Health Disparities of Minority Women and Diabetes

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Health Disparities of Minority Women and Diabetes

• Kathleen M. Rayman, Ph.D., RN
• Appalachian Center for Translational Research in
  Disparities
• Faculty Development Series
• November 30, 2006

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Trends in Diabetes

• Diabetes as a global epidemic
• Projected two-fold increase in adults by 2025
• Resulting 122 increase worldwide 300 million
  people

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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

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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

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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

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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

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Age at diagnosis

• Blacks Hispanics diagnosed at younger ages
• Longer disease duration
• Greater incidence of complications (renal, eye,
  neuropathies, amputation)

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Median Age at Diagnosis
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Risk factors for complications

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

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Economic Costs

• Direct and indirect expenditures 132 billion
• (Direct medical 91.8 billion)

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Beyond Economics

• Quality of life
• Personal and social contributions
• Influence on family health and welfare

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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

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Specific Issues for Women

• Womens 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 Womens Policy Research, 2000

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Tennessee womens health indicators related to
diabetes
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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.)

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Minority women diabetes

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

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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

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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

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Implications for womens self-care

• Organizing factors that affect self-care
  practices
• Patient characteristics
• Family context
• Practitioner and health system
• Community and work setting

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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)

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Issues of poor glycemic control that women have
in common

• Only half achieve glycemic control (HbA1c
• 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)

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Next steps

• Models of care that incorporate the important
  dimensions of womens 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

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Questions?