Health Disparities of Minority Women and Diabetes Kathleen M. Rayman, Ph.D., RN Appalachian Center for Translational Research in Disparities Faculty Development.

Health Disparities of Minority Women and Diabetes

Kathleen M. Rayman, Ph.D., RN

Appalachian Center for Translational Research in DisparitiesFaculty Development Series

November 30, 2006

Trends in Diabetes

• Diabetes as a global epidemic

• Projected two-fold increase in adults by 2025

• Resulting 122% increase worldwide = 300 million people

Diabetes in the US

• 1980-2004 more than doubled

• 5.8 million to 14.7 million

• Some estimates as high as 18 million with equal number undiagnosed

National Trends

• Prevalence up for everyone

– 76% increase for white males– 65% increase for white females– 68% increase for black males– 37% increase for black females

» National Diabetes Surveillance System Data (CDC)» 1980-2004

Minority populations disproportionately affected by

diabetes

• Prevalence up for everyone, yet

– Higher for Blacks than Whites– Higher for Blacks, Hispanics, and American

Indians than Whites across all ages – Highest among Black females

Age adds another dimension

• Prevalence for diagnosed diabetes highest among ages 65 and older

• 40% of persons with diabetes are 65 yrs. and older

• Age at diagnosis = 4 yrs. older for Whites than Blacks or Hispanics

Age at diagnosis

• Blacks & Hispanics diagnosed at younger ages

• Longer disease duration

• Greater incidence of complications (renal, eye, neuropathies, amputation)

Median Age at DiagnosisWhites 49.2

Blacks 45.2

Hispanics 43.6

(CDC, 2004, 18-79 y.o.)

Risk factors for complications

• Unfavorable upward trends in most states for adults– Overweight/ obese– Hypertensive– Hypercholesterolemia

Economic Costs

• Direct and indirect expenditures = 132 billion

• (Direct medical = 91.8 billion)

Beyond Economics

• Quality of life

• Personal and social contributions

• Influence on family health and welfare

Diabetes contributes to increased morbidity

• 5th leading cause of death (by disease) in US• 2-4 times more likely to develop other

chronic diseases • Areas of morbidity:

– Heart disease– Blindness– Renal failure– Amputation

Specific Issues for Women

• Women’s health indicators in Tennessee– TN ranks 39th of states overall

• Mental health 46th

• Heart disease mortality 44th

• Diabetes 41st

• Limitations on everyday activities 33rd• Breast cancer mortality 32nd

• Suicide 31st

• Lung cancer 25th

» Institute for Women’s Policy Research, 2000

Tennessee women’s health indicators related to diabetes

Mortality rate for heart disease per 100,000

TN:

111

US:

90.9

Percent of women told they have diabetes

TN:

6.4

US:

5.3

Average days poor mental health

TN:

4.2

US:

3.5

Average days limited activities

TN:

3.8

US:

3.6

Preventive Care and Health Behaviors: TN & US Women

» TN US

• Smoke everyday or some 22.3 20.8• No leisure time/physical activity past month 38.0 29.9 Do not eat fruits/ veg. 67.3 72.2 (5

servings/ day) Cholesterol checked 70.9 67.8 (within 5 yrs.)

Minority women & diabetes

• Prevalence is 2-4 times higher for women who are – African American– Hispanic– American Indian– Asian Pacific Islander

Women, diabetes, & fertility

• 2 to 5 % non-diabetic pregnant women develop gestational diabetes– 45% risk of developing with subsequent

pregnancies• 5 to 10% develop type 2 diabetes after pregnancy• 20 to 50% develop type 2 within 5 to 10 years

– Children likely to become obese; develop diabetes later in life

For women with diabetes

• Greater cardiovascular risk than men

• Risk of MI greater than in men• Survival after MI less than in men

– Less aggressive treatment

– Different symptom presentation

– Anatomical differences in heart and mechanical properties of arteries that influence cardiac functioning

Implications for women’s self-care

• Organizing factors that affect self-care practices

• Patient characteristics

• Family context

• Practitioner and health system

• Community and work setting

Implications cont.

• What is often interpreted as exclusive patient self-care behavior is context bound, multidimensional, and has many influences (family, spouse, work setting, geographic and economic)

Issues of poor glycemic control that women have in common

• Only half achieve glycemic control (HbA1c <6)

Diet (cooking for family, eating out, imposing diet on others)

Exercise (time, fatigue, access & safety)Workplace (privacy, testing, breaks, nature

of job) Self-management = selfishness

(relationships with spouse, family, co-workers, friends)

Expense (supplies, medication, foods)

Next steps

• Models of care that incorporate the important dimensions of women’s lives– Physiologic differences– Gendered experiences and social roles– Economic circumstances– Relational nature of self care and family,

spouse, workplace– Family & community focused interventions vs.

individual

Questions?