLL (10 mg/dL +)
17%
7%
2%
11%
14%
1%
Estimated Number of Children with
Elevated Blood Lead Levels (EBLL)
City
New York, NY
2. Chicago, IL
3. Los Angeles, CA
4. Detroit, MI
5. Philadelphia, PA
6. Baltimore, MD
7. Houston, TX
8. Cleveland, OH
9. New Orleans, LA
10. Milwaukee, WI
1.
Est. Children w/EBLL (10 mg/dL +)
41,100
20,600
15,000
12,800
11,400
6,300
6,300
5,100
4,700
4,600
Cleveland relative to
other cities in Ohio
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EBLL (10 mg/dL +)
Cleveland
20%
Cincinnati
7%
Columbus
2%
Toledo
12%
Youngstown
16%
Akron
2%
Local Data
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Years 1997 - 2000
130,190 tests representing 82,396 children
33% of children had more than one test
Included only children less than 6 years of
age
Children across the years:
–
–
–
–
28404
27603
24371
23441
children
children
children
children
tested
tested
tested
tested
in
in
in
in
1997
1998
1999
2000
Sampling
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Data come from mandatory reporting; Not a
random sample
Proportions are influenced by rates of
testing, who is tested and requirements for
testing
Cleveland is considered a universal
screening area
Medicaid population also mandated to be
tested
Other high risk zip codes in Cuyahoga
County with universal designation
High risk zip codes with
universal designation
Defining a confirmed test
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Venous tests are confirmed tests
Capillary tests under 10 mg/dL are
confirmed tests
Capillary tests with results of 10 mg/dL or
higher need a second test within the CDC
guidelines to be confirmed
Other tests were deemed unconfirmed and
child was consider not elevated
Analyses
1.
Proportion of children with EBLL





2.
3.
4.
In year 2000
Across census tracts
Trends from 1997 to 2000
Demographic correlates
Neighborhoods and municipalities with high
proportions of elevated children
Average levels over time
Multiple children in a household
Numbers of children tested
Proportion of children
with EBLL in year 2000
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
In Cleveland, 20.3% of children, one
out of five, have blood lead levels that
are elevated (e.g., 10mg/dL or higher)
In Cuyahoga County, 8.5% of children
have blood lead levels that are
elevated (e.g., 10 mg/dL or higher)
Cuyahoga County
Proportion of children with
EBLL >10 mg/dL in Year 2000
Proportion of children with EBLL
> 10 mg/dL in Year 2000
Cleveland Only
Proportion of children with EBLL
> 10 mg/dL in Year 2000
Cuyahoga County Only
Proportion of children with EBLL
> 10 mg/dL in Year 2000
East Cleveland Only
4 Sub-areas
Proportion of children
with EBLL (> 10 mg/dL)
Geographic Area
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Cleveland
East Cleveland
Inner Ring Suburbs
Outer Ring Suburbs
Year 2000
20.3
27.7
4.9
1.8
% of children with >10 mg/dL
Trends over Time:
Proportion of children with
EBLL (> 10 mg/dL)
40
35
Cleveland
30
East Cleveland
25
20
Inner Ring
Suburbs
Outer Ring
Suburbs
15
10
5
0
1997
1998
1999
2000
Proportion of children
with EBLL (> 25 mg/dL)
Geographic Area
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Cleveland
East Cleveland
Inner Ring Suburbs
Outer Ring Suburbs
Year 2000
1.9%
3.2%
0.5%
0.2%
% of children with >25 mg/dL
Trends over Time:
Proportion of children with
EBLL (> 25 mg/dL)
6
5
Cleveland
4
East Cleveland
3
Inner Ring
Suburbs
Outer Ring
Suburbs
2
1
0
1997
1998
1999
2000
Proportion of children
with EBLL (> 45 mg/dL)
Geographic Area
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Cleveland
East Cleveland
Inner Ring Suburbs
Outer Ring Suburbs
Year 2000
0.2
0.3
0.1
0.0
% of children with >45 mg/dL
Trends over Time –
Proportion of children with
EBLL (> 45 mg/dL)
1.2
1
Cleveland
0.8
East Cleveland
0.6
Inner Ring
Suburbs
Outer Ring
Suburbs
0.4
0.2
0
1997
1998
1999
2000
Tracts with EBLL of
> 45 mg/dL and > 70 mg/dL
Areas with children that
have BLL > 45 mg/dL

Neighborhoods with children > 45 mg/dL
 Clark-Fulton
 Corlett
 Cudell
 Detroit-Shoreway
 Fairfax
 Forest Hills
 Glenville
 Hough
 Mt. Pleasant
North Collinwood
South Broadway
South Collinwood
St. Clair-Superior
Union-Miles
Woodland Hills
Cleveland Heights
East Cleveland
Garfield Heights
Areas with children that
have BLL > 70 mg/dL
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Neighborhoods with children > 70 mg/dL
Cudell
Fairfax
Glenville
North Collinwood
Union-Miles
Demographic correlates
Proportion of children with EBLL
>10 mg/dL in Year 2000
Percent of Housing Built
before 1950
Median Levels of Income
Cleveland
Statistical Planning Areas with
over 12% of children having
BLL of > 10 mg/dL
Cleveland Only
Cleveland Neighborhoods
Highest and Lowest
Neighborhoods in Cleveland
over Time
50
45
40
35
30
25
20
15
10
5
0
Highest
Neighborhoods
Lowest
Nieghborhoods
1997
1998
1999
2000
6 Highest and 6 Lowest
Neighborhoods in Cleveland
Year 2000
3 Highest Neighborhoods
by Tract
St. Clair-Superior
Tract
% with EBLL of 10 mg/dL+ (N)
1112.00
1113.00
1115.00
1116.00
1118.00
1117.00
1119.02
Overall SPA
36.1 (36)
61.5 (26)
31.1 (103)
30.2 (116)
46.8 (194)
40.2 (94)
36.3 (80)
37.7 (671)
Note: Tract 1119.01 had insufficient sample and is therefore not reported
3 Highest Neighborhoods
by Tract - Glenville
Tract
%BL 10+ (N)
1114.01
1114.02
1161.00
1162.00
1164.00
26.8
58.6
33.9
35.2
32.0
(97)
(70)
(62)
(71)
(219)
Tract
%BL 10+ (N)
1165.00
1181.00
1182.00
1183.00
1185.00
24.9 (185)
34.8 (115)
31.1 (164)
31.5 (143)
27.1 (96)
Overall SPA = 32.0 (1222)
3 Highest Neighborhoods
by Tract – Fairfax
Tract
1133
1134
1135
1136
1141
Overall SPA
% with EBLL of 10+ (N)
39.5 (43)
28.3 (53)
28.9 (97)
27.5 (69)
42.2 (45)
31.3 (320)
Note: Tracts 1131, 1132 and 1139 have insufficient sample and are
therefore not reported
Municipalities
Municipalities with EBLL
of >10 mg/dL
Census Tracts in
East Cleveland
Census Tracts in
Cleveland Heights
Census Tracts in
Shaker Heights
East Cleveland, Cleveland
Heights and Shaker Heights
Census Tracts in
Garfield Heights
Average levels of those
with elevated blood levels
over time
Lead Levels of those > 10
mg/dL over time
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
70+
45-69
25-44
16-24
10-15.
1997
1998
1999
2000
Average levels of those >10 mg/dL
Average levels of those > 10
mg/dL over time
30
25
Cleveland
20
East Cleveland
15
Inner Ring
Suburbs
Outer Ring
Suburbs
10
5
0
1997
1998
1999
2000
Individuals over time
100
90
80
70
60
50
40
30
20
10
0
Result in 1997
Result in 1998
Result in 1999
Multiple Children in a
Household
Households with >1 Child Tested
and Measured BLL  25 mg/dL
All high
107 (0.8%)
Mixed
803 (6.3%)
All low 11864 (92.9%)
Glenville
East Cleveland
Cleveland
Heights
Shaker
Heights
HH+
Households with >1 Child Tested
BLL  25 mg/dL
All high 107 (0.8%)
Mixed
803 (6.3%)
All low 11864 (92.9%)
CLEV HTS, EAST CLEV,
SHAKER HTS
All high
10 (1.0%)
Mixed
81 (7.6%)
All low
971 (91.4%)
CLEVELAND
All high
97 (1.0%)
Mixed
697 (7.2%)
All low 8885 (91.8%)
OTHERS
All high
0 (0.0%)
Mixed
25 (1.2%)
All low 2030 (98.8%)
CUYAHOGA
Households with >1 Child Tested
BLL  10 mg/dL
CUYAHOGA
All high 1715 (13.5%)
Mixed 3581 (28.0%)
All low 7478 (58.5%)
CLEV HTS, EAST CLEV,
SHAKER HTS
All high 160 (15.0%)
Mixed
312 (29.4%)
All low
590 (55.6%)
CLEVELAND
All high 1511 (15.6%)
Mixed 3058 (31.6%)
All low 5113 (52.8%)
OTHERS
All high
44 (2.2%)
Mixed
211 (10.4%)
All low 1175 (87.4%)
Numbers of Children
Tested
Cuyahoga County
Calendar Year 2001
Percent of Medicaid Eligibles Age 1 - 2
in High Risk Zip Code with a
BLL** (claim) or Match with STELLAR
44132
44123
44110
44108
44143
44112
44145
44114
44106 44118
44115
44113
44107
44104
44102
44116
44120
44122
44127
44111
44105
44126
44144 44109
44128
44135
44070
44142
44138
44017
44136
Note:
* BLL = blood lead test
ODJFS, OHP, Health Services Research Section
May 23, 2003
44129
44134
44124
44022
44125 44137
44131
44130
44133
44040
44121
44103
44140
44117
44146
44139
44147 44141
% of Eligs with BLL
0 - 10 %
11% - 20%
21% - 30%
31% - 38%
39% - 49%
50% and G reater
Not High R is k Zip Code
Conclusions
Summary Point 1
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Cuyahoga County and Cleveland have
high proportions of children with
elevated blood lead levels relative to
other counties and cities in the U.S.
Summary Point 2
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Lead levels continue to decrease
although at a slower rate than
previously seen
Summary Point 3
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Age of housing and income levels are
associated with lead levels in
Cleveland and in Cuyahoga County as
has been seen nationally
Summary Point 4
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Many neighborhoods in Cleveland and
East Cleveland show consistently high
percentages of children with elevated
blood lead levels across census tracts
Summary Point 5
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Over time, the percent of children with
elevated lead levels has decreased
However the average level of those
that test over 10 mg/dL has remained
fairly constant
Summary Point 6
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There are some households with
multiple children under six in
Cleveland and some municipalities
where all the tested children have
elevated blood lead levels
Summary Point 7
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Children that are required to be lead
tested are not being tested
Conclusion

We have made important progress in
the past couple years but need to
continue our efforts to provide our
children a healthy environment in
which they can thrive
Acknowledgements
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Cuyahoga County Board of Health
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Terry Allan, M.P.H., R.S.
Chris Kippes, M.S.
John Sobolewski, R.S.
John McLeod, R.S.
–
–
–
–
Wayne Slota
Jonathan Brandt
Wendy Johnson, M.D.
Matt Carroll, J.D.
Cleveland Department of Public Health
The Local Problem
For further information contact:
Natalie Colabianchi:
[email protected]
Case Western Reserve University
http://epbiwww.cwru.edu/faculty/colabianchi.html