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Agency for Healthcare Research Quality

Health Care for Minority Women

Program Brief

Minority women continue to fare worse than white women in terms of health status, rates of disability, and mortality. Disparities are growing for some conditions. Research on improving the health care of women, especially minority women, is a priority of the Agency for Health Care Research and Quality (AHRQ). Examples of AHRQ research are given here.

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Improving Health Care for Women of Color
Cardiovascular Disease
Breast and Cervical Cancer Screening and Treatment
Reproductive Health/Childbirth
Access to Care/Insurance
Other Research
Medical Expenditure Panel Survey
More Information


Life expectancy for women of all races has nearly doubled over the past 100 years, from 48 in 1900 to 79.5 in 2000, yet minority women continue to lag about 5 years behind white women in life expectancy. For example, in the year 2000 white women could expect to live to age 80 compared with 74.9 for black women.

Minority women continue to fare worse than white women in terms of health status, rates of disability, and mortality. For some conditions, the disparities are growing, despite new technologies and other advances that have been made in recent years. For example, about one black woman in four over 55 years of age has diabetes. The prevalence of diabetes is at least two to four times as high among black, Hispanic, American Indian, and Asian Pacific Islander women as it is among white women.

Breast cancer mortality has been declining among U.S. women since 1990, but the decline has been much greater among white women than black women. Although breast cancer death rates are falling, the incidence of new breast cancers continues to rise. Blacks and poor people are much more likely than whites and more affluent people to die from cancer. In addition, high blood pressure, lupus, and HIV/AIDS disproportionately affect women of color.

According to the Centers for Disease Control and Prevention, a patient's self-assessment of health is a reliable indicator of health and well being. When asked about their health status, minorities are more likely than whites to characterize their health status as fair. Nearly 17 percent of Hispanic women and more than 15 percent of black women say they are in fair or poor health, compared with 11 percent of white women. Compared with men, women of all races are more likely to be in fair or poor health.

Adequate access to health care services can have a significant effect on health care use and health outcomes. Lack of health insurance is a barrier to receiving services. Compared with white women, black women are twice as likely and Hispanic women are nearly three times as likely to be uninsured. Furthermore, blacks and Hispanics are much more likely than whites to lack a usual source of care and to encounter other difficulties in obtaining needed care.

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Improving Health Care for Women of Color

Research on women's health, particularly the health of minority women, is a priority area for the Agency for Healthcare Research and Quality (AHRQ). AHRQ-supported investigators are seeking ways to narrow the gaps and ensure that women of all races receive high-quality health care.

Examples of recent findings from AHRQ research on health care for minority women are presented here. Select for more information or to obtain copies of articles marked with an asterisk (*).

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Cardiovascular Disease

Heart disease is the number one killer of women in the United States. More than one-third of all deaths among U.S. women are due to heart disease, which usually occurs about 10 years later in life in women than in men. Heart disease mortality differs substantially among women of different races.

High blood pressure and obesity are risk factors for heart disease, diabetes, stroke, and other health problems. Women of color have higher rates of high blood pressure, tend to develop it at an earlier age, and are less likely than white women to receive treatment to control their high blood pressure. Also, the age-adjusted prevalence of obesity continues to be higher among black women (53 percent) and Mexican-American women (52 percent) than among white women (34 percent).

  • Management of chest pain in patients with hypertension varies by sex and race.

    About one in eight patients with hypertension treated by a primary care doctor is diagnosed with some type of chest pain syndrome (CPS). These patients usually are aggressively treated for cardiovascular risk factors, but this study found disparities in treatment of CPS. Researchers analyzed the care of 72,508 people with hypertension who were receiving care at about 50 primary care practices in the Southeastern United States. They found that more men than women received definitive diagnoses of angina, while more women than men were diagnosed with vague chest pain. Also, women and blacks received fewer cardiovascular medications than men and whites, both overall and within diagnostic categories.

    Source: Hendrix, Mayhan, Lackland, and Egan, Am J Hypertens 18(8):1026-1032, 2005 (AHRQ grant HS10871).

  • Black women are less likely than other women or men to have access to lifesaving therapies for heart attack.

    Most of the 1 million U.S. patients who have heart attacks each year are candidates for reperfusion therapy, either thrombolytic drugs or primary angioplasty. However, only 57 percent of those who are eligible for this treatment actually receive it. Black women are least likely to receive reperfusion therapy (44 percent), followed by black men (50 percent), white women (56 percent), and white men (59 percent). These findings are drawn from the medical records of nearly 27,000 white and black Medicare beneficiaries who were eligible for reperfusion therapy between February 1994 and July 1995.

    Source: Canto, Allison, Kiefe, et al., New Engl J Med 342(15):1094-100, 2000 (AHRQ grants HS08843 and HS09446).

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Breast and Cervical Cancer Screening and Treatment

Cancer is the second leading cause of death among all American women except Asian/Pacific Islanders for whom it is first. Breast cancer continues to be the most commonly diagnosed cancer among women in the United States. In 2002, an estimated 203,500 women were newly diagnosed with breast cancer, and nearly 39,000 women died from the disease.

Although between 12 and 29 percent more white women than black women are stricken with breast cancer, black women are 28 percent more likely than white women to die from the disease. The 5-year breast cancer survival rate is 69 percent for black women, compared with 85 percent for white women.

An estimated 13,000 U.S. women were newly diagnosed with invasive cervical cancer in 2002, and about 4,100 women died from the disease that year. Cervical cancer occurs most often among minority women. Vietnamese women in the United States have a cervical cancer incidence rate of 47.3 per 100,000, which is more than five times greater than it is for white women (8.5 per 100,000). Hispanic women also have elevated rates of cervical cancer.

  • Among low-income black women, those most at risk for breast cancer know the least about it.

    Elderly women are more likely than younger women to die from breast cancer, and black women die more often from the disease due to late diagnosis. In this study, low-income black women 65 and older underestimated their risk of getting breast cancer, and those 85 and older were the least likely to have had a mammogram or breast exam in the preceding 2 years.

    Source: Jones, Thompson, Oster, et al., J Natl Med Assoc 95(9):791-805, 2003 (AHRQ grant HS10875).

  • Delayed or incomplete followup of suspected breast cancer is more common in black women than in white women.

    More than one-fourth of black women who have abnormal results from mammography or clinical breast exam have not resolved the diagnosis with followup tests 6 months later. Black women with prior breast abnormalities or higher levels of cancer anxiety were about half as likely as others to follow up on the abnormal results within 3 to 6 months. Delays of 3 to 6 months have been associated with lower survival rates compared with women who have shorter delays.

    Source: Kerner, Yedida, Padgett, et al., Prev Med 37:92-101, 2003 (AHRQ grant HS08395).

  • South Asian women should be targeted to receive cervical cancer screening.

    Despite the high socioeconomic status of Indian and other South Asian women living in the United States, this study found that one-fourth of them had not had a Pap smear in more than 3 years. Regions with large South Asian populations should be targeted with messages promoting cervical cancer screening. The message should be aimed particularly at unmarried South Asian women of low socioeconomic status who have spent little time in America.

    Source: Chaudhry, Fink, Gelberg, and Brook, J Gen Intern Med 18:377-84, 2003 (AHRQ grant HS10597).

  • Personalized form letters may improve breast and cervical cancer screening among low-income and minority women.

    According to this study of more than 1,500 urban low-income and minority women, sending them a personalized form letter with general cancer information increases the likelihood they will be screened for cervical and breast cancer.

    Source: Jibaja-Weiss, Volk, Kingery, et al., Patient Educ Couns 50:123-32, 2003 (AHRQ grant HS08581).

  • Older black women do not receive preferred breast cancer treatment.

    Researchers analyzed data on 984 black and 849 white Medicare-insured women aged 67 or older who had localized breast cancer. They identified a subset of 732 surviving women and interviewed them 3 to 4 years after initial treatment. Black women were 36 percent more likely than white women to receive mastectomy versus breast-conserving surgery and radiation. Further, when black women received breast-conserving surgery, they were 48 percent more likely than white women to not have radiotherapy.

    Source: Mandelblatt, Kerner, Hadley, et al., Cancer 95:1401:1414, 2002 (AHRQ grant HS08395).

  • Study highlights the role of community programs for outreach to poor and minority women.

    Researchers who examined the cost and cost-effectiveness of the Los Angeles Mammography Program (LAMP) recommend careful consideration of community-based and other approaches outside of the traditional purview of medicine to encourage use of mammography among hard-to-reach women. Also, community and church-based programs should be compared with alternative programs targeting poor and minority women who have limited access to mammography. LAMP, which involved 45 churches and 2 interventions to improve rates of mammography screening, generated 3.24 additional screenings among 56 women.

    Source: Siegel and Clancy, Health Serv Res 35(5):905-9, 2000 (Reprints, AHRQ Publication No. 01-R032).* (Intramural)

  • Attitudes about mammography affect appointment-keeping.

    Negative attitudes about mammography may play a role in the disproportionate number of breast cancer deaths among black women compared with white women. Knowledge of screening recommendations and access to free mammograms were not enough to get some low-income black women to keep their mammography appointments. Most of the women who skipped their appointments said they were embarrassed or believed that a mammogram was unnecessary if they did not have symptoms.

    Source: Crump, Mayberry, Taylor, et al., J Nat Med Assoc 92:237-46, 2000 (AHRQ grant HS07400).

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Reproductive Health/Childbirth

Maternal mortality and infant mortality among black women are 5 and 2.5 times greater, respectively, than the national average. Nearly 70 percent of all infant mortality and approximately one-third of all handicapping conditions are associated with low birthweight (less than 2,500 grams, or about 5.2 pounds). Minority women, particularly black women, are at relatively high risk for giving birth to low birthweight infants, both prematurely and at term.

  • Ectopic pregnancy rates are declining, but the decline is slower among black women.

    Rates of ectopic pregnancy (EP)—a major cause of infertility and maternal death during the first trimester of pregnancy—are declining for all women, but the decline is slower among black women than among women of other races. This study involved an analysis of discharge data for 62,829 women who were hospitalized in California for EP between 1991 and 2000. Black women were at much higher risk of EP than non-Hispanic white women, particularly those who were 35 to 44 years of age. The researchers conclude that disparities in the incidence of sexually transmitted diseases and previous EP, both major risk factors for EP, are likely to blame for this continuing disparity in the incidence of EP.

    Source: Calderon, Shaheen, Pan, et al., Ethn Dis 15(suppl 5):20-4, 2005 (AHRQ grants HS10858 and HS14022).

  • Screening new mothers for postpartum depression is particularly important in women of color.

    According to this survey of 655 women who were 2 to 6 weeks postpartum when surveyed, nearly one-half of Hispanic (47 percent) and black (45 percent) mothers reported depressive symptoms, compared with less than one-third (31 percent) of white mothers. Factors associated with postpartum depression—the burden of physical symptoms, lack of social support, and lack of self-confidence in infant care—were the same for all women regardless of race.

    Source: Howell, Mora, Horowitz, and Leventhal, Obstet Gynecol 105(6):1442-50, 2005 (AHRQ grant HS09698).

  • Home visits by a nurse-health advocate team benefits low-income minority mothers and infants.

    Researchers examined maternal/infant outcomes for 460 black and 186 Mexican-American low-income pregnant women from two university-associated prenatal clinics in Chicago. The women received regular home visits by a nurse-health advocate team over the 12-month period after childbirth. Many of the mothers were depressed and had several difficult life circumstances, such as an abusive partner or inability to pay bills. For black women, the program resulted in better tracking of infant immunizations, better parenting skills, and higher 12-month infant mental development scores. For Mexican-American women, the program improved daily living skills and knowledge of appropriate play materials for their infants.

    Source: Kuzujanakis, Kleinman, Rifas-Shiman, and Finkelstein, Ambul Pediatr 3(4):203-10, 2003 (AHRQ grant HS10247).

  • Augmented prenatal care does not reduce LBW in poor black women.

    Researchers assigned 318 Medicaid-eligible pregnant black women to augmented prenatal care and 301 similar women to usual care. Augmented care included educationally oriented peer groups, additional appointments, extended time with clinicians, other supports, and risk-reduction programs. Results show the augmented care improved knowledge about pregnancy risk, social support, care satisfaction, and a sense of control; however, it did not reduce the number of LBW infants.

    Source: Klerman, Ramey, Goldenberg, et al., Am J Public Health, 91:105-11, 2001 (Low Birthweight PORT contract 290-92-0055).

  • Black women living in the Northeast have the highest rates of abruption placentae.

    Researchers derived age-adjusted rates of abruption placentae (premature separation of the placenta) for combinations of regions of birth and regions of residence of all live singleton births among black women in the United States in the mid-1990s. The region and rates among women who had not migrated from the South included the following: Northeast (8.3 per 1,000), Midwest (6.3 per 1,000), South (6.0 per 1,000), and West (4.9 per 1,000).

    Source: Faiz, Demissie, Ananth, et al., Ethn Health 6(3):247-53, 2001 (AHRQ grant HS09788).

  • Poor birth outcomes for homeless women are worse for homeless women of color.

    Interviews of 237 homeless women aged 15 through 44 years who had given birth within the previous 3 years revealed the following: almost 17 percent had LBW babies, and 19 percent had preterm births compared with the national average of 6 percent and 10 percent respectively. About 22 percent of black and 16 percent of Hispanic homeless women had LBW babies compared with 5.4 percent of homeless white women. Also, 21 percent of black and 14 percent of Hispanic homeless women had preterm births compared with 7.8 percent of homeless white women.

    Source: Stein, Lu, and Gelberg, Health Psychol 19(6):524-34, 2000 (AHRQ grant HS08323).

  • Study finds racial differences in treatment and outcomes of women undergoing surgery for uterine fibroids.

    The researchers examined the medical charts of 225 women (53 percent black, 47 percent white) who underwent abdominal myomectomy for fibroid tumors at one medical center between 1992 and 1998. Black women were more than twice as likely as white women to have in-hospital complications or a blood transfusion. These increased complications were largely due to differences in uterine size and number of fibroids.

    Source: Roth, Gustilo-Ashby, Barber, and Myers, Obstet Gynecol 101:881-4, 2003 (AHRQ grant HS09874).

  • Incidence and management of uterine fibroids differ among racial groups.

    Based on a review of the evidence on uterine fibroids, researchers at the Duke University Evidence-based Practice Center found that black women have a higher incidence of fibroids, larger and more numerous fibroids when first diagnosed, and a higher rate of hysterectomies than women of other races. Results also show that black women are more likely to have their fibroids surgically removed through a myomectomy (a procedure that preserves the uterus) than are white or Hispanic women.

    Source: The full evidence report, Management of Uterine Fibroids (AHRQ Publication No. 01-E052),* and a summary (AHRQ Publication No. 01-E051)* are available from AHRQ (contract 290-97-0014).

  • Death of a mother or sister during pregnancy shortens pregnancy among poor black women.

    Medical University of South Carolina researchers interviewed 472 black women from three public prenatal clinics (regarding stressful life events, availability of emotional support, and health habits) and collected pregnancy and birth data from a clinical database. Pregnant women who lost a mother or sister during pregnancy delivered their babies on average 4.6 weeks earlier than other women in the study. Women who experienced the death of other family members or close friends did not have shorter pregnancies.

    Source: Barbosa, J Perinatol, 20:438-42, 2000 (AHRQ grant HS06930).

  • Cocaine and tobacco use increases the risk of miscarriage.

    Researchers led by Roberta Ness, M.D., of the University of Pittsburgh, examined the association between cocaine and tobacco use and miscarriage in a group of 970 predominantly poor and black pregnant adolescents and women. Among those who had miscarriages, 29 percent used cocaine and 35 percent smoked. Of those who did not have miscarriages, 21 percent used cocaine and 22 percent used tobacco.

    Source: Ness, Grisso, Hirschinger, et al., N Engl J Med 340(5):333-9, 1999 (AHRQ grant HS08358).

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Access to Care/Insurance

Adequate access to health care can significantly influence use of health care services and lead to better health outcomes. Research has shown that minority women and women who are poor often have problems getting care when they need it.

Also, the many changes taking place in health care delivery in the United States have serious implications for women's health. These changes include a consolidation of the health care system, a shift to managed care, and decreased public funding of health care and health-related programs. These changes can have a serious impact on access to care and out-of-pocket expenditures, and may have a disproportionate negative effect on health care for minority women.

  • Racial disparities found in Medicare managed care plans.

    Data from the 1998 Medicare Health Plan Employer Data and Information Set on 305,574 elderly patients enrolled in Medicare managed care plans revealed racial differences in clinical services. For example, blacks were less likely than whites to receive breast cancer screening (63 vs. 71 percent). Researchers said more than half of this disparity was explained by socioeconomic factors.

    Source: Schneider, Zaslavsky, and Epstein, JAMA 287(1):1288-94, 2002 (AHRQ grant HS10803).

  • Race, income, and education influence older women's health.

    A survey of the health and functional status of 91,314 women enrolled in Medicare managed care plans revealed that poorer and less educated women reported poorer health, experienced more chronic illness, and felt depressed or sad more of the time in the past year than women who were more affluent and had more education. The percentages of women reporting fair or poor health were: black (46), Hispanic (42), American Indian/Alaska Native (36), Asian/Pacific Islander (28), and white (27).

    Source: Bierman, Haffer, and Hwang, Health Care Financing Rev 22(4):187-98, 2001 (Reprints AHRQ Publication No. 02-R006)* (Intramural).

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The incidence of HIV/AIDS is growing more rapidly among U.S. women than among men. In 1985, women made up only 7 percent of all reported AIDS cases, compared with 18 percent in 1994 and 23 percent in 1999. AIDS occurs most often among women in their reproductive years (15 to 44 years of age). HIV/AIDS is the sixth leading cause of death among U.S. women 25 to 34 years of age and the leading cause of death for black women in that age group.

  • Special outreach is needed for HIV-positive black women and drug abusers.

    Researchers analyzed antiretroviral use among 1,690 HIV-positive women, most of whom were black or Hispanic. They found that receipt of highly active antiretroviral therapy (HAART) to treat HIV infection is most likely for women who have a college education, are not black, have private insurance, and do not use illicit drugs.

    Source: Cook, Cohen, Grey, et al., Am J Public Health 92(1):82-7, 2002 (cosponsored by NIH, CDC, and AHRQ).

  • Black women are recruited/retained in HIV clinical trials.

    Researchers describe the recruitment and retention of a diverse group of women infected with HIV or at risk for HIV infection participating in the Women's Interagency HIV Study. Factors found to be associated with recruitment and retention were older age, black race, stable housing, HIV-infected serostatus, past experience in studies of HIV/AIDS, and site of enrollment.

    Source: Hessol, Schneider, Greenblatt, et al., Am J Epidemiol 154:563-73, 2001 (cosponsored by NIH, CDC, and AHRQ).

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Other Research

  • Racial disparities found in receipt of osteoporosis screening and management.

    According to this survey of more than 8,000 women aged 50 or older in Alabama, postmenopausal black women are much less likely than their white counterparts to receive bone mineral density testing to detect osteoporosis. They also are less likely to be prescribed medication to treat osteoporosis. This finding held true even among those who had a previous fracture.

    Source: Mudano, Casebeer, Patino, et al., South Med J 96(5):445-51, 2003 (AHRQ grant HS10389).

  • Women are less likely than white men to be recommended for kidney transplants.

    A national random survey of 271 U.S. nephrologists was used to gauge their bases for transplant recommendations for people with end-stage renal disease. All clinical factors being equal, results show that white men were almost 2.5 times as likely as white women to be recommended for kidney transplants. White women were equally as likely as black women to be recommended for transplantation, and Asian men were half as likely as white men to be recommended.

    Source: Thamer, Hwang, Fink, et al., Transplantation 71(2):281-8, 2001 (AHRQ grant HS08365).

  • Researchers find a correlation between women's self-assessments of socioeconomic status and health.

    Investigators explored the relationship between how individuals perceive their socioeconomic status (subjective SES) and health and found that subjective SES was significantly related to health in an ethnically diverse group of pregnant women. However, household income continued to predict health after accounting for subjective SES among Hispanic and black women but not among white and Chinese-American women.

    Source: Ostrove, Adler, Kuppermann, et al., Health Psychol 19(6):613-18, 2000 (AHRQ grant HS07373).

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Medical Expenditure Panel Survey

In 1996, AHRQ launched the Medical Expenditure Panel Survey (MEPS), a nationally representative survey to collect detailed information on health status, health care use and expenses, and health insurance coverage for individuals and families in the United States, including those living in nursing homes. MEPS is helping the Agency address many questions important to women, including how health insurance coverage, access to care, use of preventive care, and changes in the health care system are affecting the kinds, amounts, and costs of health care services used by women. For more information related to MEPS, visit the AHRQ Web site at

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More Information

Select for more information about AHRQ's research portfolio and funding opportunities.

Items marked with an asterisk (*) are available free from AHRQ. Contact the AHRQ Clearinghouse at 1-800-358-9295 or request electronically by sending an E-mail to Please use the AHRQ publication number when ordering.

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AHRQ Publication No. 06-P017
Current as of June 2006
Replaces AHRQ Publication No. 03-P020

Internet Citation:

Health Care for Minority Women. Program Brief. AHRQ Publication No. 06-P017, June 2006. Agency for Healthcare Research and Quality, Rockville, MD.


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