Assessing Cardiovascular Risk Among Adults in Ann Arbor, Michigan

Amanda Keenan
NUTR 642
10 November 2022

1
Background

Since 1921, the leading cause of death in the United States has been attributed to
cardiovascular disease (1,2). Cardiovascular diseases are a group of diseases affecting the heart
and blood vessels and may result in heart attack or stroke. Almost 50% of adults in the United
States are living with cardiovascular disease such as hypertension, coronary artery disease, heart
failure, or stroke (3). Cardiovascular diseases have been associated with a poorer health-related
quality of life and disability. In one study of 7,009 adults who self-reported health-related
quality of life using a standardized questionnaire, it was found that the quality of life was
significantly lower for those with cardiovascular disease (4). The impact cardiovascular disease
on quality of life was sex specific—physical health-related quality of life was especially
impacted for men and mental health-related quality of life was impacted more significantly for
women (4). Risk factors for cardiovascular disease include diabetes, smoking, alcohol
consumption, overweight and obesity, poor diet, and physical inactivity (3). Certain groups are
also more likely to be affected by cardiovascular disease. Women have a lower prevalence of
cardiovascular disease than men (44.4% vs 54.1%); however, Black people and African
Americans (including both men and women) have a higher prevalence of cardiovascular disease
than any other group (60.1% for men and 58.8% for women) in the United States (3) The risk of
cardiovascular disease increases with age (3).

Social determinants of health are factors of the environment, including social and
economic conditions, that can impact health status. These factors include income, employment,
housing, transportation, and education. Individuals with lower income may be more likely to be
burdened by cardiovascular disease than those with a higher income due to costs of healthcare,
costs of medications, and higher costs of healthier foods. A study using NHANES data from
1999-2016 to follow the trends of cardiovascular disease among a high-income group and the
remainder of the population found that, not only was prevalence of cardiovascular disease lower
in the high-income group, but the rate of cardiovascular disease in the high-income group has
decreased between 1999 and 2016 by 20% while it has increased overall for the rest of the
population (5). Employment is also associated with cardiovascular health—while employment is
generally associated better health, the type of employment tends to vary in cardiovascular disease
risk. Jobs in the service industry, and office jobs like administration and business are associated
with a higher prevalence of cardiovascular disease, while jobs in science, entertainment, and
manual labor are associated with decreased prevalence of cardiovascular disease (6).
Homelessness may increase cardiovascular disease risk factors, such as smoking, poor diet, drug
use, poor access to healthcare, and other barriers. The prevalence of cardiovascular disease in
homeless populations and mortality associated with is three times higher in than in those who are
housed (7). Lack of available transportation, either by personal vehicle or due to limited public
transportation, may result in delays or inability to seek healthcare and poorer health outcomes.
Transportation barriers often results in missed appointments and missed prescription fills and is
linked to lower socioeconomic status (8). Lower education levels are associated with an
increased risk factors and prevalence of cardiovascular disease. Higher levels of education are
associated with increased income and resources allowing for better access to healthcare and
nutrition as well as better education and understanding of dietary, lifestyle, and health
recommendations (9).

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 The YMCA, Turner Senior Wellness Program (TSWP), and the Franklin Cardiovascular
Center at the University of Michigan Health System are community stakeholders that should be
involved in this needs assessment. The YMCA offers a hypertension monitoring program that
provides blood pressuring monitoring and consultations several times a month as well as
nutrition seminars. TSWP provides services for seniors, the population most at risk for
cardiovascular disease, such as nutrition and exercise programs, hypertension screening, and
Medicare counseling which can increase healthcare access. The Franklin Cardiovascular Center
offers support groups for those with cardiovascular disease and for their families as well as
preventative programs. These stakeholders can provide education and assistance to the
community by helping to educate about and prevent cardiovascular disease.

Community Profile Data

Demographic and Economic Data

The city of Ann Arbor, located in Washtenaw County in Michigan, has a total population
of 121,541 (10). The population of Ann Arbor is 49.5% male and 50.5% female (10). The
percentage of the population under 18 years of age is 12.9%, the percentage that is 18-64 years
of age is 73.6%, the percentage that is over 65 years of age is 13.5%, and the median age in the
population of Ann Arbor is 28.2 years (10). Table 1 below provides information of the
distribution of age in Ann Arbor, with the largest group of the population being 20-24 years of
age, making up 19.9% of the population. The risk of cardiovascular disease increases with
increasing age (3).

Table 1: Distribution of Age in Ann Arbor

Age Total Population Percent
Under 5 years 5,154 4.2%
5 to 9 years 4,241 3.5%
10 to 14 years 4,253 3.5%
15 to 19 years 14,280 11.7%
20 to 24 years 24,195 19.9%
25 to 34 years 21,494 17.7%
35 to 44 years 12,988 10.7%
45 to 54 years 8,562 7.0%
55 to 59 years 4,171 3.4%
60 to 64 years 5,753 4.7%
65 to 74 years 8,820 7.3%
75 to 84 years 5,596 4.6%
85 years and over 2,034 1.7%
Source: US Census Bureau, 2021 American Community Survey 1-yr Estimates, data available at
https://data.census.gov/cedsci/table?g=1600000US2603000&tid=ACSDP1Y2021.DP05&moe=f
alse&tp=false

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 The proportions of the populations of both Ann Arbor and Michigan by race/ethnicity can
be seen below on Table 2. In both Ann Arbor and Michigan, the largest proportions of the
populations identify as White, at 68.8% and 72.9%, respectively. The city of Ann Arbor has a
smaller proportion of people that identify as Black or African American than the state of
Michigan, at 6.7% compared to 13.2%, and a much larger proportion of people that identify as
Asian, at 15.2% compared to 3.2% for the state. The proportion of both populations that
identified as American Indian or Alaska Native was equal (0.3%). For both Ann Arbor and
Michigan, the proportions of the populations that identified as Hispanic were also relatively
similar, at 4.0% and 5.6%, respectively. Cardiovascular disease affects Black populations,
especially Black women, at the highest rate (3).

Table 2: Population of Ann Arbor and Michigan by Race/Ethnicity (Percentage)

Race Ann Arbor Michigan
White 68.8% 72.9%
Black or African American 6.7% 13.2%
American Indian and Alaska Native 0.3% 0.3%
Asian 15.2% 3.2%
Hispanic or Latino 4.0% 5.6%
Other 5.0% 4.8%
Source: US Census Bureau, 2021 American Community Survey 1-yr Estimates, data available at
https://data.census.gov/cedsci/table?g=1600000US2603000&tid=ACSDP1Y2021.DP05&moe=f
alse&tp=false

The distribution of education level by race/ethnicity for the population of Ann Arbor can
be found on Figure 1. Across all races/ethnicities in the city of Ann Arbor, more than 90% have
earned a high school diploma or higher. The White and Asian populations in Ann Arbor have
the highest percentage of people that have earned a bachelor’s degree or higher, at more than
80% for each group. The Black or African American population and American Indian and
Alaska Native population had the lowest percentages of people that have earned a bachelor’s
degree, at 37.4% and 16.1%, respectively. Lower education levels are associated with increased
risk factors and prevalence of cardiovascular disease, while higher levels of education are
associated with better access to healthcare and better understanding diet and lifestyle
recommendations which can reduce cardiovascular disease risk (9).

Table 3 depicts the unemployment rate of both the populations of Ann Arbor and
Michigan, which may decrease access to health insurance and healthcare causing an increased
risk for cardiovascular disease (9). By comparison, the population of the city of Ann Arbor has
significantly lower unemployment rates than the state of Michigan across all races/ethnicities,
however there are still some disparities between the groups. The White and Asian residents of
Ann Arbor have the lowest unemployment rates (2.9%, each). The unemployment rates in Ann
Arbor for Hispanic or Latino residents and American Indian and Alaska Native residents are
higher (5.9% and 6.7%, respectively), and the Black or African American residents have the
highest unemployment rates both in Ann Arbor and in Michigan (9.0% and 14.8%, respectively).

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Figure 1: Education Attainment Level by Race/Ethnicity
100
Percentage of Population (%)

80

60

40

20

0
White Black or American Asian Hispanic or Other
African Indian and Latino
American Alaskan
Native
High School Diploma or Higher Bachelor's Degree or Higher

Source: US Census Bureau, 2020 American Community Survey 5-yr Estimates, data available at
https://data.census.gov/cedsci/table?q=Ann%20Arbor%20city,%20Michigan&t=Educational%2
0Attainment&tid=ACSST1Y2021.S1501

Table 3: Unemployment Rate by Race/Ethnicity in Ann Arbor and Michigan (Percentage)

Race Ann Arbor Michigan
White 2.9% 5.5%
Black or African American 9.0% 14.8%
American Indian and Alaska Native 6.7% 9.7%
Asian 2.9% 4.7%
Hispanic or Latino 5.9% 8.6%
Other 3.0% 7.1%
Source: US Census Bureau, 2020 American Community Survey 5-yr Estimates, data available at
https://data.census.gov/cedsci/table?q=Ann%20Arbor%20city,%20Michigan&t=Employment&ti
d=ACSST5Y2020.S2301

In Ann Arbor, the median annual household income is $69,456, which is slightly higher
than the median annual household income of the state of Michigan ($59,234) (11). As shown in
Figure 2, in Michigan, Asian residents have the highest median annual household income at
$88,990 per year, compared to $56,169 for Asian residents in Ann Arbor. In Ann Arbor, White
residents have the highest median annual household income at $76,421 per year while Black or
African American residents have the lowest at $46,161, although both groups had higher income
in Ann Arbor than on the state level in Michigan. Hispanic or Latino households had similar
median annual incomes for both Ann Arbor and Michigan ($48,882 and $50,802, respectively).
American Indians and Alaska Natives had a median annual household income of $45,530 in
Michigan, however, there was no city-level data for this group. Income can play a large role in
the risk of cardiovascular disease due to the cost of healthcare, medications, and healthy foods.

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High income earners are less likely to develop cardiovascular disease and related complications
than those with lower income lower levels (5).

Figure 2: Median Annual Household Income in Ann Arbor and Michigan by

Race/Ethnicity
100,000
Median Annual Household

80,000
Income (Dollars)

60,000
40,000
20,000
0
White Black or American Asian Hispanic or Other
African Indian or Latino
American Alaska
Natice
Ann Arbor Michigan

Source: US Census Bureau, 2020 American Community Survey 5-yr Estimates, data available at
https://data.census.gov/cedsci/table?q=Ann%20Arbor%20city,%20Michigan&t=Income%20%2
8Households,%20Families,%20Individuals%29&tid=ACSST5Y2020.S1903

Table 4 outlines the percentage of the populations of Ann Arbor and Michigan who fall
below the poverty line by race/ethnicity. As mentioned before, this is important because high
income earners are less likely to develop cardiovascular disease or complications from it. Across
every group except for Black or African American residents and American Indian and Alaska
Native residents, the percentage of the population living below the poverty line was much higher
in Ann Arbor than in Michigan. This may be affected by the large percentage of young adults
living in Ann Arbor—as mentioned previously, the highest proportion of the population is 20-24
year of age making up 19.9% of the population.

Table 4: Population Living Below the Poverty Line in Ann Arbor and Michigan by
Race/Ethnicity (Percentage)
Race Ann Arbor Michigan
White 21.8% 10.9%
Black or African American 22.6% 27.5%
American Indian and Alaska Native 20.9% 21.3%
Asian 31.2% 12.6%
Hispanic or Latino 27.7% 20.7%
Other 20.2% 21.7%
Source: US Census Bureau, 2020 American Community Survey 5-yr Estimates, data available at
https://data.census.gov/cedsci/table?q=Ann%20Arbor%20city,%20Michigan&t=Poverty&tid=A
CSST5Y2020.S1701

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 Transportation is a key component in getting to healthcare appointments and accessing
medications. Lack of transportation is one of the most common reasons for missed healthcare
appointments, and results in delays in seeking treatment which is linked to poorer outcomes and
increases risk of cardiovascular disease (8). Table 5 displays the number of household vehicles
available for both Ann Arbor and Michigan households. Ann Arbor households are more likely
to have no or fewer vehicles available than Michigan households, with 4.8% owning zero
vehicles and 37.7% only owning one vehicle for the household. The state of Michigan has
almost half the proportion of households with zero or one vehicle available (2.6% and 20.2%,
respectively) compared to the city of Ann Arbor.

Table 5: Household Vehicles Available in Ann Arbor and Michigan

Vehicles Available Ann Arbor Michigan
No Vehicle Available 4.8% 2.6%
1 Vehicle Available 37.2% 20.2%
2 Vehicles Available 39.5% 43.3%
3 or More Vehicles Available 18.4% 33.7%
Source: US Census Bureau, 2021 American Community Survey 1-yr Estimates, data available at
https://data.census.gov/cedsci/table?q=Ann%20Arbor%20city,%20Michigan&t=Commuting&ti
d=ACSST1Y2021.S0802

Health Data

The ten leading causes of death in Michigan as well as the age-adjusted mortality rates
(per 100,000) for Ann Arbor, Michigan, and the United States are listed in Table 6. The all-
cause mortality rate was lowest in Ann Arbor (606.3) compared to Michigan (913.8) or the
United States (830.5). The city of Ann Arbor also had a lower mortality rate of the top four
leading causes of death in Michigan—heart disease (154.8), cancer (118.8), COVID-19 (39.1),
and unintentional injuries (37.2)—when compared to Michigan or the United States. Ann Arbor
had a higher mortality rate due to stroke (46.3) and Alzheimer’s disease (38.5) than Michigan or
the United States. While the mortality rate due to cardiovascular disease is lower in Ann Arbor
than the general population of Michigan or the United States, it remains the leading cause of
death in the city.

The age-adjusted mortality rates (per 100,000) for Washtenaw County for the ten leading
causes of death in Michigan are listed in Table 7 by gender and race. The all-cause mortality
rate was higher in men (815) than women (606.3) for all races. Men had higher mortality rates
than women for heart disease, cancer, COVID-19, unintentional injuries, and stroke, however,
women had a higher mortality rate from Alzheimer’s disease when compared to men.
Additionally, the all-cause mortality rate was higher for Black residents (1,055.2) than White
residents (682.7) in Washtenaw County. Black residents in Washtenaw County had significantly
higher mortality rates than White residents due to heart disease (262.5 compared to 155.8,
respectively), cancer (227.7 compared to 143.5), and COVID-19 (107.8 compared to 41.5).
Heart disease has the highest mortality rate among all groups, and the risk of cardiovascular
disease is markedly increased among Black residents.

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Table 6: Age-Adjusted Mortality Rates for Ten Leading Causes of Death in Ann Arbor,
Michigan, and the United States (per 100,000)

Source: Michigan Department of Health and Human Services, Mortality Characteristics 2020,
data available at https://vitalstats.michigan.gov/osr/CHI/deaths/frame.asp

Table 7: Age-Adjusted Mortality Rates for Ten Leading Causes of Death in Washtenaw
County by Gender and Race (per 100,000)

Source: Michigan Department of Health and Human Services, Mortality Characteristics 2020,
data available at https://vitalstats.michigan.gov/osr/CHI/deaths/frame.asp

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 Table 8 displays the age-adjusted rates of chronic diseases (per 100,000) based on
hospital discharges in Washtenaw County and Michigan. The rate of cancer in Washtenaw
County is approximately the same compared to Michigan (438.8 and 441.9, respectively),
however the rates of acute myocardial infarction (heart attack), congestive heart failure, stroke,
asthma, and diabetes are significantly lower in Washtenaw County than in Michigan. When
comparing Washtenaw County to Michigan, rates of cardiovascular diseases may be reduced,
including heart attack (115.8 compared to 373.2, respectively) and congestive heart failure (30.1
compared to 53.4), indicating that there may be factors that lower cardiovascular disease risk in
the county.

Table 8: Age-Adjusted Rate of Chronic Diseases Based on Hospital Discharges in

Washtenaw County and Michigan (per 100,000)
Chronic Disease Washtenaw County Michigan
Cancer 438.8 441.9
Acute Myocardial Infarction 115.8 373.2
Congestive Heart Failure 30.1 53.4
Stroke 201.4 507.3
Asthma 45.3 109.8
Diabetes 149.1 416.1
Source: Michigan Department of Health and Human Services, Chronic Disease Indicators 2020,
data available at https://vitalstats.michigan.gov/osr/chi/profiles/frame.html

From the Behavioral Risk Factor Surveillance System, the weight status of Washtenaw
County and Michigan is available on Table 9. Washtenaw County has a higher proportion of
individuals with a self-reported healthy weight (18.5 £ BMI £ 24.9) than the state of Michigan
(39.5% compared to 28.5%, respectively) and a lower proportion of individuals with a self-
reported obese weight (BMI ³ 30) than Michigan (27.3% compared to 35.2%). Obesity is linked
to both cardiovascular disease risk and mortality, and many factors that contribute to obesity
contribute directly to cardiovascular disease risk as well, such as stress, diet and lifestyle, and
environmental and psychosocial factors (12).

Table 9: Weight Status of Adults in Washtenaw County and Michigan (Percentage)

Weight Status Ann Arbor Michigan
Healthy Weight (18.5 £ BMI £ 24.9) 39.5% 28.5%
Overweight (25 £ BMI £ 29.9) 32.2% 34.4%
Obese (BMI ³ 30) 27.3% 35.2%
Source: Michigan BRFSS, 2019-2021 Health Indicators and Risk Estimates by Community
Health Assessment Regions & Local Health Departments, data available at
https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-
Healthy/Communicable-and-Chronic-Diseases/Epidemiology-Services/2019-
2021_MiBRFSS_Reg-
LHD_Tables.pdf?rev=2fb8e8b5aee54aba83031d09681f01e4&hash=B54BB332A9790F3EBEE
A5ECE6754C152

9
 Table 10 reviews the proportion of the population in Washtenaw County and Michigan
that has ever been told they have high blood pressure by race/ethnicity. In both Washtenaw
County and Michigan, high blood pressure was most prevalent in Black or African American
residents (40.3% and 43.8%, respectively) and lowest among Asian residents (9.9% and 13.0%,
respectively). Residents of Washtenaw County had a lower proportion of high blood pressure
than residents of Michigan. Data was not available for the proportion of high blood pressure
among American Indian and Alaska Native or Hispanic or Latino residents of Washtenaw
County. Maintaining a healthy blood pressure or reducing high blood pressure is critical for
preventing cardiovascular disease (13).

Table 10: Proportion of Population with High Blood Pressure in Washtenaw County and
Michigan Race/Ethnicity (Percentage)
Race/Ethnicity Washtenaw County Michigan
White 21.4% 35.6%
Black or African American 40.3% 43.8%
American Indian and Alaska Native N/A 41.1%
Asian 9.9% 13.0%
Hispanic or Latino N/A 23.5%
Other N/A 32.9%
All 23.1% 35.2%
Source: Washtenaw County Health Department, 2015 HIP Survey Washtenaw Adults
Cardiovascular Health, data available at
https://healthsurveys.ewashtenaw.org/#/survey/question/HIP/2015/BldPress?category=Adult&gr
oupby=Racecat3, Michigan BRFSS, 2019-2021 Michigan BRFSS Race/Ethnicity Tables, data
available at https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-
Michigan-Healthy/Communicable-and-Chronic-Diseases/Epidemiology-Services/2019-
2021_MiBRFSS_Expanded_Race_Tables.pdf?rev=51fb4b8e318146cda15b0d451b6de0c2&hash
=C69C7E94E3D4C69FDE7A57D23B961A34,

Nutrition Data

Fruit and vegetable intake has been associated with reduction in cardiovascular disease
risk in addition to all-cause mortality (14). Figure 3 illustrates the proportion of the population
of Washtenaw County and Michigan who consume at least one fruit and the proportion that
consume at least one vegetable per day. While vegetable consumption was similar for residents
of both Washtenaw County and the state of Michigan, the proportion of residents who consume
at least one fruit per day was higher among Washtenaw County residents. Additionally, the
proportion of residents for both populations who consumed at least one fruit per day increased
with age. The proportion of residents who consumed at least one vegetable per day was lower
among those who were 18-24 years of age for both Washtenaw County and Michigan but was
approximately equal among other age groups. For both populations, a higher proportion of
residents consumed at least one vegetable a day than the proportion of residents who consumed
at least one fruit per day.

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Figure 3: Consumption of at Least One or More Fruit or Vegetable per Day in Washtenaw
County and Michigan by Age
100 Consumption of at Least One or More Fruit per Day
Consumption of 1+

80
Fruit/Day (%)

60
40
20
0
18-24 25-34 35-49 Age 50-64 65-74 75+
100 Consumption of at Least One or More Vegetable per Day
Consumption of 1+
Vegetable/Day (%)

80
60
40
20
0
18-24 25-34 35-49 Age 50-64 65-74 75+
Washtenaw County Michigan
Source: Washtenaw County Health Department, 2015 HIP Survey Washtenaw Adults
Cardiovascular Health, data available at
https://healthsurveys.ewashtenaw.org/#/survey/question/HIP/2015/BldPress?category=Adult&gr
oupby=Racecat3, Michigan BRFSS, 2019-2021 Prevalence Estimates for Risk Factors and
Health Indicators, data available at https://www.michigan.gov/mdhhs/-
/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/Communicable-and-Chronic-
Diseases/Epidemiology-
Services/2021_MiBRFS_Standard_Tables.pdf?rev=418149f7957d4d648b3106ecd37305ae&has
h=BC0E85AE1BB1EB03AF985FBD5A5B0D31

Alcohol intake, especially moderate to heavy drinking, has been associated with an
increased risk of cardiovascular disease as well as increased incidence of high blood pressure and
obesity, both of which may further increase cardiovascular disease risk (15). Studies have shown
that light drinking is not protective of cardiovascular disease, but individuals that participate in
light drinking may be associated with other protective diet and lifestyle factors, including lower
rates of smoking, lower rates of obesity, higher rates of exercise, and higher rates of vegetable
consumption (15). Figure 4 displays the proportion or Washtenaw County and Michigan
residents that participated in any alcohol consumption, binge drinking, or heavy drinking in the
past month. Binge drinking was defined as having four or more drinks (for women) or five or
more drinks (for men) on at least one occasion in the past month and heavy drinking was defined
as consuming an average of one or more drinks (for women) or two or more drinks (for men) per
day for the previous month. Washtenaw County has a higher rate for any alcohol consumption
in the past month but had a similar proportion of residents that participated in binge drinking or
heavy drinking when compared to the state of Michigan.

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Figure 4: Alcohol Consumption in Washtenaw County and Michigan
100
Washtenaw County Michigan
80
% of Population

60
40
20
0
Any Alcohol in Past Binge Drinking Heavy Drinking
Month
Alcohol Consumption

Source: Michigan BRFSS, 2019-2021 Prevalence Estimates for Risk Factors and Health
Indicators, data available at https://www.michigan.gov/mdhhs/-
/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/Communicable-and-Chronic-
Diseases/Epidemiology-Services/2019-2021_MiBRFSS_Reg-
LHD_Tables.pdf?rev=2fb8e8b5aee54aba83031d09681f01e4&hash=B54BB332A9790F3EBEE
A5ECE6754C152

Table 11 depicts the percentage of the population of Washtenaw County with low access
to a grocery store. From 2010 to 2015, the percentage of residents with low access to a grocery
store decreased by 9.1%. Food security and grocery store accessibility may help to decrease
cardiovascular disease risk by reducing meals that come from fast food or convenience stores
and allow residents to choose dietary options that may be more protective against cardiovascular
disease. Additionally, better access to grocery stores and food security may reduce chronic
stress, another risk factor for cardiovascular disease (16).

Table 11: Proportion of Washtenaw County with Low Access to a Grocery Store
% Low Access to
Year
Grocery Store
2010 25.6%
2015 23.3%
Percent Change -9.1%
Source: US Department of Agriculture, Food Environment Atlas, data available at
https://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas/

Priorities

The city of Ann Arbor is located in Washtenaw County in Michigan. Ann Arbor has a
significant population of young adults, with 19.9% of its residents being 20-24 years of age and
17.7% of its residents being 25-34 years of age. Ann Arbor has an older population of adults
ages 65 and older making up 13.5% of its residents. The older population in Ann Arbor makes
up the highest risk group for cardiovascular disease due to their age (3). Ann Arbor has a lower
percentage of Black or African American residents than Michigan but a much higher percentage
of Asian residents than Michigan.

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 Education attainment levels in Ann Arbor vary significantly by race/ethnicity. Across all
groups, the percentage of residents that have earned a high school diploma or higher was above
90%, however, the percentage of Black or African American residents and American Indian and
Alaska Native residents that have earned a bachelor’s degree or higher was significantly lower
than the percentage of White residents and Asian residents in Ann Arbor that have earned a
bachelor’s degree. White and Asian residents of Ann Arbor also have the lowest rates of
unemployment, while Black or African American residents and American Indian and Alaska
Native residents have the highest rates of unemployment. Despite this, residents of all
races/ethnicities in Ann Arbor have lower unemployment rates than the state of Michigan.
Education attainment and employment may affect risk of cardiovascular disease do to access to
resources and understanding of recommendations and access to healthcare and insurance.

The median household income in Ann Arbor is $69,456, which is higher than the median
annual household income for the state of Michigan. In Ann Arbor, Black or African American,
Asian, and Hispanic or Latino residents have significantly lower median annual household
incomes than White residents. This may disproportionately affect minority access to healthcare,
which can reduce risk prevention of cardiovascular disease, delay treatment, and increase the
incidence of complications (9). There were a lower percentage of Black or African American
residents living below the poverty line in Ann Arbor than in Michigan, but a higher number of
Asian and Hispanic or Latino residents living below the poverty line in Ann Arbor.
Additionally, residents of Ann Arbor were less likely to own vehicles than residents of Michigan,
limiting transportation for both commuting and healthcare access.

The age-adjusted mortality rates for the ten leading causes of death in Michigan were
lower for residents of Ann Arbor than for residents of Michigan or the United States for heart
disease, cancer, COVID-19, and unintentional injuries, however, they were higher for stroke and
Alzheimer’s disease. Heart disease was the leading cause of death among all three populations.
In Washtenaw County, Black residents had a significantly higher all-cause mortality rate and
mortality rate due to heart disease than White residents. Age-adjusted morbidity rates in
Washtenaw County, including cardiovascular diseases such as acute myocardial infarction and
congestive heart failure, were lower than the rates among residents of Michigan.

Washtenaw County residents were more likely have a healthy weight and less likely to
have obesity than residents of Michigan. They were also less likely to have high blood pressure,
however, Black or African American residents were significantly more likely than White or
Asian residents to have high blood pressure. Washtenaw County residents are more likely to
consume fruit than Michigan residents and there is not a significant difference in vegetable
consumption between Washtenaw County residents and Michigan residents. The proportion of
residents that consume fruit or vegetables is lowest among young adults for both populations.
The proportion of residents of Washtenaw County that reported any alcohol in the past month
was higher when compared to the residents of Michigan. Binge drinking and heavy drinking was
reported by a similar proportion of residents from both populations. The percentage of residents
in Washtenaw County with low access to a grocery store has decreased from 2010 to 2015 by
9.1%. Obesity, high blood pressure, and alcohol increase risk of cardiovascular disease while
fruit and vegetable consumption is considered a protective factor (3,14).

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 A few factors should be prioritized when considering the risk of cardiovascular disease in
Ann Arbor. Cardiovascular disease risk increases with age across all populations, and Ann
Arbor has an older population ages 65 years and older of 13.5%. Vehicle access for Ann Arbor
residents is lower than the general population of Michigan, and transportation to healthcare
appointments and pharmacies may be especially important for the older population for
cardiovascular disease prevention and management. Additionally, cardiovascular disease affects
Black or African American residents at higher rates than others. This disparity may be widened
by socioeconomic factors linked to increased rates of cardiovascular diseases, such as
unemployment and low-income, which affected Black or African American residents in Ann
Arbor at higher rates than others. Lastly, lifestyle risks for cardiovascular disease may be
addressed. Residents of Washtenaw County had lower rates of obesity and high blood pressure
than residents of Michigan, however, there is still a significant proportion of the population with
those risk factors. Ann Arbor has a very high population of young adults, and the young adult
population was least likely to consume at least one fruit or vegetable per day. Washtenaw
County also has a higher proportion of residents that reported drinking alcohol in the past month
compared to residents of Michigan. The main priorities when addressing cardiovascular disease
in Ann Arbor should include the older population, Black or African American residents, and
lifestyle risk factors.

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