Losing Ground, Part 4: Stark disparities in health indicators

KEVIN VAUGHAN Updated: January 23, 2013 at 12:00 am • Published: January 23, 2013

Lucero Barrios is Latina and a new mother — circumstances that place her squarely in a group of people affected by a shocking reality in Colorado: A Hispanic baby born in this state is 63 percent more likely than a white baby to die in the first year of life.

The disparity is even more stark for Colorado’s blacks, who experience an infant mortality rate three times that of Caucasians.

The infant mortality gap is just one measurement by which the state’s largest groups of ethnic and racial minorities trail whites, and it is an anomaly unto itself. Colorado’s infant mortality rate is lower than the national average for whites and significantly higher than the national average for Latinos and blacks. And an I-News examination of more than a decade of health data found those disparities are widening.

Barrios’ daughter, Monserrat, is healthy.

“It was something I never thought would happen to me at a young age,” Barrios said of becoming pregnant.

When it did, she took steps that might have prevented her from becoming a statistic. She made an appointment at Clinica Family Health Services, which serves predominantly the working poor. She showed up for prenatal examinations with Dr. Carolyn Chen. And after her baby was born, she brought Monserrat to the Clinica office in Westminster for scheduled checkups.

A deeper examination of the numbers shows that the infant mortality rate for Hispanics has climbed in recent years at the same time that it was steadily falling for whites, according to data compiled by the Colorado Department of Public Health and Environment.

Disparities are nothing new

Health disparities between racial and ethnic minorities and white Americans are nothing new — hundreds of studies over the past 20 years consistently found that blacks and Latinos trail Caucasians in a host of measures. In Colorado, blacks are more likely to suffer from asthma, diabetes, high blood pressure, prostate cancer and obesity than whites. And Hispanics are more likely to die from flu or pneumonia, cervical cancer, diabetes and liver disease than whites.

There might be no more telling statistic about the disparities in the state than the rate of infant mortality, the death of a baby in the first year of life. It is seen by many experts as a key measure of overall health.

In the United States, infant mortality has been on a steady decline since 1958. Even so, black babies die at a rate much higher than white babies, according to data from the Centers for Disease Control and Prevention. In 2011, the rate at which black babies died before reaching their first birthday was a little more than twice that of white babies — 11.42 deaths for every 1,000 births for blacks, compared with 5.11 deaths for every 1,000 births for Caucasians.

The numbers are starkly worse in Colorado, where black babies experience 14.5 deaths for each 1,000 births, according to an average of data from 2007 through 2011 calculated by the state health department. That figure would place black Coloradans between the overall infant mortality rates of China and Colombia, according to a World Bank compilation of health data.

The latest state numbers are scheduled to be published next spring but were provided in advance to I-News by the health department.

Since the state’s first health disparity report in 2001, the infant mortality rate for whites has fallen 18 percent while for blacks it has fallen about 9 percent. And for Hispanics the rate has climbed over the past dozen years — from 7.2 deaths per thousand births in the 2001 study to eight deaths per thousand in the most current numbers.

In El Paso County, the infant mortality rate for blacks is worse than the state number — 16.1 deaths for each 1,000 births — while the rate for Hispanics is better, at 7.6 deaths per 1,000 births.

Overall, the gap in infant mortality rates based on race and ethnicity isn’t as wide in El Paso County as it for all of Colorado, said Dr. Bill Letson, medical director of El Paso County Public Health. But the disparities mirror the state figures when it comes to diseases in the adult population and life 
expectancy.

“I do think we do better at the pediatric end,” he said.

The data for the upcoming state report also showed other disparities:

• Whites, on average, now live nearly a year longer than Hispanics in Colorado — and 3.4 years longer than blacks. In 2011, the life expectancy for a Caucasian in Colorado was 80.3 years, compared with 79.4 for a Latino and 76.9 for someone who is black.

• Blacks and Latinos are significantly more likely to die from diabetes than whites. For example, in the most recent data, whites experienced a diabetes death rate of 13.9 per 100,000 residents while it was 35.5 for blacks and 36.4 for 
Hispanics.

• Blacks experience significantly higher death rates from heart disease and stroke than whites. The death rate from heart disease among blacks is 171 per 100,000 residents, compared with 138.3 for whites. And the death rate from stroke for blacks is 48.2 per 100,000 residents, compared with 35.2 for whites.

Getting similar statistics at the local level is difficult, because of sampling issues, said Letson and Amy Anderson, epidemiologist with El Paso County Public Health.

Statistics on infants are easier to obtain because of birth certificates, Letson said.

But health workers know disparities exist.

“I see it playing out here, but I don’t have a lot of data to support it,” said Jeff Martin, executive director of Open Bible Medical Clinic in Colorado Springs and one of the founders of TLC Pharmacy, both nonprofits that serve the low-income population.

“There’s just not good data in the El Paso County area in terms of health care disparities around minorities.” At his clinic, he said, most of the patients are white because most people in El Paso County are white. But minority populations are disproportionately represented.

Only in recent years has the U.S. Census Bureau begun to measure health indicators in its data. That limited data, available from the Census American Community Survey, measures health insurance, showing a disparity between blacks and Latinos and whites that lays the foundation for dramatic differences in overall health. In Colorado, slightly more than 11 percent of whites reported having no health insurance, while 28 percent of blacks and more than 31 percent of Latinos were without insurance.

College put on hold

For Lucero Barrios, being 21 and a mom means college is on hold. She is single, although Monserrat’s father is involved in the little girl’s life and attends many of her doctor’s appointments. Still, Barrios lives at home and relies on her mother, stepfather and older sister to care for Monserrat while she works part time as a bank teller.

Sitting in a conference room at 
Clinica, she talked about her hope of returning to college one day, maybe to study finance or another subject that would help her establish a career in banking. And she marveled at the little girl in the pink warm-up suit, laughing as she shared the message on Monserrat’s shirt: “I woke up on the wrong side of the crib today.”

She talked about her daughter’s ability to wave “hello” and “goodbye,” about how quiet she becomes with a book she likes, about her love for frogs.

“Maybe she’ll be a vet, or a marine biologist or something,” Dr. Chen said.

“I hope,” Lucero answered.

Gazette reporter Barbara Cotter contributed to this report.

Contact Kevin Vaughan at kvaughan@inewsnetwork.org or at 303-464-4936. This report was made possible, in part, by grants from The Colorado Health Foundation and the French-American Foundation.

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IN EL PASO COUNTY

• From 1987 to 2007, the life expectancy was 81.2 years for white women and 77.3 years for black women. For the same period, it was 76.9 years for white men and 71.8 years for black men.

• In 2009-10, about 20 percent of white adults were obese, compared with about 25 percent of Hispanics and 40 percent of blacks.

• From 2007 to 2011, the infant mortality rate was 6.1 per 1,000 live births for whites, 16.1 for blacks and 7.6 for Hispanics.

• From 2007 to 2009, the infant mortality rate tied to prematurity and low birth rate was 8 per 10,000 live births for whites, 43 for blacks and 8 for Hispanics.

• The percent of infants born to unmarried women from 2009 to 2010 was 18.3 percent for whites, 44.3 percent for blacks and 38.3 percent for Hispanics.

• From 2009 to 2011, 11.9 percent of whites were uninsured, compared with 19.1 percent for blacks and 22.8 percent for Hispanics.

• From 2005 to 2007, the diabetes mortality rate was 13.2 percent for whites, 23.5 percent for blacks and 25.7 percent of Hispanics.

• About 30 percent of white females of all ages reported unintended pregnancies, compared with 50 percent for Hispanic females and about 60 percent for black females. Unintended pregnancies were highest in the 15-19 age range for all races and ethnicities.

• The rate of live births to girls ages 15-17 (per 1,000, from 2003 to 2007) was 11 percent for whites, 56.6 percent for Hispanics and 
24.2 percent for blacks.

Source: El Paso County Public Health Indicators 2012 report, Colorado Department of Public Health and Environment Health Disparities Profile

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FINDING HELP

For general information on health services available to people in need, contact the United Way 2-1-1 helpline. A few places to get started:

• El Paso County Public Health, 578-3199, www.elpasocounty
health.org: Operates several programs for needy families, including the Nurse Family Partnership, which sends nurses to the homes of first-time, low-income parents in El Paso and Teller counties, beginning when a woman is pregnant and continuing until the child is 2 years old; the Women, Infants & Children nutritional program; and Strong & Healthy Families, which provides classroom instruction to new mothers on fetal and child development, infectious disease prevention and other parenting topics.

• Open Bible Medical Clinic, 475-0972: Primary medical care for acute and chronic illness; in-house limited mental health counseling. Patients cannot have health insurance or qualify for state or federal coverage, and they must meet income guidelines.

• Mission Medical Clinic, 219-3402: Range of free medical services, including a dental clinic, diabetes clinic, vision care and primary care, for low-income, uninsured adults.

• SET Family Medical Clinic, 776-8850: Basic medical services, including treatment for minor illnesses, and holistic health programs for uninsured and low-income people; children immunization clinics for ages 4-18 who are Medicaid eligible, uninsured or American Indian or an Alaskan Native.

• Peak Vista Community Health Clinics, 632-5700: Medical, dental and behavioral health services for people of all ages. Accepts people with Medicare and Medicaid, commercial insurance or no insurance, but there’s a waiting list for the uninsured.

A FOUR-DAY SERIES

This is the fourth of a four-day series about racial and ethnic disparities in Colorado.

Sunday: Losing Ground, Part 1: Equality gap grows for minorities.

Monday: Single parenthood contributies to disparity.

Tuesday: The changing economy is a root source of growing inequities.

Wednesday: Hispanics and blacks in Colorado have not equally enjoyed the benefits of health care advances.

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RELATED COVERAGE

• Interactive graphic: A Civil Rights history timeline.

• Interactive graphic: How the state's minorities are faring on important measures of social progress.

• Video: Coloradans speak out on the issue.

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THE PROJECT

The project has been assembled as a 128-page e-book in PDF format. The e-book includes stories, graphics, a selection of photos and more. Download at 
www.inewsnetwork.org.

• The I-News Network at Rocky Mountain PBS is a nonprofit investigative news service that focuses on investigative reporting. Its funding comes from the John S. and James L. Knight Foundation, The Ethics and Excellence in Journalism Foundation, the McCormick Foundation, The Fund for Investigative Journalism and others. I-News, founded in 2009, this month merged with Rocky Mountain PBS and public radio station KUVO. Learn more about I-News at www.inewsnetwork.org.

• I-News and The Gazette will host a community conversation about the findings of the Losing Ground project 5:30-7 p.m. Feb. 28 at the Tim Gill Center for Public Media in Colorado Springs, 315 E. Costilla St. For information, call Keanna Smith, 418-5851. Other such events are planned along the Front Range.

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