Overview of Karmanos Cancer Institute Catchment Area (KCI-CA)

Karmanos Cancer Institute (KCI) has a long and distinguished history as a comprehensive cancer center serving southeast Michigan. In 2014, KCI affiliated with McLaren Health Care and there are now 16 sites serving a catchment area covering 46 of Michigan’s 83 counties. The catchment area is now defined as the 46-county area that is home to 95% of our patients; KCI sees one-third of all new cancer patients in the catchment area.

The KCI catchment area (KCI-CA) is home to 6.7 million residents who are diverse across a range of characteristics. To better describe and address this diversity, the KCI-CA has four regions, consistent with Community Health Assessment Regions as defined by the Michigan Department of Health and Human Services (MDHHS).

The Southeast region includes the metropolitan Detroit area, defined as a tri-county area (Wayne, Oakland, Macomb) and home to over 3.86 million residents. According to the U.S. Census 2021 population estimates, the city of Detroit is the largest city in the state (639,000+ residents). Detroit is a resource-challenged area, with a median household income of $30,894 and 35% of residents living below poverty level, compared to 12.6% in the state of Michigan. The majority of census tracts in the city of Detroit are medically underserved areas based on HRSA definitions. About 78.3% of Detroit residents identify as Black or African American, a group that disproportionately carries the KCI catchment area’s cancer burden.

Another population with a strong presence in metropolitan Detroit are Arab Americans, who are not officially recognized by the U.S. government as a distinct minority group. Therefore, there is no nationally coordinated cancer-related surveillance of this group. Recent reports estimate 277,534 Arab Americans in Michigan, with 50% living in Wayne County. In fact, the proportion of Arab Americans in the city of Dearborn (directly adjacent to Detroit) is larger than that of any other U.S. city.

Beyond the metro Detroit area, the KCI catchment area is also characterized by a high proportion of rural (i.e., non-metropolitan) residents. About 45% of the population in the Central region live in a rural area while about 70% of the population in the North region are rural dwelling.

Across all of the groups, sexual and gender minorities (SGMs) are represented. According to a 2020 report from the UCLA School of Law Williams Institute, SGMs comprise 4% of the state’s population, similar to the representation nationwide, with about 311,000 adults . However, data suggest that, in Michigan, this group is more likely to be unemployed and food-insecure and less likely to receive routine healthcare compared to non-SGMs in the state. Source 1 | Source 2.

Cancer incidence and mortality

Figure 6 shows overall cancer incidence and mortality rates in the KCI-CA.

Overall cancer incidence in the KCI catchment area is higher compared to both the state and the nation.
Overall cancer mortality in the KCI catchment area is higher compared to both the state and the nation.
Overall cancer mortality is higher in the city of Detroit compared to the KCI-CA regions, the state, and the nation.

Figure 7 shows incidence rates for leading cancers in the KCI-CA.

Incidence rates in Detroit are not currently available for all cancers.
Incidence of cancers of the prostate, lung, colon/rectum, and uterus is highest in the city of Detroit compared to the KCI-CA regions, the state, and the nation.
Incidence of bladder cancer and non-Hodgkin’s lymphoma is higher in the KCI-CA compared to the nation.

Figure 7B shows mortality rates for leading cancers in the KCI-CA.

Mortality rates in Detroit are not currently available for all cancers.
Deaths from lung, prostate, breast, colon/rectum cancer are higher in the city of Detroit compared to all other areas.
Lung, breast, and uterine cancer mortality are higher in the KCI-CA compared to the state and the nation.
Mortality from pancreatic cancer, ovarian cancer, non-Hodgkin’s lymphoma, and leukemia are higher in the KCI-CA compared to the nation.

Cancer disparities

A striking area of disparity is related to African American racial group membership, as presented in the figure below.

Overall cancer incidence is higher among African Americans living in the KCI-CA compared to Whites in the catchment area and African Americans nationwide.
Overall cancer mortality is higher among African Americans living in the KCI-CA compared to Whites.

Figure 9A shows racial differences in cancer incidence across leading cancers.

Incidence of cancer of the lung, colon/rectum, kidney, and pancreas incidence is higher among African Americans in the KCI-CA compared to both Whites in the KCI-CA and African Americans nationwide.
Incidence of prostate, liver, and uterine cancer, as well as multiple myeloma is higher among African Americans in the catchment area versus Whites.

Figure 9B shows racial differences in cancer mortality.

Breast and uterine cancer mortality is higher among African Americans in the KCI-CA compared to both Whites in the KCI-CA and African Americans nationwide.
Mortality from cancers of the lung, prostate, colon/rectum, pancreas, cervix, and liver, as well as multiple myeloma, is higher among African Americans in the KCI-CA compared to Whites.

Rural cancer disparities also exist.

Counties with the highest RUCC values experience higher cancer mortality ratee compared to metropolitan urban counties with lower values, despite having a lower cancer incidence rate (Figure 10). Further, as shown in figure 11, both lung cancer incidence and mortality are higher in rural versus urban areas.

Cancer risk factors

Several risk factors, including those typically included in the social determinants of health, are relevant to the cancer burden observed in the KCI catchment area.

Figure 12 presents 2018-2020 MI-BRFSS data based on KCI catchment area sub-regions for which data are available: Detroit (Southeast), Genesee County (East, including Flint), Central Michigan (including five counties in the Central region), and Northwest (including four counties in the North region).

Data related to healthcare access differ across areas.

The proportion of adults reporting no healthcare coverage is highest in the NW counties.

The proportion of adults reporting no personal healthcare provider and no healthcare access in the past 12 months due to cost is highest in the city of Detroit.

Data related to lifestyle-related risk factors also differ.

The proportion of adults in Detroit, Genesee County, and the Central Michigan counties who are current cigarette smokers is than that of the state of MI as a whole.
The proportion of adults who are overweight is highest in the NW counties compared to other areas.
The proportion of adults who are obese is higher in Detroit, Genesee County, and the Central Michigan counties compared to the state.
The proportion of adults who report no leisure-time physical activity is higher in Detroit, Genesee County, and the Central Michigan counties compared to the state.

Last updated: 3/10/2022