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Women's Health USA 2004
Health Resources and Services Administration
U.S. Department of Health and Human Services
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Women's Health USA 2004Health Resources and Services Administration |
Table of Contents | Preface | Introduction | Chapter 1 | Chapter 2 | Chapter 3 | Indicators in Previous Editions | References | Contributors
In this Chapter:
Health Behaviors
Physical
Activity | Cigarette Smoking | Alcohol
Misuse | Illicit Drug Use
Health Indicators
Self-Reported
Health Status | Activity Limitations | AIDS | Arthritis | Asthma | Cancer | Diabetes | Eating
Disorders | Heart Disease | Hypertension | Injury| Leading
Causing of Death | Mental Illness and Suicide | Oral
Health | Osteoporosis | Overweight
and Obesity | Sexually
Transmitted Diseases | Violence and Abuse
Maternal Health
Prenatal
Care | Live
Births | Breastfeeding | Maternal
Morbidity and Mortality
Special Populations
Immigrant
Women | Border
Health | Incarcerated Women | Services
for Homeless Women | Rural
and Urban Health | American Indian/Alaska Native Women | Older
Women
The systematic assessment of women’s health status enables health professionals and policy makers to determine the impact of past and current health interventions and the need for new programs. Trends in health status help to identify new issues as they emerge.
In the following section, health status indicators are presented related to mortality, morbidity, health behaviors, and reproductive health. Issues pertinent to selected populations of women, including older, immigrant, rural and incarcerated women are also addressed. The data are displayed by sex, age, and race and ethnicity, where available. Many of the conditions discussed, such as cancer, heart disease, and hypertension, have an important genetic risk component. Although the full impact of genetic risk factors on many of these conditions is still being studied, it is vital for women to be aware of their family history so that their risk for developing such conditions can be properly assessed.
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Regular, moderate to vigorous physical activity can help to improve health and well-being. Lack of physical activity has been associated with many serious risk factors and health conditions, such as obesity, hypertension, heart disease, osteoporosis, diabetes, and cancer.
In 2002, women of all ages were less likely to report engaging in regular physical activity than men. The largest differences were observed among the youngest and oldest segments of the population. At 18 to 24 years, 44.8 percent of men reported regular physical activity compared to 33.6 percent of women; among those aged 75 and older, 23.5 percent of men compared to 12.3 percent of women reported regular activity. With increased age, rates of self-reported physical activity continually decreased among both men and women.
Rates of regular physical activity among women varied by race and ethnicity as well. Compared to all other racial and ethnic groups, non-Hispanic White women were the most likely to report regular physical activity (31.3 percent), more than 1.5 times that of Hispanic and non-Hispanic Black women.
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Cigarette smoking is associated with numerous chronic illnesses and premature death. The percentage of females who smoke has remained steady over the last several years at slightly more than 20 percent of females aged 12 and older.1 In 2002, 23.4 percent of females aged 12 and older reported smoking cigarettes within the past month. Among adolescents aged 12-17, slightly more females than males reported smoking in the past month (13.6 percent versus 12.3 percent). However, women aged 18 years and older were less likely than men of the same age to have smoked in the previous month.
In 2002, 17.3 percent of pregnant women aged 15 to 44 smoked cigarettes in the past month compared with 31.1 percent of non-pregnant women of the same age group. Among females who were not pregnant, American Indian/Alaska Native women were most likely to smoke cigarettes, followed by non-Hispanic White women. Although the prevalence of smoking was lower among pregnant women in all racial and ethnic groups, non-Hispanic White women were four times as likely to smoke during pregnancy than Hispanic women. Maternal smoking during pregnancy is associated with ectopic pregnancies, miscarriages, newborn low birth weight, and infant mortality.
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In 2002, 22.9 percent of the U.S. population aged 12 years and older reported binge alcohol use, which is defined as having five or more drinks on the same occasion at least once in the month prior to the survey. The rate of binge alcohol use among males was twice that of females (31.2 percent vs. 15.1 percent). Additionally, 3.0 percent of females and 10.8 percent of males 12 years and older reported heavy alcohol use in the past month, defined as having five or more drinks on the same occasion on five or more days within the month prior to the survey. After age 25, binge and heavy alcohol consumption declined signifi cantly for both males and females.
Alcohol misuse among women is highest for young adult women aged 18-25 years compared to their younger and older counterparts. Among women aged 18-25 years, 31.7 percent reported binge drinking and 8.7 reported heavy drinking in the past month.
Among women aged 15-44 years, alcohol misuse was significantly lower during pregnancy. Overall, 23.4 percent of non pregnant women and 3.1 percent of pregnant women reported binge drinking in the past month. Among non-pregnant women, American Indian/Alaska Native women were most likely to binge drink (35.0 percent) compared to other racial and ethnic groups; Asian women were the least likely to engage in binge drinking (9.9 percent). Drinking alcohol during pregnancy contributes to Fetal Alcohol Syndrome (FAS), infant low birth weight, and developmental delays in children.
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Because of their association with serious health consequences and addiction, marijuana/hashish, cocaine, inhalants, hallucinogens, heroin, and prescription-type psychotherapeutic drugs used for non-medical purposes are classified as illicit drugs in the U.S. In 2002, 21.9 percent of females aged 12-17 years and 31.6 percent of women aged 18-25 years had used some type of illicit drug within the past year. Marijuana/hashish was the illicit drug most commonly used by all females: over 15.2 percent of females aged 12-17 years, 25.7 percent of women aged 18-25 years, and 4.7 percent of women aged 26 years and older reported using marijuana in the past year. Inhalants were most likely to be used by females aged 12-17 years, whereas the use of cocaine and hallucinogens was highest among the 18- to 25-year-old age group. The use of all illicit substances decreases significantly among women aged 26 and older.
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In 2002, women and men aged 18 to 64 years old were more likely to report being in excellent or very good health than were adults aged 65 years and older. Among women, 64.6 percent of 18- to 64-year-olds reported excellent or very good health, compared to only 48.2 percent of women aged 65 years and older. Women aged 18 to 64 years were as likely to report fair or poor health (10.0 percent) as men of the same age (9.4 percent).
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Non-Hispanic Black and Hispanic women were most likely to report their health status as fair or poor (14.9 and 13.6 percent, respectively). In contrast, non-Hispanic women of other races (including Asian/Pacific Islanders, American Indian/Alaska Natives, and persons of more than one race) were most likely to report their health status as excellent or very good (65.3 percent) followed by non-Hispanic White women (62.9 percent).
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With age, women are more likely to report being limited in their activities due to a physical or mental/emotional problem. In 2002, the percentage of women aged 75 and older reporting activity limitations (33.2 percent) was more than three times that of younger women aged 18-44 years (9.8 percent).
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The four most frequently reported causes of activity limitations among women were arthritis or rheumatism (24.8 percent), back/neck problems (21.0 percent), heart problems (15.1 percent), and hypertension (12.1 percent). Poor mental health was also implicated as a cause of activity limitation, with 11.6 percent of women reporting that their activities were limited by depression, anxiety, or an emotional problem.
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Acquired Immunodeficiency Syndrome (AIDS) was primarily diagnosed in men in the early 1980s, but the disease has since become more prevalent among women. In 1988, 7,504 AIDS cases were reported among men compared to 524 among women. By 2002 the number of cases reported among women had grown to 11,279, an increase of 2,052 percent. Over the same period, the number of cases among men increased by 423 percent, to 32,513. The case definition for AIDS evolved between 1985 and 1993.2, 3, 4 In 1993, the definition of AIDS cases was expanded to include persons with severe immunosuppression, pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer. Such changes are partially responsible for the increased number of reported AIDS cases.
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Although the number of AIDS cases has increased among women in general, the epidemic has disproportionately affected some racial and ethnic groups. In 2002, non-Hispanic Black and Hispanic women represented less than one-fourth of all U.S. women, yet they accounted for more than three-fourths of women living with AIDS. In 1999, HIV/AIDS was the fifth leading cause of death among women aged 25-44 years in the U.S., but it was the third leading cause of death among non-Hispanic Black women of the same age.5
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Of the 11,279 reported AIDS cases among women in 2002, 42 percent were infected through heterosexual contact. Of these women, more than three-fourths were exposed through sex with an HIV-infected person without a specified risk, while just under one-fourth were exposed through sex with an injection drug user. Of all reported cases in 2002, another 21 percent were infected through their own injection drug use. One percent of women were infected by receipt of blood components or tissue, and less than one percent were exposed due to hemophilia or another coagulation disorder. Another 36 percent of women were exposed through a risk that was not reported or identified.
Within each racial and ethnic group, heterosexual contact represented the source of approximately 40 percent of AIDS cases in women reported in 2002. However, injecting drug use was the source of 30 percent of cases among non-Hispanic White women, compared to 19 percent in non-Hispanic Blacks and 20 percent in Hispanics.
Overall, between 1998 and 2002 the number of women dying of AIDS has remained steady and the number of newly reported cases has risen only slightly. The number of reported cases is potentially misleading since it does not indicate when a person was infected. In contrast, the number of women living with AIDS rose dramatically (from 57,338 to 82,764) between 1998 and 2002, due in large part to recent advances in combination drug therapies that help people with AIDS live longer.
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Arthritis is an inflammatory disease that may cause pain, stiffness and/or swelling of the joints, ligaments, muscles, bones, tendons, and some internal organs. This disease is the leading cause of disability in the U.S. for both men and women.
Rates of arthritis increase with age among both men and women. However, women had higher rates of arthritis than men overall and at all ages. Rates of arthritis also varied by race and ethnicity, with non-Hispanic White women reporting more than twice the rate of non-Hispanic women of other races. The high rate in non-Hispanic White women may be due to the older age distribution of this population.
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Asthma is a chronic inflammatory disorder of the airways characterized by episodes of wheezing, chest tightness, shortness of breath, and coughing. This disorder may be aggravated by allergens, tobacco smoke and other irritants, exercise, and infections of the respiratory tract. By taking certain precautions, however, persons with asthma may be able to effectively manage this disorder and participate in activities of daily living.
In 2002, women had higher rates of asthma than men. This disparity was most pronounced among women younger than 65, who experienced asthma at nearly twice the rate of men the same age. Between ages 65 and 74, the asthma rate among women was 64 percent higher than that of men, and after age 74, the disparity in asthma rates between men and women was narrower.
Among women in 2002, rates of asthma also differed among racial and ethnic groups. Non-Hispanic Black and non-Hispanic White women had the highest rates of asthma per 1,000 women (105.6 and 86.6, respectively), followed by women of other races (70.4) and Hispanic women (51.6).
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In 2004, it is estimated that 272,800 females will die of cancer. Of these deaths, it is estimated that 25 percent will be due to lung/bronchus cancer, 15 percent due to breast cancer, and 10 percent due to colon and rectal cancer.
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Rates of newly diagnosed cancers are tracked by the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program. According to SEER data from 1992 to 2000, age-adjusted rates of new cases of malignant lung and bronchus cancer among all females have remained statistically unchanged (48.8 per 100,000 females in 1992 and 47.2 per 100,000 females in 2000). For American Indian/Alaska Native females, rates of lung and bronchus cancer declined from 1992 to 2000. In 2000, Black and White females had the highest rates of lung/ bronchus cancer (53.6 and 49.2 per 100,000, respectively) followed by Asian/Pacific Islander, Hispanic, and American Indian/Alaska Native females. Despite the low incidence rates of lung/bronchus cancer among American Indian/Alaska Native females, cancer is the second leading cause of death for this group.6
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From 1992 to 2000, age-adjusted rates of malignant breast cancer increased among all females. During this same time period, rates among American Indian/Alaska Native women declined from a high of 63.8 in 1992 to a low of 35.3 per 100,000 females in 2000; rates among Black females remained stable. In 2000, Black and White females had the highest rates of malignant breast cancer (139.1 and 119.8 per 100,000 females, respectively).
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From 1992-2000, rates of newly diagnosed malignant colon and rectal cancer remained stable for all females and all racial and ethnic groups of females. In 2000, the highest rates of colon and rectal cancer were among Black (56.5 per 100,000 females) and White (44.8 per 100,000 females) females; the lowest rates were among American Indian/Alaska Native females (10.4 per 100,000 females).
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Although mortality rates are the highest among females with lung/bronchus cancer, in 2000, rates of new cases of malignant breast cancer among females (132.9 per 100,000) were nearly three times greater than rates of new cases of both lung/bronchus cancer (47.2 per 100,000) and colon/rectal cancer (45.3 per 100,000).
While the specific causes of cancer have not yet been identified, it appears to involve a combination of environmental, behavioral, and genetic factors. Adopting a healthy lifestyle by achieving optimal weight, exercising regularly, avoiding tobacco, eating nutritiously, and reducing sun exposure may significantly reduce the risk of cancer.7 In addition, regular cancer screenings specific to women are recommended. Pap smears are recommended after sexual activity begins, or at the age of 21, whichever comes first, to screen for cervical cancer. Mammograms are recommended for women aged 40 and older to screen for breast cancer; for persons aged 50 and older, fecal occult blood testing and sigmoidoscopy are recommended to screen for colorectal cancer.8
Diabetes is a chronic condition and a leading cause of death and disability in the United States. Complications of diabetes are serious and may include blindness, kidney damage, heart disease, stroke, nervous system disease, amputation, and pregnancy complications.
Diabetes can develop at any age. One of the two main types of diabetes, Type 1 diabetes, is usually first diagnosed in children, teenagers, or young adults, and accounts for 5 to 10 percent of all diagnosed cases of diabetes. Type 2 diabetes can develop at any age and accounts for about 90 to 95 percent of all diagnosed cases of diabetes; it is increasingly being diagnosed in children and adolescents. The risk for Type 2 diabetes is associated with obesity, physical inactivity, and family history of diabetes, and is more common among certain racial and ethnic groups.9
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In 2002, among women under the age of 44, the rate of diabetes was higher than that of men of the same age. This trend reverses after the age of 45, however, with the rate of diabetes for males exceeding females among all age groups. The rate of diabetes increases with age among both men and women. In fact, rates among women and 65 to 74 years were approximately four and seven times higher than those of women under the age of 45 years.
Racial and ethnic differences in diabetes rates were observed in 2002. For every 1,000 women, non-Hispanic Black women had the highest rate of diabetes (99.7) followed by Hispanic women (67.0), non-Hispanic White women (56.0), and non-Hispanic women of other races (42.7).
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Eating disorders are a source of significant public health concern for adolescent girls and young adult women. These disorders are distinguished by a disturbance in eating or weight-control behavior that often result in major impairment of physical health and psychosocial functioning.10 Among all the psychiatric disorders, the eating disorder anorexia nervosa is among the most life-threatening.
The classification of the eating disorders and their principal diagnostic criteria can be found in the Diagnostic and Statistical Manual (DSM-IV), 4th edition.11 Three categories of eating disorders are listed in DSM-IV: 1) anorexia nervosa, 2) bulimia nervosa, and 3) atypical eating disorders (or eating disorders not otherwise specified-EDNOS). Binge eating disorder is currently classified under the EDNOS category.
Anorexia nervosa and bulimia nervosa share some defining clinical characteristics, including an exaggeration of self-perceived shape and body weight, a fear of being fat, and body image dissatisfaction.10 In response to such perceptions, some individuals suffering from anorexia nervosa engage in self-starvation behavior while others engage in a cycle of both self-starvation and binge/purge behavior; as such, the diagnosis of anorexia is divided into two sub-types. Individuals with bulimia nervosa engage in a repetitive cycle of binge eating and purging behaviors, including self-induced vomiting, compulsive exercise, rigorous dieting or fasting periods, or laxative and diuretic abuse. Binge eating disorder is characterized by recurrent binge eating without the regular use of purging measures to counter the binge behaviors.
Evidence to date suggests that eating disorders are more common among females than among males, particularly adolescent females and young adult women in their teens and early twenties.11 A recent follow-up study to the National Heart, Lung, and Blood Institute’s Growth and Health Study examined rates of eating disorders in Black and White women ages 19 to 24. This study reported prevalence rates among White women similar to those of other studies, and found significant differences by race. No Black women were found to have had anorexia nervosa, and the odds of detecting bulimia nervosa in White women were six times that of Black women. The racial disparity in cases of binge eating disorder was narrower, with White women twice as likely as Black women to meet the criteria for this condition. Black women were also significantly less likely than White women to have received treatment for their eating disorders.
Heart disease remains the leading cause of death for women. Heart disease describes any disorder that prevents the heart from functioning normally. The most common cause of heart disease is coronary heart disease, in which the arteries of the heart slowly narrow, reducing blood flow. Risk factors include obesity, lack of physical activity, smoking, high cholesterol (low levels of high-density lipoprotein and high levels of low-density lipoprotein), hypertension, and older age.
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In 2002, men had a higher rate of heart disease than women. Comparing age groups, however, women under the age of 45 years had a higher rate than men (43.4 per 1,000 women compared to 36.5 per 1,000 men). Rates of heart disease increase substantially with age and are highest among persons aged 75 and older, underscoring the chronic nature of this disease.
Rates of heart disease among women differ substantially by race and ethnicity. The highest rates were reported among non Hispanic White women, with a rate nearly twice that of Hispanic women.
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Hypertension, also known as high blood pressure, is a risk factor for heart disease and stroke.
Hypertension is defined as a systolic pressure (during heartbeats) of 140 or higher, diastolic pressure (between heartbeats) of 90 or higher, or both. Overall, in 2002, women had higher rates of hypertension than men. Among those under the age of 75, however, the rates of hypertension among men and women were similar. In contrast, among older persons aged 75 and older, the rate of hypertension was higher among men than women.
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Similar to trends found in heart disease and diabetes, the rates of hypertension for both women and men increase with age. The rate of hypertension per 1,000 women consistently increases with age: the rates among women aged 65 and older are more than five times that of women aged 18-44.
The rate of hypertension was also found to vary widely among women of different racial and ethnic groups. Non-Hispanic Black women had the highest rates of hypertension (328.1 per 1,000 women), far higher than those of non-Hispanic White women (249.0), Hispanic women (183.8) or non-Hispanic women of other races (174.8).
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Blood pressure can be monitored through regular screening and controlled through weight loss; a diet low in saturated fat, cholesterol, and salt; and regular exercise.
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Although many injuries are preventable, in 2001, there were an estimated 39.4 million injury-related emergency department (ED) visits. Among females, nearly one third of injury-related ED visits were made by 25-44 year olds (31.5 percent), while fewer than 5 percent were made by older women (aged 65-74 years).
Overall, the rates of injury-related ED visits per year were 12.4 percent and 15.8 percent for females and males, respectively. Among females, the highest rates were among women 75 and older, whereas for males, the highest rates were among 15-24 year olds. The lowest rates of injury-related ED visits were among 65-74 year olds for both males and females. Between the ages of 45 and 74 years, rates were similar between the sexes, while among persons aged 75 and older, females had higher rates than males.
Falls are a leading cause of injury among women, especially among women aged 65 and older. Other injury causes commonly resulting in an ED visit include being struck by or against a person or object, motor vehicle accidents, overexertion, and cuts.12
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In 2001, there were over 1.2 million deaths among females. Of these deaths, more than half were attributed to diseases of the heart and malignant neoplasms (cancer), (361,047 and 266,694 deaths, respectively). Cerebrovascular diseases (stroke) accounted for 8.1 percent of all female deaths, followed by chronic lower respiratory diseases (5.1 percent).
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Crude death rates varied by race and ethnic group. Among non-Hispanic White, non-Hispanic Black, and Hispanic women, the leading cause of death was heart disease, with 298.4, 215.4, and 71.8 deaths per 100,000 females, respectively. In contrast, among Asian/Pacific Islander and American Indian women, the leading cause of death was malignant neoplasms (74.0 and 68.8 deaths per 100,000 females, respectively).
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In 2002, there were an estimated 17.5 million adults aged 18 years or older with serious mental illness (SMI).13 Females were disproportionately affected and were more likely than males to report a serious mental illness within the past 12 months. Among those aged 26-49 years and aged 50 years or older, women were nearly twice as likely as men to have experienced a serious mental illness.
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Although the majority of people who suffer from a mental illness do not die by suicide, mental illness is a primary risk factor. Over 90 percent of suicides in the U.S. are associated with mental illness and/or alcohol and substance abuse.14 In 2001, the rate of suicide continued to be substantially higher for males (17.6 per 100,000 males) than for females (4.1 per 100,000 females). It was estimated, however, that there were three female suicide attempts for every one male suicide attempt. Among females whose suicide attempts resulted in death, the rates per 100,000 females were highest among American Indian/Alaska Native females (6.2), closely followed by non-Hispanic White females (6.1). Lower rates were found among Asian/Pacific Islander females (3.5), non-Hispanic Black females (2.3), and Hispanic females (2.1).
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Oral health conditions can cause chronic pain of the mouth and face and can disrupt normal eating behaviors. Certain oral health diseases are indicative of other health problems, and influence the development and management of chronic conditions such as cardiovascular disease and diabetes.15 Among women, hormonal changes during puberty and pregnancy may contribute to the development of gingivitis, and bone density loss later in life can lead to tooth loss.16 With good oral health practices, such as brushing teeth, flossing, and visiting the dentist regularly, dental disorders may be prevented.
One type of dental disorder, coronal caries (also referred to as cavities or tooth decay) may cause significant pain if untreated. In 1999-2000, rates of men and women with at least one untreated cavity were similar, with 12 percent of females and 13.1 percent of males affected. Sealants, a hard clear substance applied to the surfaces of teeth, may help to prevent caries. In 1999-2000, among persons aged 2 to 34 years, females were more likely to have sealants than males (19.7 and 14.2 percent, respectively).
Non-Hispanic White females were less likely to have untreated dental caries (9.5 percent) than non-Hispanic Black females (19.6 percent). Likewise, non-Hispanic Black females between the ages of 2 and 34 years were less likely to have sealants than non-Hispanic White females (13.1 and 22.6 percent, respectively). Among Hispanic females, 14.3 percent were found to have dental caries and 15.7 percent had sealants.
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Osteoporosis is characterized by low bone density and deterioration of bone tissue, leading to bone fragility and increasing the risk of fracture, especially of the hip, spine, and wrist. Ten million Americans have osteoporosis and another 34 million are at risk due to low bone mass. Eighty percent of those affected are women. Osteoporosis is responsible for more than 1.5 million fractures annually. One in two women over age 50 will have an osteoporosis-related fracture in her lifetime.17 Almost one in four (24 percent) individuals with a hip fracture die within a year.18
National data from 1999-2000 indicate that 3.1 percent of women under 65 have ever been told they have osteoporosis, compared to 9.6 percent of women aged 65-74 years and 23.7 percent of women aged 75 and older. Non-Hispanic White women over 20 years of age were four times as likely (6.9 percent) to have ever been told they have osteoporosis as non-Hispanic Black women (1.7 percent) and Mexican American women (1.7 percent).19 The number of women with osteoporosis and low bone mass is projected to increase by almost 40 percent over the next 20 years. Many women with osteoporosis and low bone mass are undiagnosed and untreated, leaving them at risk for fractures.
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Risk factors for osteoporosis include female sex, older age, small or thin body size, Caucasian and Asian race, and history of fractures.
Osteoporosis may be prevented and treated through a diet rich in calcium and vitamin D, weight-bearing exercise, no smoking or excessive alcohol intake, and medication when appropriate.
Being overweight or obese has been found to increase the risk of several conditions, such as high blood pressure, heart disease, diabetes, and stroke. Using self-reported measures of height and weight from the National Center for Health Statistics’ National Health Interview Survey (NHIS), a Body Mass Index (BMI) was calculated and used to assess overweight or obesity status. As these indicators are based on self-report, it is possible that these estimates may be low, as respondents may have understated their weight.
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In 2002, a smaller proportion of women than men were overweight or obese. However, this discrepancy was more pronounced in the "overweight" category, in which rates were 25 to 47 percent higher among men than women, than in the "obese" group, where rates among the two sexes were similar for most age groups. Among women, rates of overweight and obesity were highest among those aged 65-74 years. Differences were also observed among racial and ethnic groups. Non-Hispanic Black women had the highest rate of overweight and obesity (65.0 and 37.6 percent, respectively). The lowest rate of overweight (28.6 percent) and obesity (9.3 percent) was observed among Non-Hispanic women of other races.
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Rates of reported sexually transmitted diseases (STDs) are highest among adolescent and young adult women. In 2002, chlamydia was the most common such infection, followed by gonorrhea, with rates among adolescents (aged 15-19) of 2,626 cases of chlamydia per 100,000 females and 676 cases of gonorrhea per 100,000 females. The rates for both of these STDs decrease with age.
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Rates of chlamydia and gonorrhea were much higher among non-Hispanic Black women than among women in other racial and ethnic groups, with 1,638 and 688 cases per 100,000 women, respectively, as compared to 203 and 37 cases per 100,000 non Hispanic White females.
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A third STD, syphilis, remains relatively rare (1.1 cases per 100,000 women). In 2002, this condition disproportionately affected non-Hispanic Black females (6.5 per 100,000 females) and American Indian/Alaska Native females (2.2 per 100,000 females).
Although these conditions are treatable with antibiotics, STDs can have serious health consequences. Active infections can increase the likelihood of contracting HIV, and untreated STDs can lead to pelvic inflammatory disease, infertility, and adverse pregnancy outcomes.
In 2002, there were 2.5 million violent crimes committed against females aged 12 and older. Violent crimes include rape, sexual assault, robbery, and aggravated and simple assault. Women are more likely than men to be victims of violent acts committed by people they know, such as friends or intimate partners. In 2002, intimate partner violence constituted 20 percent of violent crime against women and 2.5 percent of violent crime against men. The overall rate of intimate partner violence against women was 4.2 per 1,000 women, but rates were highest among women aged 16-19 years and 20-24 years (13.4 and 9.5 per thousand women, respectively).
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Women are also the primary victims of reported sexual assault and rape. In 2002, of the 247,730 rapes and sexual assaults reported, women made up 87.2 percent of the victims. In addition, completed rape (86,290) was more likely to be reported than attempted rape (58,950) among females. The opposite was true for males where reports of attempted rape (18,520) were higher than completed rape (4,100).
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Prenatal care is an important factor in achieving a healthy pregnancy outcome. Beginning prenatal care in the first trimester can help to reduce the incidence of perinatal illness, disability, and death by providing health advice, and identifying and managing medical and psychosocial conditions and risk factors that can affect the health of the pregnant woman and her child. The percentage of mothers receiving prenatal care in their first trimester of pregnancy remained relatively steady between 2001 and 2002, rising only slightly from 83.4 percent to 83.7 percent. Overall this figure has risen 10 percent since 1990, when only 75.8 percent of women received first-trimester care. During this 12-year period, non-Hispanic White women had the smallest increase in early prenatal care utilization (5.4 percent) and Hispanic women had the largest increase (16.5 percent).
Although a positive trend was observed among most racial and ethnic groups, there is still great disparity among women with respect to entering care early in pregnancy. In 2002, 88.6 percent of non-Hispanic White women entered care in the first trimester, followed by 84.8 percent of Asian/Pacific Islander women, non-Hispanic Black women at 75.2 percent, Hispanic women at 76.7 percent, and American Indian/Alaska Native women at 69.8 percent. Approximately 40,000 women, or one percent of all women who gave birth in 2002, received no prenatal care, and an additional 2.6 percent did not begin care until their last trimester of pregnancy. Since 1990 the number of women receiving late or no care has dropped from 6.1 to 3.6 percent.
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There were just over 4 million births in the U.S. in 2002, which is approximately the same number as in 2001. While the total number of births remained steady, there were changes within several racial/ethnic categories. While births to non-Hispanic White and non-Hispanic Black women fell by 1 to 2 percent, Hispanic births rose by 3 percent and births to Asian/Pacific Islanders rose 5 percent. The 2002 birth rate of 13.9 births per 1,000 total population is the lowest on record since the data first became available in 1909.
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The birth rate among teenagers also reached a record low in 2002. The birth rate for teens aged 10 to 14 years dropped to 0.7 births per 1,000 females, and the rate for those aged 15 to 19 years dropped from 45.3 per 1,000 in 2001 to 43.0 in 2002. As with the total number of births, there were considerable differences in teenage birth rates by race and ethnicity. In 2002, birth rates for teenagers (under 20 years of age) ranged from 18.3 per 1,000 for Asian/Pacific Islander females to 68.3 per 1,000 for non-Hispanic Black females.
Of the 4 million babies born in 2002, 73.5 percent were born via vaginal delivery and 26.1 percent by cesarean (for the remainder, the method of delivery was unknown or not stated). Of the 26 percent of births performed by cesarean, nearly two-thirds were "primary" cesareans (i.e., the mother’s first) while the remainder were repeat cesareans. Almost all of the vaginal births were to mothers who had never had a cesarean; only a small percentage were to mothers who had experienced a cesarean previously. Methods of delivery do not vary greatly by race and ethnicity.
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Breastfeeding is believed to benefit the health, growth, immunity, and development of infants, and has been shown to improve maternal health as well. In the last 30 years, the prevalence of breastfeeding in the U.S. has fluctuated, increasing during the 1970s, decreasing in the 1980s, and again increasing in the 1990s. By 2002 breastfeeding in the hospital and at 6 months of age had reached record highs of 70.1 percent and 33.2 percent respectively. Black and Hispanic mothers, mothers under 24 years of age, WIC recipients, residents of the South Atlantic region, those with only grade school education, and mothers of low birth weight infants have all shown large increases in hospital breastfeeding rates.
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However, racial and ethnic and economic differences persist. Fifty-five percent of mothers with only a grade-school education breastfed in the hospital, compared to 81.2 percent of those with a college education. The rate of in-hospital breastfeeding among Asian women was 80.2 percent, while the rate for Black mothers was only 53.9 percent, and the rate for WIC participants was 58.8 percent compared to a rate of 79.2 percent among non-WIC participants. While breastfeeding rates for mothers employed full-time and for those who are not employed are identical in the hospital (69 percent), at six months full-time workers are less likely to breastfeed (27.1 percent) than those who are not employed (35.2 percent). Rates of breastfeeding at 6 months are much lower among women in all racial and ethnic groups: the greatest decrease is seen among Black women, whose breastfeeding rates dropped 64 percent between birth and 6 months.
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During pregnancy some women experience medical problems that can lead to serious complications and even maternal and infant mortality. In 2002, the most frequently reported medical risk factors in pregnancy were pregnancy-associated hypertension (reported in 37.8 women per 1,000 live births), gestational diabetes (32.8 per 1,000 live births), and anemia (25.7 per 1,000 live births). These have been the most common medical risks since such data became available from birth certificates in 1989. The risk of having a medical condition during pregnancy can vary by both maternal age, and race and ethnicity. For instance, the incidence of anemia among teenage mothers is greater than among mothers in their thirties (36 women per 1,000 live births versus 20 per 1,000 live births), while the incidence of diabetes among teenage mothers is far lower than among women 40 to 54 years of age (9 per 1,000 live births versus 76 per 1,000 live births). The racial and ethnic differences in medical risk factors include a greater incidence of anemia among American Indian/Alaska Native women than among non-Hispanic White women (56 per 1,000 live births versus 22 per 1,000 live births), and a greater incidence of pregnancy-related hypertension among American Indian/Alaska Native women than among Asian/Pacific Islander women (46.5 per 1,000 live births versus 20.8 per 1,000 live births).
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A total of 399 women died of maternal causes in 2001, for an overall rate of 9.9 per 100,000 live births. Maternal deaths are defined as those reported on the death certificate to be related to or aggravated by pregnancy or pregnancy management that occur within 42 days after the end of the pregnancy. Analysis of maternal mortality rates by race and ethnicity shows that non Hispanic Black women are nearly four times as likely to die of pregnancy-related causes as non-Hispanic White women (24.7 maternal deaths per 100,000 live births compared to 6.5 per 100,000 live births). The rate of maternal mortality has risen in recent years among both Black and White women.
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The immigrant population, especially non-citizens and newly arrived persons, face both language and cultural barriers to accessing health care services. In March of 2002, of the estimated 14.7 million foreign-born women aged 18 years and older residing in the U.S., 58.0 percent were non-citizens.21
In 2002, women without citizenship were more likely to lack both a usual source of care (18.5 percent) and health insurance (42.4 percent) when compared to naturalized citizens or U.S.-born women. Among foreign-born women, the percentage of women without health insurance decreased with increasing length of time in the U.S., although not consistently for all racial and ethnic groups. The highest rates of uninsurance were reported among Hispanic (64.5 percent) and non-Hispanic Black women (63.0 percent) in the U.S. for less than five years. After 15 years or more in the U.S., Asian and non-Hispanic White women were the least likely to be uninsured (9.7 percent and 10.8 percent, respectively).
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Women along the U.S. side of the U.S.-Mexico border - within 100 kilometers, or 62 miles, of the border - face many health disparities in comparison to their counterparts in the rest of the Nation. Along the approximately 2,000-mile border, the composition of the female population differs from the general U.S. female population. In 2000, in the border region, Hispanic females were the largest racial/ethnic group (49.5 percent) followed by non-Hispanic White females (40.1 percent), and females of other races (10.4 percent). In contrast, non-Hispanic Whites represent the majority of females in the U.S. (68.3 percent), with Hispanic females representing 13.1 percent. The diverse population along the border creates unique challenges when addressing health disparities; in addition to increasing access to health services, services must be made available in a culturally and linguistically appropriate manner.
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In 2000, women in the U.S. border region averaged 2.5 children during reproductive years, greater than the U.S. national average of 2.1. Despite the higher birth rate in this region, only 73 percent of women who gave birth received prenatal care during the first trimester, and only 64 percent received adequate care with regard to timing and number of prenatal visits.22
In 2000, women living in the border region had breast cancer death rates similar to the entire U.S. female population (27.2 and 27.1 per 100,000 females). Cervical cancer death rates were 3.7 per 100,000 females and 2.8 per 100,000 females along the border region and entire U.S., respectively. With early detection through regular mammography and Pap smear tests, breast self-examination, and adoption of healthy behaviors, many of these deaths could be prevented.
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In 2002, the number of incarcerated women continued to increase, reaching 165,800 at midyear. This number has nearly doubled since 1990, when 83,253 women were housed in Federal and State prisons and local jails. The rate of incarceration among women is far lower than among men, with 113 inmates per 100,000 females compared to 1,309 inmates per 100,000 males. However, since 1995 the annual rate of growth in the inmate population has averaged 5.4 percent for women and 3.6 percent for men.23
Racial and ethnic differences exist in incarceration rates among women. The highest rate of incarceration is among non-Hispanic Black women aged 30-34 years, with a rate of 1,024 inmates per 100,000 non-Hispanic Black women. Among non-Hispanic White and Hispanic women the highest rates are also in the 30-34 year age bracket, with a rate of 366 per 100,000 Hispanic women and 213 per 100,000 non-Hispanic White women. The total rate for women aged 18 years and older is also highest among non-Hispanic Black women at 349 per 100,000 women, compared to 137 per 100,000 Hispanic women and 68 per 100,000 non-Hispanic White women.24
Mental illness is a significant health problem among female inmates. According to a 1998 report, 23.6 percent of female State inmates were mentally ill, followed by 22.7 percent of jail inmates, 21.7 percent of probationers, and 12.5 percent of Federal inmates. The highest rate of mental illness existed among non-Hispanic White women in State prisons, with 29 percent reported as having a mental health problem. Of these women, 37 percent aged 24 years or younger were mentally ill.25 HIV infection is also a notable health problem among the incarcerated population, with 2.9 percent of female State and Federal prison inmates reported to be infected with the virus in 2001. A greater percentage of women inmates are infected with HIV than men. Nine States reported that more than 5 percent of female inmates were infected, while only one State reported an infection rate of more than 5 percent in males.26
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While the majority of single homeless adults are men, most homeless adults with children are women.27 Women may be at risk of homelessness for a number of reasons, including mental health problems and substance abuse in addition to extreme poverty. Numerous studies have found that domestic violence is a major contributor to homelessness among women and their children, and that homeless women are disproportionately likely to have experienced violence or abuse at some time in their lives.28
It is difficult to get an accurate count of the homeless population at any given time, and no national surveys have been attempted since the mid-1990s. However, one way to describe the demographics of this population, if not its size, is to look at those who use specific services, such as emergency shelters and health care services targeted to homeless people.
The U.S. Census Bureau counted the number of people using emergency and transitional shelters on one night in 2000 as part of the 2000 Census. Of the 170,706 people counted, 38.6 percent were female, and two-thirds of the females were adults. About 40 percent of the women in these shelters were White, 40 percent were Black or African American, 2.5 percent were American Indian or Alaska Native, 8.9 percent were "other", and 4.4 percent named more than one race. In addition to their racial classification, 18.5 percent listed their ethnicity as Hispanic.
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HRSA’s Health Care for the Homeless program offers primary care and substance abuse treatment services to homeless people, provides referrals to inpatient care and mental health services, and conducts outreach to identify hard-to-reach homeless persons. In 2002, these clinics served more than 545,000 people, 34 percent of them adult women. Female users of Health Care for the Homeless programs were more likely than males to be young adults or elderly. The health problems most commonly seen in these clinics include hypertension, gastrointestinal problems, neurological disorders, arthritis, and substance abuse.
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In 2000, 59 million people, or approximately 21 percent of the population, lived in a rural area.29 Residents of rural areas tend to be older, poorer, less educated, have fewer health providers and live farther from health care resources than their metropolitan counterparts. These issues create special health concerns and barriers that can lead to poorer health. In 2002, women in non metropolitan areas were more likely than urban women to report having been diagnosed with hypertension (high blood pressure) and cancer, two diseases that seriously affect women’s health. In addition to the demographic and health access issues listed above, rural women are typically diagnosed with cancer in later stages of the disease than urban residents, decreasing their likelihood of survival.30 Rates of heart disease, however, were similar among woman in metropolitan and non-metropolitan areas.
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Health behaviors, such as low levels of physical activity, smoking, and heavy drinking may contribute to poor health status; however, the percentage of women reporting regular physical activity or current heavy drinking did not significantly differ between metropolitan and non-metropolitan areas. Although women in non-metropolitan areas were slightly more likely to smoke than metropolitan women, the higher rates of hypertension and cancer may be attributed to the older age distribution of rural women, as well as the access, transportation, and provider supply barriers that rural women face.
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According to the U.S. Census Bureau, in 2002 there were almost 3.5 million American Indian/Alaska Natives (AI/AN) in the U.S., and approximately 52 percent were female. In general, younger age groups are more heavily represented in the AI/AN population than among the general population.
According to the Indian Health Service, age-adjusted death rates among the AI/AN population are much higher than among the general U.S. population, both overall and for a number of individual health conditions. In 1994-1996, the total death rate for the AI/AN population was 699.3 per 100,000, compared to 503.9 per 100,000 among the general population. For individual causes, the rate of alcohol-related deaths was 627 percent greater, the rate of deaths from tuberculosis was 533 percent greater, and the rate of diabetes-related deaths was 249 percent greater than among the general U.S. population.31
Among AI/AN women, the leading cause of death in 2001 was diseases of the heart, followed by malignant neoplasms, unintentional injuries, cerebrovascular diseases, and diabetes mellitus. In 2000, the rate of diagnosed cases of malignant breast cancer among AI/AN women was 35.3 per 100,000 — far below the rate of 139.1 among non-Hispanic White women and 119.8 among non-Hispanic Black women.31
The prevalence of cigarette smoking among AI/AN women exceeds all other racial and ethnic groups. In 2002, the rate of cigarette use in the past month among AI/AN women who were not pregnant was 47.5 percent, compared to 36 percent among non-Hispanic Whites, 25.3 percent among non-Hispanic Blacks, and 18.8 percent among Hispanics. Overweight and obesity are also significant problems among the AI/AN population, with over 60 percent of adult women under 60 years of age likely to be overweight or obese.32 This trend may contribute to the high rate of diabetes among the AI/AN population. In 2002, 15.9 percent of AI/AN women over the age of 20 were living with diagnosed diabetes, compared to 7.1 percent of the general population.
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 [d] |
In 2002, an estimated 19.4 million women aged 65 years and older were living in non-institutionalized settings, representing 13.5 percent of all women. The ratio of women to men increases with age, with women comprising 51.1 percent of the entire population and 57.0 percent of people aged 65 and older.33
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In 2001, although the majority (56.6 percent) of non-institutionalized women over the age of 65 years did not report any disabilities, the remaining 43.4 percent were living with either one disability (18.9 percent) or two or more disabilities (24.4 percent). Among women with one disability, the most commonly reported disabilities were those that limit physical activities such as walking, reaching, or lifting (11.2 percent). Compared to women with only one type of disability, women with two or more types of disabilities were more likely to report a self-care disability (0.1 percent compared to 10.3 percent). These women are likely to need the assistance of paid or family caregivers.
The Centers for Disease Control and Prevention recommends that adults aged 65 and older have an annual influenza (flu) vaccination as well as a pneumococcal vaccination at least once during their lifetime. In 2002, the majority of women 65 and older received a flu shot (64.5 percent) and/or pneumonia shot (55.8 percent); however, vaccination rates varied by race and ethnicity. Non-Hispanic White women were the most likely (67.9 percent) to have received a flu shot during the past year, whereas Hispanic women were the least likely (46.8 percent). The racial and ethnic disparities in the receipt of a pneumonia vaccination were even greater: the percent of non-Hispanic White women receiving a pneumonia shot (60.2 percent) was more than twice that of Hispanic women (29.8 percent).
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Table of Contents | Preface | Introduction | Chapter 1 | Chapter 2 | Chapter 3 | Indicators in Previous Editions | References | Contributors