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Health Disparities of Minority Women and Diabetes

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Heart disease mortality 44th. Diabetes 41st. Limitations on ... for heart disease per 100, ... incorporate the important dimensions of women's lives ... – PowerPoint PPT presentation

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Title: Health Disparities of Minority Women and Diabetes


1
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

2
Trends in Diabetes
  • Diabetes as a global epidemic
  • Projected two-fold increase in adults by 2025
  • Resulting 122 increase worldwide 300 million
    people

3
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

4
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

5
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

6
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

7
Age at diagnosis
  • Blacks Hispanics diagnosed at younger ages
  • Longer disease duration
  • Greater incidence of complications (renal, eye,
    neuropathies, amputation)

8
Median Age at Diagnosis
9
Risk factors for complications
  • Unfavorable upward trends in most states for
    adults
  • Overweight/ obese
  • Hypertensive
  • Hypercholesterolemia

10
Economic Costs
  • Direct and indirect expenditures 132 billion
  • (Direct medical 91.8 billion)

11
Beyond Economics
  • Quality of life
  • Personal and social contributions
  • Influence on family health and welfare

12
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

13
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

14
Tennessee womens health indicators related to
diabetes
15
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.)

16
Minority women diabetes
  • Prevalence is 2-4 times higher for women who are
  • African American
  • Hispanic
  • American Indian
  • Asian Pacific Islander

17
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

18
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

19
Implications for womens self-care
  • Organizing factors that affect self-care
    practices
  • Patient characteristics
  • Family context
  • Practitioner and health system
  • Community and work setting

20
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)

21
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)

22
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

23
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