Health Risks & Health Outcomes in Houston

While cancer mortality rates have declined and residents in the Houston three-county region are more physically active, other important indicators of overall health and wellbeing have declined

Slightly fewer Houstonians are sedentary and the rate of individuals dying from cancer is our region is increasing; however, food insecurity continues to rise while self-rated health falls. Additionally, life expectancy in the Houston region has slightly decreased while rates of premature death rise. These outcomes ultimately lead to a decline in quality of life and contribute to the most common causes of death.

Residents in Fort Bend and Montgomery counties report more physical activity than Harris County residents

activity can increase the risk for diseases, including cardiovascular diseases, diabetes and obesity, hypertension, cancer, depression, and anxiety.³ In addition, physical inactivity is associated with reduced expenditures on health care treatments for circulatory system diseases.⁴

Rates of physical inactivity overall have been in decline. In 2019 about 26% of adults across the U.S. reported no physical activity decreasing to 23% in 2021. This rate is slightly higher across Texas with 25% of adults reporting no physical activity. In the three-county Houston region, Harris County sees the highest rate of residents who are not regularly physically active at 28% compared to Fort Bend County (23%) and Montgomery County (22%). Montgomery County has seen the biggest decline in the percent of physically inactive adults going from 28% in 2019 to 22% in 2021.

Research shows that trends in physical activity correlate strongly with income and education level, a finding consistent with Texas trends as well.⁵ On average, those with lower household incomes and lower levels of educational attainment were more likely to be physically inactive.⁶ Research from the Robert Wood Johnson Foundation suggests this is because people with more education tend to have higher paying jobs, which allows them the option to live in neighborhoods that have lower crime rates and greater access to recreational facilities. Additionally, people with high levels of educational attainment are more likely to work one job only, which affords them more time for recreational activities.

Because of the high correlation between race and income/education, it is not surprising that Black and Hispanic adults in Texas are more likely to be physically inactive than white adults, according to Behavioral Risk Factor Surveillance System (BRFSS) data from the Texas Department of State Health Services; in 2023, about 79% of white Texans engaged in recreational physical activity compared to 73% of Black and 67% of Latino Texans. Additionally, women in Texas are more likely to be physically inactive than men by 7. percentage points.

Prior to the pandemic, food insecurity in the Houston region was in decline

The U.S. Department of Agriculture (USDA) defines food insecurity as a lack of consistent access to adequate food for a healthy life. In 2023, more than one in 10 Americans were food insecure (13.5%). That is equivalent to about 47.4 million people, including more than 13 million children. Food insecurity is most common amongst people living below the poverty line, people of color, single adults and single-parent households. Although food insecurity is closely related to poverty, people living above the poverty line also experience food insecurity.

Feeding America provides estimates for food insecurity at different community levels. Using the relationship between food insecurity and its closely linked indicators (poverty, unemployment, homeownership, disability prevalence, etc.) an estimated food insecurity rate is generated.

According to Feeding America, the food insecurity rate declined in Houston’s three-county area between 2017 and 2019. However, the effects of COVID-19 in Houston led to an increase in the estimated food insecurity rate in 2020. In 2021, food insecurity rates slightly declined likely in part due to increased benefits and greater flexibility in assistance programs during the pandemic. In fact, in 2021, national food insecurity rates reached a two-decade low. However, food insecurity rates then increased in both 2022 and 2023 due to the termination of pandemic-related assistance. Feeding America estimates that food insecurity is highest in Harris County and lowest in Fort Bend County, and Texas has a higher rate than the national average. It is important to note that in the U.S., children are more vulnerable to food insecurities, 17.9% compared to 12.9% for all individuals.

Given that this data is based on proxy indicators, it is very likely that the rate of food insecurity is undercounted. A 2024 study conducted by Kinder Institute for Urban Research estimates that about 39% of households in Houston and Harris County are food insecure.

Houston region residents’ physical health has worsened since 2020

How one rates their own health is a reliable indicator of a person’s overall physical state and well-being and has been found to be a strong indicator of mortality.⁷ People who rate their health as “poor” had twice the mortality risk, compared with those with “excellent” self-rated health.⁸ This measure is also found to be closely correlated with the results of physical exams by health providers.⁹

Harris County had the highest proportion of adults who rated their current state of health as “fair” or “poor,” at 25% in 2022, compared to 16% in Fort Bend County and 20% in Montgomery County. The percentage of adults in Harris County who considered themselves to be in poor or fair health was also higher than the state, which was higher than the national average. While self-reported rates of “fair” or “poor” health decreased in 2020 they began to increase starting in 2021. Between 2020 and 2022, the percent of residents reporting “fair” or “poor” health grew by 7 percentage points in Harris County, 6 points in Montgomery County, and 3 points in Fort Bend County.

Another way to predict healthy outcomes and measure health-related quality of life is the average number of physically unhealthy days in the past 30 days, which shows how people rate their recent health. A study on the number of healthy days reported in a county found that counties with more unhealthy days were likely to have higher unemployment, poverty, percentage of adults who did not complete high school, mortality rates, and prevalence of disability than counties with fewer unhealthy days.¹⁰

This indicator’s trend over time is similar to the self-rated health indicator decreasing in 2020 and then increasing in 2021 and 2022.

Residents in Fort Bend County (3.4) reported fewer physically unhealthy days than both the state (3.8) and nation (3.9), whereas Harris County reported the most unhealthy days (4.3) with the average number of physically unhealth days experienced by Harris County residents increasing by nearly one day between 2021 and 2022.

At least one-third of adults in the Houston three-county region are living with obesity

Obesity, defined as having a body mass index (BMI) of 30 or more, is a complex health condition affecting both adults and children. Obesity increases the risk for health conditions such as coronary heart disease, type 2 diabetes, cancer, hypertension, and more.

Among all the “modifiable” behavioral risk factors, obesity is found to take more years of life than diabetes, tobacco use, hypertension or high cholesterol. Obesity also has significant economic consequences. On average, adults with obesity spend $3,429 more per person annually on medical expenses than those with medically healthy weights.¹¹

Since at least the late 1990’s, obesity rates have generally trended upward. In 1996, in Texas and across the country, about 17% of adults 18 years and older were living with obesity. As of 2023, that rate sits at about 34%. The nine-county Houston metropolitan area has seen similar trends since the early 2000s (the earliest data available) with obesity rates sitting at 23% in 2002 and increasing to 31% as of 2023.

If we look closer at the Houston three-county region, we see that Harris and Montgomery counties have slightly higher obesity rates compared to Fort Bend County and the nation. Although at least one-third of all adults in each county are living with obesity. In Montgomery County, about 36% of adults 18 years and older are living with obesity. That rate is 35% in Harris County and 34% in Fort Bend County. For Montgomery and Harris counties, these rates are very similar to what they were in 2018. In Fort Bend County, obesity rates increased by about 5 percentage points between 2018 and 2022.

Adults who are between the ages of 18 and 29 have the lowest obesity rates, but one in four was still considered obese in 2022. However, this is a decrease of 12 percentage points from 2016 when the rate was around 37%. Residents 65 years and older in Harris County have the second lowest rates of obesity at 27%. Adults 30-44 now have the highest rates of obesity in Harris County at 38%, an increase of about 7 percentage points from 2016, followed closely by adults 45-64 at 36%, an increase of about 5 percentage points since 2016.

Obesity in Harris County tends to be more prevalent among individuals with less education. About 37% of individuals with a high school diploma only are living with obesity compared to 29% of Harris County residents with some college education. Historically, adults with a college degree had lower obesity rates than those with some college but no degree. However, this pattern shifted around 2021. As of 2022, individuals with a college degree have obesity rates at about 33% — higher than rates for those with some college but no degree.

In terms of income, 43% of adults in Harris County who earn less than $25,000 annually are living with obesity compared to about 28% of adults earning $50,000 or more annually.

And, consistent with national trends, obesity rates are highest among Black and Hispanic/Latino adults in Harris County (40% and 36%, respectively). However, nearly one in four white adults also experienced obesity in 2022.

Between 2016 and 2022, obesity rates remained the same for Hispanic/Latino and white adults in Harris County while there was a decrease of nearly 8 percentage points for Black adults.

The prevalence of diabetes in the Houston region has continued to tick up

Diabetes is the seventh leading cause of death in America, accounting for nearly 70,000 or 4% of total deaths in 2023. About 1 out of 10 Americans (38 million people) have diabetes, and 90-95% of them are diagnosed with type 2 diabetes, according to the Centers for Disease Control and Prevention (CDC). An additional 98 million U.S. adults are pre-diabetic — where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes — and over 80% are not aware they are headed toward a full diabetes diagnosis. The total medical costs and lost work and wages for people with diagnosed diabetes was estimated at around $413 billion yearly.

The percentage of adults in Texas with diabetes has increased by 2 percentage points from 10% in 2011 to 12% in 2023. The percentage of adults with diabetes in Texas is consistently higher than the national rate, which stood at 9% in 2023 — a slight increase compared to 8% in 2011.

The percentage of adults aged 20 and older with diagnosed diabetes in the Houston region is in the top quartile of the state. In 2023, the percent of adults 20 years and older with diabetes sat at around 11% for all three counties in the region — either flat or slightly increased compared to 2011.

Cancer mortality and incidence rates in Houston’s three-county region have declined

In 2023, over 600,000 people in the U.S. died of cancer, making it the second leading cause of death in the nation. In 2022, the latest year for which incidence data are available, 1.8 million new cases of cancer were reported in the United States. Fortunately, over time there has been a decrease in the rates of deaths caused by cancer and new cancer incidence rates. According to the CDC, the rate of cancer deaths across the U.S. has decreased by 14% and the rate of new cancers decreased by 4%.

Cancer mortality rates have fallen in Houston’s three-county region. Since 2010, Harris and Montgomery counties have had cancer mortality rates close to one another and about on par with the state. Fort Bend County has consistently had the lowest rates of cancer mortality in the region.

Additionally, since 2010, Fort Bend County has seen the largest drop in its cancer mortality rate falling by 23% between 2010 and 2022. Harris and Montgomery counties also experienced a decline over the same time at 19% and 13% respectively. At 111 deaths per 100,000, Fort Bend’s cancer mortality rate is already below the Healthy People 2030 target of 122.7 deaths per 100,000.

Risk of cancer and cancer mortality is affected by many behaviors, diseases, and genetic factors. It is also influenced by health disparities in socioeconomic status and access to care. These various drivers of cancer mortality is why we see disparities in cancer mortality by certain demographic characteristics.

Across Texas and throughout the three-county Houston region, Black residents experienced the highest cancer mortality rates among the four largest racial/ethnic groups in both 2010 and 2022, and men had higher rates than women. However, mirroring trends we’re seeing for the overall population, cancer mortality declined for most demographics during this time period between 2010 and 2022. However, cancer mortality did increase among Asian residents in Fort Bend and Harris counties.

In a similar fashion, new cancer incidence rates in the three-county area have also seen decreases over time. Between 2010 and 2022, rates of new cancer decreased between 8-9% in Fort Bend, Harris, and Montgomery counties compared to a 2% decline across Texas. As of 2022, Texas has the highest rates of new cancer incidents at 427 followed closely by Montgomery County at 424. In Harris County in 2022, there were 409 cancer case reported for every 100,000 residents and that rate was 383 in Fort Bend County during the same year.

Cancer clusters

A “cancer cluster” refers to a greater than expected number of cancer cases that occur within a group of people in a geographic area over a defined period of time, according to the CDC. In 2019, the Texas Department of State Health Services (DSHS) identified a cluster of lung and throat cancers among adults between 2000 and 2016 in the communities of Fifth Ward and Kashmere Gardens in North East Houston. In an analysis one year later, an additional cancer cluster was found in the same neighborhoods when children were diagnosed with leukemia at five times the state rate during the same time period. A study conducted by the U.S. Environmental Protection Agency (EPA) found that dioxins, a highly toxic cancer-causing compound, were present in soil around these communities. The EPA has developed a website to provide ongoing information on actions being taken to address this soil contamination.

Life spans in the Houston region slightly decline

Life expectancy is a reflection of the mortality patterns of a population and is a common measure used to describe overall public health across different communities. It refers to the average number of years one person can expect to live (from a specified age) based on the age-specific mortality rates of the population.

Across the country, life expectancy from birth has increased by decades over the past 120 years. The greatest improvements occurred in the first half of the 20th century. Since then, life expectancy has steadily and consistently increased, though at a slower rate. Until the COVID-19 pandemic.

Life expectancy in the U.S. fell to 77.0 years in 2020 from 78.8 in 2019. This reduction of 1.8 years of life was the largest single-year decline in more than 75 years. In addition to COVID-19, the decline was also attributed to the increase in deaths from unintentional injuries, heart disease, homicide, and diabetes.

Additionally, U.S. life expectancy fell from 77.0 in 2020 to 76.4 in 2021, then recovered to  78.4 by 2023 — nearly matching pre-pandemic levels of 78.8 in 2019.

While life expectancy has grown for both Black and white Americans, a gap between the two groups remains. In 1900, the gap was nearly 15 years, but that has narrowed to 4.5 years in 2023.

What are life spans like for the population in Houston? Overall, residents in Houston’s three-county area live slightly longer than the state average (76.7). Across the three counties, the life expectancy for residents of Fort Bend County (81.4) is higher than that of Harris (77.9) and Montgomery (78.6) counties. Similar to national trends, Texas and the Houston region did also see decreases in life expectancy during the COVID-19 pandemic with the largest decrease of 1.7 years of life happening across the state of Texas.

Disparities in life expectancy among race/ethnicity continue in the Houston three-county region and they have widened over time. During the 2016-18 years, the life expectancy gap between white and Black residents in Fort Bend and Montgomery counties was about 1 year. As of the 2021-23 years it has risen to over 2 years with white residents expected to live about 2.5 years longer than Black residents. In Harris County, where this disparity is widest it increased from 4.3 years to 4.9 years between 2016-18 to 2021-23.

How long we live depends on a variety of interrelated factors, including genetics, access to high-quality medical care, and quality of nutrition. More significantly, however, is the fact that established research has found direct links among health, economic opportunity, race, and place, both nationally and locally.¹² Put another way, differences in life expectancy are closely related to socioeconomic opportunity, which is why we see disparities in life span across race/ethnicity, income level, and place.

It is also worth noting that Hispanic residents in the region average longer lifespans than white residents by three to six years, despite the fact that Hispanics tend to have greater economic insecurity and uninsured rates, a national phenomenon known as the “Hispanic paradox” or the “Latino Mortality Advantage.”¹³ While more research is necessary, research suggests the counter-intuitive outcome can be attributed to lower smoking rates, family structure and strong social networks among Latinos.¹⁴ However, some research also suggests this advantage could disappear as the prevalence of obesity and diabetes increases among Latinos.¹⁵

And we may already begin to be seeing this happen given that the life expectancy gap between Hispanic and white residents has begun to shrink mostly driven by a decrease in life expectancy for the Hispanic population. The life expectancy for Hispanic residents in the Houston region decreased by about 5 years between 2016-18 and 2021-23. In comparison, the life expectancy for white residents decreased by about 2 years.

Comparing life expectancy to income reveals the extent to which higher income is associated with greater longevity. Nationally, research has shown that the richest men live 15 years longer than the poorest men, while the gaps in lifespan between the richest women and the poorest women is 10 years.¹⁶

Further, life expectancies vary depending on where one lives within the three-county area — by as much as 23.4 years. Residents in a high-poverty East Houston neighborhood have the lowest life expectancy in the three-county area (65.7 years). On the other side of the spectrum, a wealthy neighborhood in the Clear Lake area near Bay Oaks Country Club has the longest life span of 89.1 years. This gap between low-income areas and their high-income counterparts is almost equivalent to the difference between low-income developing countries and high-income developed countries.

Continue reading about health in Houston, including mental health and access to health care

Total deaths in the Houston region have decreased in recent years but remain about pre-pandemic levels

There were more than 3.0 million deaths in the U.S. in 2023, a decrease of nearly 200,000 from 2022. The death rate (age-adjusted), which measures the number of deaths per 100,000 people, decreased for all age groups 5 years and older — the death rates for children under 5 did not significantly change from 2022 to 2023.

The rate of total deaths in the Houston region mirrors what we see at the national level with a decrease in 2020 and 2021 and then decreases throughout 2022 and 2023. However, the number of deaths that occurred in 2023 is still higher than the number of deaths that occurred pre-pandemic in 2019. The number of annual deaths in 2023 compared to 2019 is 27% higher in Fort Bend County, 21% higher in Montgomery County, and 13% higher in Harris County.

The Houston region’s premature death rates increase

Premature death measures 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 CDC, the leading causes of premature death that occurred before the age of 80 in the United States between 2010 and 2022 were  heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Non-Medical drivers such as poverty, lower educational attainment and social isolation contribute to premature death.¹⁷ Populations at high risk for premature death include people with obesity or diabetes, individuals who drink excessively or smoke, and those who face occupational and environmental hazards.¹⁸ Many of these premature deaths may be preventable by changing lifestyles, maintaining healthy behaviors, and increased access to health care.

Overall, the rate of premature deaths in the Houston region increased between 2016-18 and 2021-23—19% in Fort Bend County, 22% in Harris County, and 14% in Montgomery County. The premature death rate has also increased for all racial/ethnic groups with Hispanic residents in each county experiencing the largest increase between 2016-18 and 2021-23 increasing by 32% in Fort Bend County, 41% in Harris County, and 25% in Montgomery County. Fort Bend County has the lowest premature death rate in the three-county region (261 premature deaths per 100,000 residents) while Harris County has the highest (347 deaths per 100,000 residents). Across all three counties, Black residents experience the highest rate of premature deaths.

Heart disease and cancer cause nearly half of all deaths in the region and nation

In 2023, the top 10 leading causes of death in the U.S. were heart disease, cancer, chronic lower respiratory diseases, stroke, accidents (unintentional injuries), Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide. Cumulatively, these diseases accounted for 60% of all deaths.

The top 10 leading causes of death in Texas are slightly different from the nation as a whole. While heart disease and cancer   were the top two leading causes of death in both the U.S. and Texas in 2023, the remaining causes of death in Texas varied slightly. Accidents (unintentional injuries), stroke, Alzheimer’s disease, chronic lower respiratory diseases, diabetes, liver disease, kidney disease, and suicide make up the remainder of the top 10 list in 2023 for Texas in descending order.

What are the most significant health issues in Houston? In 2023, the top 10 leading causes of death in the Houston three-county area were heart disease (21%), cancer (20%), accidents (8%), stroke (5%), Alzheimer disease (3%), chronic lower respiratory diseases (3%), diabetes (3%), kidney disease (2%), liver disease (2%), and blood infections (2%). There are slight differences by county.

Suicide is the 11^th leading causes of death in the Houston three-county region. In 2023, 2% of deaths in all three counties were the result of suicide — double what we see at the national level.

Helpful Articles by Understanding Houston:

• Examining the Effects of Environmental Inequity in Houston
• Exploring the Legacy of Redlining in Houston
• The 21-Year Gap
• Children’s Mental Health in the Context of the COVID-19 Pandemic
• A Deep Dive into Domestic Violence in Texas and Houston