Study Examines Island's Health

First-of-its-kind report finished for Vineyard adult population; early links are seen between Lyme disease, depression

By IAN FEIN

While high rates of Lyme disease and depression have long been documented among Vineyard residents, a new report released today indicates that the two may possibly be linked.

The authors of the Health Conditions and Health Status Report of Martha's Vineyard have found that people with Lyme disease, a tick-borne illness, were almost twice as likely to have a history of diagnosed depression - independent of other factors such as age, sex or amount of time spent on the Island.

Other findings in the report suggest that seasonal Vineyard residents suffer from skin cancer in rates double those of year-round residents, and that excessive alcohol consumption on the Island is most prevalent in Edgartown and Oak Bluffs. The report also notes that Vineyard residents are relatively healthy compared to their mainland counterparts, with cigarette smoking and obesity rates far below national averages.

This is the Island picture of public health that emerges in the 84-page document, co-authored by Dr. Diane Becker and Dr. Charles Silberstein. The full text of the report is available on the Gazette web site today at mvgazette.com.

The status report represents further analysis, narrative and explication of data from the 2004 Health Report of Martha's Vineyard, a first-of-its-kind comprehensive study that surveyed more than 1,000 full-time and 700 part-time adult Island residents. The survey did not include children or the non-English-speaking population.

Both Dr. Becker and Dr. Silberstein yesterday praised the framers of the 2004 health report, a collaborative venture that was supported by nearly every health care organization on the Island, and said that the new document should serve as a complement to the earlier, in which they were both heavily involved. They said it will add another dimension of insight and perspective to the raw data from before.

"The purpose behind this new one was to take it away from just being a compendium of tables that didn't seem to be very mobilizing to the population, and to put it in context of its actual meaning relative to the nation's health," said Dr. Becker, a longtime seasonal resident of Vineyard Haven, professor of medicine and director of the Center for Health Promotion at Johns Hopkins University in Baltimore, Md.

Both doctors said they hope the report will inspire action and further study about public health issues that so far have confounded the Vineyard community.

"A lot of these problems are very treatable and preventable - Lyme disease, skin cancer, depression and excessive alcohol consumption - these are all things we have technologies to address," said Dr. Silberstein, a Vineyard psychiatrist and board member of the Foundation for Island Health, the organization which commissioned the original health survey. "Hopefully this new report will stir some attention and thoughtful planning."

Dr. Becker and Dr. Silberstein plan to release the status report in both electronic and written forms, and hope to make the document widely available to public health organizations, as well as the general population.

The original health report was never formally released to the public, though it was obtained and written about extensively by the Gazette two years ago, and is still available on the Gazette Web site. The status report released today does not include data from the 2004 survey about health care resources, utilization and clinician opinions.

"We hope this new document can be used by a sixth grader at the West Tisbury School for a paper on Vineyard health, or by a health professional who might want to set up a specific investigation," Dr. Becker said yesterday. "It should be useful for everybody."

The most pointed recommendation in the report calls for a population study on Lyme disease, the debilitating bacterial illness which has reached epidemic levels on the Vineyard. The report strongly urges long-term research to track the disease and possibly identify predisposing factors, noting that such a study could add to a wider understanding of the disease, which occurs as an acute illness and is transferred to humans through ticks.

"There is little consensus and considerable controversy about treating longer-term cases. The treatment of Lyme disease is evolving, and no currently effective vaccine exists," the report says. "There is a paucity of long-term follow-up studies of people with Lyme disease, so that the full impact of the disease is not yet known."

Dr. Becker and Dr. Silberstein have seen a marked increase in Lyme disease rates, even since the 2003 survey - which found that more than 12 per cent of full-time and 7 per cent of part-time residents had reported a tick-borne disease at any time in their life. For full-time residents the numbers are triple the statewide rate and for part-time residents they are nearly double the rate seen in the state.

Up-Island residents were also almost five times as likely as down-Island residents to have contracted the illness, with more than one-third of year-round Chilmark and West Tisbury residents having reported tick-borne diseases.

"What the Island needs, and needs desperately, is for the entire population to be enrolled in a registry so we can truly follow to see who is susceptible, and what the long-term impacts are," Dr. Becker said, noting that similar studies are planned for Nantucket and Block Island, R.I. "This should be a call to arms. It's time for the Vineyard to be involved."

The potential link to depression is also a brand new discovery, which had never before been found in a population-based study, according to Dr. Becker.

"The findings of this preliminary analysis suggest that Lyme disease is associated with depression on Martha's Vineyard, although this conclusion would have to be examined more extensively in a long-term population-based study," the report says. "Unfortunately, the results only leave us knowing that depression is associated with a history of Lyme disease, but does not tell us which came first," it adds.

"It's certainly an important finding, but we don't really know what it means," Dr. Silberstein said. "Scientifically, it's something that needs research, especially out here. Every time I look at the Lyme disease data, it is staggering to see our high epidemic rates."

Other tick-borne diseases - such as rocky mountain spotted fever and babesiosis - are still quite rare, according to the report, but are being recognized on the Vineyard more often and must be watched. Educational efforts could help prevent tularemia - a potentially fatal disease which can be transferred either through ticks or inhalation - by encouraging more people to wear masks while doing landscaping.

Preventative education could also decrease the high rates of skin cancer in seasonal residents, Dr. Silberstein noted. The survey found that eight per cent of full-time residents and 14 per cent of part-time residents reported non-melanoma skin cancer, while the national prevalence is only about two per cent. The numbers suggest that the cancer is caused by short, intense exposure during summer recreational activities, according to the report.

Vineyard residents also far outpace national and state averages for problem drinking, defined by the Centers for Disease Control as five or more drinks on any one occasion within the last month. Roughly 30 per cent of year-round and 25 per cent of seasonal Island residents reported excessive alcohol consumption, compared to 18 per cent statewide and 16 nationally.

The status report found that younger men with less education were more likely to consume excessive alcohol, and that - even accounting for those factors - residents from Oak Bluffs and Edgartown were almost 20 per cent more likely to drink heavily than those in so-called dry towns on the Vineyard.

Dr. Becker said the geographic data point should be part of the political dialogue when considering whether to extend alcohol sales to other towns on the Island. "From a public health perspective, that's a potent finding," she said.

The report spells out the number of year-round and seasonal residents who describe their lives as particularly stressful, but there is insufficient data to suggest whether the mental illness rates on the Island are higher or lower compared to the rest of the nation.

However, the report notes that the prevalence of common chronic diseases - such as arthritis, bronchitis and heart disease - are no higher on the Vineyard than nationwide. And while obesity is a growing problem nationwide - with about a third of the population obese - the Island rate is roughly half that.

Island residents also smoke much less than their national counterparts. Compared with 21 per cent of adults who smoke cigarettes in the United States, only 14 per cent of full-time and five per cent of part-time Vineyard residents described themselves as current smokers.

"Overall, the Vineyard is still a relatively healthy place to be," Dr. Becker said.