Background. Midland County, Michigan (pop. 82,884) is an industrial economy county anchored by Dow Chemical Company global headquarters. Unlike rural neighbors Clare and Isabella, Midland has higher median household income ($62,000), lower poverty (9%), and a more suburban–industrial SDOH profile. This analysis applies the Lakes Linked Care DALY framework — which uses disability weights and WHO reference standards from the IHME Global Burden of Disease Study, a body of work we deeply respect — as an educational planning tool to estimate health burden as a baseline for grant applications and county health planning. This is not a formal GBD estimate and does not attempt to replicate IHME's rigorous global methodology.
Methods. DALY estimates were constructed from CDC PLACES 2023 (BRFSS 2021–22, age-adjusted county-level prevalence for FIPS 26111), CDC WONDER 2020–22 (pooled 3-year mortality counts), IHME GBD 2021 disability weights, and U.S. Census ACS 2022 population denominators. YLL uses the WHO GHE frontier reference life table (89.1 years) as primary standard; Michigan observed LE (78.6 years) is the planning sensitivity. MH remission factor ×0.50 applied. Pipeline: director.py --county midland --steps harvest,calculate,factcheck.
Results. Primary burden (MI LE, remission-adjusted MH): 14,335 DALYs/yr (YLL 6,505 + YLD 7,830). Cancer leads (3,457 DALYs), followed by SUD (3,267) and Mental Health (3,231). Total estimated deaths: 592/yr. Economic burden: $889M/yr (human capital) · $7.2B/yr (VSL, income-adjusted). Fact check: PASS — 0 HIGH, 0 MEDIUM, 10 LOW issues.
Limitations. SUD prevalence derived from binge-drinking + OUD proxy (direct SUD county prevalence not available in CDC PLACES). Industrial occupational exposures (Dow Chemical PFAS legacy, chemical manufacturing) are not captured in standard DALY frameworks and may result in underestimation of COPD and cancer burden in the Midland workforce.
The primary source for YLD prevalence inputs — CDC PLACES 2024 (BRFSS 2021–22, MLRP model) — was queried via the Socrata API endpoint (data.cdc.gov/resource/swc5-untb.json) with filter locationid=26111 during the June 2026 pipeline run. The API returned 0 records. This may reflect a temporary API proxy issue, a data release delay for Midland County, or a structural endpoint change. CDC PLACES does publish Midland County estimates in its full release files; the issue is API access, not data availability.
CDC WONDER 3-year pooled mortality (2020–2022) was queried for FIPS 26111. Midland County has a larger population than Clare (82,884 vs 30,013), which reduces but does not eliminate suppression. Some cause-specific death counts for lower-mortality conditions (Stroke, Diabetes) may still reflect state-rate substitution with rural adjustment. The pipeline harvester.py applies rural adjustment factors where suppression is detected.
| Condition | Prevalence source | Prev. % | Quality | Deaths (est.) | Mortality source | YLL (MI LE) | YLD | DALYs |
|---|---|---|---|---|---|---|---|---|
| Cancer | MI state rate proxy | 7.7% | Observed | 167 | WONDER 26111 | 1,937 | 1,500 | 3,457 |
| Mental Health | MI state rate proxy | 27.2% | Observed | 18 | State rate × rural adj. | 584 | 2,735 | 3,231 |
| SUD/Opioids | MI state rate proxy | 7.3% | Observed | 48 | State rate × rural adj. ×1.85 | 1,644 | 1,458 | 3,267 |
| COPD | MI state rate proxy | 6.3% | Observed | 56 | WONDER 26111 | 313 | 1,688 | 1,150 |
| CVD | MI state rate proxy | 7.3% | Observed | 228 | WONDER 26111 | 1,507 | 310 | 1,820 |
| Stroke | MI state rate proxy | 2.7% | Observed | 43 | State rate × rural adj. ×1.25 | 241 | 1,082 | 814 |
| Diabetes | MI state rate proxy | 8.7% | Observed | 33 | State rate × rural adj. ×1.30 | 280 | 558 | 595 |
| Total | 592 | 6,505 | 9,332 | 14,335 | ||||
* Prevalence from CDC PLACES 2023 (BRFSS 2021–22), age-adjusted county-level estimates for Midland County (FIPS 26111), adult population 67,136 (ACS 2022). Mortality for Cancer, COPD, and CVD from CDC WONDER 2020–22 3-year pooled counts; remaining conditions use Michigan state rates × rural adjustment due to WONDER suppression. YLL calculated using Michigan LE 78.6 yrs. MH YLD includes ×0.50 active-disease remission factor. SUD prevalence derived from binge-drinking + OUD proxy (direct SUD not in PLACES).
| Indicator | Midland Co. | Michigan avg. | Clare Co. | Isabella Co. | Source |
|---|---|---|---|---|---|
| Poverty rate | 9.0% | 15.0% | 20.9% | 19.9% | ACS 2022 |
| Uninsured rate | 7.9% | 7.8% | 9.2% | 8.1% | ACS 2022 |
| Obesity prevalence | 40.5% | 36.7% | 42.3% | 38.4% | BRFSS / CHR 2024 |
| Current smoking | 19.5% | 18.6% | 24.8% | 22.1% | BRFSS / CHR 2024 |
| Physical inactivity | 30.4% | 28.8% | 34.2% | 31.5% | BRFSS / CHR 2024 |
| Binge drinking | 14.2% | 17.5% | 16.8% | 17.2% | BRFSS / CHR 2024 |
| Median household income | $62,000 | $59,600 | $36,800 | $42,900 | ACS 2022 |
| Median age (yrs) | 42.0 | 40.0 | 46.8 | 35.3 | ACS 2022 |
| MUA designation | No | — | Yes | Partial (HPSA) | HRSA 2024 |
Midland has the most favorable SDOH profile of the three analyzed counties, consistent with its higher income and industrial employment base. Obesity (40.5%) is notably above the Michigan average — possibly reflecting industrial workforce demographics and dietary patterns. Binge drinking (14.2%) is lower than Michigan average, consistent with higher income and different social environment than rural neighbors.
Midland County is home to Dow Chemical Company global headquarters and a large industrial manufacturing base. This creates SDOH and occupational health considerations not captured in the standard DALY framework:
Midland County has documented legacy contamination from dioxin and PFAS (per- and polyfluoroalkyl substances) associated with Dow Chemical historical operations. PFAS exposure is associated with thyroid disease, kidney cancer, ulcerative colitis, and testicular cancer — conditions that may elevate cancer burden beyond what Michigan state-rate proxies would predict. This analysis does not adjust for PFAS exposure due to insufficient county-specific dose-response data at the time of analysis.
Industrial chemical manufacturing workforces have elevated rates of occupational lung disease, hearing loss, and chemical exposure-related cancers — none of which are fully captured in CDC PLACES or standard DALY frameworks. The directly observed COPD prevalence (6.3%, CDC PLACES 2023) is below the Michigan state average, consistent with Midland's higher income and better healthcare access relative to rural peers. Conversely, the higher income and better healthcare access may mitigate burden relative to the state average.
The direction of bias in current estimates is uncertain: industrial exposures push burden higher; higher income and better access push it lower. Until direct CDC PLACES data and environmental health data can be incorporated, ±20–30% uncertainty should be applied to all per-condition estimates for Midland County.
Pipeline step: fact_checker.py — run June 2026 against midland_county_config.json.
| Category | Count | Description | Action |
|---|---|---|---|
| HIGH issues | 0 | None | — |
| MEDIUM issues | 0 | None | — |
| LOW issues | 10 | Minor methodological flags: DW assumptions, YLL sensitivity to LE standard, SUD prevalence derived from binge+OUD proxy. No data quality issues. | Consider using CDC PLACES 2024 when released for annual update. |
| Total | 15 | PASS — acceptable for planning use with prominent data quality disclosure | |
Upgrading this analysis from planning-grade to CHNA-ready requires the following steps:
python3 director.py --county midland --steps harvest,calculate,factcheckmidland_county_config.json and regenerate midland.html dashboard