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Introduction
In 2006, women represented 50.8 percent of the 299 million people residing in the United States. In most age groups, women accounted for approximately half of the population, with the exception of people aged 65 years and older; within this age group, women represented 58 percent of the population. The growing diversity of the U.S. population is reflected in the racial and ethnic distribution of women across age groups. Black and Hispanic women accounted for 8.9 and 6.3 percent of the female population aged 65 years and older, respectively, but they represented 14.7 and 21.0 percent of females under 15 years of age. Non-Hispanic Whites accounted for 80.6 percent of women aged 65 years and older, but only 56.4 percent of those under 15 years of age.
America’s growing diversity underscores the importance of examining and addressing racial and ethnic disparities in health status and the use of health care services. In 2006, 62.3 percent of non-Hispanic White women reported themselves to be in excellent or very good health, compared to only 53.4 percent of Hispanic women and 50.2 percent of non-Hispanic Black women. Minority women are disproportionately affected by a number of diseases and health conditions, including HIV/AIDS, sexually transmitted infections, diabetes, and asthma. For instance, in 2006, non-Hispanic Black and Hispanic women accounted for more than three-fourths of women living with HIV/AIDS (63.9 and 15.2 percent, respectively). One-third of non-Hispanic White women had ever been tested for HIV, compared to 53.7 percent of non-Hispanic Black women and 46.1 percent of Hispanic women.
Diabetes is a chronic condition and a leading cause of death and disability in the United States, and is especially prevalent among minority populations. Among non-Hispanic Black and Hispanic women, diabetes occurred at a rate of 117.6 and 111.8 per 1,000 women, respectively, compared to 69.4 per 1,000 non-Hispanic White women. Hypertension, or high blood pressure, was also more prevalent among non-Hispanic Black women than women of other races. In 2005–2006, this condition occurred at a rate of 179.2 per 1,000 non-Hispanic Black women, compared to 157.0 per 1,000 non-Hispanic White women and 113.1 per 1,000 Hispanic women.
Some conditions, such as arthritis and heart disease, disproportionately affect non-Hispanic White women. For instance, in 2006, more than 27 percent of non-Hispanic White women had arthritis, compared to 23.5 percent of non-Hispanic Black women and 14.3 percent of Hispanic women.
In addition to race and ethnicity, income and education are important factors that contribute to women’s health and access to health care. Regardless of family structure, women are more likely than men to live in poverty. Poverty rates were highest among women who were heads of their households (25.1 percent). Poverty rates were also highest among American Indian/Alaska Native women (27.6 percent), followed by non-Hispanic Black and Hispanic women (23.4 and 20.2 percent, respectively). Non-Hispanic Black and Hispanic women were also more likely to be heads of households than their non-Hispanic White and Asian counterparts.
Some conditions and health risks are more closely linked to family income than to race and ethnicity, such as asthma. Rates of asthma decline as income increases and women with higher incomes are more likely to effectively manage their asthma. Among women with asthma whose incomes were below 100 percent of poverty, nearly 36 percent had an asthma-related emergency room visit in the past year, compared to 24.8 percent of women with family incomes of 300 percent or more of poverty.
Mental health is another important aspect of women’s overall health. A range of mental health problems including depression, anxiety, phobias, and post-traumatic stress disorder, disproportionately affect women. Unlike many other health concerns, younger women are more likely than older women to suffer from serious psychological stress and major depressive episodes.
Physical disabilities are more prevalent among women as well. Disability can be defined as impairment of the ability to perform common activities like walking up stairs, sitting or standing for 2 hours or more, grasping small objects, or carrying items like groceries. Therefore, the terms “activity limitations” and “disabilities” are used interchangeably throughout this book. Overall, 15.0 percent of women and 12.6 percent of men reported having activity limitations in 2006. Men, however, bear a disproportionate burden of some health conditions, such as HIV/AIDS, hypertension and heart disease. In 2006, for instance, adolescent and adult males accounted for 72.9 percent of new AIDS cases, though a smaller proportion of men had ever been tested for HIV than women (33.7 versus 37.8 percent, respectively).
Certain health risks, such as cigarette use and injury, occur more commonly among men than women. In 2006, 27.8 percent of males smoked cigarettes, compared to 22.4 percent of females. Among men, 30.2 percent of emergency department visits were injury related, while only 21.3 percent of women’s visits were due to injury. In addition, men were more likely than women to lack health insurance. Many diseases and health conditions, such as those mentioned above, can be avoided or minimized through good nutrition, regular physical activity, and preventive health care. In 2005, 19.7 percent of women’s visits to physicians were for preventive care, including prenatal care, preventive screenings, and immunizations. Overall, 64.6 percent of older women reported receiving a flu shot in 2006; however, this percentage ranged from 46.6 percent among Hispanic women to 67.3 percent of non-Hispanic White women.
In addition to preventive health care, preventive dental care is also important to prevent dental caries and gum disease. In 2003–2004, 74.6 percent of women with incomes of 300 percent or more of poverty saw a dentist in the past year, compared to 51.4 percent of women with incomes below 100 percent of poverty, and 44.9 percent of women with incomes of 200–299 percent of poverty.
There are many ways women (and men) can promote health and help prevent disease and disability. Regular physical activity is one of these. In 2006, 10.3 percent of women participated in adequate physical activity–30 minutes of moderate-intensity physical activity on most days of the week or 20 minutes of vigorous-intensity activity on 3 or more days per week. Non-Hispanic White women and women with higher incomes were most likely to meet the recommended levels of physical activity. Healthy eating habits can also be a major contributor to long-term health and prevention of chronic disease. In 2003–2004, however, more than half of all adult women had diets that included more than the recommended amount of saturated fat and sodium and less than the recommended amount of folate and calcium. Overall, 63.5 percent of women exceeded the maximum daily intake of saturated fat, and 70 percent exceeded the maximum amount of sodium.
While some behaviors have a positive effect on health, a number of others, such as smoking, illicit drug use, and excessive alcohol use can have a negative effect. In 2006, 22.4 percent of women smoked. However, nearly 46 percent of female smokers tried to quit at some point in the past year. During the same year, 44.9 percent of women reported any alcohol use in the past month, but relatively few women (15.6 percent) reported binge drinking (five or more drinks on the same occasion) and even fewer (3.5 percent) reported heavy alcohol use (binge drinking on 5 days or more in the past month).
Cigarette, alcohol, and illicit drug use is particularly harmful during pregnancy. The use of tobacco during pregnancy has declined steadily since 1989. Based on data from 36 states, 10.5 percent of pregnant women reported smoking during pregnancy in 2005. This rate was highest among American Indian/Alaska Native women (18.1 percent) and lowest among Asian/Pacific Islander women (2.1 percent).
Women’s Health USA 2008 can be an important tool for emphasizing the importance of preventive care, counseling, and education, and for illustrating disparities in the health status of women from all age groups and racial and ethnic backgrounds. Health problems can only be remedied if they are recognized. This data book provides information on a range of indicators that can help us track the health behaviors, risk factors, and health care utilization practices of women throughout the United States.
