The largest mortality disproportion involves Detroiters in the 50 to 59 age brackets, who are dying at a rate 131 percent higher than residents in the same age group in the rest of Michigan. In fact, the study said, this age group of Detroit residents are dying at nearly the same rate as outstate residents who are 60 to 74 years old. In addition, overall hospitalization rates are 30 percent higher in Detroit than in the rest of the state.
Officials releasing the study said the U.S. Supreme Court’s approval of the Affordable Care Act last week can help to close the mortality and chronic illness gap by making health care more affordable to a traditionally underserved segment of the population.
“Detroit residents are getting sicker and dying at a younger age than people in the rest of the State of Michigan,” said DAAA President and CEO Paul Bridgewater. “Because of the lack of availability of health care coverage, younger residents are developing chronic illnesses that are not treated at an early stage. If found early enough, these illnesses could have been treated and prevented from advancing to a chronic stage and having a negative effect on overall health and causing premature death.”
The health status analysis, commissioned by DAAA, was conducted by a research team of medical and public policy experts from Wayne State University’s School of Medicine/Detroit Medical Center. The effort examined mortality trends from 1999 to 2009 and focused on the study period of 2007 to 2009.
Principal investigators conducting the study are Herbert C. Smitherman, Jr., MD, MPH, FACP Wayne State University School of Medicine/Detroit Medical Center and Lee Kallenbach, MHP, Ph.D., an independent health epidemiologist now based in the Dallas-Fort Worth, Texas area and formerly of the Wayne State University School of Medicine/Detroit Medical Center.
Researchers examined mortality rates, hospital use, preventable hospitalizations, chronic illness and access to care among older adults in Detroit for a three-year period from 2007 to 2009 and compared them to health trends among members of the same age group at the same time period living in the rest of Michigan.
The study looked at residents age 50 to 59 and seniors age 60 to 74 who live in the DAAA service area—also known as Planning & Service Area 1-A (PSA 1-A). The area includes Detroit and the eight communities of Grosse Pointe, Grosse Pointe Farms, Grosse Pointe Park, Grosse Pointe Shores, Grosse Pointe Woods, Hamtramck, Harper Woods and Highland Park.
During the three-year study period of 2007-2009, the mortality rate for Detroiters age 50-59 was 1,321 per 100,000 compared to a mortality rate of 571 per 100,000 for that age group in the rest of the state. In that period a total of 1,443 Detroiters in the 50 to 59 age group died. If the mortality rate in Detroit were the same as the rest of the state, the number of deaths statistically likely to happen would have been 626 deaths, meaning that there were 822 excessive deaths.
The death rate for seniors age 60 to 74 was 60 percent higher in Detroit compared to the rest of the state. During those three years, the mortality rate in Detroit for this age group was 2,340 per 100,000 compared to 1,478 per 100,000 in that age group for the rest of the State. In that period a total of 2,159 seniors died in Detroit. If the DAAA service area had the same mortality rate as the rest of the state, 796 of those individuals would have lived.
The comparison shows that the mortality rate for Detroiters age 50-59 almost equals the mortality rate for the older 60-74 age group in the rest of Michigan.
“Low-income seniors in Detroit are more likely to enter the health care system with a more advanced stage of disease, resulting in more complications, a higher level of service needs, avoidable higher costs, and a higher death rate, than exists for seniors in the rest of the State of Michigan and those that can seek care regularly,” said Smitherman.
Researchers also found the mortality rate in Detroit during 2007 to 2009 is similar to some other urban areas in Michigan when they examined 19 other communities.
Smitherman said adults as young as age 50 who live in Medically Underserved Areas, such as Detroit, and the other urban cities in Michigan suffer more chronic illnesses, such as stroke or heart disease, which requires them to be hospitalized more frequently, and ultimately die earlier than expected. Those who do survive enter their senior years already sick and weakened from battling years of chronic illness, also causing them to succumb to death earlier than expected.
Likewise, annual hospitalization rates among seniors age 60 to 74 and older are 43 percent higher in Detroit than in the rest of the state. In 2007 to 2009, annually 33,343 Detroit seniors age 60 to 74 required hospitalization. Researchers found that was 10, 065 more than would have occurred if the hospitalization rate in Detroit were the same as the rest of Michigan.
The researchers found that heart disease, cancer, stroke, chronic lower respiratory, pneumonia/influenza, diabetes mellitus, kidney disease and septicemia (blood poisoning) are the most common chronic illnesses that require seniors in Detroit and urban areas to be hospitalized. They found that seniors in Detroit are likely to have three or more of these chronic illnesses.
“Detroit is medically underserved,” Smitherman said. “About 64.6 percent of the city’s residents are classified as living in a Medically Underserved Area because the number of primary care physicians is low, infant mortality is high and much of the population is below the poverty level or is elderly. In addition, many residents are not covered by any form of health insurance, making routine medical care unaffordable.”
Smitherman said the local impact of the national Affordable Care Act (ACA), which was upheld June 28 by the U.S. Supreme Court, will help to close the health care gap for nearly 200,000 to 300,000 uninsured and underserved residents in the DAAA service area by guaranteeing them basic health care coverage for the first time.
“The decision by the high court approving the act will make access to affordable health care finally possible for many currently without health insurance and will result in vastly improved health outcomes and reduced health disparities in our community and our country,” he said.
Since the mortality rate for residents age 50 to 59 in the DAAA service area is almost equal to the rates for seniors age 60 to 74 living in the rest of Michigan, Bridgewater said DAAA is working to change legislation that would allow the agency to provide services to anyone 50 or over in its coverage area, rather than the current 60 and over.
“Those who do survive enter their senior years already sick and weakened from battling years of chronic illness,” Bridgewater said. “The excess death toll is the result of delay in seeking care for chronic and other conditions by those who do not have insurance and cannot afford health care.”
DAAA is also working to encourage system and policy change that support interventions at earlier ages as well as more community resources to address the special needs of this targeted population. Key services that address the needs of this population include access to primary care physicians and other practitioners; evidence-based health promotion and chronic disease self-management; home and community care services through a robust continuum of care; Care Coordination and Care Transition services; and special outreach to older adults who do not have health insurance, transportation, experience literacy and language barriers, or need assistance making better lifestyle choices.
Data sources for the Dying Before Their Time II study include the U.S. Census 2000 and 2010, the Michigan Department of Community Health, the Michigan Health and Hospital Association, and the HRSA Data Warehouse and Shortage Designation.
About Detroit Area Agency on Aging www.daaa1a.org
DAAA is a private, non-profit agency that was established in 1980 with a mission to educate, advocate and promote healthy aging to enable people to make choices about home and community-based services and long term care that will improve their quality of life. DAAA services residents age 60 and over in a region of nine communities in central and eastern Wayne County in an area known as Region 1-A that includes the cities of Detroit, Highland Park, Hamtramck, Harper Woods, Grosse Pointe, Grosse Pointe Farms, Grosse Pointe Park, Grosse Pointe Shores and Grosse Pointe Woods. It also provides home and community-based care to individuals 18 to 64 through its MI CHOICE Program.
About Detroit Medical Center www.dmc.org
The Detroit Medical Center includes DMC Children’s Hospital of Michigan, DMC Detroit Receiving Hospital, DMC Harper University Hospital, DMC Huron Valley-Sinai Hospital, DMC Hutzel Women’s Hospital, DMC Rehabilitation Institute of Michigan, DMC Sinai-Grace Hospital, DMC Surgery Hospital, and DMC Cardiovascular Institute. The Detroit Medical Center is a leading regional healthcare system with a mission of excellence in clinical care, research and medical education.
About Wayne State University www.wayne.edu
Wayne State University is a premier urban research institution offering more than 400 academic programs through 13 schools and colleges to nearly 32,000 students. Its School of Medicine is the largest single-campus medical school in the nation with more than 1,200 medical students. In addition to undergraduate medical education, the school offers master’s degree, Ph.D. and M.D.-Ph.D. programs in 14 areas of basic science to about 400 students annually.
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