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 Whites49.2 Blacks45.2 Hispanics43.6 (CDC, 2004, 18-79 y.o.)

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 5 th 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 Women’s health indicators in Tennessee –TN ranks 39 th of states overall Mental health 46 th Heart disease mortality 44 th Diabetes 41 st Limitations on everyday activities 33rd Breast cancer mortality 32 nd Suicide 31 st Lung cancer 25 th »Institute for Women’s Policy Research, 2000

14. 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

15. Preventive Care and Health Behaviors: TN & US Women » TN US Smoke everyday or some22.3 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 checked70.9 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 women’s 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 <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)

22. 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

23. Questions?