Thursday, February 22, 2018

Study: High rates of infant deaths in area ZIP codes

From Staff and wire Reports
Feb. 10, 2018 at 11:13 p.m.

Amanda Stowers, RN, checks the vitals of newborn Levi Watson in the Labor and Delivery Department at Good Shepherd Medical Center Friday, July 17, 2015. (Les Hassell/News-Journal Photo)

A deep dive into state birth and death records reveals wide disparity in infant mortality rates across Texas ZIP codes, including a stark figure arising from Longview.

The collaboration between the University of Texas System and UT Health Northeast looked at overall infant mortality, from 2011 to 2014, by ZIP code. It also separates data for Hispanic, black and white populations within those ZIP codes.

The national average for infant mortality, defined as death within one year of birth, is 5.9 per 1,000 births. The Texas average is 5.7 per 1,000 births.

The study reports wildly varying infant mortality rates in Longview ZIP codes.

That includes 22.65 infant deaths per 1,000 among black residents living in the 75602 ZIP code, which takes in South Longview and stretches to Easton.

White residents don't fare well in the 75605 ZIP, which is North Longview up to Judson, where the rate is 12.33 per 1,000 births. That's more than twice the state average.

That Longview ZIP code put the city in company with Wichita Falls as having the highest rates of infant mortality to white mothers outside the state's metro areas.

"We learned the ZIP code, where you live, can have a huge impact on health," said Dr. David Lakey, UT System chief medical officer and vice chancellor for health affairs. "Where you live — that context of the environment, education, income, poverty levels, access to good foods — they have a huge impact. ... Infant mortality is complex. That's why we need people to look at the data in their community. Are we getting women into pre-natal care in those communities like we need to?"

One of the study's contributors, Lakey said researchers reported data from ZIP codes where at least 400 delivering mothers lived during the four-year span.

He said the ZIP code focus can allow limited health dollars to be focused where the needs are greatest.

"If you can target to ZIP codes where problems are, you don't have to cover the whole state," he said. "A lot of the poor health outcomes throughout the state occur in Northeast Texas."

There also is disparity.

"Just west of Marshall, it's 11.25 per 1,000," Lakey said, referring to the 75670 code, western Marshall to Longview.

That same indicator for the 75672 code, eastern Marshall, is 1.4 per 1,000 births.

"So, there is a 10 point difference in those two ZIP codes in your region," Lakey said.

Neither Longview hospital chose to comment on the UT report.

Fred Killingsworth, executive administrative assistant at the Gregg County Health Authority, said the Northeast Texas numbers reflect a diminished presence of health facilities in rural areas.

"One thing that it brings out is, it's kind of showing this to us because of the withdrawal of medical facilities, hospital satellites," he said. "Services offered to the rural patient loads are outside (their home), and they can't make it to the hub cities. So, a lot of patients don't get the care they need."

Killingsworth said the ZIP code parameter makes the study a bit unwieldy for his purposes, since ZIP codes spill across the Gregg County line that binds his operations.

"The ZIP codes do not differentiate rural versus city, as the report alludes that it does," he said, after noting the overall trends reflected in the study are accurate — especially the rural/urban divide. "It just reiterates the fact the rural population doesn't get what they need. This is just a byproduct of what happens when the medical community is pulled out of these smaller communities. They have to travel farther to get to health care. The health care is good, once they get there, but they've got to go to a hub."

Lakey said Texas' size works against it in allowing spikes in infant mortality to hide in an overall state average that beats the national average.

"Because Texas is so big, that size can hide that we have higher rates in certain areas of the state," he said. "I don't feel reassured that our infant mortality rate is that much better than others — it's just right at the national average — so I wouldn't say it's really good."

For example, Fort Worth's 76164 ZIP code area had an infant death rate of 12.3 deaths per 1,000 births — more than six times the rate of neighboring 76107. Hispanic mothers in two adjacent ZIP codes in San Antonio, 78203 and 78220, had respective rates of 16.0 and 11.6 infant deaths per 1,000 births.

Race isn't the sole reason infant mortality rates may be higher or lower, Lakey said.

"It's not something that's just genetic," he said. "We shouldn't just accept that it's a racial thing by just based by your ethnicity — there are others factors in that community that can have a profound chance that your baby will survive the first year of life."

Deneen Robinson, program director of The Afiya Center, a Dallas reproductive justice center for black women and girls, said black women's high rates of infant mortality can stem from factors such as depression, diabetes, hypertension and substance abuse — but a principal factor is racism and discrimination in maternal health care.

"For black folks, there doesn't seem to be any protection like there are for other races," Robinson said. "When we access care, there are biases that meet us at the door. There seems to be an unwillingness to hear us."

Robinson gave an example of a young black woman she spoke with recently who continuously told her doctor she was having health issues during her pregnancy.

According to the doctor, her complaints were "just a part of pregnancy" and were occurring "because she was young." After continually pressing the doctor about her health, it turned out the woman had blood clots in both her cervix and her head, which almost killed her during childbirth.

"She was young," Robinson said. "But just the fact that throughout the whole process, her visibly complaining that she was having these health concerns — and her providers were not listening to her."



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