Health Status of Cuyahoga County Residents
Story by Amy R. Sheon, PhD, MPH
On average, residents of Cuyahoga County live 76.4 years, well below the national average of 78.7 years. Survival of Cleveland residents is even more dismal, an average of only 72.2 years. However, these statistics belie the 24 year gap across the county where life expectancy ranges from 64.5 years to 88.6 years in different Census Tracts. Life expectancy differences represent a complex interplay of many factors affecting health including genes, behavior, the social and physical environment, and health care. Poverty represents one of the strongest "Social Determinants of Health."
The vast majority of Black and of White County residents live in neighborhoods that are inhabited almost exclusively by people of their own race.
Areas that are more than 90% Black fall appear as a "C" shape.
Segregation is closely associated with poverty, While many poor areas have a predominance of White and Hispanic residents, most of the predominantly Black areas have high poverty.
The top two maps above show the prevalence of diabetes and coronary heart disease. Both conditions reduce life expectancy, lower productivity and incur high health care costs..
Diabetes is especially high on the east side, in the region designated by Health Data Matters Co-Director, Dr. Scott Frank as "Cleveland Crescent," neighborhoods that are almost entirely Black and poor. Diabetes in some areas is more than six times higher than in other areas; the prevalence ranges from 5.1% to 32.6% in different census tracts.
Obesity is a strong risk factor for diabetes. Obesity prevalence mirrors diabetes prevalence geographically. More than one half of residents in many areas are obese. Within the cities of Cleveland and Parma, the lowest rates of obesity are 23.5%.
The cost of obesity to the economy is enormous, with obese men generating $1,152 more in health costs than men of normal weight. For women, the excess cost is even more striking, at $3,613 per year.
Other factors associated with poor health status
In 2016, 35.2% of all Cleveland adults smoked, as did 21.0% of residents of the County, rates far in excess of the 15.5% seen nationwide and of the 12.0% national benchmark established by Health People 2020. The prevalence of smoking across Cleveland varies nearly three-fold, from 16.6% to 42.6%. In addition to the high prevalence in some east side neighborhoods, prevalence is also elevated in West side neighborhoods inhabited by young White residents. Research elsewhere suggests that excess healthcare costs from smoking is $2,056 per year, plus the $3,077 annual cost of partial absenteeism due to smoke breaks. Second-hand smoke is a major trigger of asthma, which among adults, varies more than two fold across Cleveland, ranging from 8.9% to 21.4%. Among children, asthma and tooth decay are leading reasons for missing school.
The fraction of Cleveland residents stating that their mental health is fair or poor varies three-fold across Cleveland, ranging from 9.6 to 29.4%. The final chart shows a very close link between poor mental health and smoking. The higher the rate of poor mental health in a census tract, the higher the smoking prevalence.
State, National and aggregate prevalence data come from the 2018 Cuyahoga County Community Health Assessment. Health Improvement Partnership Cuyahoga; 2018 January. Available from: http://hipcuyahoga.org/2018cha/
Life expectancy data come from the Cuyahoga County Board of Health.
Data presented for Cities of Cleveland and Parma are from the CDC's 500 Cities Project.
Cost of obesity and smoking: Zellner S, Bowdish L. The ROI of Health and Well-Being: Business Investment in Healthier Communities. NAM Perspectives. 2017 Nov 6; Available from: https://nam.edu/roi-health-well-business-investment-healthier-communities/