Facts

I. United States

General Demographics

Population: There were over 280,000,000 people living in the U.S. in the year 2000. More than 80% of the U.S. population lives in metropolitan areas and 30% of the population lives in cities of 5 million or more. Although almost three-quarters of counties are classified as non-metropolitan areas, only 20% of the U.S. population lives there.

Age: The age distribution tends to get younger as urbanization increases. Infants and children ages 1-4 years constitute a larger percentage of the population in the most urbanized counties (7.5%) compared to non-metropolitan counties (6.5%). In the other end of the age spectrum, adults ages 65 years and over constitute a smaller percentage of the population in the most urbanized counties (11.8%) compared to non-metropolitan counties (14.6%).

Race/Ethnicity: In the U.S., counties of large metropolitan areas, areas that are considered most urbanized, are more racially and ethnically diverse than countries at other urbanization levels. Non-Hispanic Whites in 1998 made up over 75% of the population in large and small suburban counties and in non-metropolitan counties, but only a little more than 50% in the most urbanized counties. The population of the most urbanized counties in the U.S. in 1998 was 21% Hispanic, 19% non-Hispanic Black, 6% non-Hispanic Asian, and less than 1% non-Hispanic American Indian or of Alaskan native origin. With the exception of American Indians/Alaskan natives, all of these groups are more likely to live in metropolitan areas.

Poverty: Thirteen percent of Americans lived with incomes below the poverty level in 1997.In the Northeast, the highest concentration of poverty is found in the most urbanized counties (17.6%), and the lowest in the suburban counties (7.5%). At all ages, there are higher percentages of Blacks and Hispanics than non-Hispanics that were poor or near poor. In 2000, more than one fourth of Black and Hispanic children were poor and more than half of elderly Black and Hispanic persons were either poor or near poor.

Health

- Half of all causes of death are linked to social and behavioral factors not addressed by advances in medical technology and that can be prevented through early detection and prevention strategies that include changes in lifestyle behaviors, living conditions related to poverty, reduction of racial and ethnic disparities in health, and improved access to health care.

- Many health conditions disproportionately affect urban populations-including: HIV Infection, Asthma, Injuries, some Mental Health Disorders, Tuberculosis, Heart Disease, Cancer, Stroke, Obesity, and Diabetes.

- There is evidence that city residents in the U.S. have a significant excess mortality risk. This excess risk is not attributable to differences between city residents and others in terms of age, race/ethnicity, sex, education, income, marital status, or health, and this excess is larger in older persons.

- There is an increased risk of death and illness associated with poverty and racial/ethnic minority status in great part related to the concentration of these populations in urban areas.

- Healthy People 2010, the prevention agenda for the nation, calls attention to socioeconomic disparities in health and calls for the elimination of racial/ethnic and socioeconomic disparities in health.

Overall Mortality Rate: Nationally, the mortality rate of working age adults (ages 25-64) is higher in the most urbanized (419.6 deaths per 100,000 populations) and most rural (421.5 per 100,000) counties, compared to the national mortality rate (386.0 per 100,000).

Deaths due to Heart Disease: Heart disease is the leading cause of death in the United States, and ischemic heart disease accounts for the majority of heart disease deaths. For adult women in the country, highest death rates of ischemic heart disease occur in the most urbanized counties (211.7 deaths per 100,000 women) compared to non-metropolitan counties (198.4 deaths per 100,000 women).

Adolescent Births: In the country as a whole-the highest rates of adolescent births are in the most urbanized (59.6 births per 1,000 female adolescents) and most rural counties (57.9 births per 1,000 female adolescents). The lowest adolescent birth rates are in suburban counties (36.1 births per 1,000 female adolescents).

Homicide: Nationally, the age adjusted homicide rate is highest in the most urbanized counties. The homicide rate in the most urbanized metropolitan counties is 11.5 deaths per 100,000 population, compared to the national average of 7.1 deaths per 100,000 population, and 5.3 deaths per 100,00 population in non-metropolitan counties.

Asthma: Asthma is the most common chronic disease for children. The Centers for Disease Control estimates that asthma affects 15 million people in the US, a third of them children.

- The Centers for Disease Control (CDC) has reported that between 1980-1994, the number of Americans with asthma doubled and that the percentage of Americans that have asthma has increased approximately 75%. The increase was even more substantial among pre-school age children where percentage of children with asthma increased 160% in that time period.

- Low income and minority populations experience substantially higher rates of hospital admissions, ER visits and fatalities due to asthma.

- According to the U.S. Department of Health and Human Services from 1993-1995, African Americans and Hispanics each had over two times the death rate from asthma as White Americans.

- In 1996, pediatric hospitalizations for asthma were estimated to be five times higher for children in lower income families than national norms.

HIV and AIDS: Blacks and Hispanics are disproportionately affected by new HIV infection and by AIDS, compared to other races/ethnicities. According to the 2000 U.S. Census, Blacks represents only 12.3% of the U.S. population and Hispanics 12.5%, yet half of the men being newly infected by HIV are Black and 20% are Hispanic. Among women, Black women account for an estimated 64% of new HIV infections and Hispanics women 18%. During the five-year period 1996-2000 Blacks accounted for a greater percentage of newly reported cases of AIDS (44.9%) than other racial groups.

II. Northeast Region

Poverty Levels: In the Northeast, the most urbanized counties have poverty levels that are more than two times as high than those in suburban counties (17.6% and 7.5%, respectively).

Physical Inactivity: In the Northeast, the urbanized counties have a much higher percentage of adults that are physically inactive during leisure time (49.2% of adults), compared to adults in rural counties (27.3% of adults).

Infant Mortality: In the Northeast, infants living in the most urbanized counties are at highest risk of death. The infant mortality rate for the most urbanized counties (7.7 infant deaths per 1,000 live births) is 17% higher than the overall infant mortality rate for the region (6.6 infant deaths per 1,000 live births) and 24% higher than the infant mortality rate in non-metropolitan counties (6.2 deaths per 1,000 live births). Geographic variations in racial and ethnic composition and poverty contributes to the urbanization differences in infant mortality (with infants born to Black mothers at higher risk of death than those in other racial and ethnic groups).

Death Rates: In the Northeast, death rates for working age adults (25-64 year olds) are highest in the most urbanized counties. The overall death rate for working age adults in the most urbanized counties of the Northeast region (445.9 deaths per 100,000 population) is 26% higher in than those in non-metropolitan counties (355.1 deaths per 100,000 population). This excess of deaths in urban settings is true for both men (30% higher in urban vs. rural settings) and women (23% higher in urban vs. rural settings).

Deaths Due to Heart Disease: In the Northeast, the most urbanized counties have the highest death rates of ischemic heart disease (306.0 deaths per 100,000 population) for adults, compared to less urban counties (262.8 deaths per 100,000 in large suburban counties and 276.5 deaths per 100,000 in non-metropolitan counties).

Uninsured Persons: In the Northeast, the most urbanized counties had the highest percentage of uninsured residents relative to less urbanized counties. Sixteen and a half percent of residents in the most urbanized counties did not have insurance, compared to 11.0% in suburban counties and 13.9% in non-metropolitan counties).

Asthma: In 1979, the four U.S. regions had similar asthma hospitalization rates. By 1994, the Northeast had over twice the rate of asthma hospitalizations as the West. Among those ages 5-34 the difference was more than threefold.

Adolescent births: In the Northeast, the most urbanized counties had the highest birth rates among adolescents 15-19 yrs of age. The most urbanized counties had a rate (49.5 births per 1,000 adolescent females) two times higher than the suburban rate (24.7 births per 1,000 adolescent females) and 1.5 times higher than the rate in non-metropolitan counties (33.2 births per 1,000 adolescent females).

Homicide: In the Northeast, the highest homicide rate is in the most urbanized counties. The homicide rate in the most urbanized counties (10.0 deaths per 100,000 population) is four times higher than the suburban counties (2.4 deaths per 100,000) and almost five times higher than the homicide rate in non-metropolitan counties (2.1 deaths per 100,000).

III. Boston

Population: In 2000 there were 589,141 Boston residents.

Racial/Ethnic Make Up: 49.5% White Non-Hispanic (one race), 23.4% Black or African-American (one race), 7.5% Asian (one race), 14.4% Hispanic/Latino (of any race), and 3.1% Non-Hispanic -More than one race.

Homelessness: In the ten year period 1992-2001 the number of people who were homeless increased 36.0%. There were 6,001 homeless people residing either in shelter or on the street in December 2001.

Weight Control: Only about half (54.1%) of Boston's residents weigh in the normal range for their height. The remainder residents are either overweight (32.1%) or obese (13.9%).

Overall (All Causes) Mortality Rates: The mortality rate for Blacks in 2000 (1,028.1 deaths per 1,000 population) was higher than the Boston rate (888.4 deaths per 100,000 population) and the highest among races/ethnicities (Whites: 942.8 deaths per 100,000; Hispanics: 498.7 deaths per 100,000; Asians:434.7 deaths per 100,000).

Leading Causes of Death in Boston (2000):

- Cancer (226.9 deaths per 100,000)
- Heart Disease (211.1 deaths per 100,000)
- Stroke (52.9 deaths per 100,000)
- All Injuries Combined (38.0 deaths per 100,000)
- COPD (34.5 deaths per 100,000)

Most of these causes of death are health conditions that affect urban populations more greatly than rural populations.

Cancer Mortality: In 2000, cancer mortality was highest for Blacks (276.9 per 100,000), as compared to Whites (240.8), Asians (112.8) and Hispanics (128.1).

Adolescent Births: in 2000, the Boston birthrate among adolescents was 35.3 births per 1000 female adolescents. The birthrates among adolescents was much higher for Hispanics (71.6 births per 1000 female adolescents) and for Blacks (63.7 births per 1000 adolescents).

Low Birthweight: In 2000, 9.0% of births were low birthweight (less than 2500g or 5.5 lbs.) at delivery. The Healthy People 2010 goal is to reduce the low birthweight rate to 5%.

Infant Mortality Rate: In 2000, the Boston infant mortality rate was 6.7 deaths per 1000 births. Boston's Black residents have the highest infant mortality rate of all races/ethnicities (13.6 deaths per 1000 births). In 2000 the infant mortality rate for Black infants was two times higher than the rate for Boston.

Asthma: Asthma hospitalization rates among male children under 5 (1997-2000): the neighborhoods of Roxbury, South Dorchester, North Dorchester, and Mattapan had higher rates than Boston rate for males under 5 (85%, 17%, 42%, and 35% higher, respectively). In females under 5, the neighborhoods of the Fenway, Roxbury, JP, North Dorchester, South Dorchester, and the South End had the highest rates of hospitalizations of all Boston neighborhoods. The Fenway's rate of asthma hospitalizations among females under 5, had a rate that was more than two times higher than the overall Boston rate for that population.

Lead Poisoning: Although declines occurred in all Boston neighborhoods in the past few years, elevated Blood Lead Levels continued to be highest in neighborhoods with higher proportions of minority children and children from low income families. In 2001, the percentage of children with elevated Blood Lead Levels was highest in North Dorchester (6.1%), Mattapan (6.8%), South Dorchester (6.3%) and Roxbury (4.7%). The overall Boston rate was 4.6%.

Heart Disease Mortality: In 1999, heart disease was the leading cause of death for Boston residents. In 2000, it was the second leading cause of death.

- In 2000, the Heart Disease Mortality rate was highest for Whites (230.6 deaths per 100,000) and Blacks (224.8 deaths per 100,000), compared to 63.3 deaths per 100,000 among Hispanics and 85.6 deaths per 100,000 for Asians). The overall Boston Heart Disease Mortality rate was 211.1 deaths per 100,000.

Cancer: In 2000, the cancer mortality rate was highest for Blacks, 22% higher than the overall Boston rate.

Stroke: In 2000, stroke mortality rate was highest among Hispanics and Blacks; 19% higher and 13% higher than the Boston rate of 52.9 deaths per 100,000, respectively.

Diabetes: Over eight percent of Blacks living in Boston have been told they have diabetes. That is more than 2.5 times higher than the percentage of Whites (2.9%), and over 3 times higher than the percentage of Hispanics that have been told they have diabetes. In 2000, the mortality rate due to diabetes was highest for Blacks (33.0 deaths per 100,000) and Hispanics (52.2 deaths per 100,000). The Boston diabetes mortality rate was 19.8 deaths per 100,000.

Violence: Higher proportions of Black Boston residents (60.2%) are victims of violence-related injuries than members of other race/ethnicity groups, followed by Hispanics (16.7%) and Whites (13.2%). The percentage of Hispanics that are victims of violence-related injuries increased 23.7% from 1995 to 2000, while the percentage of Whites that are victims of violence-related injuries decreased 29.0% during that time period.

Homicide: Homicide mortality rates for Blacks ( 19.7 deaths per 100,000 population in 2000) are substantially higher than overall Boston rates (5.4 deaths per 100,000 population) and the highest among all racial/ethnic groups (Whites: 2.5 deaths per 100,000; Asians and Hispanics, data not available for that year).

Domestic Violence: Of all aggravated assaults documented by the Boston Police Department, almost a third (29.1%) were related to Domestic Violence (includes intimate partner and violence by other family members).

STD's:

By Neighborhoods: The overall Boston incidence rate of Sexually Transmitted Diseases in Boston in 2000 was of 721.2 new cases per 100,000 populations. Roxbury (1,092.4 new cases per 100,000), North Dorchester (926.5 new cases per 100,000), South Dorchester (1,934.2 new cases per 100,000), and Mattapan (1,546.3 new cases per 100,000) had the highest rates of Sexually Transmitted Diseases in the city.

By Race/Ethnicity: The incidence rates of Chlamydia, Syphilis, and Gonorrhea were highest among Blacks and Hispanics. The incidence rates for Chlamydia in 2000 for Blacks and Hispanics were 955.0 new cases per 100,000 population, and 952.2 new cases per 100,000 population, respectively, much higher than the rates for Whites (68.0 new cases per 100,000) and Asians (193.7 new cases per 100,000). Great racial/ethnic differences also existed for incidence rates for Syphilis (Blacks: 50.8 new cases per 100,000; Hispanics: 59.7 new cases per 100,000; Whites: 5.9 new cases per 100,000; Asians: Not Available) and Gonorrhea (Blacks: 403.7 new cases per 100,000; Hispanics: 185.6 new cases per 100,000; Whites: 36.6 new cases per 100,000; Asians: Not Available).

HIV and AIDS: As of January 1, 2002, in Boston, the HIV cases rate among Hispanic residents (283.2 cases per 100,000 population) and among Black residents (343.2 cases per 100,000) were higher than the Boston rate (259.0 cases per 100,000).

- The AIDS incidence rate for Blacks and Hispanics has been higher than the incidence rate of Whites from 1992-2000. For instance, in 2000 the AIDS incidence rate for Blacks was 57.6 new cases per 100,000 population, for Hispanics it was 44.7 new cases per 100,000 population, whereas for Whites the AIDS incidence rate was 15.0 new cases per 100,000 population.

- In 2000, HIV/AIDS mortality rates were highest among Blacks. Their rates were more than two times higher than the Boston rate of 11.4 HIV/AIDS deaths per 100,000 population.