Census 2000 counted 140 million females, 51% of the U.S. population, of whom 40 million are members of racial or ethnic minority groups.25 By 2050, it is projected that just under half of females in the United States will be members of racial or ethnic minority groups.26 The ratio of males to females is highest at birth, when male infants outnumber female infants, and gradually declines with age due to higher male mortality rates. Among Americans 85 and older, women outnumber men by more than 2 to 1.27 Poverty disproportionately affects women; almost 13 million women lived in households with incomes below the Federal poverty level in 2001.28
Women in the United States have a life expectancy 5 years longer than men29 and lower age-adjusted death rates than men for 13 of the 15 leading causes of death.30 However, women are more likely than men to report having arthritis, asthma, autoimmune diseases, and depression.31 Overall, many women's health needs are inadequately addressed.32 Among women, racial and ethnic differences in mortality and health status are observed. Black women have higher death rates than White women due to heart disease, cancer, and stroke while Hispanic, API, and AI/AN women have lower death rates due to these conditions.31 Black and Hispanic women are also more likely to report fair or poor overall health and having diabetes. Poor or near poor women are more likely to report fair or poor overall health; limitations of activity; and having anxiety or depression, arthritis, asthma, diabetes, hypertension, obesity, and osteoporosis.33
In general, gender differences in quality of care are small. However, significant gender differences in cardiovascular care have been demonstrated. Among women, racial, ethnic, and socioeconomic differences in quality of care exist. Racial and ethnic differences are noted in receipt of cardiovascular procedures, cancer screening, and management of fibroids.34 Socioeconomic differences are noted in receipt of Pap tests and mammograms.35 Women are more likely to obtain preventive services than men.31
Among women, racial, ethnic, and socioeconomic differences in access to care are observed. Black women are more likely than White women to report forgoing needed physician care; and Hispanic women are more likely than non-Hispanic White women to report lack of health insurance and coverage for dental and vision care, not having a regular health care provider, not seeing a specialist when needed, and problems communicating with physicians.36 Poor and near poor women are more likely than high income women to report lack of health insurance, dissatisfaction with their health plan when insured, and not having a usual source of care.35
Many measures of relevance to women are tracked in the NHDR. Findings presented here highlight six quality measures and one access measure of particular importance to women:
| Component of health care need: | Measure: |
|---|---|
| Prevention | Osteoporosis screening, dental care |
| Treatment | Hospital care for heart attack |
| Management | Recommended services for diabetes |
| Maternal health | Prenatal care |
| Patient safety | Obstetric trauma |
| Access to care | Uninsurance |
Additionally this year, the section on cancer in Chapter 2 focuses on breast cancer prevention.