The Impact of Violent Crime on Community Health

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After reading the book The Deepest Well by Dr. Nadine Burke, I had the idea to take a closer look Dr. Burke’s perceived connection between trauma and chronic illness. To do this, I investigated one specific type of trauma and compared its relationship to community health.

For over 20 years, Detroit has repeatedly ranked near the top of US cities with the most violent crime [1]. But Detroit isn’t just one of the most violent places in the United States--it’s also one of the sickest. Compared with the 267 largest cities in the US, Detroit ranks in the top three for heart disease, kidney disease, asthma, and diabetes.

Is this a coincidence or a trend? Detroit doesn’t appear to be the only city with both high levels of violence and illness. For this capstone project, I combined and compared over 200,000 rows of data from both the FBI and CDC on violent crime and chronic diseases in major cities across the United States. The goal was to determine if there is a clear relationship between community health and violent crime rates.

The Process

For this analysis, reported violent crime rates were compared to per capita rates of several chronic diseases like asthma and negative coping behaviors like binge drinking. The data on diseases was pulled from the CDC's "500 Cities: Local Data for Better Health, 2019 release."[2] The crime data was pulled from the FBI's 2017 reporting on violent crime in US cities [3].

Before discussing the findings, it's necessary to point out potential pitfalls and why I believe the results are still directionally accurate. The CDC reports data through Census Tracts. In other words, data collections for each city are counted in pieces. The city of Chicago, for example, was broken up into almost 800 regions for which local clinics individually reported data. It would have been more accurate to find each region's population size and weight the results accordingly to have a perfect representation of chronic illnesses in these cities. Unfortunately, that information was not readily available, so these results are slightly less precise than they could be. They still give a relatively good overview of the overarching pattern in chronic disease presentation. It should also be kept in mind that all of this data is reported by clinics and hospitals which means some instances of undiagnosed chronic illnesses are most likely not counted. Additionally, children are excluded from this analysis.

Asthma, Diabetes, & Kidney Disease

After analyzing, asthma, diabetes, and kidney disease all had moderate correlations to violent crime. In other words, there appears to be a trend that where there are higher levels of violent crime, there are higher levels of asthma, diabetes, and kidney disease. Out of the categories tested, the strongest of all relationships was between kidney disease and violent crime.

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Cancer

Interestingly, cancer had a minimal negative correlation (-0.157) to violent crime. There's no way to know why that is based on this data. However, one possible explanation could be age. Typically cancer occurs in older populations, and more violent cities tend to have a slightly younger population. The two highest-cancer cities Largo, Florida and Scottsdale, Arizona, have higher median ages [4] than, for example, Detroit, Michigan, which has a lower prevalence of cancer. It could also potentially be explained by socioeconomic differences and the availability of cancer screenings. Either way, there is no clear connection between cancer and cities with high violent crime.

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Heart Disease

The relationship between heart disease and violent crime was surprising. While coronary heart disease and violent crime had a correlation of 0.426, the correlation of strokes to violent crime was even higher at 0.607. One explanation could be that there aren't as many preventative measures to treat heart disease in high crime areas. The data indicated that cholesterol levels were tested more often in areas with lower crime rates than in areas with higher crime rates. One explanation for this difference in testing could be that populations in high crime areas are younger, so there is less of a need to test for cholesterol levels. Another explanation could be that the position of hospitals throws off the data. When someone has a severe stroke, they are often transferred to bigger, better equipped hospitals sometimes in other cities. If hospitals are reporting strokes they have treated and not where the individual lives, it could cause unusual concentrations of stoke occurrences in cities with better hospitals. It wasn’t clear from the data whether that was happening, but it could be a possibility. Without further studies, it wouldn't be possible to tell precisely what causes the differences. Regardless, there appears to be a relationship between heart conditions and living in high crime areas

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Negative Coping Behaviors

After seeing trends between chronic illnesses and crime, I wanted to understand if there was a simple explanation. Because of this, I looked to see if higher crime areas also had a higher rates of engaging in negative coping behaviors. As the final part of this analysis, I investigated the rates of binge drinking, smoking, obesity, and poor mental health in major cities.

Binge Drinking

Many studies have found that binge drinking can lead to chronic illnesses like diabetes and heart disease [5]. After seeing the correlations between chronic illness and high violent crime, I had expected to find the same correlation with binge drinking. However, that was not the case. Binge drinking had a mild negative correlation (-0.249), meaning it could be slightly less prevalent in high crime areas.

However, after looking more closely at the data, I don't believe that's entirely the case. The data seems to be thrown off by some outliers. For example, in 2017, six of the top 20 cities for binge drinking were in Wisconsin. (And in case you're curious, it only got worse for Wisconsin in 2019--they now house 12 of the top 20 cities [6]) Outside of Wisconsin, many of the top cities for binge drinking were college towns. According to the New York Times [7], around 40% of college students binge drink at some point so that could have also skewed the data. Interestingly, after being at the top of so many categories, Detroit, Michigan, actually had the 10th lowest reported binge drinking rate out of 267 cities. As you can see from the data plot, the data points on binge drinking were far more skewed than some of the other conditions compared.

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Obesity & Smoking

Obesity and smoking both correlated to violent crime. Obesity had a moderate correlation of 0.534, while smoking had a stronger correlation of 0.605. Both of those factors could play into higher rates of the chronic illnesses analyzed above.

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Final Summary

The link between disease and violent crime areas has been found by other researchers. A study done in the UK found that the fear of crime was associated with worse self-reported health. Even after controlling for unhealthy coping behaviors related to health risks like drinking and smoking, fear of crime was still linked to poorer health. It's worth noting that this study found the fear of crime predicted adverse health regardless of crime experienced by the individual [8].

In her book The Deepest Well, Dr. Nadine Burke offers a possible explanation for the link between stress and illness [9].

"Dysregulation of the stress response has a profound impact on immune and inflammatory responses because virtually all the components of the immune system are influenced by stress hormones. Chronic exposure to stress hormones can suppress the immune system in some ways and activate it in others, and unfortunately none of it's good. Stress can lead to deficiency in the part of the immune system that fights off the common cold, tuberculosis, and certain tumors." (The Deepest Well, p. 73)

It's also very possible that some of these factors could have been caused by pollution or other environmental factors that occur when living in other major cities. However, I think there is enough consistency in the data to indicate that violent crime plays a part.

While we cannot say based on the data presented above from the CDC and FBI that living in areas with violent crime causes illness, it's fair to say there is at least a relationship between the two. Understanding the potential impact of stress and trauma on health should cause us to reevaluate the way healthcare is approached in high crime areas, especially for individuals who have experienced trauma.

See all of my work for this project on GitHub