Report: Black women are getting healthier, but care is still a challenge
3rd July 2017 · 0 Comments
By Susan Buchanan
Contributing Writer
Editor’s Note: This is the second in a series of articles on “The Status of Black Women in the United States” recent study. The first in the series, “Black women work hard but earn less than most Americans,” appeared in the June 26 – July 2, 2017 issue of The Louisiana Weekly.
Sixty percent of African-American women say they’re in good health, but as a group they have relatively high death rates from heart disease and cancer and less access to quality care than whites. While mortality rates from diseases are declining among Black women, that positive trend could be reversed if reforms made under the Affordable Care Act of 2010 are repealed, according to “The Status of Black Women in the United States,” released in early June.
The status study was conducted by the Institute for Women’s Policy Research in Washington and the National Domestic Workers Alliance in New York. Below, we consider what the researchers said about disease, infections, reproductive health, mental illness and insurance.
Heart disease is the main cause of death among the nation’s Black and white women. In now four-year-old data, 7.6 percent of Black women and 5.8 percent of white females suffered from coronary heart disease in 2013, according to the Centers for Disease Control and Prevention. About the same number of American women and men die of heart disease yearly, but women are at higher risk for coronary microvascular disease, in which the walls of the heart’s tiny arteries are damaged. They’re also at greater risk than men for stress-induced cardiomyopathy, or heart-muscle failure caused by emotional strain.
Compared with the rest of the nation, Black women have high rates of heart-disease mortality. Their deaths from heart disease are related to diabetes and obesity, elevated cholesterol and high blood pressure. Black women are less likely than whites to receive preventive care for heart problems. What’s more, an under-representation among all women and minorities in clinical studies about the heart is thought to contribute to their mortality.
Deaths from heart disease among Black women are highest in Michigan at 226.0 per 100,000, with Oklahoma and Mississippi next, at 224.9 and 221.1 per 100,000, respectively. On the positive side, however, heart-disease mortality rates among American women fell from 1999 to 2013. Black women’s heart-disease deaths shrank by nearly 39 percent from 1999 to 176.4 per 100,000 in 2013.
“In general, rates of heart disease and stroke are higher among Black women than White, Hispanic and Asian American women,” Dr. Keith C. Ferdinand, cardiologist and professor of medicine at Tulane University’s Heart and Vascular Institute, said last week. “Rates of heart disease and stroke are premature and excessive for Black women. For them, heart disease and disabilities occur earlier in life and are more often the cause of death, and they more closely reflect rates of heart disease and death seen in White men than in White women.”
“Louisiana and New Orleans specifically have higher rates of heart disease and stroke because of overweight/obesity status and diabetes, along with high rates of hypertension with poor blood-pressure control,” Ferdinand said. The downward trend in death from heart disease among the nation’s Black women is likely to slow, and it might even reverse. “Diabetes rates and overweight/obesity status are increasing across the U.S., especially in Louisiana, pointing to potentially higher rates of heart disease and stroke ahead,” he said.
“Heart disease is associated with genetic factors, but even more importantly with unhealthy lifestyles, socially disadvantaged states and stress,” Ferdinand said. For his work in health equity, Ferdinand won the 2017 Wenger Award for Excellence in Medical Leadership from WomenHeart: The National Coalition for Women with Heart Disease in Washington.
Nationally, almost three-quarters of Black females age 18 and older are overweight or obese, according to the status study. In Wisconsin and Iowa, four out of five are overweight or obese. Obesity can increase the risk of diabetes, cancer, pregnancy complications and other causes of preventable death. “Evidence suggests that the incidence of obesity among Black women is influenced by limited access to affordable, healthy food; to dietary choices; lower levels of engagement in regular physical activity; and experiences of racism,” the status-study researchers said.
The incidence of diabetes, in which glucose builds, has risen among American women and men since the 1980s. For women age 18 and older, Blacks and Native Americans are most likely to have been told they have diabetes. Diabetics are at risk for heart disease, stroke, blindness, kidney disease and other conditions. States with the largest components of diabetic Black women are South Carolina, Alabama and West Virginia, with 17.7, 17.7 and 17.2 percent afflicted there, respectively.
After heart disease, cancer is the next leading cause of death for all women in the United States. Rates for all cancers combined are higher among white women at 416.7 per 100,000, versus 391.5 per 100,000 for Black females, according to the CDC. But death rates for all cancers combined are higher among Black women at 161.9 per 100,000, against 142.1 per 100,000 for white females. For American women as a whole, lung cancer is the deadliest form, followed by breast cancer. Among Black women specifically, breast cancer is the disease’s most common form, however, at 30.2 per 100,000 women.
Black women’s lung-cancer mortality rates are highest in Wisconsin, Kentucky and Iowa, at 56.5, 56.4, and 52.2 per 100,000 respectively. Though white women historically have had higher cancer rates, by 2012 the incidence of breast cancer among Black women was equal to White women’s. Louisiana and Oklahoma have the highest rates of breast cancer mortality among Black women, at 34.7 per 100,000. In 2015, the national median age of diagnosis for breast cancer was 58 years old among Black women, versus 62 years for white females. Between 2008 and 2012, breast cancer mortality rates fell among Black women in most states, however.
AIDS is higher among Black women at 25.1 per 100,000 women, than American females of other racial and ethnic groups. Between 2000 and 2013, the average incidence of AIDS among Black women dropped from 45.7 per 100,000 to 25.1 per 100,000, however. HIV/AIDS poses serious threats to women, increasing their risk of human papillomavirus, which can lead to cervical cancer and pelvic inflammatory disease.
HIV prevention tends to focus on sex between men, preventing risk assessment from reaching Black females as effectively as it should, advocates for Black women’s health assert. Anyone at high risk for HIV should be screened annually or more often, and HIV screening should be included in prenatal tests for pregnant women, the CDC says.
Women are more likely than men to be diagnosed with sexually transmitted infections or STIs, and are thus more subject to associated health problems, including infertility. Black women have higher rates of many of the most common STIs than white women. Among American women, Black females had the highest reported rates of chlamydia in 2014 at 1,432.6 cases per 100,000 women. Infection can lead to pelvic inflammatory disease, a common cause of infertility and ectopic pregnancy.
With 42.8 deaths per 100,000 live births, Black women are more than three times as likely to die from pregnancy and childbirth as white women. Inequalities in Black women’s fertility, natality and infant health are due in part to unequal access to health care and to racial discrimination within care systems. Prenatal care in the first trimester of pregnancy is highest for Prenatal care in the first trimester of pregnancy is highest for white women. Those who don’t get prenatal care are three times more likely to have low birth-weight babies and five times more likely to have babies who die in infancy. But, in a favorable trend, from 2001 to 2011 the number of Black women starting prenatal care in the first trimester of pregnancy rose by seven percent.
Among American females, Black women are most likely to have low birth-weight babies. Differences in birth outcomes between Black and white mothers, including low-weight births, are related to socioeconomic standing, education, employment and health insurance, the status-study researchers said. Stress related to racial discrimination, finances and other factors contribute to disparities in outcomes. Mississippi has the largest proportion of babies born with low birth weights to Black women at 16.1 percent, followed by Louisiana, West Virginia, Colorado and Alabama.
Nationally, Black women have the highest rate of infant mortality, with 11.3 lost per 1,000 live births in 2013. Black women’s infant mortality rate fell by 2.3 percentage points between 2001 and 2012, however. Infant mortality is influenced by inadequate prenatal care, smoking and stress. Kansas and Wisconsin have the highest rates of infant mortality among Black women, at 14.2 and 14 per 1,000 live births, respectively.
One in seven African-American women aged 21 to 64 has a disability. Black women with disabilities earn less than Black women without them and are more likely to live in poverty, the status-study researchers said.
As for mental health, Black men and women are affected by depression at higher rates than Whites, and have less access to needed services. “Racism negatively influences minorities’ mental health,” the status-study researchers said. All women nationally have higher incidences of anxiety and more eating disorders than men. Compared with men, women’s mental health is influenced by higher rates of poverty, greater responsibility for family members and domestic violence. But nationally, women across all racial groups are much less likely than men to commit suicide. And Black women rarely commit suicide, with a rate of 2.1 per 100,000, versus 5.1 per 100,000 for all American women.
Health insurance coverage for women and Blacks has grown, following implementation of the 2010 Affordable Care Act. At this juncture at midyear, all eyes are on Congress. “National efforts to reform health care may roll back access to insurance and Medicaid, especially among patients who were previously uninsured or inadequately insured prior to the ACA,” Dr. Ferdinand at Tulane warned.
The ACA expanded Medicaid eligibility to those under age 65 who have incomes up to 138 percent of the federal poverty line. Louisiana has participated in the expansion but some states haven’t. Since Medicaid expansion began under Governor John Bel Edwards a year ago, an additional 433,412 adults had been enrolled in the program by June 26, according to Louisiana’s Department of Health. Greater New Orleans has the most new enrollees, with 52,157 in Orleans Parish and 44,634 in Jefferson Parish.
Many low-income Louisianians new to Medicaid could lose their coverage if one of the Republican-backed plans to repeal Obamacare becomes law. The Housed passed its bill in early May. The Senate won’t vote on its version, the Better Care Reconciliation Act, until sometime after its July 4 recess. Last week, the Congressional Budget Office estimated that 22 million Americans would be uninsured by 2026 if a current proposal by some senators becomes law.
Low-income Black women in states that decided not to expand Medicaid, including Mississippi and Texas, have missed out on coverage. If Medicaid expansion ends in Louisiana, worries are that uninsured residents and their families will resort to using hospital emergency rooms for routine care.
This article originally published in the July 3, 2017 print edition of The Louisiana Weekly newspaper.
