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The Local Problem

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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The Local Problem

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  1. 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

  2. Background • 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 • Rates remain high in urban areas and in poor communities • Steep rates of decline not likely to continue

  3. Ohio compared to 18 other states

  4. Cuyahoga County relative to other counties in Ohio EBLL (10 mg/dL +) • Cuyahoga 17% • Hamilton 7% • Franklin 2% • Lucas 11% • Mahoning 14% • Summit 1%

  5. Estimated Number of Children with Elevated Blood Lead Levels (EBLL) City Est. Children w/EBLL (10 mg/dL +) • New York, NY 41,100 • Chicago, IL 20,600 • Los Angeles, CA 15,000 • Detroit, MI 12,800 • Philadelphia, PA 11,400 • Baltimore, MD 6,300 • Houston, TX 6,300 • Cleveland, OH 5,100 • New Orleans, LA 4,700 • Milwaukee, WI 4,600  

  6. Cleveland relative to other cities in Ohio EBLL (10 mg/dL +) • Cleveland 20% • Cincinnati 7% • Columbus 2% • Toledo 12% • Youngstown 16% • Akron 2%

  7. Local Data • 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 children tested in 1997 • 27603 children tested in 1998 • 24371 children tested in 1999 • 23441 children tested in 2000

  8. Sampling • 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

  9. High risk zip codes with universal designation

  10. Defining a confirmed test • 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

  11. Analyses • Proportion of children with EBLL • 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

  12. Proportion of children with EBLL in year 2000 • 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)

  13. Cuyahoga County

  14. Proportion of children with EBLL >10 mg/dL in Year 2000

  15. Proportion of children with EBLL > 10 mg/dL in Year 2000Cleveland Only

  16. Proportion of children with EBLL > 10 mg/dL in Year 2000Cuyahoga County Only

  17. Proportion of children with EBLL > 10 mg/dL in Year 2000East Cleveland Only

  18. 4 Sub-areas

  19. Proportion of children with EBLL (> 10 mg/dL) Geographic AreaYear 2000 • Cleveland 20.3 • East Cleveland 27.7 • Inner Ring Suburbs 4.9 • Outer Ring Suburbs 1.8

  20. Trends over Time: Proportion of children with EBLL (> 10 mg/dL) % of children with >10 mg/dL

  21. Proportion of children with EBLL (> 25 mg/dL) Geographic AreaYear 2000 • Cleveland 1.9% • East Cleveland 3.2% • Inner Ring Suburbs 0.5% • Outer Ring Suburbs 0.2%

  22. Trends over Time: Proportion of children with EBLL (> 25 mg/dL) % of children with >25 mg/dL

  23. Proportion of children with EBLL (> 45 mg/dL) Geographic AreaYear 2000 • Cleveland 0.2 • East Cleveland 0.3 • Inner Ring Suburbs 0.1 • Outer Ring Suburbs 0.0

  24. Trends over Time – Proportion of children with EBLL (> 45 mg/dL) % of children with >45 mg/dL

  25. Tracts with EBLL of > 45 mg/dL and > 70 mg/dL

  26. 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

  27. Areas with children that have BLL > 70 mg/dL • Neighborhoods with children > 70 mg/dL • Cudell • Fairfax • Glenville • North Collinwood • Union-Miles

  28. Demographic correlates

  29. Proportion of children with EBLL >10 mg/dL in Year 2000

  30. Percent of Housing Built before 1950

  31. Median Levels of Income

  32. Cleveland

  33. Statistical Planning Areas with over 12% of children having BLL of > 10 mg/dL Cleveland Only

  34. Cleveland Neighborhoods

  35. Highest and Lowest Neighborhoods in Cleveland over Time

  36. 6 Highest and 6 Lowest Neighborhoods in Cleveland Year 2000

  37. 3 Highest Neighborhoods by Tract

  38. Tract% with EBLL of 10 mg/dL+ (N) 1112.00 36.1 (36) 1113.00 61.5 (26) 1115.00 31.1 (103) 1116.00 30.2 (116) 1118.00 46.8 (194) 1117.00 40.2 (94) 1119.02 36.3 (80) Overall SPA 37.7 (671) Note: Tract 1119.01 had insufficient sample and is therefore not reported St. Clair-Superior

  39. Tract %BL 10+ (N) 1114.01 26.8 (97) 1114.02 58.6 (70) 1161.00 33.9 (62) 1162.00 35.2 (71) 1164.00 32.0 (219) Tract %BL 10+ (N) 1165.00 24.9 (185) 1181.00 34.8 (115) 1182.00 31.1 (164) 1183.00 31.5 (143) 1185.00 27.1 (96) 3 Highest Neighborhoods by Tract - Glenville Overall SPA = 32.0 (1222)

  40. 3 Highest Neighborhoods by Tract – Fairfax Tract% with EBLL of 10+ (N) 1133 39.5 (43) 1134 28.3 (53) 1135 28.9 (97) 1136 27.5 (69) 1141 42.2 (45) Overall SPA 31.3 (320) Note: Tracts 1131, 1132 and 1139 have insufficient sample and are therefore not reported

  41. Municipalities

  42. Municipalities with EBLL of >10 mg/dL

  43. Census Tracts in East Cleveland

  44. Census Tracts in Cleveland Heights

  45. Census Tracts in Shaker Heights

  46. East Cleveland, Cleveland Heights and Shaker Heights

  47. Census Tracts in Garfield Heights

  48. Average levels of those with elevated blood levels over time

  49. Lead Levels of those > 10 mg/dL over time

  50. Average levels of those > 10 mg/dL over time Average levels of those >10 mg/dL

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