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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Contents
Introduction
Improving Health Care for Women of Color
Cardiovascular Disease
Breast and Cervical Cancer Screening and Treatment
Reproductive Health/Childbirth
Access to Care/Insurance
HIV/AIDS
Other Research
Medical Expenditure Panel Survey
More Information
Introduction
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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HIV/AIDS
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 http://www.ahrq.gov/data/mepsix.htm.
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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 AHRQPubs@ahrq.hhs.gov. 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. http://www.ahrq.gov/research/minority.htm
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