Women With Diabetes: Quality of Health Care, 2004-2005
Demographic and Socioeconomic Characteristics of Women
In 2004, women accounted for 51.4% of the estimated 220.4 million U.S. residents age 18 and over.11 By 2050, the female population is projected to grow by 70 million.12 This growth will primarily be due to low birth rates, declining death rates, and net international migration, with middle-aged and older women contributing the greatest share of the increase.13 The percentage of women among immigrants has been increasing steadily.14 In 2004, women comprised 54.5% of legal immigrants and 42% of unauthorized migrants to the United States.15 Growth of the female population will enlarge the number of women at risk of diabetes. Already, the number of women diagnosed with diabetes is projected to reach more than 14 million by 2050, nearly 60% of whom will be age 65 and over.2
Age and race/ethnicity are strongly associated with access to care and quality of care.16-18 Older women are more likely than older men to have reduced access to care and to receive suboptimal levels of recommended health care services.19 Minority women are more likely than White women to have similar circumstances. In 2004, 49.2% of women were in the reproductive years (18-44), 32.0% were in the middle years (45-64), and 18.7% were age 65 and over.11 As the population ages, women increasingly outnumber men such that, by age 75, there are 60% more women than men and twice as many women as men are age 85 and over.
The female population is also racially and ethnically heterogeneous.12 Of the estimated 146.9 million (98.5%) women reporting a single race in 2004,20 almost 70% were non-Hispanic White, 12.8% were non-Hispanic Black, 13.4% were Hispanics of any race, 4.2% were Asians, 0.8% were American Indians or Alaska Natives, and 0.1% were Native Hawaiians or Other Pacific Islanders. The minority population is expected to double by 2050.13 Diabetes is nearly twice as common among minority women,21-22 and both the number of minority women and the prevalence of diabetes in these groups are projected to increase most rapidly.2, 13 Recent studies indicate that a substantial number of women with diabetes receive worse diabetes care than men with diabetes and that the sex disparity is greater in ethnic minority groups.23-24
Socioeconomic position (SEP), as measured by education or income, is strongly related to health, access to health care, and quality of care. As SEP decreases, people become increasingly vulnerable to conditions such as diabetes.25-26 They also are less likely to have adequate access to health care and more likely to receive low levels of recommended evidence-based health care services.17
Despite increasing percentages of women who attain high levels of education and participate in the labor force, a substantial proportion of women live in socioeconomically disadvantaged circumstances.27 Among women age 18 and over in 2004, approximately 15% had not completed high school and only about one-quarter had completed college or higher; estimates for older women were 28% and 14%, respectively. Regardless of level of education, women are less likely than men to be employed. Even when they work full time, their median earnings are three-quarters of men's earnings.27 Consequently, poverty is a major concern for women across the lifespan.28
In 2004, more than 14 million (13%) women lived in poverty (at or below 100% of the Federal poverty level), accounting for 3 out of every 5 poor adults age 18 and over. Most poor women (59%) were in the reproductive years and nearly 20% were age 65 and over. The poverty statistics for minority women of all ages are especially grave: overall, 1 in 4 Black women and 1 in 5 Hispanic women lived at or below the Federal poverty level and there was little variation with age.28 Women were also more likely to live in poverty if they were foreign born, were age 65 and over and lived alone, had not completed high school, worked part time, or lived in single female-headed households or central cities.14, 28-30 Women with diabetes are more likely than women without diabetes to have low levels of formal education and to live in low-income households, independent of marital status, size of household, or employment status. Furthermore, the SEP gap in prevalence of diabetes has been widening over the past 25 years.
In summary, the demographic and socioeconomic profiles of women have important implications for the health care of women with, or at risk of, diabetes. First, until the middle of the 21st century, it is anticipated that women will be the majority of adults with diabetes. Second, barriers to optimal diabetes care (older age, minority ethnicity, low levels of education, economic insecurity) are common among women.