Lisa Knox and Kelly Leevey laugh as they study together at the University of Texas Health Science Center at Tyler in Tyler, Texas, on Wednesday, April 25, 2018. (Chelsea Purgahn/Tyler Morning Telegraph)

A silent killer is stalking East Texas and neighboring regions.

It’s not a person or animal, but a conglomeration of health afflictions that seem to grow in frequency with each passing year.

The estimated 1.5 million people who call the Northeast Texas area home are sicker and dying earlier than counterparts in the rest of the state and United States, especially in Smith County, where many pass before the golden years.

Smith County is listed as having the highest rate of infant morality of all 254 counties in Texas and is the only place in the state that’s not seen a decrease in its death rate since 2005, records show.

But there’s more: people in the region are more likely to be obese, suffer from certain chronic diseases and take their own lives, according to data compiled by the University of Texas System in partnership with UT Health Northeast, which is now part of UT Health East Texas.

So what’s going on, and why are so many people sick or dying prematurely?

“There are a variety of factors,” said Dr. David L. Lakey, a nationally recognized expert on disease prevention, community health and environmental and consumer safety. “A lot is attributed to tobacco … another (factor) is demographics.”

Dr. Lakey serves as a vice chancellor at The University of Texas System and senior adviser for The University of Texas Health Science Center Tyler.

His position enabled him to spearhead a comprehensive look at the health status of Northeast Texas, based in part on information contained within a 2012 study by the Department of State Health Services.

The report identifies a number of reasons for the region’s concerning health checkup: environment, education, genetics, age, income and access to health care, to name a few.

The findings are helping health professionals, interested stakeholders and community leaders create resources to improve failing marks cited in the report.

“Our health status is much poorer than the rest of the state of Texas,” said Dr. Gerald Ledlow, who oversees The School of Community and Rural Health at The University of Texas Health Science Center at Tyler. “It’s not good.”

TOBACCO, MORTALITY AND DISEASE

A goal of the study is to not only identify problems but also help experts pinpoint solutions that can help people in Northeast Texas lead longer, happier, healthier lives.

“It becomes a question of, ‘How do we keep people healthy?’” Lakey said.

Many factors are at play.

The area’s population is largely rural, and slightly older than the rest of the state.

And while unemployment is slightly lower than the rest of the state, so are median household incomes, leaving some at a disadvantage for basic care and services.

The study reveals the consequences of those challenges.

The region experiences higher mortality rates among the five leading causes of death in the United States — heart disease, cancer, stroke, chronic lower respiratory diseases and unintentional injury.

Some diseases cited in the report are preventable, experts said.

“A close look at the data reveals that for most of the causes of death for which rates are higher in Northeast Texas than in Texas overall … a major determinant is tobacco use,” Lakey said, summarizing the report.

As of 2014, about one in four adults in Northeast Texas smoked, compared to 15 percent statewide.

About 14 percent of expectant mothers in East Texas smoked, far more than the state average of 4 percent, according to the study that also points out the area’s soaring infant death rates.

Upon closer examination of the data, the health report also reveals that Northeast Texans have a 33 percent higher likelihood of dying from heart disease than people living elsewhere in the state, and are 6 percent more likely to die from cancer.

Further, chances of someone from this region dying from chronic lower respiratory diseases is 40 percent higher than other Texans; 28 percent higher for stroke; and 29 percent higher for unintentional injuries.

“Those are significant differences than the rest of the state,” Dr. Lakey said.

Age factors into the results, as can other issues, such as inadequate income levels, a lack of education and difficulty accessing the health care system.

A person’s environment can affect other aspects of their lives, such as their ability to purchase nutritious food, live in an unpolluted area and reside in a safe neighborhood.

Those attributes can factor into other issues plaguing the region, such as diabetes and poor mental health.

“Northeast Texas is more like Louisiana, Oklahoma, Mississippi, Arkansas,” Lakey said. “Those states are struggling with those types of issues.”

CARING FOR EACH OTHER

It’s critically important for people to see a qualified physician for wellness checks, routine care and treatment to maintain good health, according to medical experts.

The problem is, people aren’t going.

“There seem to be plenty of doctors and insurance rates are comparable,” Lakey said. “We’re just not getting people in to see a doctor.”

People who see their physician on a regular basis tend to receive information about the importance of giving up tobacco, eating nutritious foods and exercising on a regular basis.

Without those reminders, good health habits are often set aside.

“There are folks who are uncomfortable seeing physicians,” Lakey said, but skipping the doctor can mean the difference between life and death, especially among infants.

It’s very concerning, he said, and the focus now is on preventing ailments before they develop.

“Physicians need to be more on the preventive side … I don’t think we should be happy where the U.S. is as a whole, on health,” Lakey said.

Since the release of the report almost two years ago, it’s been presented in a multitude of settings and before a variety of audiences, from healthcare to economic development.

“I’ve learned not to be afraid of data,” Lakey said. “It’s what’s going on … I think it sets the stage to do a variety of things.”

Efforts are underway to create opportunities for education, intervention and prevention, such as the new Texas Collaboration for Healthy Mothers and Babies that strives to connect moms and babies to appropriate care options.

The goal is to improve disparities between the offspring of black and white mothers by increasing access to care and working with providers to promote understanding.

Those two objectives are part of the Healthy Families project, formed to help curb infant mortality through collaborative efforts of UT Health Sciences Center at Tyler and Texas Health and Human Services Commission.

In a separate venture, Tyler’s UT Health Science Center is pushing forward to complete a structure to house its new School of Community and Rural Health, which offers a generalized master’s degree program in community health.

The goal is to train professionals to work with rural and underserved populations and educate them about healthy living choices, said Dr. Ludlow, who serves as interim dean.

“In essence that’s why the school was created,” Ludlow said. “We need a trained work force.”

In many ways, the study that’s helping propel these and other efforts is a living document that will change and update over time.

“Businesses look at this type of information,” Lakey said, especially those that are required to provide health insurance to their employees. “I don’t think we put a target on East Texas … there are some conversations. People are looking at this, trying to figure out what it means.”

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