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?