Tài liệu Erie County, New York 2010 – 2013 Community Health Assessment pptx

Erie County, New York

2010 – 2013
Community Health Assessment










Anthony J. Billittier IV, MD, FACEP
Commissioner of Health
Updated 8/2011

2010-2013 COMMUNITY HEALTH ASSESSMENT
Erie County

CHA CHECKLIST/ INDEX

CHA Checklist/INDEX
INDEX

(page no.)

X Section One - Populations at Risk …………………………………… 1

A. Demographic and Health Status Information –

narrative and statistical description of the county……… 1 – 6

Basic Service Area: Family Health
Programs:
X Dental Health Education …………………………… ………7
X Primary and Preventive Health Care Services………….…….12
X Lead Poisoning……………………………….… … ………13
X Prenatal Care and Infant Mortality………………… …… 19
X Family Planning……………………………………… ……23
X Nutrition………………………………………… … ……. 31
X Injury Prevention…………………………………… …… 43

Basic Service Area: Disease Control
Programs:
X Sexually Transmitted Diseases…………………… …… …58
X Tuberculosis………………………………………………….71
X Communicable Diseases……………………… ……………74
X Immunization………………………………… … …… … 82
X Chronic Diseases…………………………………… … …91
Asthma…………………………………………………… 91
Cancer…………………………………………………… 103
Diabetes………………………………………………… 123
Heart Disease and Stroke………………………………….129
Tobacco Use………………………………………………136
X Human Immunodeficiency Virus (HIV)……………….……146

Optional Service Areas
X Dental Health Services……………………………… ….…155

Optional Other Service Areas/Programs

X Medical Examiner…………….…… …………………….…156
X Emergency Medical Services….……………………………. 157
X Laboratories………………………………………… ……. 159
X Early Intervention and Preschool…………………………….160

X
B. Access to Care – general discussion of health resources………………… 162

X
C. The Local Health Care Environment ………………………… ………… 170
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X
Section Two - Local Health Unit Capacity Profile - profile of staff and
program resources available for public health activity in the county.
(Suggested Resource: APEXPH)……………………………………….……172


X
Section Three - Problems and Issues in the Community

X
A. Profile of Community Resources 180

X
B. Behavioral Risk Factors 180

X
C. Profile of Unmet Need for Services 185


X
Section Four - Local Health Priorities 186

X
Section Five - Opportunities for Action 193

X
Appendix A 194

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Section One - Populations at Risk

Demographic Information

Erie County is the largest metropolitan county in upstate New York with a population of
913,338 and covering 1,044 square miles. Erie County is located in western New York,
bordered to the west by Lake Erie and
the Niagara River, and shares an
international border with Canada.
Several bridges span the Niagara River
and provide convenient access and

trade for residents of the United States
and Canada. Niagara County lies to the
north, Genesee and Wyoming Counties
to the east, and Cattaraugus and
Chautauqua Counties are to the south.
There are three cities in the County.
Buffalo is the second largest city in the
state and the largest city in the region
with a population of 272,632. Buffalo
serves as the County seat. In addition,
there are 16 villages, 25 towns, and two
Native American Indian reservations
within the County.

Erie County is largely a metropolitan,
urban County with the majority of the
population living within the cities and
surrounding communities. There is also a significant rural population that resides outside
the first and second ring suburban areas.

The population of the County has been declining over the past decade. In 2000 the
population of Erie County was 950,265. This represents a 3.9% decrease from 2000 to 2007.
The City of Buffalo had a population decline of 6.9% from 2000 to 2007. It is interesting to
note that in 2005 there was a shift in population from the City of Buffalo to the suburbs, but
by 2007 the population was also decreasing in the suburbs. People have been leaving the
County completely.

According to the US Census 5.3% of the Erie County population are under the age of five,
21.5% are under the age of 18 and 15.6% are age 65 or over. Compared to New York State
and National age distributions, the County has slightly lower percentages of young people

and a higher percentage of people 65 and older. This comparison does not hold with the City
of Buffalo distribution. In Buffalo 26.3% are under the age of 18, which is higher than both
New York State (24.7%) and USA (24.3%). The percent of persons age 65 and over in the
City of Buffalo is lower than the County as a whole and equal to the New York State
percentage of 13.4%.
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In Erie County 51.8% of the population is female and 48.2% of the population is male. This
distribution is very similar to the New York State distribution, but the US distribution is
closer to 50% (50.7%). In the City of Buffalo there is a higher percentage of females
(53.0%) and lower percentage of males (47.0%.)
According to the 2007 American Community Survey, 82.4% of the Erie County population is
non-Hispanic Whites, 13.5% non-Hispanic African Americans, 3.7% Hispanic, 0.5% Native
Americans, and 2% Asian/Pacific Islander. Upon closer examination of the demographics of
the County, there are significant differences in the racial composition of the City of Buffalo
as compared to the rest of Erie County. The City of Buffalo is characterized by a much
higher percentage of African Americans (39.8%) and Hispanics (8.3%) The west side of
Buffalo is home to a large immigrant and refugee population where there are 29 ethnicities
and at a minimum of 31 languages and dialects spoken. Lackawanna, New York, just south
of Buffalo is home to a large Arab community, many of whom do not speak English. Nearly
9% of the population in Erie County speak a language other than English in their homes.
The median household income in Erie County is $45,076. The median earnings for male
full-time workers is $46,348. The median earnings for female full-time workers is $34,238.
For all families in Erie County, 9.9% are below the federal poverty level. For families with
children under 18 years of age, 17% are below the poverty level. For families with children

under the age of 5, 18.2% are below the poverty level. The likelihood of families living
below the poverty level is compounded for female headed families that do not have a
husband present. Ten percent of families in Erie County have a female head of household
with no husband present and 30.1% of these families are below the poverty level. For these
families with children under 18 years of age, 42.5% are below the poverty level and 53.4% of
these families with children under the age of 5 are below the poverty level. Erie County’s
per capita income in 2007 was $25,995. In the City of Buffalo, poverty is significantly more
present. In Buffalo the median household income is $24,536, over $20,000 less than the
County as a whole, and the per capita income is $14,991, almost $11,000 less than the
County. In Erie County 13.7% of all residents are below the federal poverty level, which is
very similar to the percent for New York State. In the City of Buffalo, 26.6% of residents are
living below the poverty line.

Erie County had long been a blue collar community with the steel industry dominating the
region. During the 1980’s many companies including Bethlehem Steel and Republic Steel,
two of the largest employers in the County, reduced their local production and laid off a
majority of their workforce. As those factories/facilities closed, people took lower paying
jobs or left the area all together, triggering the great decrease in population over the last 25
years. The primary industries in Erie County have since shifted from blue collar
manufacturing industries to service industries. The number of manufacturing jobs fell from
over 67,742 in 2000 to 53,414 in 2007. Conversely, in 1975 there were approximately
67,000 jobs in the service industry compared to over 141,000 service industry jobs in 2000.



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Employment in Erie County by industry and occupation is listed in the following table.

Industry Population Percentage
Education, Health and Social Services 113,784 26.4
Manufacturing 53,414 12.4
Retail Trade 47,322 11.0
Professional, scientific, management,
administrative, and waste management services

43,320

10.1
Arts, entertainment, recreation, accommodation
and food services
36,867 8.6
Finance, insurance, real estate, and rental and
leasing
34,771 8.1

Occupation Population Percentage
Management, professional, and related
occupations
156,603 36.3
Sales and office occupations 115,972 26.9
Service occupations 76,112 17.7
Production, transportation, and material moving
occupations
52,856 12.3
Construction, extraction, and maintenance

occupations
29,093 6.8
Both Tables above data obtained from American Community Survey, 2007
In New York State the unemployment rate was estimated at 5.6% in November 2008. Erie
County’s unemployment rate during the same time period was higher then the state level at
6%. There was a 77% increase in the unemployment rate from the end of 2007 to the
beginning of 2008. The table below shows the percent of people who were unemployed in
Erie County during the end of 2007 and the beginning of 2008.

TIME PERIOD UNEMPLOYMENT TOTAL UNEMPLOYMENT RATE
August 2007 20,629 4.4%
September 2007 20,506 4.4%
October 2007 19,488 4.2%
November 2007 20,578 4.4%
December 2007 23,139 5%
January 2008 27,213 5.8%
February 2008 27,962 6%
March 2008 27,463 5.9%
April 2008 23,839 5.1%

Of persons over the age of 25, the following table demonstrates the educational level
achieved in New York State, Erie County and the City of Buffalo. Erie County has higher
high school graduation rates than the State, but in the City of Buffalo the rates are
significantly lower. Completion of higher education is lower in the County than in New
York State, and even lower in the City of Buffalo. It should be noted that there are a number
of zip codes in the City of Buffalo that have extremely low high school and higher education
graduation rates.
Demographics and Educational Level NYS Erie County

Buffalo

High School Graduates 79.1%

82.9%

74.6%

Bachelor’s Degree or Higher 27.4%

24.5%

18.3%

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Erie County’s total school enrollment was 243,634 in 2007. Nursery school and Kindergarten
enrollment was 12.2%, and Elementary and High School enrollment was 58.3%. Within the
city of Buffalo there were approximately 77,420 students enrolled in local schools from
2005-2007. Student enrollment in Nursery school and Kindergarten was 9.9%, Elementary
was 38.7%, and High School was 20%.
Housing costs in Erie County are among the lowest in the northeast. In 2007, the median
housing cost for monthly home owners with a mortgage was $ 1,202. Housing units with out
a mortgage median monthly cost was $480, and renters median monthly cost was $651.
Housing stock in Erie County is aging, particularly in the City of Buffalo. It should be noted
that Erie County was not affected by the housing boom and the subsequent housing bust
experienced in the rest of the country. Housing costs in this region have remained relatively
stable over the past decade. While the County and region did not enjoy they sharp increases

in housing values, it also did not have the rapid decline in value or the high foreclosure rates
seen in many other parts of the country.

There are an average of about 10,000 births each year in Erie County. The annual birth rate
in Erie County (11.0 per 1,000) was lower than in New York State (13.1 per 1,000) in 2007.
This is consistent with the difference between Erie County and New York State since 2003.
Since 2003 the birth rate has remained relatively stable over time for both Erie County and
New York State. The rate of low birth weight in Erie County dropped nearly one full point
from 2006 to 2007 (7.8 per 1,000 in 2007 and 8.9 per 1,000 in 2006) and 2007 was the
lowest it had been since prior to 2003. In 2007 Erie County had higher rates per 1,000 of
infant deaths (7.8), neonatal deaths (5.2) and postneonatal deaths (2.6) than reported in the
State as a whole. Erie County having higher rates for these occurrences is consistent with
data through 2003.

The following table shows morbidity data for Erie County for 2003-2007.



The AIDS case rate per 100,000 in 2007 is much lower in Erie County than in New York
State (20.9.) However, since 2003 the State rates have been on the decline. In 2003 the rate
in New York State was 28.4 per 100,000 and it has fallen every year. In Erie County, the
rate has shown a significant increase since 2003 with 2007 being the highest rate reported in
this time period.

While Early Syphilis rates per 100,000 are significantly lower in Erie County than rates in
the State, Chlamydia incidence rates are sharply higher than the State. Rates of TB incidence
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and Lyme Disease are significantly lower in Erie County than in New York State.

The overall mortality rate in Erie County is much higher than the State rate (1040.0 per
100,000 for Erie County vs. 757.9 per 100,000 in New York State.) Mortality rates for lung
cancer for both men and women, breast cancer, cerebrovasular disease, diseases of the heart,
homicides, and cirrhosis are all much higher in Erie County than in New York State. The
following table provides mortality rates per 100,000 for New York State and Erie County
from 2003 through 2007.

MORTALITY
(Rates per
100,000
Population)
NYS
Rate
2007
Erie
County
Rate
2007
NYS
Rate
2006
Erie
County
Rate
2006
NYS

Rate
2005
Erie
County
Rate
2005
NYS
Rate
2004
Erie
County
Rate
2004
NYS
Rate
2003
Erie
County
Rate
2003
Total Deaths 757.9

1040 765.6 1019.1 785.1 1048.5 787.7 1031.8 807.8 1061
Lung Cancer
(Total)
48.3

70.8 47.6 71 48.2 69.4 48.7 70.9 49.3 72.5
Lung Cancer
(Male)

52.2

74.8 52.5 80.3 53.1 75.6 53.4 73.7 55 81.1
Lung Cancer
(Female)
44.6

67.2 43 62.3 43.7 63.7 44.3 68.4 44 64.5
Breast Cancer
(Female)
27.3

44.1 27.3 36 28.6 34.5 29.1 34.7 30.2 41.2
Cervical Cancer 3

1.9 2.8 2.1 2.9 1.4 2.7 2.1 3 2.7
Cerebrovasular
Disease
30.5

55 32.7 58.6 34.2 66.1 35.7 63.3 37.6 70.4
Diseases of the
Heart
256

275.8 260 278.2 271 296.9 271 286.1 288 330.1
Homicides 4.3

6.5 4.9 8.8 4.7 6.7 4.5 5.6 5 6.5
Suicides 7.1

8.3 6.7 7.6 6.8 7.7 6.2 7.3 6.3 7.2
Unintentional
Injury
25.5

24.2 23 22.4 23 22.2 20.4 21.6 21.9 25.4
Motor Vehicle 7.3

6.7 7.9 7.7 7.8 5.7 7.9 7.6 7.9 7.3
Non-Motor Vehicle 18.2

17.5 15.1 14.7 15.2 16.5 12.5 14 14 18.1
AIDS 6.9

3.1 7.5 3.4 8.6 2.3 9

4.1 9.9 3.1
Cirrhosis (Liver) 6.7

11.1 6.2 9.6 6.3 8.5 6.6 9.1 7.2 11.7

Within Erie County there are zip codes with significantly lower socioeconomic status than
the county as a whole. These zip codes primarily are within the City of Buffalo. To
illustrate, 73% of the Erie County Department of Health clinic patients come from five zip
codes in the City of Buffalo. These five zip codes are 14204, 14206, 14211, 14212, and
14215. Data is based on 2008 clinic data and 2008 census data. Unemployment and
disabilities are significantly higher in these zip codes than in the County, New York State or
nationally. Median household income and per capita income are half of Erie County income
levels in three of five of these zip codes. Race and ethnicity distributions are also very

different in these zip codes as compared to Erie County percentages. High school graduation
rates are also much lower in these zip codes as compared to the County as a whole.

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Characteristic US NYS Erie Buffalo 14204 14206 14211 14212 14215
% In labor force
65.0% 63.0% 61.2% 57.0% 48.6% 55.2% 54.2% 50.5% 60.7%
% Disabled
15.1% 13.9% 16.1% 22.7% 34.4% 28.6% 29.3% 32.6% 24.1%
Median Household
Income
$48,451 $51,384 $42,494 $27,850 $15,901 $27,645 $20,336 $18,015 $27,338
Per Capita Income
$25,267 $28,024 $23,585 $17,411 $12,369 $15,685 $11,800 $11,058 $14,952
% Families Below
Poverty
9.8% 10.9% 10.5% 23.8% 31.9% 13.4% 29.9% 32.4% 21.6%
% Individuals
Below poverty
14.5% 14.2% 14.5% 29.9% 36.7% 16.6% 33.0% 36.9% 22.6%
% Black
12.4% 15.5% 13.4% 39.7% 75.1% 9.2% 71.5% 45.1% 72.3%
% Hispanic
14.8% 16.3% 3.6% 8.9% 7.7% 1.5% 1.9% 1.7% 2.3%
% White

73.9% 66.4% 81.3% 51.0% 18.3% 88.4% 24.5% 50.5% 22.7%
Not High School
Graduate %
19.6% 15.9% 12.7% 22.4% 36.5% 30.8% 31.5% 38.8% 20.2%

Analysis of demographic trends as they relate to poor health and needs for public health
services indicates that where poverty is highest, poor health outcomes are the greatest. This
is evidenced by the Preventive Quality Indicator zip code data and US Census zip code level
data. For example, zip code 14215 has significantly higher poverty rates than many other
areas in the City of Buffalo and Erie County. The PQI data for zip code 14215 shows a
significantly higher rate of hospital admissions than would normally be expected, particularly
for African Americans (179%.) These findings also hold true in zip code 14211 where
poverty is also higher than in other areas of Buffalo and Erie County. Data provided is for all
conditions.

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Health Status Information

Basic Service Area: Family Health

Dental Health Education

1. HEALTH/VITAL STATISTICS

The New York State Department of Health and Centers for Disease Control and Prevention

established a surveillance system for monitoring oral health status, risk factors, workforce,
and the use of dental services. To collect data on tooth decay or dental caries in children, the
New York State Department of Health assisted Erie County in conducting a survey of 3
rd

grade children. The results of this survey were published by the New York State Department
of Health in “Oral Health Status of Third Grade Children: New York State Oral Health
Surveillance System” in December 2006.

Dental caries, the most common chronic childhood disease, impacts children’s functions
including eating, growth, speaking, and learning. Oral diseases in adults negatively impact
their employability and systemic health. Although dental caries are preventable, almost 80%
of children will have experienced tooth decay by the time they finish high school. For
children, oral diseases can jeopardize their physical growth, self-esteem and capacity to
socialize. It is estimated that children lose numerous school hours annually because of dental
problems and dental visits. The report noted profound disparities in oral health among poor
children.

The Erie County data collected through this project as well as New York State rates are
provided in the following table. Findings that demonstrate a significant variation from State
rates include: Erie County 3
rd
Graders with low socio-economic status are significantly more
likely to have experience with caries; Erie County 3
rd
Graders are significantly less likely to
report taking fluoride tablets on a regular basis; and the caries outpatient visit rate per 10,000
for the ages of 3-5 years during 2005-2007 is over four times higher in Erie County than the
State rates. None of the outcomes meet Healthy People 2010 goals.

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Oral Health in Erie County, 2002-2004



The following Economic Security Indicators from the Kids Count/U.S. Census relates to the
dental status of dental health in Erie County. There is a direct relationship between
socioeconomic status and dental health.


Erie County NYS
Economic Security Indicators 2000 2007 2007
Children and Youth (Ages: Birth - 17

Years) Living Below Poverty
35,286 (15.8%) 38,138 (19.3%) 19.6
Children and Youth Receiving Public
Assistance (Ages: Birth - 17 Years)
20,228 (8.8%) 14,060 (7.0%)

7.0
Children Grades K-6 Receiving
Free/Reduced
Lunch in Public Schools
33,010 (42.7%) 29,128 (42.4%) 49.1

Statewide in New York State, 71%-74% of adults report a dental visit within the past year.
This data is provided in the following table for 1999-2008. In Erie County in 2008 only
63.8% of adults surveyed reported a dental visit within the past year. Subgroups that were
more likely to have had a dental visit in the past year are women (67.8%) and individuals
who have education beyond high school. This is shown in both the State and County data.

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2. AVAILABLE RESOURCES

Fluoride Rinse Program
Ninety-five percent (95%) of the children in Erie County are on public water systems and are
receiving fluoridated water. The five percent (5%) that don’t live in areas with fluoridated

water systems include three school districts (Akron, Alden, and North Collins School.) The
New York State Department of Health provides fluoride treatments to students in these areas.
Dental Education
School districts in Erie County include dental health education as part of their health
education curriculum. In the Buffalo Public Schools in the 2010 – 2011 school year, all 2
nd

grade students will receive a 20 minute in classroom education session covering brushing,
flossing, dangers of smoking and good nutrition for strong teeth. Toothbrushes, toothpaste
and floss will be solicited from companies to distribute to children at time of education to
promote continuation of learned dental hygiene practices. This will be measured through
administration of an age appropriate pre and post test. It is anticipated that 95% or greater of
participants will show increased knowledge of appropriate dental health. All parents at
registration/orientation sessions will get an overview of the importance of dental health and
resources for dental care. Referrals to services will be provided as needed. A Dental
Hygenist is the Buffalo Public Schools designated trainer for the recently awarded Chompers
collaborative grant and will be providing training and technical assistance to the Buffalo
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Public Schools kindergarten and prekindergarten teachers through this initiative as well as
assisting with implementation in select classrooms. This program will be expanded to
additional districts as staff and resources allow.
Dental Services
Dental services appear to be widespread through Erie County. There are 752 Licensed
Dentists and another 789 licensed Dental Hygienists in the County. Dentists that accept
Medicaid are available in or very close to the areas that have a high percentage of low

income population. Only 41% of dentists accept Medicaid. The growth of the Medicaid
Managed Care System and the advent of Child Health Plus has extended dental care to more
participants. According to Health Research and Services Administration (HRSA) the City of
Buffalo is designated as a Health Provider Shortage Area for dental services, which means
that the pool of dental providers is not sufficient to care for the population within the City.
It should be noted in this discussion that with the new Department of Education regulation
requiring a dental exam for children entering kindergarten, the demand for dental services
will increase significantly. While less of a challenge for middle and upper income families in
the suburbs, the challenge will be significantly greater for families in lower socioeconomic
groups, particularly in the City of Buffalo where there are fewer providers willing to take
care of their needs.

DENTAL EXAM PROVIDERS AND INSURANCE TYPE ACCEPTED
Baker Victory Services www.bakervictoryservices.org
780 Ridge Road Lackawanna, NY 14218 (716) 828-9500
Medicaid, most insurance, and self pay

Life Time Health www.lifetimehealth.org
899 Main Street Buffalo, NY 14203 (716) 656-4270
Medicaid, most insurance, and self pay

Community Health Center of Buffalo www.chcb.net
462 Grider Street Buffalo, NY 14215 (716) 986-9199
All insurance accepted and sliding fee scale. No one refused due to inability to pay.

ECMC www.ecmc.edu
462 Grider Street Buffalo, NY 14215 (716) 898-3189
All insurance accepted and self pay

Good Neighbors Health Care www.gnhcbuffalo.org

175 Jefferson Avenue Buffalo, NY 14208 (716) 856-2400
No fee

University at Buffalo Dental Clinic www.sdm.buffalo.edu
114 Squire Hall Buffalo, NY 14214 (716) 829-3717
Self pay

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Children’s Hospital of Buffalo www.wchob.org
219 Bryant Street Buffalo, NY 14222 (716)878-7000
All insurance accepted

Northwest Buffalo Community Health Center
155 Lawn Avenue Buffalo, NY 14207 (716) 875-2904
Medicaid, most insurance, and sliding fee scale

Aspire Family Dental www.aspirefamilydental.com
Buffalo locations:
484 Ontario Street Buffalo, NY 1407 (716) 873-0681
476 Hertel Avenue Buffalo, NY 14207 (716) 877-3510
Medicaid, most insurance, and self pay


DENTAL EDUCATION ONLY
• Head Start Program

• Local and National Dental Societies
• American Dental Association
• Erie County Department of Health

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Primary and Preventive Health Care Services

This topic is covered in depth in other sections of this document. Please refer to the
following sections for discussion of the current trends, issues, and available services:

 Dental Health Education
 Lead Poisoning
 Prenatal Care and Infant Mortality
 Nutrition
 Injury Prevention
 Immunization
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Lead Poisoning

1. HEALTH/VITAL STATISTICS

Lead can affect the developing nervous system and brains of fetuses and young children. A
young child's exposure to lead can cause learning and behavioral problems and possibly
damage their brains, kidneys, and other organs. The most difficult part is that there are often
no symptoms of lead poisoning for a caretaker to discover. Every child, especially those
living in older housing should be tested for lead poisoning at six months and then again as
the doctor recommends.

Erie County does extensive screening for elevated lead levels compared to other counties in
NY State. Lead table 1 below indicates the percentage of children screened for elevated lead
in New York State and Erie County. Erie County has higher screening rates than the State as
a whole and ranks among the highest of all counties in the State.

Test Years
Children receiving
Blood Lead
Screening test at
0-9 months
Children receiving
Blood Lead
Screening test at
9-18 months
Children receiving
Blood Lead
Screening test at
18-36 months
Children receiving
two Blood Lead
Screening tests by
36 months

2003-2006 2.8 59.3 47.2 36.6 NYS
2004-2007 2.7 60.6 51.6 40.8
2003-2006 1.5 70.7 50.2 39.9 Erie
2004-2007 1.4 70.7 57.8 45.9



Lead table 2 displays the number of children newly identified with elevated blood lead levels
and the incidence rate per 1,000 children tested > 10mcg/dL for New York State excluding
New York City and Erie County. Erie County’s incidence rate for 2005-2007 is more than
double the Statewide rate and Erie County has the seventh highest incidence rate in the state.

Year of Test Number of
children > 10-
14 mcg/dL
Number of
children > 15-
19 mcg/dL
Number of
children > 20
mcg/dL
Incidence
Rate > 10
mcg/dL
NYS 2005 1,497 460 326 11.8
2006 1328 448 306 10.3
2007 1216 394 275 9.2

2005-2007
average

1347 434 313 10.4
Erie 2005 250 72 61 25.1
2006 249 70 52 22.7
2007 243 62 48 20.8

2005-2007
average
247 68 54 22.8






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Elevated blood lead levels are not
evenly distributed through the County.
There are areas and zip codes, primarily
within the City of Buffalo, with higher
incidences of elevated blood lead levels.
The map to the right displays the
distribution of blood lead levels in Erie
County.

Lead table 3 shows the number of elevated lead levels for the 6 highest zip codes in Erie
County for 2006. The highest zip codes are 14207, 14208, 14211, 14212, 14213, and 14215.
These areas have a high percentage of old homes, children living in poverty and low home
ownership.


TABLE 3: OVERALL TARGET AREA ELEVATED LEAD SCREENINGS 2006
Zip Code
BLL
< 10 ug/dl
BLL

10-19 ug/dl

BLL
20+ ug/dl

Total
Elevations

Total Tested
14207
847 45 4 49 896
14208
334 45 8 53 387
14211
961 165 28 193 1154
14212
410 70 13 83 493
14213
1042 141 47 188 1230
14215
1446 93 25 118 1564




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Erie County has one of the most active environmental investigation units associated with
children with elevated blood lead levels in New York State. In 2006, Erie County
investigated a total of 306 dwellings based on children with elevated blood lead levels.
Monroe County conducted the next highest number of investigations of dwellings with 254
and Onondaga County investigated 236 dwellings. Nearly 60% of all dwellings investigated
in the state were conducted in these three counties. Erie County personnel performed 2,640
field visits and identified 107 dwellings with lead hazards.

The age of housing stock is a significant factor in lead poisoning prevention. More than 75%
of

the housing stock in Erie County was built before 1970 and is very likely to contain lead
based paint. There are 46,605 renter occupied units that were built before 1940 (2000
Census). Age and housing tenure increase the likelihood that these housing units are
substandard and may contain lead hazards.

Housing choices for very low income and low income families are very often limited to the
oldest housing most in need of maintenance and with a higher risk of lead based paint
hazards. There are 23,933 related, non elderly, renter occupied households in Erie County
with household incomes less than or equal to 50% of the median family income (MFI). An
additional 8,423 related, non elderly, owner occupied households have incomes at or below
50% MFI. There are 25,784 related, non elderly households in the 50-80% MFI range.
Adding elderly households, but omitting the “all other” category which includes single
person, non-related and college student households, 122,316 (32.1%) families have incomes
at or below 80% MFI in the target area. Looking at the City of Buffalo, which is home to a
majority of the children in the County with elevated blood lead levels (EBLS), 52,014
(42.4%) families have incomes at or below 80% MFI. All of the above mentioned data is
from the SOCDS CHAS Data 2000.

In the thirty years between 1970 and 2000 Buffalo’s population decreased by 37% placing
once stable neighborhoods at great risk of urban decline. The number of vacant housing
units in Buffalo has almost tripled since 1970 with 16% of housing units vacant in 2000. The
number of owner occupied housing units, expressed as a percent of total housing units, has
decreased from 56% in 1970 to 43% in 2000 (SOCDS Census Data). These changing
demographics contribute to a destabilization of the City’s housing stock resulting in an
increased risk for childhood lead poisoning.












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Table 4 provides additional information regarding housing in the highest need zip codes
relative to elevated blood lead levels (14207, 14208, 14211, 14212, 14213, and 14215) and
comparison data for the City of Buffalo and Erie County as a whole. Clearly, environmental
hazards related to housing is much more likely in the City of Buffalo identified zip codes
than in the City of Buffalo as a whole or in the County.



14207 14208 14211 14212 14213 14215 Buffalo
City
Erie
County
% of total units occupied
1990
92.1
89.4 88.5 89.8
91.8
93.3 89.8 93.7
% of occupied units owner
occupied 1990
46.9
44.9 42.5 41.3
33.9
54.9 43.2 63.7
% of total units occupied
2000
87.5
80.1 76.7 76.0
79.3
88.2 84.3 91.6
% of occupied units owner
occupied 2000
44.9
45.3 46.2 42.5
32.9
54.0 43.5 65.3

% change occupied
1990-2000
-5.0
-10.4 -13.3 -18.2
-13.6
-5.5 -6.1 -2.2
% change
owner occupied
1990-2000
-4.3
+0.9 +8.7 +2.9
-2.9
-1.6 +0.7 +2.5
% vacant units 2000 12.5
19.9 23.3 24.0
20.7
11.8 15.7 8.4
% of units built
before 1950
82.2
80.7 84.5 78.0
85.9
81.0 80.6 50.6
total housing units 1990
151,971 402,131
total housing units 2000
145,574 415,868
Change in # of housing
units 1990- 2000
-6,397 +13,737

2. PROBLEM IDENTIFICATION

Lead Poisoning is a significant danger to young children and pregnant women. Houses built
before 1978 often contain lead paint. Old lead paint can flake from the walls and get into the
environment through dust particles that a young child may breathe in and through larger
flakes that may find their way into a child’s digestive tract. Children often get lead poisoning
by putting toys in their mouths that may have been lying on the floor near flakes of lead
paint. They may chew on a window sill or even put the paint directly into their mouth
believing the brightly colored pieces are candy. Lead can also be found in soil, air, water
(from lead pipes), and old toys and those from other countries.

Pregnant women should also avoid situations of environments that would put them at higher
risk of lead exposure. They should not disturb lead based paint and should remain away
from environments where lead based paint has been disturbed for twenty-four hours.




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3. AVAILABLE RESOURCES

The Erie County Lead Poisoning Prevention Program (Lead Program) is a pediatric program

dedicated to support and enhance local efforts to reduce the prevalence of elevated blood lead
levels in children less than six years of age. It is a comprehensive program of primary and
secondary prevention which includes:
 Public and professional outreach and education
 Screening
 Diagnostic and evaluation
 Medical management
 Education and environmental interventions.

The Lead Program is organized into two divisions; a medical and an environmental division.
The Medical division is further organized in the areas of primary and secondary prevention.


Primary Prevention entails:
 Community outreach/education which participates in a variety of local health fairs, in
neighborhoods and schools, community centers; the program has linkages to
programs such as Young Parent Program (YPP), Head Start and the pre-k program in
the Buffalo Public schools.
 Professional outreach/education providing in-service training to professional
groups/organizations, teachers, physicians including their staff and WIC.
 Immunization Action Plan which provides literature about lead poisoning prevention
to local birthing centers that is distributed to parents of newborns.
 Healthy homes/neighborhoods make referrals to CLPPP to track the lead status of
children that dwell in homes that are visited by program staff.

Secondary prevention entails:
 Nurse case managers teach/counsel parents/guardians about the dangers of lead
poisoning in the home. They follow children who have Blood Lead Levels (BLLs)
that are 13 ug/dl and greater, by venipuncture and 15ug/dl and greater by finger stick.
 WNY Lead Resource Center treats children with elevated BLL’s. The center also

provides advisement to physicians on treatment of their pediatric patients (Tertiary
Prevention).
 Lead Safe Interim Housing Project provides temporary housing to families with
children which have BLL’s of 20 ug/dl or greater.
 Early Intervention Program receives referrals to determine the developmental status
of children whose BLL’s are 20 ug/dl and greater.

The Environmental Division is also organized in a primary and secondary organizational
structure.

Primary prevention:
• Healthy Homes and Neighborhoods provide educational programs to families on
ways to keep their home healthy. This includes education about lead poisoning
prevention as well as supplies to maintain a healthy home.
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Secondary prevention:
• Housing inspections of primary dwellings at levels of 15 mcg/dl and greater.
• Housing inspections of primary secondary and adjacent dwellings at levels of 20
ug/dl and greater.
• Sanitarians also provide simple housecleaning equipment to these families with
instruction regarding use of these items to control lead dust and dirt.

The Lead Program has partnered with the Immunization Action Plan to investigate and
evaluate blood lead level screening compliance of Health Care and Day Care Providers to

children less than six years of age. There will be on-site visits of Health and Day care center
providers, a review of charts, data collection, evaluation and a statistical data report.

The Lead Program has developed a Child Health Promotion Specialist Program which
currently consists of two public health nurses that provide training and consultation to Day
Care Providers and their staff The goal is to enhance the health and safety of children in out
of home child care settings. The Program hopes to be able to grow to cover Day Care
Providers throughout Erie County.

4. NEEDED SERVICES

There needs to be more programs/funding that focus on primary prevention. This would
include having more lead hazard control, especially by increasing funding for new housing.
Erie County has a large number of old homes that still contain lead paint. The abatement or
replacement of these homes could greatly decrease the number of children with elevated lead
levels.



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Prenatal Care and Infant Mortality

1. HEALTH/VITAL STATISTICS

There are an average of about 10,000 births each year in Erie County. The annual birth rate
in Erie County (11.0 per 1,000) was lower than in New York State (13.1 per 1,000) in 2007.
This is consistent with the difference between Erie County and New York State since 2003.
Since 2003, the birth rate has remained relatively stable over time for both Erie County and
New York State.

Prenatal care in the first trimester is a strong indicator for health outcomes. In Erie County in
2004 and 2005 the rates of prenatal care in the first trimester were sharply higher than in
other years examined. In fact, during these two years Erie County surpassed Upstate New
York State rates. In 2006 and 2007, all geographic categories have seen a decline, with the
sharpest rate of decline occurring in Erie County.


Statewide, early prenatal care (within the first trimester) is more common for White, non-
Hispanic women (77%) than for Black, non-Hispanic women (60.9%) and Hispanic women
(64.4%). Conversely, it is more Black, non-Hispanic and Hispanic women are more likely to
begin prenatal care later in the pregnancy (after the first trimester) or not receive any prenatal
care than White, non-Hispanic women. New York State also lags behind the nation with
75.4% receiving early prenatal care as compared to 83.9% for the U.S as a whole.









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The rate of low birth weight in Erie County dropped nearly one full point from 2006 to 2007
(7.8 per 1,000 in 2007 and 8.9 per 1,000 in 2006) and 2007 was the lowest it had been since
prior to 2003.


Statewide, there are also significant disparities in low birthweight related to race. Based on
2005 data, 6.7% of White, non-Hispanics have low birthweight babies and 7.4% of Hispanics
have low birthweight babies compared to 12.9% of Black, non-Hispanic births. These
disparities are also seen here in Erie County.

In 2007 Erie County had higher rates per 1,000 of infant deaths (7.8), neonatal deaths (5.2)
and postneonatal deaths (2.6) than reported in the State as a whole. Erie County having
higher rates for these occurrences is consistent with data through 2003.






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Again, racial disparities are present related to infant deaths. The following table displays the

rate per 1,000 of infant deaths based on 2005 data. Black, non-Hispanic infant deaths are
almost two and a half times more common than that for White, non-Hispanics and Hispanics.

Infant Deaths, Rate per 1,000
U.S. NYS
White,
non-
Hispanic
Black,
non-
Hispanic
Hispanic
6.9 5.8 4.6 11.1 4.5

Additional maternal and infant health indicators worth noting are:
 For the time period 2005-2007, 86.5% of pregnant women with low socio-
economic status (SES) enrolled in the WIC program in Erie County received
early prenatal care. This is comparable to the percent of women statewide.
 For the period 2005-2007, only 10.9% of infants enrolled in WIC with low
SES were breastfeeding. This is significantly lower than the statewide
percentage of 39%.
 The maternal mortality rate per 100,000 births in Erie County was 16.8 for the
period 2005-2007. This is comparable to the NYS rate of 16.7. Because of
the low number of events for this indicator, the Erie County figure is unstable,
but is included as a point of reference.
 The newborn drug related discharge rate per 10,000 newborn discharges was
134.0 in Erie County for 2005-2007. This is well over double the NYS rate of
58.1.

2. AVAILABLE RESOURCES

Erie County has a variety of resources in place that address prenatal care and infant mortality.
These include physicians and healthcare providers, the insurance companies, and community
based organizations that provide a wide range of health, human, and supportive services to
pregnant women. There are also several sectors or systems that these women may interact
with such as mental health, substance abuse treatment, education, faith-based and community
services, and the County’s social service programs.

There are a number of agencies that provide prenatal home visiting services, three of them
that seem to be most active with this population are the Buffalo Prenatal-Perinatal Network
(BPPN) which operates a Community Health Worker Program and a Healthy Family New
York Program, Visiting Nurse Association of Western New York (VNA), and McAuley-
Seton Home Care (part of the Catholic Health System.) The BPPN program addresses a
broad spectrum of issues, both medical and social, while the VNA and McAuley-Seton focus
primarily on medical needs.

Buffalo Prenatal-Perinatal Network (BPPN) is the lead agency for the Buffalo Community
Action for Prenatal Care (CAPC) project. CAPC seeks to improve pregnancy outcomes
relative to HIV. BPPN is also the facilitator for the Comprehensive Prenatal-Perinatal