Death by ZIP code: In Shelby County, life expectancy varies up to 13 years depending on where you live

Durrell Brown fears he's destined to die young.

At age 49, the security guard living in South Memphis already has spent a decade battling diabetes, the result, he says, of "not eating right." Nutritious food isn't easy to come by, after all, in a neighborhood that's not close to any grocery stores.

Brown also lacks ready access to health care. He has no insurance and can't afford to go the doctor, relying instead on visits to the emergency room at Regional Medical Center when illness strikes.

"I worry about it a lot," Brown says of his long-term health prospects.

Statistically, Brown's concerns are justified based just on where he lives: ZIP code 38106.

Studies by Health Department officials found that residents in 38106 and neighboring 38126 -- a swath of South Memphis stretching from Beale Street to Nonconnah Creek containing nearly 35,000 people -- were living an average of just 69.01 years as of 2015. That's the lowest life-expectancy of any area in Shelby County and more than 13 years below the 82.59-year average lifespan in the healthiest ZIP code, 38017, which encompasses Collierville.

In the starkest of terms, the life-expectancy numbers illustrate the vast disparities in health care and health conditions within Greater Memphis. Although a mere 20 miles separate South Memphis and Collierville, the gap between them, in terms of their life-expectancy rates, is akin to the difference between Cambodia and Norway.

"Your ZIP code determines your health outcomes more than your genetic code," said Dr. Scott Morris, founder and CEO of Church Health.

The variation in life expectancy locally mirrors a nationwide trend, one so pervasive that some researchers call it "death by ZIP code."

A study published by the Journal of the American Medical Association network last year surveyed mortality data nationwide from 1980 to 2014 and concluded that inequities in life-expectancy rates from county to county are "large and growing." Among other causes, they blame socioeconomic factors, differences in metabolic-disease risks among ethnic groups and behavioral issues.

For Shelby County as a whole, the life-expectancy rate in 2013 was 76.2 years compared to the 76.3 figure for all of Tennessee. More than 8,000 people a year die in the county, with heart disease and cancer accounting for nearly half of those deaths.

But Health Department officials several years ago began to delve deeper into the numbers to get a more localized look.

'Meaningful' differences within county

"If you just ran numbers for the county as a whole, we're about average for the state of Tennessee," said David Sweat, chief of epidemiology and infectious diseases at the Health Department.

"We had a sense that didn't tell the whole story. That single measure can mask differences that are meaningful."

Sweat said he expected significant variations in the life-expectancy figures, but he added, "I was a little surprised by the magnitude."

What the data showed, in general, was a progression of lower to higher life-expectancy rates from the west to east ends of the county, except for parts of Downtown and Midtown.

In North Memphis, Frayser, South Memphis and Southwest Memphis, residents live an average 69 to 71.5 years, while in an area from Mud Island to Hickory Hill the life expectancy is from 71.6 to 75.3 years, compared to 75.34 to 79.2 in places like Millington and Southeast Shelby County. East Memphis, Cordova, Arlington, Germantown and Collierville had rates between 79.22 and 82.59 years.

Not surprisingly, the pattern that emerged most clearly was a correlation between economic conditions and life expectancy.

In addition to suffering poverty rates of 42 and 60 percent, respectively, ZIP codes 38106 and 38126 have by far the highest "economic hardship index," a measure that also considers unemployment, low education levels and crowded housing, according to the Health Department. Collierville and Bartlett had the lowest economic hardship score.

"It's the most important predictor of health status. If we want to improve overall health, one thing we have to do is improve overall economic well-being," Sweat said.

"The best public health intervention that was ever invented was a job."

The high cost of maintaining health

Residents of poverty-stricken neighborhoods typically have poor access to health care. In 38106 and 38126, some 28 percent and 22 percent, respectively, of adults aged 18-64 had no health insurance in 2016, census figures show.

As a result, many simply endure illnesses and neglect their health, community leaders say.

"You have people working two or three jobs, but they still don't have health insurance or excess funds to deal with medical issues, so medical issues get pushed to the back-burner," said Reginald Porter, pastor of Metropolitan Baptist Church, located on Walker in 38126.

"It is very real that people have to choose between paying the light bill, paying the rent, buying shoes for the kids or buying some medicine. More often than not, it's the prescription that gets left at the pharmacy."

There are few pharmacies or health-care providers in either of the two South Memphis ZIP codes. A major provider is Memphis Health Center, which has its main offices at 360 E.H. Crump and serves 17,000 patients annually. Some 45 percent of its $11 million budget is federally funded.

The patient case load at Memphis Health offers telling insights into health conditions in 38106 and 38126. Chief Financial Officer and Chief Operating Officer Don Holloman said in an email that 25 percent of the people treated there suffer from hypertension, 20 percent are obese and 10 percent have diabetes. All three chronic conditions are virtually epidemic in South Memphis.

"There's a much higher rate of chronic disease by ZIP code, much of it related to a lack of food -- appropriate food, healthy food -- and activity," said Renee Frazier, CEO emeritus of the Common Table Health Alliance, a non-profit group that works with community partners to improve health in the Memphis area.

Area described as a 'food desert'

The recent closings of two Kroger stores in neighboring ZIP codes served to exacerbate the scarcity of fresh produce and other nutritious food in 38106 and 38126. Despite the numerous corner markets and convenience stores can be found there, South Memphis has the classic hallmarks of a "food desert," community leaders say.

"There's not a shortage of stores. But if you want an apple, grapes or anything green, you won't find it," said Devin Marzette, store manager at the South Memphis Farmers Market, which does offer some produce.

Among the few real grocery stores within the area is Gordin's Butcher Shoppe on Bellevue near McLemore. Store manager Richard Conner said Gordin's gets a lot of "walk-up customers" because so many people have no access to a car.

Several groups are working to bring nutritious food to the area. Knowledge Quest, for instance, has been operating the Green Leaf Learning Farm on Jennette Place to provide fresh produce and teach residents how to grow gardens. Farm manager Theo Davies said he hopes the operation will attract more customers and involvement from the surrounding neighborhoods.

"It's not as big as we'd like it to be," Davies said.

It's not just a lack of health care, nutritious food and opportunities for exercise producing early deaths in ZIP codes like 38106 and 38126. Studies published by the American Medical Association and others have focused on the stress experienced by low-income residents struggling to pay bills and avoid crime.

Stress releases cortisol, a hormone that increases inflammation, hypertension and insulin resistance while suppressing immune response.

Tobacco use, crime also are problems

Stress also could contribute to unhealthy habits in 38108 and 38126. By examining state tax data on tobacco sales, Health Department officials determined that the two ZIP codes have by far the heaviest concentration of cigarette smokers of any area of the county.

About 50 percent of adults there smoke a pack a day -- more than twice the percentage of smokers in most other ZIP codes, according to the department's estimates. And adult per-capita spending on tobacco in 38106 and 38126 is several times higher than in places like Collierville.

Sweat said the heavy tobacco use isn't surprising.

"First of all, nicotine is a drug, and it's a drug that helps people cope," he said.

As Mike Rockett, 56, emerged from a market on McLemore after buying cigarettes on a recent afternoon, he recalled smelling the smoke from his father's unfiltered cigarettes as a child.

"It's a habit I picked up from my dad," Rockett said. "He quit, but I didn't."

As if the other health hazards weren't enough, residents in 38106 and 38126 face threats from the high level of violent crime in the area. During just a eight-month period from February through September last year, there were at least 13 homicides in the two ZIP Codes, according to a "homicide tracker" compiled by The Commercial Appeal.

Countywide, homicides were the fourth-leading cause of premature death in 2016, according to Tennessee Department of Health figures.

"I've seen a high number of homicides," said Richard Flowers, funeral director at R.S. Lewis and Sons Funeral Home on Vance in 38126.

For all the problems in South Memphis, community leaders and health officials have launched several initiatives that could narrow the life-expectancy gap between it and other parts of the county. Outreach programs by Le Bonheur Children's Hospital and initiatives such as the Healthier Tennessee Neighborhoods effort are aimed at reducing problems ranging from obesity to tobacco use.

However, Frazier, with the Common Table Health Alliance, said, more must be done to assist people "who don't have access to the basics."

Reach Tom Charlier at thomas.charlier@commercialappeal.com or 901-529-2572 and on Twitter at @thomasrcharlier.