Women’s Health Status Report 2002 potx

Specifically, breast cancer screening has increased and death rates have come down; a higher proportion of pregnant women are getting early and adequate prenatal care; and fewer women ar

Health Status Report

‘02 Vermont Department of Health

December 2002

Vermont Department of Health

108 Cherry Street

P.O Box 70

Burlington, VT 05402

This publication is available in other accessible formats

and at the Vermont Department of Health website:

www.HealthyVermonters.info.

Health Status Indicators

• Access to Health Care 2

• Alcohol & Drug Use 3

• Arthritis & Osteoporosis 4

• Cancer 5

• Diabetes 7

• Heart Disease & Stroke 8

• HIV/AIDS/STDs 9

• Immunization & Infectious Disease 10

• Injury & Violence 11

• Maternal & Reproductive Health 12

• Mental Health & Suicide 13

• Obesity & Physical Activity 14

• Respiratory Disease 15

• Tobacco 16

References & Data Notes 17 Vermont Adult Population Tables Back Cover

Vermont Department of Health

Agency of Human Services

108 Cherry Street, P.O Box 70 Burlington, VT 05402

November 2002 Dear Vermonter,

The very essence of public health is examining the health of populations rather than the health of a single patient

Earlier this year, we published Health Status Report ’02 which provided information about Vermont’s population as a whole Now I am pleased to present Women’s Health Status Report ’02, a more detailed look at health issues and

trends relating to women in Vermont

In many areas women’s health issues mirror those of the population as a whole, in other areas there are important differences For example, people often think of cardiovascular disease as a man’s disease In fact, more women than men die from the combination of heart disease and stroke every year

In this report we bring together data from many diverse sources into a single document It includes trends in illness and disease, use of clinical preventive services, and trends in personal behaviors It shows how women are doing in

key areas, and allows us to compare to the nation and to Healthy Vermonters 2010 public health goals.

Over the past decade, women’s health has improved in many areas Specifically, breast cancer screening has increased and death rates have come down; a higher proportion of pregnant women are getting early and adequate prenatal care; and fewer women are being diagnosed with chlamydia, the most common sexually transmitted disease

It is also clear that we face many challenges in improving women’s health status There are broad disparities based on income and education in the areas of depression, obesity, physical activity, asthma and smoking The rate of deaths from chronic lung disease is rising among women, even as it declines among men A higher percentage of Vermont women binge drink compared to the U.S as a whole And still, too many women smoke during pregnancy

This is the second in our series of reports on the Health Status of Vermonters I hope you will join us in the work of public health and in improving the health of our communities and citizens

Jan K Carney, MD, MPH Commissioner of Health

Access to Health Car

Increase the percentage of people who have specific,

ongoing primary care (a primary care provider)

Goal: 96%

VT 2001: 88% of women age 18+

Increase the percentage of people with health

insurance

Goal: 100%

VT 2000: 93% of women

Facts:

• Primary care includes screening for disease and risk

factors, counseling about health-related behaviors,

treating illness, and referring for specialty care In

2001, approximately 209,800 Vermont women age

18+ (88%) reported having a primary care provider

• Women of color, lesbians, disabled women,

incarcer-ated women and homeless women experience major

disparities in access to health care and in health

status.1

• In Vermont, 9 percent of women age 18-64 were

uninsured in 2000 compared to 18 percent nationally

The percentage uninsured varies among Vermont

women in different population groups—African

American (8%), Asian/Pacific Islander (6%), American

Indian (5%), Caucasian (7%) and Hispanic (15%)

• Nationally, women age 65+ spend 22 percent of

their incomes on health care.1

• Older women with limited incomes who do not

have Medicaid to augment Medicare spend about half

Private

59%

Medicaid 17%

Medicare 16%

Military 1%

Uninsured 7%

Source of Health Insurance

Percentage of women (2000)

Uninsured by Federal Poverty Level

Percentage of Vermont women age 18-64 with NO health insurance (2000)

0 2 4 6 8 10 12 14

Percent of Federal Poverty Level

Cost as a Barrier to Health Care by Age

Percentage of Vermont women who postponed or did not get care due to cost (2000)

0 5 10 15 20 25 30 35 40

Uninsured Insured

Alcohol & Drug Use

3

0 5 10 15 20 25

Problem Drinking by Income/Education

Percentage of Vermont women age 25-64 who binge drink, are chronic drinkers, or who drink and drive (1996-2000)

Income/Education Level

Healthy Vermonters 2010 Objectives:

Increase the percentage of adults counseled by a

primary care professional about alcohol and drug use

National goal to be set

VT 1996: 14% of women counseled about alcohol

8% of women counseled about drug use

Reduce alcohol-related motor vehicle deaths

Goal: 4.0 per 100,000 population

VT 2001: 1.3 per 100,000 women

Facts:

• Women absorb and metabolize alcohol differently

than men, and are susceptible to alcohol-related heart

damage at lower levels of consumption than men.2

• Women who use alcohol have higher rates of liver

disease and related deaths than men, and at earlier

ages Long-term heavy drinking increases the risk for

high blood pressure and heart disease.1

• Prenatal exposure to alcohol is one of the leading

preventable causes of birth defects and mental

retardation.3 In Vermont, 2.6 percent of women

report alcohol use during pregnancy

• In 2001, 7 percent of Vermont women reported

heavy drinking (having an average of more than one

drink per day), and 9 percent reported binge drinking

five or more drinks on one or more occasions in the

past month

• In 2001, at least 1,981 Vermont women received

substance abuse treatment, up from 1,339 in 1998

Binge Drinking

Percentage of women who report having had five

or more drinks on a single occasion

0 2 4 6 8 10 12 14

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Vermont Women U.S Women

VT 3-year-avg US

Alcohol-related Motor Vehicle Deaths

Per 100,000 females

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

1993 1994 1995 1996 1997 1998 1999 2000 2001

Healthy Vermonters 2010 Objectives:

Increase the percentage of adults who have seen a

health care professional for their arthritis

National goal to be set

VT 2000: 36% of women

Increase the percentage of women age 50+

coun-seled about prevention of osteoporosis

National goal to be set

VT 2000: 61% of women

Facts:

• Arthritis is more common in women than in men

It is the most common chronic condition among

women in the U.S.4 In 2000, an estimated 60,400

Vermont women had been diagnosed with arthritis

• All forms of arthritis can be treated and some

can be prevented Maintaining a healthy weight can

reduce a person’s risk of developing osteoarthritis

Physical activity helps control arthritis pain and joint

swelling.4

• Osteoporosis is the leading cause of disability

among women and contributes to hip fracture.5

• Women develop osteoporosis more often than

men, in part because they can lose up to 20 percent

of bone mass in the seven years following

meno-pause.6

• Women age 65+ should be routinely screened for

osteoporosis Routine screening should begin at age

60 for women at increased risk.7

Arthritis Prevalence

Percentage of women ever diagnosed with arthritis (1999-2000)

No National 2010 Goal has been established.

Franklin 29

Grand Isle

24 Essex 36

Caledonia 27

Chittenden 20

Washington 25

Orange 27

Addison 21

Rutland 30

Windsor 32

Bennington 33

Windham 25

Lamoille 25

Risk Factors for Arthritis and Osteoporosis

• Obesity • Menopause before age 45

• Sports injuries • Hysterectomy before age 45

• Joint injuries • Cigarette smoking

• Work injuries • Excessive alcohol use

• Repetitive motion • Diet low in calcium

• Family history of osteoporosis

5

0 5 10 15 20 25 30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

VT 3-year-avg US

Colorectal Cancer Deaths

Per 100,000 women

Lung Cancer Deaths

Per 100,000 women

0 10 20 30 40 50 60

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

VT 3-year-avg US

Healthy Vermonters 2010 Objectives:

Increase the percentage of women age 40+ who have

had a mammogram in the preceding two years, and

women age 18+ who have had a Pap test within the

preceding three years

Goal: 70% (mammogram) 90% (Pap test)

VT 2000: 78% (mammogram) 86% (Pap test)

Increase the percentage of adults age 50+ who have

had a fecal occult blood test (FOBT) in preceding two

years and who have ever had a sigmoid/colonoscopy

Goal: 50%

VT 1999: 21% of women (FOBT)

18% of women (sigmoid/colonoscopy)

Facts:

• The three leading causes of cancer death for women

in Vermont and nationwide are lung cancer, breast

cancer, and colorectal cancer, in that order.8

• Nationally lung cancer death rates are rising in

women and falling in men More women die each

year from lung cancer than from breast cancer.8

• Cigarette smoking is by far the leading risk for

developing lung cancer.9

• Each year in Vermont, an average of 187 women are

diagnosed with colorectal cancer and 71 women die

from this cancer Vermont’s female incidence rate is

statistically worse than the national average

• People over age 50 are at highest risk for colorectal

cancer A family history of colorectal cancer, physical

inactivity, obesity and smoking are also risks.14

Colorectal Cancer Screening by Age

Percentage of Vermont women who had screening FOBT or sigmoidoscopy/colonoscopy (1996, 1997, 1999)

0 20 40 60 80 100

▲Goal 50% of people age 50+

69

Grand

Isle

69 Essex 75

Caledonia 64

Chittenden

78

Washington 78

Orange 68

Addison

72

Rutland

72

Windsor 74

Bennington

78

Windham 70

Lamoille 74

Breast Cancer Screening (1996-2000)

Percentage of women age 40+ who had a mammogram in past two years

Goal: 70%

Significantly Better

At or Near Goal (90%CI) Significantly Worse

Breast Cancer Screening

Percentage of women age 40+ screened in the past two years

0 20 40 60 80 100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Goal 70%▲

Clinical Breast Exam Mammogram

Breast Cancer Deaths

Per 100,000 women

0 5 10 15 20 25 30 35 40

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

VT 3-year-avg US

• Early detection can prevent colorectal cancer by finding

polyps and removing them before they become

cancer-ous Beginning at age 50 all adults should be screening by

colonoscopy, sigmoidoscopy or FOBT.8

• Breast cancer is the most commonly diagnosed cancer

among women.10 Each year in Vermont, approximately 433

new cases of breast cancer are diagnosed and 95 women

die from the disease

• Nationally, breast cancer death rates are 36 percent higher among black women than among white women This higher mortality rate is due mostly to detection and diagnosis at a later stage.11,12

• Women age 40 and older should get a breast cancer screening mammogram every one to two years.13

7

Healthy Vermonters 2010 Objectives:

Reduce diabetes-related deaths

Goal: 45 per 100,000

VT 2001: 82 per 100,000 women

Reduce hospitalizations related to uncontrolled

diabetes among adults age 18-64

Goal: 5.4 per 10,000

VT 1997-99: 2.9 per 10,000 women

Increase the percentage of people with diabetes who

receive formal diabetes education

Goal: 60%

VT 2001: 42 % of women

Increase the percentage of adults with diabetes who

have an annual dilated eye exam

Goal: 75%

VT 2001: 73% of women

Facts:

• Approximately 289 Vermont women die from

diabetes-related causes each year

• Women with diabetes are at greater risk for

diabe-tes-related blindness than men and have a shorter life

expectancy than women without diabetes.15

• Diabetes is a major contributor to health problems

such as heart disease, stroke, blindness, kidney disease,

and non-traumatic leg and foot amputations.16

• Nationally, the prevalence of diabetes is at least 2.4

times higher among black, Hispanic, American Indian,

and Asian/Pacific Islander women than among white

women.15

Diabetes-related Deaths

Deaths per 100,000 Vermont adults

0 20 40 60 80 100 120

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Men Women

Diabetes by Income/Education

Percentage of Vermont women age 25-64 who report being told by a physician that they have diabetes (1996-2000)

0 5 10 15 20

Goal 2.5%▼

Income/Education Level

Risk Factors for Diabetes

• Age over 45

• Being obese

• Inadequate physical activity

• Having a very large baby or gestational diabetes

• Being African American, Hispanic/Latino, Asian American, Pacific Islander or American Indian

• Having a close relative with diabetes (mother, father, sister or brother)

Stroke Deaths

Per 100,000 women

0 10 20 30 40 50 60 70 80

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

0 5 10 15 20 25 30 35

Heart Disease Prevalence by Age and Gender

Percentage of Vermont adults who report being told by

a physician that they have cardiovascular disease (1999)

Prevalence of Risk Factors

Percentage of Vermont women who report risk factors for heart disease and stroke (2001)

0 10 20 30 40 50 60

Smoking Overweight Inadequate

Physical Activity

High Blood Pressure

High Cholesterol

Healthy Vermonters 2010 Objectives:

Reduce coronary heart disease deaths

Goal: 166 per 100,000 population

VT 2001: 132 per 100,000 women

Reduce stroke deaths

Goal: 48 per 100,000 population

VT 2001: 54 per 100,000 women

Reduce the percentage of adults with high blood

pressure

Goal: 16%

VT 2001: 22% of women

Facts:

• Heart disease is the leading cause of death among

women More than half of all heart disease deaths each

year occur among women.17

• In 2001, the heart disease death rate in Vermont was

132 per 100,000 women compared to 236 per

100,000 men

• Stroke is the third leading cause of death, behind

heart disease and cancer At all ages, more women

than men die of stroke.18

• In 1999, 97 percent of Vermont women had their

blood pressure checked within two years and 72

percent had their cholesterol checked within five

years

• Smoking cigarettes is a major risk factor for heart

disease and stroke.18 In Vermont, 21 percent of women

smoke

9

0 100 200 300 400 500 600 700 800

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Chlamydia Infection

Number of reported cases of chlamydia infection among Vermont women age 15-44

Healthy Vermonters 2010 Objectives:

Reduce HIV infection among adolescents and adults

National goal to be set

Increase the percentage of sexually active adults age

18-49 at risk for HIV/STDs who use condoms

Goal: 75%

VT 2000-01: 51% percent of women at risk

Reduce the percentage of people age 15-24 with

Chlamydia trachomatis infections (attending family

planning clinics)

Goal: 3%

Vermont gender-specific data not currently available

Facts:

• As of September 2002, at least 35 Vermont women

were living with HIV and an additional 50 women had

been diagnosed with AIDS About one-third the

women with HIV were infected through heterosexual

contact and one-third through injection drug use

• In 1999, HIV/AIDS was the fifth leading cause of

death for U.S women aged 25-44 Among African

American women in this same age group, HIV/AIDS

was the third leading cause of death.19

• Chlamydia is the most reported sexually transmitted

disease If untreated, up to 40 percent of infected

women develop Pelvic Inflammatory Disease and up

to 20 percent will become infertile.10

• Pelvic inflammatory disease (PID) is an infection of

the genital tract Untreated, PID can lead to infertility,

tubal (ectopic) pregnancy, chronic pelvic pain, and

other serious consequences.20

Cumulative HIV Infection by Gender

Percentage of Vermont cases

Male 80%

Female 20%

Condom Use by Age

Percentage of Vermont women at high risk for HIV and STDs who used a condom at last intercourse (2000-2001)

0 10 20 30 40 50 60 70 80