Health Outcomes in Houston
Racial disparities in health outcomes persist despite progress on mortality rates
Overall, our region has lower premature mortality rates, lower cancer mortality and incidence rates, and longer life expectancies compared to the nation. However, the infant mortality rate and percentage of infants with low birth weights are higher than the national rate.
Why health outcomes matter to Houston
Analyzing health outcomes provides a snapshot of area residents’ health within a period of time, based on overall length and quality of life. There are considerable differences in health outcomes by race and ethnicity, socioeconomic status, family history, and where we live, play and work. Monitoring trends in population health outcomes is critical to evaluate the performance of health systems at all levels. Additionally, it is important to understand how and why health outcomes differ by communities, and how environmental factors influence the state of health in different ways.
The more we understand how health affects Houston-area residents, the more we can do to increase access and improve outcomes for everyone.
Life spans vary by 23 years across the region
Life expectancy is a common measure used to describe public health in different geographic areas. It refers to the average number of years one person can expect to live from being born, based on the age-specific mortality rates of the population.
The average life expectancy in the United States has been declining for three consecutive years. A baby born in 2017 is expected to live to be 78.6 years old, down from 78.7 from the year before.1 Consistently, life expectancy for females is higher than it is for males. In 2017, the difference in life expectancy between males and females was five years.
Overall, the life span of residents in the three-county area is longer than the state and national average. Across the three counties, the life expectancy for Fort Bend County residents is higher than that for Harris and Montgomery counties.
Racial disparities in life expectancy remain in Harris County, with Black life expectancies averaging to about four years less than those of White residents. Most of the Black-White gap in life expectancy at age one can be accounted for by differences in socioeconomic and demographic characteristics.2 It is also worth noting that Hispanic-Americans have a longer lifespan than Whites by 5–10 years in the region, despite the fact that Hispanics are more likely to be economically disadvantaged and uninsured. This is referred to as the Hispanic paradox.3
Comparing life expectancy to income reveals the extent to which higher income is associated with greater longevity.4 Research has shown that the richest American men live 15 years longer than the poorest men, while the gaps in lifespan between the richest American women and the poorest is 10 years. According to the Health Inequality Project, Harris County ranked 61st among the 100 most-populated counties in America for life expectancies of those with incomes in the bottom quartile. Specifically, the overall life expectancy at age 40 for Harris County residents is 79.4 years. The average life expectancy at age 40 for men is 76.9 and for women 81.8.
Further, life expectancies vary by 23.4 years depending on where one lives within the three-county area. Residents in a high poverty East Houston neighborhood (tract 2309) have the lowest life expectancy in the three-county area (65.7 years). While on the other spectrum, a neighborhood in the Clear Lake area near Bay Oaks Country Club has the longest typical life span, with a life expectancy of 89.1 years. This gap is almost equivalent to the difference between low-income developing countries and high-income developed countries.
Heart disease is the number one cause of death in the country and the region followed closely by cancer
Premature death refers to deaths among those under age 75 per 100,000 population. Deaths at younger ages contribute more to the premature mortality rate than deaths closer to age 75.
According to the Centers for Disease Control and Prevention (CDC), the leading causes of premature death in the United States include cancer, unintentional injury, heart disease, suicide and perinatal deaths.5 Social determinants such as poverty, low education and social isolation contribute to premature death.6 Populations at high risk for premature death include people with obesity or diabetes, individuals who smoke or drink excessively, individuals who have risky behaviors, and who face occupational and environmental hazards.7 As many as half of all premature deaths may be preventable by changing lifestyles and maintaining healthy behaviors.8
Overall, our region is doing better than the state and national average. In particular, Fort Bend County has the lowest premature death rate for all racial/ethnic groups. The premature mortality rate for Black residents in Harris County is higher than the state and national averages.
In 2017, the top 10 leading causes of death were heart disease, cancer (malignant neoplasms), accidents (unintentional injuries), chronic lower respiratory diseases (CLRD), stroke (cerebrovascular diseases), Alzheimer disease, diabetes, influenza and pneumonia, kidney disease, and suicide (intentional self-harm).9 Altogether they accounted for 74% of all deaths in the United States.
The top 10 leading causes of death in Texas were slightly different than the nation as a whole. Septicemia (blood infection) and chronic liver disease made to the top 10 list for Texas.
In 2017, the total number of deaths was 34,141. The top 10 leading causes of death in Houston three-county area were heart disease (22.1%), cancer (21%), accidents (6.3%), stroke (5.5%), chronic lower respiratory diseases (4.1%), Alzheimer disease (3.8%), septicemia (3.0%), diabetes (2.8%), kidney diseases (2.5%), and suicide (1.9%).
Troubling racial disparities characterize Houston-area infant mortality
Infant mortality refers to the ratio of infant deaths to live births in a given year. It is regarded as a good indicator of the overall health of a population.10 The infant mortality rate in the United States was 5.79 deaths per 1,000 live births in 2017. Despite the progress made to reduce infant mortality in the past decades, the U.S. rate is still higher than that of other developed countries.11 The five leading causes of infant death were congenital malformations, low birth weight, maternal complications, sudden infant death syndrome (SIDS), and unintentional injuries.12
In 2017, there were 506 infant deaths (5.94 deaths per 1,000 live births) in the three-county area. The infant mortality rate in the region is higher than the state rate (5.85 deaths per 1,000 live births) and the national rate.
The infant mortality rate for babies born to Black women is more than twice the rate for babies born to White women in Harris County. Maternal health, prenatal and postnatal care, and access to health care are all known factors associated with infant mortality.13 Research has found that the infant mortality rate is higher among babies born to unmarried mothers than those born to married mothers.14 Additionally, the infant mortality rate is highest among infants born to teenage moms and women older than 40 years.15 Babies born to mothers with obesity or mothers who smoke or consume alcohol during pregnancy have a greater risk of infant mortality, particularly during the first 28 days after birth.16,17
Low birth weight
Low birth weight (LBW) is the second leading cause of infant death in America. Low birth weight infants are those weighing less than 2,500 grams (or 5.5 lbs) at birth. In addition to high risk of infant mortality, low birth weight infants also face short- and long-term health conditions such as health problems, intestinal disorders, learning and behavioral problems, and type 2 diabetes, which can permanently affect their quality of life.18,19,20
Across the U.S., the percentage of infants born LBW rose from 8.17% in 2016 to 8.28% in 2017, and remained unchanged in 2018. It was the highest rate reported since the 2006 peak (8.26%).21
In the three-county area, 8.93% of babies were born with low birth weight in 2018. Low birth weight is more common among babies born to Black women than those born to Hispanic or White women.22
The most common causes of low birth weight are premature birth (birth prior to 37 weeks gestation) and restricted fetal growth. Risk factors such as smoking or drinking alcohol during pregnancy may lead to growth retardation even if the baby was born full-term. Exposure to air pollution (both indoor and outdoor) and drinking water contaminated with lead are also found associated with low birth weight.23
Cancer mortality and cancer incidence rates in the region have declined and are lower than the national rates
One in every five deaths is due to cancer, making it the second leading cause of death in the United States and in the three-county region. In 2016, more than 1.6 million new cases of cancer were diagnosed and reported in the United States, and almost 600,000 people died of cancer.24
In the three-county area, cancer mortality rates for all types of cancer have been declining. In 2016, more than 7,000 deaths in the three-county area are caused by cancer. The overall cancer mortality rate for the region is below the state and national rate, and Fort Bend County has the lowest cancer mortality rate.
Between 2012 and 2016, the cancer mortality rate in the United States dropped from 166.3 deaths per 100,000 people to 155.9 per 100,000, a decline of 6.3%. During the same period, the cancer mortality rates for Fort Bend and Harris counties have dropped by more than 10%, faster than the state and the nation. However, there was less change in the cancer mortality rate in Montgomery County, decreasing from 152.5 deaths per 100,000 people to 148.1 per 100,000, or 2.9%. The cancer mortality rate for all three counties is already below the Healthy People 2020 target (161.4 deaths per 100,000 population).
Risk of cancer and cancer mortality is affected by many behavioral factors, diseases and genetic factors.25 It is also influenced by health disparities in socioeconomic status and access to care. Men have higher rates of cancer mortality rate for any cancer than women. Blacks have higher cancer mortality rates than other racial/ethnic groups. In general, Hispanic and Asian residents have lower cancer mortality rates than Black or White residents.
In a similar fashion, the age-adjusted cancer incidence rates in the three-county area are lower than the state and national rates. Additionally, annual rates of new cancer cases have declined in the past few years.26 In Texas,109,083 cancer cases were reported in 2016, equivalent to 392 reported cancer cases for every 100,000 people, lower than the national rate (436 per 100,000 people). In the three-county area, a total of 19,814 new cancer cases were reported in 2016.
Between 2012 and 2016, the national cancer incidence rate declined by 4%, compared to 6% in Texas. During the same period, the decline in cancer incidence rates in the three-county area is much faster, 12% in Fort Bend and Harris counties and 15% in Montgomery County.
The most common cancers in the nation are breast, prostate, lung and bronchus, and colorectal cancer.27 Lung cancer accounts for 26% of cancer deaths among men, and 25% among women.28 With advances in preventive care and cancer treatment, the number of cancer survivors has increased over the years.29
The prevalence of diabetes
Diabetes is also among the leading causes of death in America, accounting for 83,564 or 3% of total deaths in 2017.30 More than 30 million people have diabetes (about 1-in-10), and 90–95% of them are diagnosed with type 2 diabetes.31 The total medical costs and lost work and wages for people with diagnosed diabetes was estimated at around $327 billion yearly.32
In the past few years, the number of adults diagnosed with diabetes has increased although the age-adjusted rate for adults with diagnosed diabetes remains steady. The percentage of adults with diabetes in Texas is consistently higher than the national percentage.
Within the three-county area, the percentage of adults aged 20 and more with diagnosed diabetes in Harris County has increased in recent years, surpassing Fort Bend and Montgomery counties since 2014.
As of 2016, men in all three counties were more likely to have diabetes than women. The difference is most pronounced in Harris County. National statistics also show that the racial differences in the prevalence of diagnosed diabetes. Overall, Blacks and Hispanic adults have a higher percentage, compared to White and Asian adults. Further, adults with lower educational attainment are more likely to have been diagnosed with diabetes.
Additionally, over a third of U.S. adults have prediabetes, a serious health condition where blood sugar levels are higher than normal, but not high enough to be diagnosed as having type 2 diabetes.33 The rates of type 2 diabetes in youth are rising as childhood obesity rates increase in the United States.
Self-rated health in Harris County is worse than that in Fort Bend and Montgomery counties
Self-rated health has been found to be a strong indicator of mortality, and a reliable indicator of a person’s overall well-being.34 People with “poor” self-rated health had twice mortality risk, compared with those with “excellent” self-rated health.35 This measure is found to be closely correlated with the results of physical exams by health providers.36
According to data from the Behavioral Risk Factor Surveillance System, Harris County had the highest proportion of adults who rated their current state of health as “fair” or “poor,” at 18.2%, compared to 14.1% in Fort Bend and Montgomery counties. The percentage of adults in Harris County who considered themselves to be in poor or fair health is also higher than the state and national average.
- National Vital Statistics System, CDC. (2019). United States Life Tables, 2017. National Vital Statistics Reports.Vol 68 (7).
- Franzini L, Ribble JC, Keddie AM (2001). “Understanding the Hispanic paradox.” Ethn Dis. 11 (3): 496–518. PMID 11572416.
- Chetty, Raj et al. “The Association Between Income and Life Expectancy in the United States, 2001-2014.” JAMA vol. 315,16 (2016): 1750-66. doi:10.1001/jama.2016.4226
- National Research Council (NRC) and Institute of Medicine, Measuring the Risks and Causes of Premature Death: Summary of Workshops, H.G. Rhodes, rapporteur, Committee on Population, Division of Behavioral and Social Sciences and Education and Board on Health Care Services, Institute of Medicine (Washington, DC: The National Academies Press, 2015).
- Heron, Melonie. Deaths: Leading Causes for 2017. National Vital Statistics Reports; vol 68 no 6. Hyattsville, MD: National Center for Health Statistics. 2018.
- Julie A. Jacob. “U.S. Infant Mortality Rate Declines but Still Exceeds Other Developed Countries.” Journal of the American Medical Association 315, no. 5 (2016): 451-52.
- NCHS Data Brief, No. 328 (November 2018).
- Gopal K. Singh et al. “Infant Mortality in the United States: Trends, Differentials, and Projections, 1950 through 2010.” American Journal of Public Health 85, no. 7 (1995): 957-64.
- Sean Meehan et al. “Maternal Obesity and Infant Mortality: A Meta-Analysis.” Pediatrics 133, no. 5 (2014): 863-71.
- Ward Hofhuis et al. “Adverse Health Effects of Prenatal and Postnatal Tobacco Smoke Exposure on Children.” Archives of Disease in Childhood 88 (2003): 1086-90.
- Colleen M. O’Leary et al. “Maternal Alcohol Use and Sudden Infant Death Syndrome and Infant Mortality Excluding Sids.” Pediatrics 131, no. 3 (Mar 2013): e770-8.
- Mi D, Fang H, Zhao Y, Zhong L. Birth weight and type 2 diabetes: A meta-analysis. Exp Ther Med. 2017;14(6):5313–5320. doi:10.3892/etm.2017.5234
- Hack M, Klein NK, Taylor HG. Long-term developmental outcomes of low-birth weight infants. Future Child. 1995 Spring; 5(1): 176-96. Chandra PC, Schiavello HJ, Ravi B, Weinstein AG, Hook FB. Pregnancy outcomes in urban teenagers. Int J Gynaecol Obstet. 2002;79:117-122.
- Centers for Disease Control and Prevention. United States Cancer Statistics: Highlights from 2016 Incidence. USCS Data Brief, no. 8. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2019.
- Namrata Vijayvergia et al. “Lifestyle Factors in Cancer Survivorship: Where We Are and Where We Are Headed.” Journal of Personalized Medicine 5, no. 3 (2015): 243-263. https://doi.org/10.3390/jpm5030243
- Idler, Ellen L., and Angel, Ronald J. 1990. “Self-Rated Health and Mortality in the NHANES-I Epidemiologic Follow-Up Study.” American Journal of Public Health 80(4):446-452.
- Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med. 2009;69:307-316.
- Idler, Ellen L., and Benyamini, Yael. 1997. “Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies.” Journal of Health and Social Behavior 38(3):21-37.