the local problem

The Local ProblemThe Local Problem

Natalie Colabianchi, Ph.D.Natalie Colabianchi, Ph.D.Chris Kippes, M.S.Chris Kippes, M.S.

Mireya Diaz-Insua, Ph.D.Mireya Diaz-Insua, Ph.D.Alfred Rimm, Ph.D.Alfred Rimm, Ph.D.

Jessica DiggsJessica Diggs

In cooperation with:In cooperation with:Cuyahoga County Board of HealthCuyahoga County Board of HealthCleveland Department of Public Cleveland Department of Public

HealthHealth

BackgroundBackground

Lead poisoning may be the most significant Lead poisoning may be the most significant environmental problem facing our childrenenvironmental problem facing our children

Nationally and locally, lead levels in children Nationally and locally, lead levels in children have been decreasing dramatically over the have been decreasing dramatically over the past 20 yearspast 20 years– Much of the decline is due to the removal of lead Much of the decline is due to the removal of lead

from gasolinefrom gasoline Rates remain high in urban areas and in Rates remain high in urban areas and in

poor communities poor communities Steep rates of decline not likely to continueSteep rates of decline not likely to continue

Ohio compared to 18 Ohio compared to 18 other statesother states

Cuyahoga County Cuyahoga County relative to other relative to other counties in Ohiocounties in Ohio

EBLL (10 EBLL (10 g/dL +g/dL +)) CuyahogaCuyahoga 17%17% HamiltonHamilton 7% 7% FranklinFranklin 2% 2% LucasLucas 11%11% Mahoning Mahoning 14%14% SummitSummit 1% 1%

Estimated Number of Children Estimated Number of Children with Elevated Blood Lead with Elevated Blood Lead Levels (EBLL)Levels (EBLL)

CityCity Est. Children w/EBLLEst. Children w/EBLL (10 (10 g/dL +g/dL +))

1.1. New York, NYNew York, NY 41,10041,1002.2. Chicago, ILChicago, IL 20,60020,6003.3. Los Angeles, CALos Angeles, CA 15,00015,0004.4. Detroit, MIDetroit, MI 12,80012,8005.5. Philadelphia, PAPhiladelphia, PA 11,40011,4006.6. Baltimore, MDBaltimore, MD 6,300 6,3007.7. Houston, TXHouston, TX 6,300 6,3008.8. Cleveland, OHCleveland, OH 5,100 5,1009.9. New Orleans, LANew Orleans, LA 4,700 4,70010.10. Milwaukee, WIMilwaukee, WI 4,600 4,600

Cleveland relative to Cleveland relative to other cities in Ohioother cities in Ohio

EBLL (10 EBLL (10 g/dL +g/dL +)) ClevelandCleveland 20%20% CincinnatiCincinnati 7% 7% ColumbusColumbus 2% 2% ToledoToledo 12%12% YoungstownYoungstown 16%16% AkronAkron 2% 2%

Local DataLocal Data

Years 1997 - 2000Years 1997 - 2000 130,190 tests representing 82,396 130,190 tests representing 82,396

childrenchildren 33% of children had more than one test33% of children had more than one test Included only children less than 6 years Included only children less than 6 years

of ageof age Children across the years:Children across the years:

– 28404 children tested in 1997 28404 children tested in 1997 – 27603 children tested in 199827603 children tested in 1998– 24371 children tested in 199924371 children tested in 1999– 23441 children tested in 200023441 children tested in 2000

SamplingSampling

Data come from mandatory reporting; Not Data come from mandatory reporting; Not a random samplea random sample

Proportions are influenced by rates of Proportions are influenced by rates of testing, who is tested and requirements for testing, who is tested and requirements for testingtesting

Cleveland is considered a universal Cleveland is considered a universal screening areascreening area

Medicaid population also mandated to be Medicaid population also mandated to be testedtested

Other high risk zip codes in Cuyahoga Other high risk zip codes in Cuyahoga County with universal designationCounty with universal designation

High risk zip codes High risk zip codes with universal with universal designationdesignation

Defining a confirmed Defining a confirmed testtest Venous tests are confirmed testsVenous tests are confirmed tests Capillary tests under 10 Capillary tests under 10 g/dLg/dL are are

confirmed testsconfirmed tests Capillary tests with results of 10 Capillary tests with results of 10 g/dLg/dL

or higher need a second test within the or higher need a second test within the CDC guidelines to be confirmed CDC guidelines to be confirmed

Other tests were deemed unconfirmed Other tests were deemed unconfirmed and child was consider and child was consider not elevatednot elevated

AnalysesAnalyses

1.1. Proportion of children with EBLL Proportion of children with EBLL In year 2000In year 2000 Across census tractsAcross census tracts Trends from 1997 to 2000Trends from 1997 to 2000 Demographic correlatesDemographic correlates Neighborhoods and municipalities with Neighborhoods and municipalities with

high proportions of elevated childrenhigh proportions of elevated children

2.2. Average levels over timeAverage levels over time3.3. Multiple children in a householdMultiple children in a household4.4. Numbers of children testedNumbers of children tested

Proportion of children Proportion of children with EBLL in year 2000with EBLL in year 2000 In Cleveland, In Cleveland, 20.3%20.3% of children, of children,

one out of fiveone out of five, have blood lead , have blood lead levels that are elevated (e.g., levels that are elevated (e.g., 1010g/dLg/dL or higher) or higher)

In Cuyahoga County, In Cuyahoga County, 8.5%8.5% of of children have blood lead levels children have blood lead levels that are elevated (e.g., 10 that are elevated (e.g., 10 g/dLg/dL or higher)or higher)

Cuyahoga CountyCuyahoga County

Proportion of children with EBLL >10 g/dLg/dL in Year 2000

Proportion of children with EBLL > 10 g/dLg/dL in Year 2000Cleveland Only

Proportion of children with EBLL > 10 g/dLg/dL in Year 2000Cuyahoga County Only

Proportion of children with EBLL > 10 g/dLg/dL in Year 2000East Cleveland Only

4 Sub-areas4 Sub-areas

Proportion of children Proportion of children with EBLL (with EBLL (> 10 10 g/dLg/dL))

Geographic AreaGeographic Area Year 2000Year 2000

ClevelandCleveland 20.320.3 East ClevelandEast Cleveland 27.727.7 Inner Ring SuburbsInner Ring Suburbs 4.94.9 Outer Ring SuburbsOuter Ring Suburbs 1.81.8

Trends over Time: Trends over Time: Proportion of children Proportion of children with EBLL (with EBLL (> 10 10 g/dLg/dL))

0

5

10

15

20

25

30

35

40

1997 1998 1999 2000

Cleveland

East Cleveland

Inner RingSuburbsOuter RingSuburbs

% o

f ch

ildre

n w

ith >

10

mg

/dL

mg

/dL



ClevelandCleveland 1.9%1.9%

East ClevelandEast Cleveland 3.2%3.2% Inner Ring SuburbsInner Ring Suburbs 0.5%0.5% Outer Ring SuburbsOuter Ring Suburbs 0.2%0.2%

Trends over Time: Trends over Time: Proportion of children Proportion of children with EBLL (with EBLL (> 25 25 g/dLg/dL))

0

1

2

3

4

5

6

1997 1998 1999 2000

Cleveland

East Cleveland


% o

f ch

ildre

n w

ith >

25

mg

/dL

mg

/dL



ClevelandCleveland 0.20.2 East ClevelandEast Cleveland 0.30.3 Inner Ring SuburbsInner Ring Suburbs 0.10.1 Outer Ring SuburbsOuter Ring Suburbs 0.00.0

Trends over Time – Trends over Time – Proportion of children Proportion of children with EBLL (with EBLL (> 45 45 g/dLg/dL))

0

0.2

0.4

0.6

0.8

1

1.2

1997 1998 1999 2000

Cleveland

East Cleveland


% o

f ch

ildre

n w

ith >

45

mg

/dL

mg

/dL

Tracts with EBLL of Tracts with EBLL of > 45 45 g/dLg/dL and and > 70 70 g/dLg/dL

Areas with children Areas with children that have BLL that have BLL > 45 45 g/dLg/dL Neighborhoods with children Neighborhoods with children > 45 45 g/dLg/dL

Clark-FultonClark-Fulton CorlettCorlett CudellCudell Detroit-ShorewayDetroit-Shoreway FairfaxFairfax Forest HillsForest Hills GlenvilleGlenville HoughHough Mt. PleasantMt. Pleasant

North CollinwoodNorth CollinwoodSouth BroadwaySouth BroadwaySouth CollinwoodSouth CollinwoodSt. Clair-SuperiorSt. Clair-SuperiorUnion-MilesUnion-MilesWoodland HillsWoodland HillsCleveland HeightsCleveland HeightsEast ClevelandEast ClevelandGarfield HeightsGarfield Heights

Areas with children Areas with children that have BLL that have BLL > 70 70 g/dLg/dL Neighborhoods with children Neighborhoods with children > 70 70

g/dLg/dLCudellCudellFairfaxFairfaxGlenvilleGlenvilleNorth CollinwoodNorth CollinwoodUnion-MilesUnion-Miles

Demographic Demographic correlatescorrelates

Proportion of children with EBLL >10 g/dLg/dL in Year 2000

Percent of Housing Percent of Housing Built before 1950Built before 1950

Median Levels of Median Levels of IncomeIncome

ClevelandCleveland

Statistical Planning Areas Statistical Planning Areas with over 12% of children with over 12% of children having BLL of having BLL of > 10 10 g/dLg/dL

Cleveland Only

Cleveland Cleveland NeighborhoodsNeighborhoods

Highest and Lowest Highest and Lowest Neighborhoods in Neighborhoods in Cleveland over TimeCleveland over Time

05

101520253035404550

1997 1998 1999 2000

HighestNeighborhoodsLowestNieghborhoods

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

3 Highest 3 Highest Neighborhoods by TractNeighborhoods by Tract

St. Clair-SuperiorSt. Clair-Superior

TractTract % with EBLL of 10 % with EBLL of 10 g/dLg/dL+ + (N)(N)

1112.001112.00 36.1 (36) 36.1 (36) 1113.001113.00 61.5 (26)61.5 (26)1115.001115.00 31.1 (103)31.1 (103)1116.001116.00 30.2 (116)30.2 (116)1118.001118.00 46.8 (194)46.8 (194)1117.001117.00 40.2 (94)40.2 (94)1119.021119.02 36.3 (80)36.3 (80)Overall SPAOverall SPA 37.7 (671)37.7 (671)Note: Tract 1119.01 had insufficient sample and is therefore not Note: Tract 1119.01 had insufficient sample and is therefore not

reportedreported

3 Highest 3 Highest Neighborhoods by Neighborhoods by Tract - GlenvilleTract - GlenvilleTractTract %BL 10+ %BL 10+

(N)(N)

1114.01 26.8 (97)1114.01 26.8 (97)

1114.02 58.6 (70)1114.02 58.6 (70)

1161.00 33.9 (62)1161.00 33.9 (62)

1162.00 35.2 (71)1162.00 35.2 (71)

1164.00 32.0 1164.00 32.0 (219)(219)

TractTract %BL 10+ (N)%BL 10+ (N)

1165.00 24.9 (185)1165.00 24.9 (185)

1181.00 34.8 (115)1181.00 34.8 (115)

1182.00 31.1 (164)1182.00 31.1 (164)

1183.00 31.5 (143)1183.00 31.5 (143)

1185.00 27.1 (96)1185.00 27.1 (96)

Overall SPA = 32.0 (1222)

3 Highest 3 Highest Neighborhoods by Neighborhoods by Tract – FairfaxTract – FairfaxTractTract % with EBLL of 10+ % with EBLL of 10+

(N)(N)

11331133 39.5 (43)39.5 (43)11341134 28.3 (53)28.3 (53)11351135 28.9 (97)28.9 (97)11361136 27.5 (69)27.5 (69)11411141 42.2 (45)42.2 (45)Overall SPA Overall SPA 31.3 (320)31.3 (320)

Note: Tracts 1131, 1132 and 1139 have insufficient sample and Note: Tracts 1131, 1132 and 1139 have insufficient sample and are therefore not reportedare therefore not reported

MunicipalitiesMunicipalities

Municipalities with Municipalities with EBLL of EBLL of >>10 10 g/dLg/dL

Census Tracts in Census Tracts in East ClevelandEast Cleveland

Census Tracts in Census Tracts in Cleveland HeightsCleveland Heights

Census Tracts in Census Tracts in Shaker HeightsShaker Heights

East Cleveland, East Cleveland, Cleveland Heights and Cleveland Heights and Shaker HeightsShaker Heights

Census Tracts in Census Tracts in Garfield HeightsGarfield Heights

Average levels of those Average levels of those with elevated blood with elevated blood levels over timelevels over time

Lead Levels of those Lead Levels of those > 10 10 g/dLg/dL over time over time

0%10%20%30%40%50%60%70%80%90%

100%

1997 1998 1999 2000

70+45-6925-4416-2410-15.

Average levels of those Average levels of those > 10 10 g/dLg/dL over time over time

0

5

10

15

20

25

30

1997 1998 1999 2000

Cleveland

East Cleveland


Avera

ge levels

of

those

>10

mg

/dL

mg

/dL

Individuals over timeIndividuals over time

0

10

20

30

40

50

60

70

80

90

100

Result in 1997 Result in 1998 Result in 1999

Multiple Children in a Multiple Children in a HouseholdHousehold

Households with >1 Child Households with >1 Child Tested and Measured BLL Tested and Measured BLL 25 25 g/dLg/dL

HH+

East Cleveland

ClevelandHeights

ShakerHeights

Glenville

All high 107 (0.8%)Mixed 803 (6.3%)All low 11864 (92.9%)

Households with >1 Child Households with >1 Child TestedTested BLL 25 g/dL

CUYAHOGA


CLEVELANDAll high 97 (1.0%)Mixed 697 (7.2%)All low 8885 (91.8%)

CLEV HTS, EAST CLEV, SHAKER HTSAll high 10 (1.0%)Mixed 81 (7.6%)All low 971 (91.4%)

OTHERSAll high 0 (0.0%)Mixed 25 (1.2%)All low 2030 (98.8%)

Households with >1 Child Households with >1 Child Tested Tested BLL 10 g/dL

CUYAHOGA


CLEVELANDAll high 1511 (15.6%)Mixed 3058 (31.6%)All low 5113 (52.8%)

CLEV HTS, EAST CLEV, SHAKER HTSAll high 160 (15.0%)Mixed 312 (29.4%)All low 590 (55.6%)

OTHERSAll high 44 (2.2%)Mixed 211 (10.4%)All low 1175 (87.4%)

Numbers of Children Numbers of Children TestedTested

44136

44139

44022

44133

44146

44141

4413044131

44145

44124

44138

44125

44143

44122

44147

44070

44134

44040

4413544105

44128

44142

44109

44140 44107

44118

44121

44102

44144

4411144116

44129

44120

44126

44137

44017

44113

44103

44104

44114

44108

44110

44106

44112

44117

4413244123

44115

44127

% of Eligs with BLL0 - 10%11% - 20%21% - 30%31% - 38%39% - 49%50% and GreaterNot High Risk Zip Code

Cuyahoga CountyCalendar Year 2001

Percent of Medicaid Eligibles Age 1 - 2in High Risk Zip Code with a

BLL** (claim) or Match with STELLAR

Note:* BLL = blood lead test

ODJFS, OHP, Health Services Research SectionMay 23, 2003

ConclusionsConclusions

Summary Point 1Summary Point 1

Cuyahoga County and Cleveland Cuyahoga County and Cleveland have high proportions of children have high proportions of children with elevated blood lead levels with elevated blood lead levels relative to other counties and relative to other counties and cities in the U.S.cities in the U.S.


Lead levels continue to decrease Lead levels continue to decrease although at a slower rate than although at a slower rate than previously seenpreviously seen


Age of housing and income levels Age of housing and income levels are associated with lead levels in are associated with lead levels in Cleveland and in Cuyahoga Cleveland and in Cuyahoga County as has been seen County as has been seen nationallynationally


Many neighborhoods in Cleveland Many neighborhoods in Cleveland and East Cleveland show and East Cleveland show consistently high percentages of consistently high percentages of children with elevated blood lead children with elevated blood lead levels across census tractslevels across census tracts


Over time, the percent of children Over time, the percent of children with elevated lead levels has with elevated lead levels has decreased decreased

However the average level of However the average level of those that test over 10 those that test over 10 g/dL has has remained fairly constantremained fairly constant


There are some households with There are some households with multiple children under six in multiple children under six in Cleveland and some Cleveland and some municipalities where all the municipalities where all the tested children have elevated tested children have elevated blood lead levelsblood lead levels


Children that are required to be Children that are required to be lead tested are not being testedlead tested are not being tested

ConclusionConclusion

We have made important We have made important progress in the past couple years progress in the past couple years but need to continue our efforts but need to continue our efforts to provide our children a healthy to provide our children a healthy environment in which they can environment in which they can thrivethrive

AcknowledgementsAcknowledgements

Cuyahoga County Board of HealthCuyahoga County Board of Health– Terry Allan, M.P.H., R.S.Terry Allan, M.P.H., R.S.– Chris Kippes, M.S.Chris Kippes, M.S.– John Sobolewski, R.S.John Sobolewski, R.S.– John McLeod, R.S.John McLeod, R.S.

Cleveland Department of Public HealthCleveland Department of Public Health– Wayne SlotaWayne Slota– Jonathan BrandtJonathan Brandt– Wendy Johnson, M.D.Wendy Johnson, M.D.– Matt Carroll, J.D.Matt Carroll, J.D.

The Local ProblemThe Local Problem

For further information contact:For further information contact:Natalie Colabianchi: Natalie Colabianchi:

[email protected]@cwru.eduCase Western Reserve Case Western Reserve

UniversityUniversity

http://epbiwww.cwru.edu/faculty/http://epbiwww.cwru.edu/faculty/colabianchi.htmlcolabianchi.html

the local problem

Documents

mgdl proportion of children

timemultiple children

children webll

estimated number of

mgdl cuyahoga17

mgdl cleveland20

mgdl new york

cleveland relative