Poverty, little access to prenatal care and untreated chronic illness in mothers are likely the causes behind new findings that show Hispanic babies in part of San Antonioâs East Side die at more than twice the overall statewide rate, experts said.
The study of infant deaths in Texas released Thursday found that two adjacent ZIP codes on the East Side â 78203 and 78220 â had rates among Hispanics of 16.0 and 11.6 deaths per 1,000 births, respectively. In contrast, the state rate was 5.8 deaths, based on 2011-14 data.
Infant mortality is defined as a baby who dies before turning 1.
The report itself didnât address why deaths were so high in some places, such as the two ZIP codes, an area that once was predominantly African-American that has increasingly become more Hispanic and struggles with high poverty rates.
One local expert said economic inequality may be at the root of the local infant mortality problem in those specific ZIP codes and elsewhere. San Antonio has been ranked as among the most economically segregated cities in the nation, studies have shown.
âThese hot pockets, with high preterm birth rates and high infant mortality, show that overall this is an economics issue,â said Dr. Patrick Ramsey, professor of obstetrics and gynecology at UT Health San Antonio.
âPoor nutrition, smoking and exposure to secondhand smoke, lack of health insurance and access to clinical care, lack of transportation â it all plays a role. Weâre doing the right thing to drill down to the ZIP code level and figure out what those barriers are that are creating these disparities, and we need to find the keys to better intervention,â he said.
A separate report using more recent data showed that â of the 28,182 live births in Bexar County in 2015 â 182 infants died. About 20 percent suffocated due to unsafe sleeping environments, such as too many pillows or blankets in a crib, or infants co-sleeping with parents or siblings. The number of deaths caused by unsafe sleeping is increasing sharply, one pediatric specialist said.
The 2015 rate in Bexar County was 6.5 deaths per 1,000 births, the second worst of the big counties in the state after Dallas County, which had an infant mortality rate of 7.
The rate was especially high â 10.9 â for black infants, which is in keeping with other studies that have shown infant mortality to be a long-standing problem nationally among African-Americans, although the local rate is statistically âunstableâ due to small numbers, according to the Metropolitan Health District.
In the study released Thursday, researchers at the University of Texas System and UT Health Northeast in Tyler also found wide variations in statewide infant mortality rates that were linked to geographic location and racial/ethnic categories.
Data for this map was taken from UT’s Population Health page. The data was collected from Texas Vital Statistics between 2011 and 2014. Zip-code level infant mortality rates were calculated if there were more than 400 births to mothers living in that zip code. Visit the Population Health page for more information.
âGenerally, the cause relates to various social factors â poverty, education, jobs, single-mother homes, tobacco use and lack of access to health care,â said Dr. David Lakey, chief medical officer and vice chancellor for Health Affairs for the UT System.
Other health issues can play a role in infant mortality, including obesity and diabetes in mothers, which can cause them to give birth prematurely, increasing the odds of an infant dying, experts said. Sometimes, genetic disorders or other problems with the baby are the cause.
That was the case for Vivian and Braden Graham Sr. of San Antonio, who lost their son James when he was just three days old. During Vivianâs 20th week of pregnancy, the couple learned their second child had a form of dwarfism linked to a genetic mutation, which prevented his limbs and chest from developing normally.
When James was born Oct. 14, 2016, they knew he wouldnât live long. Vivian, 34, held him for the first time when he was unhooked from machines on Oct. 17. He died in her arms about an hour later.
âI carried him for 34 weeks, knowing what the outcome would be,â she said. âBut during those 34 weeks, he was alive and kicking in my belly. For those three days I had with him, I just tried to enjoy every moment, capture every smell.â
Graham encourages other parents who lose infants to reach out to find help and support, as she did at Sharing Hearts of Texas, a local bereavement support group.
âIt helps to know youâre not alone,â she said.
In general, Hispanics tend to have lower infant death rates than other ethnic/racial groups, Lakey said, âwe think because of multigenerational support to moms and babies.â So the finding of high death rates among Hispanic babies in the two San Antonio ZIP codes was somewhat counterintuitive.
The ZIP code with the highest rate â 78203 â is located within EastPoint, a 3.5-square-mile area that in recent years has received millions in federal anti-poverty aid and other help. One chronic issue in the area, home to 18,000 residents, is a historic problem of easy access to medical care.
Thatâs about to change. A new University Health System clinic in the nearby 78208 ZIP code will host a ribbon-cutting Saturday.
Across Texas, the study found similar examples of disparities in infant deaths, even as the overall state rate of 5.8 deaths was lower than the national one of 6.1.
âThe infant mortality picture is dramatically more complex than we knew,â Lakey said. âThe state average obscures ZIP codes where rates are terribly high. Some of the higher city or county level rates, on the other hand, have obscured the variation within communities, including neighborhoods where rates are very low.â
For example, the study, which includes a mapping tool, found that in Fort Worth the infant mortality rate was over six times higher in the 76164 ZIP code than it was in neighboring 76107.
In Houston, mortality rates for infants of black mothers varied eight fold across ZIP codes â from 3.3 deaths per 1,000 births in 77077 to 28.7 deaths per 1,000 births in 77026.
Anglo mothers in Texas have a relatively low risk, the study found. The highest mortality rates for Anglo infants were seen outside the major metro areas. Longview and Wichita Falls, for instance, had more than one ZIP code with an Anglo infant mortality rate that was two or more times the stateâs overall rate.
The infant death rate in Bexar County overall has waxed and waned over the years, but remains a significant problem, experts said.
The high number in 2015 prompted Metro Health the following year to relaunch its Fetal Infant Mortality Review, with the goal of gathering information on infant deaths to identify risk factors and come up with solutions.
âWeâve been looking at the high rate of premature births and how it is linked to maternal age and chronic health conditions, and how those things relate to infant death,â said Kori Eberle, a spokeswoman for Metro Health and member of the review board.
Many mothers who lose an infant after birth have pre-existing health conditions like diabetes and lack access to prenatal care, she said. In many cases the board reviewed, problems with the pregnancy that could have been resolved in the first trimester went uncorrected.
âThese women also often lack postpartum care and pediatric visits,â she said
So far, the board has recommended a number of changes, such as standardizing infant death certificates to enhance the accuracy of data collected, and improving âthe continuity of careâ women receive over their reproductive lives, from preconception to postnatal care.
âWeâre exploring with different hospitals and doctors the idea of how to connect and integrate the health systems, so a womanâs caregivers are all on the same page,â she said.
Part of the solution, she added, are programs like Healthy Start, Metro Healthâs home visiting program that provides health and other support services to vulnerable mothers in specific areas of the city that have higher infant mortality rates.
The free program, more than a decade old, sends staffers to at-risk women, following them through their pregnancies and the childâs second year. On average, the program serves about 500 mothers annually, Eberle said.
One big factor in infant deaths in Bexar County involves unsafe sleeping environments, said Dr. Sanjie Garza-Cox, chief of staff of neonatology at the Childrenâs Hospital of San Antonio.
In 2015, 35 infants in the county died when they either were suffocated by blankets, toys or other sleeping material or were suffocated while sleeping with parents or siblings. The number increased to 45 the next year; by the mid-point of 2017 the number of co-sleeping or unsafe sleep environment deaths had already exceeded 45.
âItâs prevalent for many reasons, one of them being (co-sleeping) has been done for many generations, and itâs commonly done in the African-American and Hispanic community,â she said. âThe big difference now is that we tend to sleep with more pillows and cushions and softer mattresses.â
Last year saw an increase in the incidence of co-sleeping deaths tied to babies sleeping with family members on air mattresses, she said. Alcohol and drugs sometimes play a role, Garza-Cox added, but most often it is âplain old parental exhaustion.â
Garza-Cox, president of Baby Education for South Texas (or B.E.S.T.), said co-sleeping deaths from 2014 and 2015 didnât show up in any particular area of the city, but ânow that we have two more years of data, it may.â
She said surveys show about 40 percent parents know they shouldnât sleep with their babies or put them down on their stomachs, but these practices continue. BEST continues to work across the city to standardize education on safe newborn sleep practices, she said.
One proven practice is the use of the Baby Box, a cardboard box fitted with a foam mattress, free to parents who complete a quick online education course, available through Baby Box University.
With the release of the statewide study Thursday, the UT System is making the data, as well as other technical information, available to the public to facilitate work by other researchers, Lakey said
âTexas is deeply committed to reducing infant mortality in every community,â he said. âHaving a lower than average rate, nationally, is not enough, particularly when we know that there are communities where rates are tragically high.â
The ZIP code-level rates were calculated for communities with 400 or more births during the four years studied and were identified by the motherâs ZIP code of residence at delivery. That accounted for 93 percent of all the births in Texas at that time. The data were obtained from the Texas Department of State Health Services.
The report should be used to identify best practices for caring for infants and mothers and how to better target interventions and deploy resources in reducing deaths, Lackey added.
âWe strongly encourage others to make use of this data and to work on finding solutions. The sooner we can understand why babies are dying, the better off we will all be.â
Melissa Fletcher Stoeltje is a San Antonio Express-News staff writer. Read more of her stories here. | firstname.lastname@example.org | @mstoeltje