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Health Depends on Where You Live

Your neighborhood could hurt your health.

People who live on the South Side of Chicago are as much as 14 times more likely to have diabetes than residents near Wrigley Field.

In the Dallas area, the risk of stroke is much higher in the south than the north. Just 2 percent of Plano adults have a history of stroke, but the rate exceeds 7 percent in south Dallas.

Coronary heart disease is three times more prevalent among some residents of Staten Island than in parts of midtown Manhattan.

That's according to the 500 Cities Project, a joint effort of the U.S. Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation. 500 Cities provides a close-up view of the health of 100 million Americans living in 27,000 neighborhoods in all 50 states.

Source: CDC, Census Bureau
Credit: Sam Hart/NBC

500 Cities assesses each neighborhood's health by measuring unhealthy behaviors such as smoking, conditions like high blood pressure and preventive services like annual checkups.

Lorna Thorpe, an epidemiologist at NYU School of Medicine, said there are clear geographic patterns in the data.

"On average, cities in the West have lower rates of obesity, hypertension, smoking, binge drinking and diabetes compared to cities in other regions and the U.S. as a whole," Thorpe said.

Thorpe gave the example of diabetes: "In the 50 cities with the lowest rates, less than 7 percent of adults have diabetes, while in the 50 cities with the highest rates, 14 percent or more have the condition."

An analysis by the NBC Owned Television Stations showed that cities in the West and near universities ranked among the 25 healthiest in most categories. At the top: four California cities – Irvine, Redondo Beach, San Ramon and Mountain View, followed by Provo, Utah. Irvine and Provo are both college towns. Two other college towns, Boulder, Colorado, and College Station, Texas, were in the top 10.

The five least healthy were all in the Midwest: Flint and Detroit, Michigan, followed by Gary, Indiana, and Youngstown and Cleveland, Ohio

We ranked cities by counting the number of times they appeared among the healthiest or unhealthiest 25 cities for five unhealthy behaviors and 13 health outcomes. Irvine appeared 16 of a possible 18 times on the list of most healthy cities. Flint and Detroit each appeared 16 of 18 times on the list of least healthy cities.

"Place matters. Disease is no different," said Kevin Fitzpatrick, a sociologist at the University of Arkansas.

"Health care providers need to be way more sensitive to the geography of their patients," Fitzpatrick said. "It can provide a history of exposure, social injustice (and) inadequate care." He said doctors should ask patients for their Zip code when they take a medical history to get "a glimpse of their exposure to risks as well as protections."

History and economics help explain why some neighborhoods fare worse than others, Thorpe said.

"The historical disinvestment in some neighborhoods, combined with a selection process that sorts lower- and higher-income individuals into different parts of the city, leads to geographic disparities," Thorpe said.

The data shows that behavior has a big impact on health, said Shelley Liu, an assistant professor at the Icahn School of Medicine at Mount Sinai, New York.

"Good health doesn't just depend on good healthcare," Liu said. "We have to focus on reducing unhealthy behaviors like smoking, binge drinking and lack of physical activity.

"Even if we are good at using preventive care, like going to annual screenings and checkups, unhealthy behaviors are still pretty bad for us, and we can prevent some chronic disease outcomes by reducing unhealthy behaviors."

About the story

This story is based on the 500 Cities Project, a database created by the U.S. Centers for Disease Control and Prevention with funding from the Robert Wood Johnson Foundation and the CDC Foundation.

500 Cities takes information from the Behavioral Risk Factor Surveillance System, an annual phone survey of 400,000 households. It joins this data with the Census Bureau’s American Community Survey, which collects demographic, social and economic data from nearly 3 million households each year.

Through statistical modeling 500 Cities then makes estimates at the census tract level for the following:

  • Five unhealthy behaviors: binge drinking, current smoking, no leisure time physical activity, obesity and sleeping less than seven hours per day.
  • 13 health outcomes: arthritis, high blood pressure, cancer (except skin cancer), asthma, coronary heart disease, chronic obstructive pulmonary disease, diabetes, high cholesterol, kidney disease, history of stroke, loss of all teeth, mental health poor for 14 of the previous 30 days and physical health poor for 14 of the previous 30 days.
  • Nine preventive services: current lack of health insurance, annual visit to a physician for a checkup, annual visit to a dentist or dental clinic, taking medication for blood pressure control (if diagnosed with high blood pressure), periodic cholesterol screening, mammogram screening for women aged 50 to 74, Pap smear for women aged 21 to 65, periodic colon screening for adults aged 50 to 75 and preventive screening for older adults.

The 500 Cities Project covers the nation’s 497 largest cities, ranging from New York (population 8.2 million) to Schenectady, NY (population 66,000), plus three smaller cities in order to extend coverage to all 50 states: Cheyenne, Wyoming, Charleston, West Virginia, and Burlington, Vermont.