Added on June 3, 2019  Marsha Chartrand

High blood pressure is rampant in Michigan. Better data may lead to a cure.

By Robin Erb (Bridge)

They call it the silent killer because of its ability to lurk undetected – hardening arteries, stiffening heart muscles, depriving blood from the brain and damaging kidneys and retinas.

Now, high blood pressure may be losing a bit of its ability to hide.

A new color-coded, data-driven mapping tool developed at Wayne State University reveals dangerously high blood pressure readings from an extraordinary perspective: neighborhood by neighborhood.

In this hypertension dashboard, areas with the highest blood pressure readings in four counties – Wayne, Macomb, Oakland, and Livingston – are exposed as a patchwork of deepening shades of orange.

By studying such health data maps, doctors, public health advocates, businesses, policymakers and others can better understand how geography dictates health and even life expectancy. Most importantly, such data can help maximize disease control and prevention efforts, saving both healthcare dollars and human lives.

“You can throw all the medicines you want at the [hypertension] problem, but if you can’t fix the upstream social determinants, you’ll never solve it,” said Dr. Phillip Levy, an emergency room physician at Detroit Receiving Hospital and cardiovascular researcher who developed the tool.

Levy’s work was presented Thursday at the Detroit Regional Chamber Mackinac Policy Conference.

If all goes well, the map could one day address health disparities at the street level throughout Michigan, combining neighborhood health data with demographic information such as age, race, demographics, income, insurance coverage, pollutants, access to transportation, fresh food and more.

“This is about using information to address adverse health outcomes of the state. We know that heart disease disproportionately affects Detroit, so it makes sense to start there,” he said.

Levy trained in New York and has worked in Detroit for 17 years. He said he’s seen far too many heart attacks and strokes that could have been prevented by better blood pressure control.

In fact, Michigan – a state crisscrossed by hiking and biking trails and parks and lakes – for years has had some of the highest rates nationally for cardiovascular disease, considered one of the most preventable diseases through medication and lifestyle change.

In Michigan, 298 residents for every 100,000 die of stroke, heart failure, and other cardiovascular disease deaths. That’s 42nd in the nation (the healthiest state, Minnesota, is at 190 per 100,000), according to the United Health Foundation, a Minnesota-based nonprofit that compiles the annual  America’s Health Rankings report that pulls together a trove of data.

The national rate is just under 257 deaths per 100,000, and only Nevada and mostly southern states such as West Virginia, Mississippi, Louisiana and Oklahoma have worse rates than Michigan.

The rate of cardiovascular deaths in Michigan are highest in Wayne County and Detroit, along with counties in the Northeast Lower Peninsula and Thumb, according to data from the Centers for Disease Control and Prevention.

For Levy, those data points are patients rushed to the ER, followed by the panicked and grieving family and friends: “Telling a loved one that their husband or father died from consequences of high blood pressure, an inherently treatable condition, is really devastating,” he said.

So last year Levy, who also is a professor and researcher at Wayne State University’s School of Medicine, again turned to data – this time for a more close-up look and for a solution.

Exact data. Targeted fights.

Levy’s work is part of an emerging focus in health care on “precision public health, as more practitioners, public health advocates, and even community leaders and businesses better understand that certain demographics and neighborhoods carry more “disease burden” than others.

Like precision cancer drugs that are personalized according to a patient’s gene code, public health efforts, can be guided by an area’s demographics and environment.

Just as data shows where disease lives, data can also reveal ways to fight it, by guiding providers and funders in how to reframe health care and target resources to keep disease in check rather than reacting to disease – expensively – when it spirals out of control, said Dr. Faiyaz Syed.

He is the chief medical officer of the Michigan Primary Care Association, which operates 45 community health centers for about 700,000 patients throughout Michigan.

Front line staff in community health centers have long known that ZIP Code, as much as genetic code, dictates health, he said.

But knowing something – even seeing it firsthand day in and day out – is far different than being able to analyze it and act on it.

“As we move from volume- to value-based care, data is how we are going to show we’re moving the needle … Just gathering data is not enough. Making it actionable is what counts,” he said.

Beginning in December 2016, Levy and his team began compiling blood pressure data from every patient who arrived at emergency rooms of the Detroit Medical Center, later adding Henry Ford Health System as well.

Through February 2019, they collected data for nearly 552,000 “encounters” or emergency room visits – arrivals that were driven not only by heart attacks and strokes and other crises related to high blood pressure, but also by things like earaches and broken bones.

Levy’s team stripped personal identifiers from the readings, assigning them instead to census tracts where patients lived.

Then, they added more data: age and poverty estimates, along with measures from the Area Deprivation Index, a tool used by researchers to rank neighborhoods based on socioeconomic status that incorporates factors from income and education to employment and housing quality.

Despite treating and researching heart disease for a long time, Levy said he and others were “pretty astonished” by the “sheer magnitude of the impact of uncontrolled blood pressure across the region.”

Hot spots and trends

The areas with the highest readings emerged deep orange – places like Census Tract 26163518900 – a Detroit neighborhood northwest of I-75 and Gratiot Avenue, around Eastern Market.

On average, blood pressure readings here measured 137/83 mmHg, compared to 120/80 mmHg, which is considered normal. That means, even accounting for patients in the emergency room whose blood pressure was healthy, the census tract as a whole has moved beyond “normal” and “elevated,” registering an average blood pressure in the first stage of hypertension.

Jewrell Roquemore, 65, isn’t surprised. He made his way down the sidewalk recently in a pair of white athletic shoes, his blood pressure pills in hand in a plastic bag. He’d just left Gateway Medical Clinic.

Roquemore said he tries to walk often and takes his medications “religiously.” Sometimes, though, he feels like the outlier here.

“I tell them: ‘You’ve got to do this, take care of yourself, or you’ll perish.’ But people are busy. They don’t think they have time to think about [high blood pressure],” he said.

Revealing, too, are numbers outside the blood pressure readings, WSU’s Levy said.

In this same census tract, there were more than twice as many emergency room visits – 4,493 – as there were people – 2,122 – in the 26 months of data collection.