Women's Health USA Data Book

Women's Health USA 2008.pdf

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

Women's Health USA Data Book

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Women’s Health USA 2008

Please note that Women’s Health USA 2008 is not copyrighted. Readers are free to duplicate
and use all or part of the information contained in this publication.

Suggested Citation:
U.S. Department of Health and Human Services,
Health Resources and Services Administration. Women’s Health USA 2008.
Rockville, Maryland: U.S. Department of Health and Human Services, 2008.

This publication is available online at www.hrsa.gov/womenshealth
Single copies of this publication are also available at no charge from the
HRSA Information Center
P.O. Box 2910
Merrifield, VA 22116
1- 888-ASK-HRSA or [email protected]
The data book is available in limited quantities in CD format.

WOMEN’S HEALTH USA 2008

PREFACE AND READER’S GUIDE

CONTENTS

INTRODUCTION

POPULATION CHARACTERISTICS

U.S. Population
U.S. Female Population

10
11

Chronic Fatigue Syndrome

Special Populations

Cancer

Older Women

Diabetes

Rural and Urban Women

Overweight and Obesity

Heart Disease and Stroke

Hypertension

HEALTH SERVICES UTILIZATION

Usual Source of Care

Health Insurance

Medicare and Medicaid

Preventive Care

Vaccination

Household Composition

Oral Health and Dental Care

Women and Poverty

Eye Health

Osteoporosis

Digestive Disorders

Hospitalizations

Endocrine and Metabolic Disorders

Health Care Expenditures

Genetics and Women’s Health

Medication Use

HIV/AIDS

Mental Health Care Utilization

Sexually Transmitted Infections

HIV Testing

Injury

Organ Transplantation

Food Security

Women and Federal Nutrition Programs

Women in Health Profession Schools

Educational Degrees and Instructional Staff

Women in the Labor Force

HEALTH STATUS

Health Behaviors
Physical Activity

Occupational Injury

Quality of Women’s Health Care

Nutrition

Attention Deficit Hyperactivity Disorder

Satisfaction with Health Care

Alcohol Use

Mental Illness and Suicide

HRSA Programs Related to Women’s Health

Cigarette Smoking

Intimate Partner Violence

Illicit Drug Use

Urologic Disorders

INDICATORS IN PREVIOUS EDITIONS

Gynecological and Reproductive Disorders

ENDNOTES

DATA SOURCES

CONTRIBUTORS

Health Indicators
Self-Reported Health Status

Maternal Health

Life Expectancy

Live Births

Leading Causes of Death

Breastfeeding

Activity Limitations and Disabilities

Smoking During Pregnancy

Arthritis

Maternal Morbidity and Risk Factors in Pregnancy

Asthma

Maternal Mortality

PREFACE

PREFACE AND READER’S
GUIDE
The U.S. Department of Health and Human
Services, Health Resources and Services Administration (HRSA) supports healthy women
building healthy communities. HRSA is charged
with ensuring access to quality health care
through a network of community-based health
centers, maternal and child health programs, and
community HIV/AIDS programs throughout
the States and Territories. In addition, HRSA’s
mission includes supporting individuals pursuing
careers in medicine, nursing, and many other
health disciplines. HRSA fulfills these responsibilities by collecting and analyzing timely, topical
information that identifies health priorities and
trends that can be addressed through program
interventions and capacity building.
HRSA is pleased to present Women’s Health
USA 2008, the seventh edition of the Women’s
Health USA data book. To reflect the everchanging, increasingly diverse population and its
characteristics, Women’s Health USA selectively
highlights emerging issues and trends in women’s
health. Data and information on occupational
injury, maternal mortality, digestive disorders,
oral health, eye health, and urologic disorders are
only a few of the new topics included in this
edition. Every effort has been made to highlight
racial and ethnic, sex/gender, and socioeconomic

WOMEN’S HEALTH USA 2008

disparities where possible. Where race and
ethnicity data are reported, every effort was made
to ensure that groups are mutually exclusive;
when groups of Blacks and Whites exclude
Hispanics they are described as non-Hispanic,
and Asian/Pacific Islanders and American
Indian/Alaska Natives are also generally nonHispanic. In some instances, it was not possible
to provide data for all races due to the design of
the original data source or the size of the sample
population; therefore, data with a relative
standard error of 30 percent or greater were
considered unreliable and were not reported.
The data book was developed by HRSA to
provide readers with an easy-to-use collection of
current and historical data on some of the most
pressing health challenges facing women, their
families, and their communities. Women’s Health
USA 2008 is intended to be a concise reference
for policymakers and program managers at the
Federal, State, and local levels to identify and
clarify issues affecting the health of women. In
these pages, readers will find a profile of women’s
health from a variety of data sources. The data
book brings together the latest available information from various agencies within the Federal
government, including the U.S. Department of
Health and Human Services, U.S. Department
of Agriculture, U.S. Department of Labor, and
U.S. Department of Justice. Non-Federal data

sources were used when no Federal source was
available. Every attempt has been made to use
data collected in the past 5 years. It is important
to note that the incidence data included are
generally not age-adjusted to the 2000 population standard of the United States. This affects
the comparability of data from year to year, and
the interpretation of differences across various
groups, especially those of different races and
ethnicities. Without age adjustment, it is difficult
to know how much of the difference in incidence
rates between groups can be attributed to differences in the groups’ age distributions.
Women’s Health USA 2008 is available online
through either the HRSA Office of Women’s
Health Web site at www.hrsa.gov/womenshealth
or the Office of Data and Program Development’s Web site at www.mchb.hrsa.gov/data. In
an effort to produce a timely document, some of
the topics covered in Women’s Health USA 2007
were not included in this year’s edition because
new data were not available. For coverage of these
issues, please refer to Women’s Health USA 2007,
also available online. The National Women’s
Health Information Center, located online at
www.womenshealth.gov, has updated and
detailed women’s and minority health data and
maps. These data are available through Quick
Health Data Online at www.4woman.gov/
quickhealthdata. Data are available at the State

and county levels, by age, race and ethnicity, and
sex/gender.
Women’s Health USA 2008 is not copyrighted.
Readers are free to duplicate and use any of the
information contained in this publication. Please
provide any feedback on this publication to the
HRSA Information Center which offers single
copies of the data book in print or on CD at no
charge:
HRSA Information Center
P.O. Box 2910
Merrifield, VA 22116
Phone: 703-442-9051
Toll-free: 1-888-ASK-HRSA
TTY: 1-877-4TY-HRSA
Fax: 703-821-2098
[email protected]
www.ask.hrsa.gov

INTRODUCTION
In 2006, women represented 50.8 percent of
the 299 million people residing in the United
States. In most age groups, women accounted for
approximately half of the population, with the
exception of people aged 65 years and older;
within this age group, women represented 58
percent of the population. The growing diversity
of the U.S. population is reflected in the racial
and ethnic distribution of women across age
groups. Black and Hispanic women accounted
for 8.9 and 6.3 percent of the female population
aged 65 years and older, respectively, but they
represented 14.7 and 21.0 percent of females
under 15 years of age. Non-Hispanic Whites
accounted for 80.6 percent of women aged 65
years and older, but only 56.4 percent of those
under 15 years of age.
America’s growing diversity underscores the
importance of examining and addressing racial
and ethnic disparities in health status and the use
of health care services. In 2006, 62.3 percent of
non-Hispanic White women reported themselves
to be in excellent or very good health, compared
to only 53.4 percent of Hispanic women and
50.2 percent of non-Hispanic Black women.
Minority women are disproportionately
affected by a number of diseases and health
conditions, including HIV/AIDS, sexually
transmitted infections, diabetes, and asthma. For

WOMEN’S HEALTH USA 2008

instance, in 2006, non-Hispanic Black and
Hispanic women accounted for more than threefourths of women living with HIV/AIDS (63.9
and 15.2 percent, respectively). One-third of
non-Hispanic White women had ever been tested
for HIV, compared to 53.7 percent of nonHispanic Black women and 46.1 percent of
Hispanic women.
Diabetes is a chronic condition and a leading
cause of death and disability in the United States,
and is especially prevalent among minority
populations. Among non-Hispanic Black and
Hispanic women, diabetes occurred at a rate of
117.6 and 111.8 per 1,000 women, respectively,
compared to 69.4 per 1,000 non-Hispanic White
women. Hypertension, or high blood pressure,
was also more prevalent among non-Hispanic
Black women than women of other races. In
2005–2006, this condition occurred at a rate of
179.2 per 1,000 non-Hispanic Black women,
compared to 157.0 per 1,000 non-Hispanic
White women and 113.1 per 1,000 Hispanic
women.
Some conditions, such as arthritis and heart
disease, disproportionately affect non-Hispanic
White women. For instance, in 2006, more than
27 percent of non-Hispanic White women had
arthritis, compared to 23.5 percent of nonHispanic Black women and 14.3 percent of
Hispanic women.

INTRODUCTION

In addition to race and ethnicity, income and
education are important factors that contribute to
women’s health and access to health care. Regardless of family structure, women are more likely
than men to live in poverty. Poverty rates were
highest among women who were heads of their
households (25.1 percent). Poverty rates were also
highest among American Indian/Alaska Native
women (27.6 percent), followed by non-Hispanic
Black and Hispanic women (23.4 and 20.2
percent, respectively). Non-Hispanic Black and
Hispanic women were also more likely to be
heads of households than their non-Hispanic
White and Asian counterparts.
Some conditions and health risks are more
closely linked to family income than to race and
ethnicity, such as asthma. Rates of asthma decline
as income increases and women with higher
incomes are more likely to effectively manage
their asthma. Among women with asthma whose
incomes were below 100 percent of poverty,
nearly 36 percent had an asthma-related
emergency room visit in the past year, compared
to 24.8 percent of women with family incomes of
300 percent or more of poverty.
Mental health is another important aspect of
women’s overall health. A range of mental health
problems, including depression, anxiety, phobias,
and post-traumatic stress disorder, disproportionately affect women. Unlike many other health

concerns, younger women are more likely than
older women to suffer from serious psychological
stress and major depressive episodes.
Physical disabilities are more prevalent among
women as well. Disability can be defined as
impairment of the ability to perform common
activities like walking up stairs, sitting or standing
for 2 hours or more, grasping small objects, or
carrying items like groceries. Therefore, the terms
“activity limitations” and “disabilities” are used
interchangeably throughout this book. Overall,
15.0 percent of women and 12.6 percent of men
reported having activity limitations in 2006.
Men, however, bear a disproportionate burden
of some health conditions, such as HIV/AIDS,
hypertension and heart disease. In 2006, for
instance, adolescent and adult males accounted
for 72.9 percent of new AIDS cases, though a
smaller proportion of men had ever been tested
for HIV than women (33.7 versus 37.8 percent,
respectively).
Certain health risks, such as cigarette use and
injury, occur more commonly among men than
women. In 2006, 27.8 percent of males smoked
cigarettes, compared to 22.4 percent of females.
Among men, 30.2 percent of emergency department visits were injury related, while only 21.3
percent of women’s visits were due to injury. In
addition, men were more likely than women to
lack health insurance.

INTRODUCTION

Many diseases and health conditions, such as
those mentioned above, can be avoided or
minimized through good nutrition, regular
physical activity, and preventive health care. In
2005, 19.7 percent of women’s visits to physicians
were for preventive care, including prenatal care,
preventive screenings, and immunizations.
Overall, 64.6 percent of older women reported
receiving a flu shot in 2006; however, this
percentage ranged from 46.6 percent among
Hispanic women to 67.3 percent of nonHispanic White women.
In addition to preventive health care, preventive
dental care is also important to prevent dental
caries and gum disease. In 2003–2004, 74.6
percent of women with incomes of 300 percent or
more of poverty saw a dentist in the past year,
compared to 51.4 percent of women with
incomes below 100 percent of poverty, and 44.9
percent of women with incomes of 200–299
percent of poverty.
There are many ways women (and men) can
promote health and help prevent disease and
disability. Regular physical activity is one of these.
In 2006, 10.3 percent of women participated in
adequate physical activity–30 minutes of
moderate-intensity physical activity on most days
of the week or 20 minutes of vigorous-intensity
activity on 3 or more days per week. NonHispanic White women and women with higher

WOMEN’S HEALTH USA 2008

incomes were most likely to meet the
recommended levels of physical activity.
Healthy eating habits can also be a major
contributor to long-term health and prevention
of chronic disease. In 2003–2004, however, more
than half of all adult women had diets that
included more than the recommended amount of
saturated fat and sodium and less than the
recommended amount of folate and calcium.
Overall, 63.5 percent of women exceeded the
maximum daily intake of saturated fat, and 70
percent exceeded the maximum amount of
sodium.
While some behaviors have a positive effect on
health, a number of others, such as smoking,
illicit drug use, and excessive alcohol use can have
a negative effect. In 2006, 22.4 percent of women
smoked. However, nearly 46 percent of female
smokers tried to quit at some point in the past
year. During the same year, 44.9 percent of
women reported any alcohol use in the past
month, but relatively few women (15.6 percent)
reported binge drinking (five or more drinks on
the same occasion) and even fewer (3.5 percent)
reported heavy alcohol use (binge drinking on 5
days or more in the past month).
Cigarette, alcohol, and illicit drug use is particularly harmful during pregnancy. The use of
tobacco during pregnancy has declined steadily
since 1989. Based on data from 36 states, 10.5

percent of pregnant women reported smoking
during pregnancy in 2005. This rate was highest
among American Indian/Alaska Native women
(18.1 percent) and lowest among Asian/Pacific
Islander women (2.1 percent).
Women’s Health USA 2008 can be an important
tool for emphasizing the importance of preventive care, counseling, and education, and for
illustrating disparities in the health status of
women from all age groups and racial and ethnic
backgrounds. Health problems can only be
remedied if they are recognized. This data book
provides information on a range of indicators that
can help us track the health behaviors, risk factors,
and health care utilization practices of women
throughout the United States.

WOMEN’S HEALTH USA 2008

INTRODUCTION

POPULATIO N
CHARACTERISTICS
Population characteristics describe the diverse
social, demographic, and economic features of the
Nation’s population. There were over 151 million
females in the United States in 2006, representing
slightly more than half of the population.
Examining data by demographic factors such as
sex, age, and race/ethnicity can serve a number of
purposes for policymakers and program planners.
For instance, these comparisons can be used to
tailor the development and evaluation of policies
and programs serving women.
The following section presents data on population characteristics that affect women’s physical,
social, and emotional health. Some of these
characteristics include the age and racial and
ethnic distribution of the population, household
composition, education, income, occupation,
and participation in Federal programs.

WOMEN’S HEALTH USA 2008

U.S. Female Population,* by Age, 2006
Source I.1: U.S. Census Bureau, American
Community Survey

U.S. Population,* by Age and Sex, 2006
Source I.1: U.S. Census Bureau, American Community Survey
151,963
150,000
147,434

140,000

130,000
Female
Male
Number in Thousands

U.S. POPULATION
In 2006, the total U.S. population was over 299
million, with females comprising 50.8 percent of
that total. Females younger than 35 years of age
accounted for 46.1 percent of the female population, those aged 35–64 years accounted for 39.7
percent, and females aged 65 years and older
accounted for 14.2 percent.
The distribution by sex was fairly even across
younger age groups; however, women accounted
for a greater percentage of the older population
than men. Of those aged 65 and older, 58.0
percent were women.

35,000
31,107
29,705

30,000

25,000

65 Years and
Older 14.2%

21,943 21,948 22,004

21,967
20,685
Under 15
Years 19.6%

20,000

19,656

20,249

21,584

21,321

16,384
55-64 Years
10.8%

15,233

15,606

15,000

45-54 Years
14.5%

15-24 Years
13.6%
10,000

25-34 Years
12.9%

5,000

35-44 Years
14.4%
Total
*Includes only non-institutionalized population not living in group housing.

Under 15 Years

15-24 Years

25-34 Years

35-44 Years

*Includes only non-institutionalized population not living in group housing.

45-54 Years

55-64 Years

65 Years
and Older

WOMEN'S HEALTH USA 2008

U.S. Female Population,* by Age and Race/Ethnicity, 2006
Source I.1: U.S. Census Bureau, American Community Survey
80.6
80
75.8
Non-Hispanic White
Black**
Hispanic
Asian/Pacific Islander**
American Indian/Alaska Native**

61.0

68.2

59.7

60
56.4

50
Percent of Females

U.S. FEMALE POPULATION
The growing diversity of the U.S. population is
reflected in the racial and ethnic distribution of
women across age groups. The younger female
population (under 15 years) is significantly more
diverse than the older female population. In
2006, 56.4 percent of females under 15 years
were non-Hispanic White, while 21.0 percent of
that group were Hispanic. In contrast, among
women aged 65 years and older, 80.6 percent
were non-Hispanic White and only 6.3 percent
were Hispanic. The distribution of the Black
population was more consistent across age
groups, ranging from 14.7 percent of females
under 15 years of age to 8.9 percent of women
aged 65 years and older.
Evidence indicates that race and ethnicity
represent important factors related to health
disparities. Coupled with the increasing diversity
of the U.S. population, these health disparities
make culturally-appropriate, community-driven
programs critical to improving the health of the
entire U.S. population.1

POPULATION CHARACTERISTICS

21.0
14.7

18.3
13.6

16.9
15.0

12.7
12.2
10.6
10

8.9

8.1
6.2
0.9
Under 15 Years

1.0
15-24 Years

6.3

5.1

4.4

4.2

0.9
25-34 Years

4.2
0.8

35-54 Years

3.2
0.7

55-64 Years

0.5
65 Years and Older

*Includes only non-institutionalized population not living in group housing. Percentages do not equal 100 because data are not shown for
persons selecting other races or more than one race. **May include Hispanics.

POPULATION CHARACTERISTICS

WOMEN’S HEALTH USA 2008

HOUSEHOLD COMPOSITION
In 2006, 52.5 percent of women aged 18 years
and older were married and living with a spouse;
this includes married couples living with other
people, such as parents. Just over 12 percent of
women over age 18 were the heads of their
households, meaning that they have children or
other family members, but no spouse, living with
them in a house that they own or rent. Women
who are heads of households include single

mothers, single women with a parent or other
close relative in their house, and women with
other household compositions. The remaining
women lived alone (15.3 percent), with parents or
other relatives (12.7 percent), or with nonrelatives (7.2 percent).
Women in households with no spouse present
are more likely than women in married couple
families to have incomes below poverty (see
“Women and Poverty” on the next page). In

Adult Women,* by Household Composition, 2006
Source I.2: U.S. Census Bureau, Current Population Survey

2006, Black women were most likely to be single
heads of households (28.9 percent) while Asian
women were least likely (7.5 percent). Hispanic
women and women of other races were also more
likely than non-Hispanic White and Asian
women to be heads of households (16.2 and 17.7
percent, respectively).

Women Who Are Heads of Households,* by Race/Ethnicity,
2006
Source I.2: U.S. Census Bureau, Current Population Survey

Living with Parents
or Other Relatives
12.7%

Married, Spouse
Present 52.5%

Percent of Women

Living with
Non-Relatives
7.2%

Living Alone
15.3%

28.9

20
17.7
16.2
15

9.0
7.5

5
Head of Household,
No Spouse Present
12.3%

*Civilian, non-institutionalized population aged 18 years and older.

Non-Hispanic White

Black**

Hispanic

Asian**

Other Races†

*Civilian, non-institutionalized population aged 18 years and older; includes women who have children or
other family members, but no spouse, living in a house that they own or rent. **May include Hispanics.
†Includes American Indian/Alaska Natives and persons of more than one race. May include Hispanics.

WOMEN'S HEALTH USA 2008

POPULATION CHARACTERISTICS

WOMEN AND POVERTY
women (23.4 percent) and Hispanic women
Women in families—a group of at least two
In 2006, nearly 36.5 million people in the
(20.2 percent; data not shown).
people related by birth, marriage, or adoption and
United States lived with incomes below the
Poverty status varies with age. Among women
residing together—experience higher rates of
poverty level.2 More than 12 percent of women
of each race and ethnicity, those aged 45–64 years
poverty than men in families (9.4 versus 6.2
aged 18 years and older (14.1 million) lived in
were less likely to experience poverty than those
percent). Men in families with no spouse present
poverty, compared to 8.8 percent of men. With
aged 18–44 and 65 years and older. For instance,
were considerably less likely to have family
regard to race and ethnicity, non-Hispanic White
17.2 percent of non-Hispanic Black women aged
incomes below the poverty level than women in
women were the least likely to experience poverty
45–64 were in poverty in 2006, compared to
families with no spouse present (12.0 versus 25.1
(9.0 percent), while American Indian/Alaska
more than 26 percent of non-Hispanic Black
percent).
Native women were the most likely (27.6
women aged 18–44 and 65 years and older.
percent), followed closely by non-Hispanic Black
Women Aged 18 and Older Living Below the Poverty Level,*
Adults in Families* Living Below the Poverty Level,**
by Race/Ethnicity and Age, 2006
by Household Type and Sex, 2006
Source I.3: U.S. Census Bureau, Current Population Survey

Source I.3: U.S. Census Bureau, Current Population Survey
34.6

35
18-44 Years

45-64 Years
65 Years and Older

Percent of Women

27.3
25.5

26.4

26.3

21.7

20.8

20
17.2
15

14.9
11.5

16.1

11.5
11.3

11.0

9.0

25.1

9.4 8.7

9.0

Percent of Adults

20
Female
Male
15
12.0
10

6.6

9.4
6.2
4.8

Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian/
American Indian/
Pacific Islander Alaska Native

*Poverty level, defined by the U.S. Census Bureau, was $20,444 for a family of four in 2006.

Adults in Families,
Total

4.8

Adults in Families,
Married Couple

Adults in Families,
No Spouse Present

*Families are a group of at least two people related by birth, marriage, or adoption and residing together.
**Poverty level, defined by the U.S. Census Bureau, was $20,444 for a family of four in 2006.

POPULATION CHARACTERISTICS

WOMEN’S HEALTH USA 2008

FOOD SECURITY
Food security is defined as having access at all
times to enough nutritionally adequate and safe
foods to lead a healthy, active lifestyle.3 Food
security is measured through a series of indicators
such as whether people worry that food would
run out before there would be money to buy
more; whether an individual or his/her family cut
the size of meals or skipped meals because there
was not enough money for food; and whether an
individual or his/her family ever went a whole day
without eating as there was not enough food.
In 2006, an estimated 35.5 million people lived
in households that were classified as not fully food
secure. Households or persons experiencing food
insecurity may be categorized as experiencing low

food security or very low food security (formerly
referred to as “food insecurity with hunger”). Low
food security generally indicates multiple food
access issues, while very low food security
indicates reduced food intake and disrupted
eating patterns due to inadequate resources for
food. Periods of low or very low food security may
be occasional or episodic, placing the members of
a household at greater nutritional risk due to
insufficient access to nutritionally adequate and
safe foods.
In 2005–2006, nearly 17 percent of women
were not fully food secure, and this percentage
varied by race and ethnicity. Among women,
non-Hispanic Whites were most likely to be fully
food secure (89.4 percent), while Hispanics were

least likely (62.2 percent). Non-Hispanic Black
women had the highest rate of very low food
security (5.6 percent), and Hispanic women had
the highest rates of being marginally food secure
and having low food security (20.2 and 14.6
percent, respectively).
Food security status also varies by household
composition. While adult men and women living
alone had similar rates of food insecurity in 2006,
female-headed households with no spouse present
were more likely than male heads of households
with no spouse present to experience food insecurity (30.4 versus 17.0 percent, respectively).

Food Security Status Among Adults Aged 18 and Older,
by Household Composition* and Sex, 2006

Source I.4: Centers for Disease Control and Prevention, National Center for Health Statistics,
National Health and Nutrition Examination Survey

Source I.5: U.S. Department of Agriculture, Economic Research Service

100
90
80
70
60
50
40
30
20
10

Fully Food Secure
Marginally Food Secure
Low Food Security
Very Low Food Security
69.4

89.4

83.5

35
Percent of Adults

Percent of Women

Food Security Status of Women Aged 18 and Older,
by Race/Ethnicity,* 2005–2006

62.2

7.5 5.9
3.2
Total

13.8 11.2
4.7 3.3 2.6
Non-Hispanic White

20.2

14.6

5.6

Non-Hispanic Black

2.9
Hispanic

*The sample of Asian/Pacific Islanders, American Indian/Alaska Natives, persons of more than one race,
and persons of all other races not specified were too small to produce reliable estimates.

30.4

30
25
20
15
10

10.3
Female

Male

11.3

11.4

17.0
4.2
10.1

10.1

5.8

5.9

2.1

5.5

5.6

8.0

5
Adults Living Alone

Adults in Families,
Married Couple

*Percentages may not add to totals due to rounding.

20.1

12.7

Adults in Families,
No Spouse Present

Very Low
Food
Security
Low Food
Security

WOMEN'S HEALTH USA 2008

POPULATION CHARACTERISTICS

WOMEN AND FEDERAL
NUTRITION PROGRAMS
Federal programs can provide low-income
women and their families with essential help in
obtaining food and income support. The Federal
Food Stamp Program (FSP) helps low-income
individuals purchase food. In 2006, nearly 13.0
million adults participated in the FSP; of these,
more than 8.8 million (68 percent) were women.
Of these women, more than 4 million (almost
half ) were in the 18- to 35-year-old age group.

Female-headed households with children make
up nearly one-third of households that rely on
food stamps, and represent nearly 60 percent of
food stamp households with children (data not
shown).
The Special Supplemental Nutrition Program
for Women, Infants, and Children (WIC) also
plays an important role in serving women and
families by providing supplementary nutrition
during pregnancy, the postpartum period, and
while breastfeeding. Most WIC participants are

infants and children (75.0 percent); however, the
program also serves more than 2 million pregnant
women and mothers, representing 25.0 percent
of WIC participants. During the years
1992–2006, the number of women participating
in WIC increased by 65 percent, and it continues
to rise.

Adult Recipients of Food Stamps, by Age and Sex, 2006

Women Participating in WIC,* 1992–2006

Source I.6: U.S. Department of Agriculture, Food Stamp Quality Control Sample

Source I.7: U.S. Department of Agriculture, WIC Program Participation Data
2,023,309

9,000

2,000,000

8,804

1,931,651

8,000

1,800,000

7,000

1,812,786

Female
1,734,033

6,000

Number of Women

Number in Thousands

Male

5,000

4,188
4,000

4,053
3,224

3,000

1,600,000

1,748,792

1,647,338

1,499,218
1,400,000

1,978

2,000

1,200,000

1,526

1,507

1,000

1,226,115

703
1,000,000
Total (18 Years
and Older)

18-35 Years

36-59 Years

60 Years and Older

1992

1994

1996

1998

2000

2002

2004

2006

* Participants are classified as women, infants, or children based on nutritional-risk status; data reported include
all pregnant women and mothers regardless of age.

POPULATION CHARACTERISTICS

WOMEN’S HEALTH USA 2008

WOMEN IN HEALTH
PROFESSION SCHOOLS
The health professions have long been characterized by gender disparities. Some professions,
such as medicine and dentistry, have historically
been dominated by males, while others, such as

nursing, have been predominantly female. Over
the past several decades, these disparities have
narrowed, and in some cases reversed. In
1980–1981, 47.4 percent of pharmacy students
were women, while in the fall of 2006, women
represented more than 63 percent of pharmacy

Women in Schools for Selected Health Professions, 1980–1981 and 2006–2007
Source I.8: Professional Associations
100
94.3
91.2
90

1980-1981
2006-2007

85.6

75.9
70.0

70
Percent of Students

63.2
60
55.2
49.9

48.8

47.4
44.3

26.5
19.7

17.0

Medicine

Osteopathic
Medicine

Nursing

*Most recent data for dentistry are from the 2005-2006 school year.

Dentistry*

Pharmacy

Public Health

Social Work

students. Even in fields where men are still in the
majority, the representation of female students
has grown. In 1980–1981, only 26.5 percent of
medical students were women, compared to
nearly one-half (48.8 percent) of students in the
fall of 2006. Similar gains have been made in the
fields of osteopathic medicine and dentistry,
where the most recent data indicate that 49.9
and 44.3 percent of students, respectively, were
women, compared to 19.7 and 17.0 percent in
1980–1981.
During the 2006–2007 academic year, female
students represented a large majority in graduate
public health (70.0 percent) and social work
programs (85.6 percent). Nursing, at both the
undergraduate and graduate levels, also continues to be dominated by women, although the
proportion of students who are female is slowly
declining. In the 1980–1981 academic year,
94.3 percent of graduate students in nursing
programs were female, while in the fall of 2006,
females represented 91.2 percent of graduate
students in nursing programs. Women also
represent a majority of students studying
optometry (64.2 percent) and dietetics (91
percent; data not shown). Comparative data for
these programs were not available for the
1980–1981 academic year.

WOMEN'S HEALTH USA 2008

POPULATION CHARACTERISTICS

EDUCATIONAL DEGREES
instructors and lecturers, they made up only 25.1
nearly half of all first professional and doctoral
AND INSTRUCTIONAL STAFF
percent of professors and less than 39 percent of
degrees. The most significant increase has been in
The number of post-secondary educational
associate professors.
the proportion of first professional degree earners
degrees awarded to women rose from just over
Among female instructors, a significant racial
who are women, which jumped from 5.3 percent
half a million in the 1969–1970 academic year to
and ethnic disparity exists as well: 78.1 percent of
in 1969–1970 to 49.8 percent in 2004–2005. In
nearly 1.7 million in 2004–2005. Although the
all female instructional staff were non-Hispanic
2004–2005, the total number of women earning
number of degrees earned by men has also
White. This disparity is even more pronounced
their first professional degree (43,440) was 23
increased, the rate of growth among women has
among higher-level staff, such as professors, where
times greater than in 1969–1970 (1,841).
been much faster; therefore, the proportion of
non-Hispanic White women composed 86.8
Although sex disparities in education have
degrees earned by women has risen dramatically.
percent of full-time female staff, compared to 4.7
almost disappeared, there is still a disparity among
In 1969–1970, men earned a majority of every
percent for non-Hispanic Black women and 2.6
instructional staff in degree-granting institutions.
type of post-secondary degree, while in
percent for Hispanic women (data not shown).
In fall 2005, only 40.6 percent of full-time
2004–2005, women earned more than half of all
instructional faculty were women. While women
associate’s, bachelor’s, and master’s degrees and
accounted for more than half of all full-time
*
Full-Time Instructional Staff in Degree-Granting Institutions,
Degrees Awarded to Women, by Type, 1969–1970
by Academic Rank and Sex, Fall 2005
and 2004–2005
Source I.9: U.S. Department of Education, Digest of Education Statistics

Source I.9: U.S. Department of Education, Digest of Education Statistics
100
90
Percent of Degrees

59.4

All Ranks
52.3

47.7

52.8

47.2

46.0

54.0

38.8

61.2

25.1

74.9

Lecturer

70
61.6

60
50

Male

Female

40.6

2004-2005
1969-1970

59.3

57.4

49.8
43.0

43.1

48.8

Instructor
Assistant
Professor

39.7

Associate
Professor

13.3

Professor

5.3
Associate's
Degree

Bachelor's
Degree

Master's
Degree

First Professional
Degree**

Doctoral
Degree†

40
50
60
Percent of Full-Time Staff

*Remaining percentage of degrees were earned by men. **Includes fields of dentistry (D.D.S. or D.M.D.), medicine (M.D.), optometry (O.D.), osteopathic medicine (D.O.), pharmacy (D.Phar.), podiatry (D.P.M.),
veterinary medicine (D.V.M.), chiropractic (D.C. or D.C.M.), law (LL.B. or J.D.), and theological professions (M.Div. or M.H.L.) †Includes Doctor of Philosophy degree (Ph.D.) and degrees awarded for fulfilling specialized
requirements in professional fields such as education (Ed.D.), musical arts (D.M.A.), business administration (D.B.A.), and engineering (D.Eng. or D.E.S.). Does not include first-professional degrees.

100

POPULATION CHARACTERISTICS

WOMEN’S HEALTH USA 2008

WOMEN IN THE LABOR
FORCE
In 2007, 59.4 percent of women aged 16 and
older were in the labor force (either employed or
unemployed and actively seeking employment).
This represents a 37 percent increase from the
43.3 percent of women who were in the labor
force in 1970.4 In 2006, females accounted for
46.5 percent of workers, while males accounted
for 53.5 percent.
The representation of females in the labor force
varies greatly by occupational sector. In 2006,
women accounted for 63.1 percent of sales and
office workers, but only 3.5 percent of construc-

tion, extraction, maintenance, and repair workers.
Other positions which were more commonly
held by women than men included service jobs
(56.5 percent) and management, professional,
and related jobs (51.1 percent). Women were the
minority in production, transportation, and
material moving (23.2 percent); farming, fishing,
and forestry (20.3 percent); and in the military
(14.6 percent). In 2006, a total of 165,231
women were on active duty in the armed services.
Women are disproportionately represented
among lower-income workers. Among workers
aged 16 and older, more than 55 percent of those
earning less than $25,000 per year were women,

while 69 percent of those earning more than
$50,000 per year were men (data not shown).
Annual earnings by women aged 16 and older
vary greatly by race and ethnicity. In 2006, 24.4
percent of Asian/Pacific Islander women earned
more than $50,000, compared to 8.4 and 8.5
percent of Hispanic and American Indian/ Alaska
Native women, respectively. The proportion of
female workers earning less than $25,000 ranged
from 68.2 percent of Hispanic women to 47.7
percent of Asian/Pacific Islanders. More than half
of Black, non-Hispanic White, and American
Indian/Alaska Native women earned less than
$25,000.

Workforce Representation in Selected Occupational Sectors, Annual Earning Levels of Females Aged 16 and Older,*
by Race/Ethnicity, 2006
by Sex, 2006
Source I.1: U.S. Census Bureau, American Community Survey

Sources I.1, I.10: U.S. Census Bureau, American Community Survey; U.S. Department
of Defense*
Female
Male

Less Than $25,000

63.1

36.9

56.5

43.5

51.1

48.9

23.2

76.8

20.3

79.7

14.6

85.4

3.5

96.5

Sales and Office
Service
Management, Professional,
and Related
Production, Transportation,
and Material Moving
Farming, Fishing,
and Forestry
Military, Active Duty
Personnel
Construction, Extraction,
and Maintenance

40
50
60
Percent of Workers

*Military enlistment data are from the U.S. Department of Defense; all other from the U.S. Census Bureau.

100

Non-Hispanic
White

$50,000
or More

$25,000-49,999
30.3

52.1

30.4

57.2

17.6
12.4

Black**
23.4

68.2

8.4

Hispanic
Asian/Pacific
Islander
American Indian/
Alaska Native

47.7

27.9

65.2

24.4
26.3

40
50
60
Percent of Females

8.5

100

*Estimates have not been adjusted for area/region of employment or other factors that may influence earnings
levels. **May include Hispanics.

WOMEN'S HEALTH USA 2008

HEALTH STATUS
Analysis of women’s health status enables health
professionals and policymakers to determine the
impact of past and current health interventions
and the need for new programs. Trends in health
status help to identify new issues as they emerge.
In this section, health status indicators related
to morbidity, mortality, health behaviors, and
maternal health are presented. New topics
include chronic fatigue syndrome, eye health,
digestive disorders, endocrine and metabolic
disorders, occupational injury, attention deficit
hyperactivity disorder, intimate partner violence,
urologic disorders, and maternal mortality, as well
as a discussion of genetics and women’s health.
The data are displayed by sex, age, race and
ethnicity, and income, where feasible.

HEALTH STATUS – HEALTH BEHAVIORS

PHYSICAL ACTIVITY
Regular physical activity promotes health,
psychological well-being, and a healthy body
weight; enhances independent living; and
improves one’s quality of life. To reduce the risk of
chronic disease, the Dietary Guidelines for
Americans, 2005, recommended that adults
engage in at least 30 minutes of moderateintensity physical activity, above usual activity at
work or home on most, or preferably all, days of
the week.1 For most people, greater health
benefits can be obtained by engaging in more
vigorous or longer periods of physical activity.
The Healthy People 2010 objectives include
increasing the percentage of adults participating

WOMEN’S HEALTH USA 2008

in regular moderate or vigorous physical activity.2
In 2006, only 10.3 percent of women reported
participating in adequate physical activity
(defined as engaging in moderate-intensity
physical activity for at least 30 minutes per day
on a minimum of 5 days per week or vigorousintensity activity for at least 20 minutes per day
for a minimum of 3 days per week). While there
was little variation between women and men
engaging in adequate physical activity, the
percentage of women reporting regular physical
activity varied by race/ethnicity, age, and income.
In 2006, non-Hispanic White women were
more likely than women of other races/ethnicities
to report adequate physical activity (12.0

percent). Hispanic women were least likely to
report adequate physical activity (5.7 percent).
Among women in all income groups, rates of
adequate physical activity peak during the ages of
25–44 years and decline as women grow older. In
addition, among women in most age groups,
those with higher income levels are more likely to
engage in adequate physical activity. The women
most likely to do so are those aged 25–44 years
with incomes of 200 percent or more of poverty
(19.2 percent), compared to 13.4 percent of
women in the same age group with incomes of
100–199 percent of poverty and 12.7 percent of
women in the same age group with incomes less
than 100 percent of poverty.

Women Aged 18 and Older Engaging in Adequate*
Physical Activity, by Race/Ethnicity, 2006

Women Aged 18 and Older Engaging in Adequate*
Physical Activity, by Age and Poverty Status,** 2006

Source II.1: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey

12.0
10.3
10

7.9

7.4

8.0

5.7
5

Total

Non-Hispanic Non-Hispanic
White
Black

Hispanic

Asian

Non-Hispanic
Other Races**

*Adequate physical activity is defined as 30 minutes per day or more of moderate-intensity activity on 5
or more days per week or 20 minutes per day of vigorous-intensity activity on 3 or more days per week.
**Includes American Indian/Alaska Natives, persons of more than one race, and persons of all other
races not specified.

Percent of Women

Less Than 100% of Poverty
100-199% of Poverty

200% or
More of
Poverty

19.2

10.8

8.2
6.7

16.3

15.9

12.7 13.4
9.3
7.7

5.6
3.3

18-24 Years

25-44 Years

45-64 Years

65 Years and Older

*Adequate physical activity is defined as 30 minutes per day or more of moderate-intensity activity on 5 or
more days per week or 20 minutes per day of vigorous-intensity activity on 3 or more days per week.
**Poverty level, defined by the U.S. Census Bureau, was $20,444 for a family of four in 2006.

WOMEN'S HEALTH USA 2008

HEALTH STATUS – HEALTH BEHAVIORS

NUTRITION
The Dietary Guidelines for Americans, 2005
recommends eating a variety of nutrient-dense
foods while not exceeding caloric needs. For most
people, this means eating a daily assortment of
fruits and vegetables, whole grains, lean meats
and beans, and low-fat or fat-free milk products
while limiting added sugar, sodium, saturated and
trans fats, and cholesterol.1
Some fats, mostly those that come from sources
of polyunsaturated or monounsaturated fatty
acids, such as fish, nuts, and vegetable oils, are an
important part of a healthy diet. However, high
intake of saturated fats, trans fats, and cholesterol
may increase the risk of coronary heart disease.
Most Americans should consume fewer than 10
percent of calories from saturated fats, less than

300 mg/day of cholesterol, and keep trans fatty
acid consumption to a minimum. In 2003–2004,
63.5 percent of women exceeded the
recommended maximum daily intake of
saturated fat—most commonly non-Hispanic
White women and non-Hispanic Black women
(65.9 and 64.4 percent, respectively).
Salt, or sodium chloride, also plays an
important role in heart health, as high salt intake
can contribute to high blood pressure. In
2003–2004, nearly 70 percent of women
exceeded the recommended maximum intake of
less than 2,300 mg/day of sodium, or about
1 teaspoon of salt (data not shown).
Calcium is important for strengthening bones
and teeth, and inadequate calcium consumption
can lead to lower bone density, bone loss, and

increased risk of osteoporosis. The recommended
intake of calcium is 1,000 mg/day for women
aged 19–50 and 1,200 mg/day for women aged
51 years and older. In 2003–2004, 20.2 percent
of women met or exceeded the recommended
daily intake. Folate is also an important part of a
healthy diet, especially among women of
childbearing age, since it can help reduce the risk
of neural tube defects early in pregnancy. In
2003–2004, fewer than 30 percent of women
consumed the recommended daily intake of
folate (400 μg/day). Fewer than 20 percent of
non-Hispanic Black women consumed the
recommended amount of folate, compared to
more than 30 percent each of non-Hispanic
White and Hispanic women.

Women Exceeding the Recommended Daily Intake of
Saturated Fat and Cholesterol,* by Race/Ethnicity, 2003–2004

Women Meeting the Recommended Daily Intake of Calcium
and Folate,* by Race/Ethnicity,** 2003–2004

Source II.2: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey

65.9

63.5

Saturated Fat

64.4

51.0

50
40
30

34.3
27.5

25.7

Cholesterol

31.7

70
49.5

27.3

20
10
Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Non-Hispanic
Other Races**

*Recommended maximum daily intake of saturated fat is 10 percent of daily caloric intake or less;
recommended maximum daily intake of cholesterol is less than 300mg/day. **Includes American Indian/Alaska
Natives, Asian/Pacific Islanders, persons of more than one race, and persons of other races not specified.

Percent of Women

Folate
Calcium

50
40
30
20

31.0

30.5

29.5
20.2

21.3
13.9

19.4

23.0

10
Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

*Recommended daily intake of calcium is 1,000 mg/day for women aged 19–50 and 1,200 mg/day for
women aged 51 years and older; recommended folate intake is 400 µg/day. **The sample of American
Indian/Alaska Natives, Asian/Pacific Islanders, persons of more than one race, and persons of other races
not specified was too small to produce reliable results.

HEALTH STATUS – HEALTH BEHAVIORS

WOMEN’S HEALTH USA 2008

ALCOHOL USE
In 2006, 50.8 percent of the total U.S. population aged 12 and older reported using alcohol in
the past month; among those aged 18 and older,
the rate was 54.7 percent (data not shown).
According to the Centers for Disease Control and
Prevention (CDC), alcohol is a central nervous
system depressant that, in small amounts, can
have a relaxing effect. Although there is some
debate over the health benefits of small amounts
of alcohol consumed regularly, the negative health
effects of excessive alcohol use and abuse are well
established.3 Short-term effects can include
increased risk of motor vehicle injuries, falls,
domestic violence, and child abuse. Long-term

effects can include pancreatitis, high blood pressure,
liver cirrhosis, various cancers, and psychological
disorders, including alcohol dependency.
Overall, males are more likely to drink alcohol
than females, with past-month alcohol use
reported by 57.0 percent of males and 44.9
percent of females aged 12 years and older. This
is true across all age groups with the exception of
12- to 17-year-olds; in that group, 17.5 percent of
females and 16.6 percent of males reported pastmonth use.
Alcohol use, and the frequency of use, also vary
by race and ethnicity. Among women aged 18
and older, non-Hispanic White women were
most likely to report any alcohol use in the past

Past Month Alcohol Use, by Sex and Age, 2006
Source II.3: Substance Abuse and Mental Health Services Administration, National Survey
on Drug Use and Health

Percent of Population

Male

44.9

60
44.9

30
17.5

16.6

12-17 Years

18-25 Years

26 Years and Older

Binge Alcohol Use

53.5

Heavy Alcohol Use

47.9

36.3

35.9

31.1

28.4

10
Total (12 Years
and Older)

Any Alcohol Use

61.2

58.3

Source II.3: Substance Abuse and Mental Health Services Administration, National Survey
on Drug Use and Health

66.1

Female
57.0

month (53.5 percent), while Asian/Pacific
Islander women were least likely (28.4 percent),
followed by American Indian/Alaska Native
women (31.1 percent). American Indian/Alaska
Native women were more likely than women of
other races and ethnicities to engage in binge
drinking, which is defined as drinking five or
more drinks on the same occasion at least once in
the past month (19.6 percent), and heavy
drinking, which is defined as five or more drinks
on the same occasion at least five times in the past
month (6.9 percent). Non-Hispanic White
women reported the next highest percentages of
binge drinking and heavy drinking (16.8 and 4.1
percent, respectively).

Past Month Alcohol Use Among Women Aged 18 and Older,
by Type* and Race/Ethnicity, 2006

Percent of Women

15.6
3.5
Total

16.8
4.1
Non-Hispanic
White

19.6
13.5
1.9
Non-Hispanic
Black

13.0
2.0
Hispanic

8.7

6.9
1.7

Asian/
American Indian/
Pacific Islander Alaska Native

*Binge alcohol use is defined as drinking 5 or more drinks on the same occasion on at least 1 day in the
past 30 days; heavy alcohol use is defined as drinking 5 or more drinks on the same occasion on each
of 5 or more days in the past 30 days. All heavy alcohol users are also binge alcohol users.

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH BEHAVIORS

CIGARETTE SMOKING
According to the U.S. Surgeon General,
smoking damages every organ in the human
body. Cigarette smoke contains toxic ingredients
that prevent red blood cells from carrying a full
load of oxygen, impairs genes that control the
growth of cells, and binds to the airways of
smokers. This contributes to numerous chronic
illnesses, including several types of cancers,
chronic obstructive pulmonary disease (COPD),
cardiovascular disease, reduced bone density and
fertility, and premature death.4
In 2006, more than 61.5 million people in the
United States aged 12 and older smoked
cigarettes within the past month. Smoking was
less common among females aged 12 and older

(22.4 percent) than among males of the same age
group (27.8 percent). Cigarette use has declined
over the past several decades among both sexes,
though it has leveled off in recent years. In 1985,
the rate among males was 43.4 percent while the
rate among females was 34.5 percent.
Among women, the rate of smoking varied by
race and ethnicity in 2006. American Indian/
Alaska Native women were most likely to have
smoked cigarettes in the past month (39.1
percent), followed by non-Hispanic White
women (24.9 percent). Asian/Pacific Islander
women were least likely to have smoked cigarettes
(9.7 percent).
Quitting smoking has major and immediate
health benefits, including reducing the risk of

diseases caused by smoking and improving overall
health.3 In 2006, nearly 46 percent of female
smokers aged 18 and older reported trying to quit
at least once in the past year; however, this varied
by age. Women aged 18–44 were most likely to
have attempted quitting (49.3 percent), followed
by women aged 45–64 years (44.3 percent).
Fewer than 30 percent of female smokers aged 65
years and older attempted to quit smoking in
2006 (data not shown).5 Research indicates that
smoking cessation programs, including behavioral therapy, telephone support, and
pharmacotherapy, may increase the likelihood of
quitting smoking,6 although participation rates in
such programs are unknown.

Past Month Cigarette Use Among Persons Aged 12 and
Older, by Sex, 1985–2006

Past Month Cigarette Use Among Women Aged 18 and Older,
by Race/Ethnicity, 2006

Source II.4: Substance Abuse and Mental Health Services Administration, National Survey
on Drug Use and Health

Source II.3: Substance Abuse and Mental Health Services Administration, National Survey
on Drug Use and Health

45
39.1
Female

Male

35
30
27.8
25.0
22.4

1985

1992

1999

2006

Percent of Women

Percent of Population

Total
36

37.1
27

22.4

24.9
19.2
15.8

9.7
9

Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian/
American Indian/
Pacific Islander Alaska Native

HEALTH STATUS – HEALTH BEHAVIORS

WOMEN’S HEALTH USA 2008

ILLICIT DRUG USE
Illicit drug use is associated with serious health
and social consequences, such as impaired
cognitive functioning, kidney and liver damage,
drug addition, and decreased worker productivity.7 Illicit drugs include marijuana/hashish,
cocaine, inhalants, hallucinogens, crack, and
prescription-type psychotherapeutic drugs used
for non-medical purposes. In 2006, nearly 12.6
million women aged 18 years and older reported
using an illicit drug within the past year; this
represents 11.0 percent of women. In comparison, 18.2 million men, representing 17.1 percent
of the adult male population, used at least one

illicit drug in the past year. Past-year illicit drug
use was significantly higher among women aged
18–25 years than among women 26 years and
older (30.3 versus 7.8 percent). Among adolescent females aged 12–17 years, 19.7 percent used
at least one illicit drug in the past year.
In 2006, marijuana was the most commonly
used illicit drug among females in each age group,
followed by the non-medical use of prescriptiontype psychotherapeutic drugs. Short-term effects
of marijuana use can include difficulty thinking
and solving problems, memory and learning
problems, and distorted perception. Prescription
drugs commonly used or abused for non-medical

Females Reporting Past Year Use of Illicit Drugs, by Age and Drug Type, 2006
Source II.4: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health
30.3

12-17 Years
18-25 Years
26 Years and Older

27
24.2

Percent of Females

24
21

19.7

18
15

13.9

12.9
12
9

9.0

7.8
5.4

5.0

4.3

3
Any Illicit Drug*

Marijuana/Hashish

4.7

4.2

2.7

1.9

1.0
Cocaine

0.5
Hallucinogens

1.2

0.1
Inhalants

Non-medical Use
of Psychotherapeutics**

*Includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, and any prescription-type psychotherapeutic drugs used
for non-medical purposes. **Includes prescription-type pain relievers, tranquilizers, stimulants, and sedatives, but not over-the-counter drugs.

purposes include opioids, central nervous system
depressants, and stimulants. Long-term use of
these drugs can lead to physical dependence and
addiction. In addition, when taken in large doses,
stimulant use can lead to compulsivity, paranoia,
dangerously high body temperature, and an
irregular heartbeat.7
Use of all drug types, except inhalants, was
highest among females aged 18–25 years, with
24.2 percent reporting past-year marijuana use
and 13.9 percent reporting non-medical use of
prescription-type psychotherapeutic drugs. Use of
inhalants in the past-year was highest among
females aged 12–17 (4.7 percent), compared to
1.2 percent of those aged 18–25 and 0.1 percent
of those aged 26 years and older.
Methamphetamine is a stimulant with a high
potential for abuse, and use can result in
decreased appetite, increased respiration and
blood pressure, rapid heart rate, irregular
heartbeat, and hyperthermia. Long-term effects
can include paranoia, delusions, hallucinations,
and stroke.7 The Monitoring the Future Survey
estimates that, in 2006, 1.8 percent of women
aged 19–30 years used methamphetamine and
1.3 percent used crystal methamphetamine. Use
of crystal methamphetamine was more common
among females than males in this age group,
while there was no difference in the use of
methamphetamine (data not shown).8

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

SELF-REPORTED HEALTH
STATUS
In 2006, men were more likely than women to
report being in excellent or very good health (62.2
versus 59.7 percent); this was true in every racial
and ethnic group. Among both sexes, Asians most
often reported that they were in excellent or very
good health, followed by non-Hispanic Whites;
non-Hispanic Blacks were the least likely to
report being in excellent or very good health.

Self-reported health status declines with age:
70.8 percent of women aged 18–44 years
reported excellent or very good health status,
compared to 54.5 percent of those aged 45–64
years, 42.4 percent of those aged 65–74 years, and
35.9 percent of those aged 75 years and older.
Among those in the oldest age group, 27.0
percent reported fair or poor health, compared to
only 6.2 percent of those in the youngest age
group.

The rate of women reporting excellent or very
good health also varies with income (data not
shown). Women with family incomes of 300
percent or more of poverty were most likely to
report excellent or very good health (71.1
percent), followed by 58.2 percent of women
with family incomes of 200–299 percent of
poverty. Only 42.5 percent of women whose
family incomes were below 100 percent of
poverty reported excellent or very good health.

Adults Aged 18 and Older Reporting Excellent or Very Good
Health, by Sex and Race/Ethnicity, 2006

Self-Reported Health Status of Women Aged 18 and Older,
by Age, 2006

Source II.1: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey

70
60

67.5

Female
59.7

62.2

62.3

64.1

56.8

Good

23.0

Fair/Poor

6.2

18-44 Years

53.4

50.2

Excellent/Very Good

70.8

61.5
57.4

54.6
Percent of Adults

69.6

Male

54.5

15.9

29.6

45-64 Years
40
42.4

22.4

35.2

30
65-74 Years
20
35.9

27.0

37.1

75 Years
and Older

Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian

Non-Hispanic
Other Races*

*Includes American Indian/Alaska Natives, persons of more than one race, and persons of all other races
not specified.

Percent of Women

100

HEALTH STATUS – HEALTH INDICATORS

LIFE EXPECTAN CY
A baby girl born in the United States in 2005
could expect to live 80.4 years, 5.2 years longer
than a male baby, whose life expectancy would be
75.2 years. The differential between male and
female life expectancy was greater among Blacks
than Whites. Black males could expect to live
69.5 years, 7 years fewer than Black females (76.5
years). The difference between White males and
females was 5.1 years, with a life expectancy at
birth for White females of 80.8 years and 75.7
years for White males. White females could
expect to live 4.3 years longer than Black females.
The lower life expectancy among Blacks may be
partly accounted for by higher infant mortality
rates.
Life expectancy has steadily increased since
1970 for males and females in both racial groups.
Between 1970 and 2005, White males’ life
expectancy increased from 68.0 to 75.7 years
(11.3 percent), while White females’ life
expectancy increased from 75.6 to 80.8 years (6.9
percent). During the same period, the life
expectancy for Black males increased from 60.0 to
69.5 years (15.8 percent), while life expectancy
increased from 68.3 to 76.5 years (11.7 percent)
for Black females.
Life expectancy data have not been uniformly
calculated and reported for the Hispanic,
Asian/Pacific Islander, and American Indian/

WOMEN’S HEALTH USA 2008

Alaska Native populations. However, estimated
life expectancy is generally lower for these groups.
An American Indian/Alaska Native born in
1999–2001 could expect to live 74.5 years; this is
a 17.1 percent increase over the life expectancy in
1972–1974 (63.6 years).9 The U.S. Census

Bureau estimated that Hispanics born in 1999
would have a life expectancy of 83.7 years for
females and 77.2 years for males. Asian males
born in 1999 had a life expectancy of 80.9 years,
while life expectancy for Asian females born in
that year was 86.5 years (data not shown).10

Life Expectancy at Birth, by Race* and Sex, 1970–2005
Source II.5: Centers for Disease Control and Prevention, National Center for Health Statistics
82
80.8
80

White Female

78
76.5

Black Female

75.7

74
Number of Years

72
70
69.5
68
66

White Male

64
62

Black Male

1970

1975

*Both racial categories include Hispanics.

1980

1985

1990

1995

2000

2005

WOMEN’S HEALTH USA 2008

LEADING CAUSES OF DEATH
In 2005, there were 1,240,342 female deaths in
the United States. Of these deaths, nearly half
were attributable to heart disease and malignant
neoplasms (cancer), responsible for 26.5 and 21.7
percent of deaths, respectively. The next two
leading causes of death were cerebrovascular
diseases (stroke), which accounted for 7.0 percent
of deaths, followed by chronic lower respiratory
disease, which accounted for 5.5 percent. Among
both males and females under 44 years of age,
unintentional injury was the leading cause of
death (data not shown).
Heart disease was the leading cause of death for
women in almost every racial and ethnic group;
the exception was Asian/Pacific Islander females,
for whom the leading cause of death was cancer.
One of the most noticeable differences in leading
causes of death by race and ethnicity is that
diabetes mellitus was the eighth leading cause of
death among non-Hispanic White females, while
it was the fourth among all other racial and ethnic
groups. Similarly, chronic lower respiratory
disease was the fourth leading cause of death
among non-Hispanic White females while it
ranked sixth or seventh among other racial and
ethnic groups. Death in the perinatal period was
the ninth leading cause of death among Hispanic
females, and hypertension was the tenth leading
cause among Asian/Pacific Islander females (data

HEALTH STATUS – HEALTH INDICATORS

not shown). Also noteworthy is that American
Indian/Alaska Native females experienced a
higher proportion of deaths due to unintentional

injury (8.0 percent) and liver disease (4.0 percent;
seventh leading cause of death) than females of
other racial and ethnic groups.

Ten Leading Causes of Death Among Females (All Ages), by Race/Ethnicity, 2005
Source II.6: Centers for Disease Control and Prevention, National Vital Statistics System
Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian/Pacific
Islander

American Indian/
Alaska Native

% (Rank)

26.5 (1)

26.8 (1)

26.3 (1)

23.8 (1)

23.4 (2)

19.0 (1)

Malignant Neoplasms
(cancer)

21.7 (2)

21.2 (2)

21.4 (2)

27.7 (1)

18.6 (2)

Cerebrovascular
Diseases (stroke)

7.0 (3)

6.3 (3)

9.5 (3)

6.0 (5)

Chronic Lower
Respiratory Disease

5.5 (4)

6.2 (4)

2.6 (7)

2.8 (6)

2.4 (7)

4.1 (6)

4.1 (5)

4.5 (5)

2.3 (9)

2.5 (8)

1.9 (8)

2.0 (10)

3.3 (6)

3.0 (6)

5.0 (5)

3.9 (5)

8.0 (3)

3.1 (7)

2.6 (8)

5.0 (4)

5.9 (4)

4.0 (4)

6.3 (4)

Influenza
and Pneumonia

2.8 (8)

2.9 (7)

2.1 (10)

2.8 (7)

3.0 (6)

2.8 (8)

Nephritis (kidney
inflammation)

1.8 (9)

1.6 (9)

3.1 (5)

2.0 (10)

1.8 (9)

2.6 (9)

Septicemia (blood
poisoning)

1.5 (10)

1.4 (10)

2.4 (8)

N/A

Cause of Death
Heart Disease

Alzheimer’s Disease

Unintentional Injury

Diabetes Mellitus

N/A = not in the top 10 leading causes of death for this racial/ethnic group.

HEALTH STATUS – HEALTH INDICATORS

WOMEN’S HEALTH USA 2008

ACTIVITY LIMITATIONS
AND DISABILITIES
Although there are many different ways to
define a disability, one common guideline is
whether a person is able to perform common
activities—such as walking up stairs, standing or
sitting for several hours at a time, grasping small
objects, or carrying items such as groceries—
without assistance. In 2006, nearly 14 percent of
adults reported having at least one condition that
limited their ability to perform one or more of
these common activities. Women were more
likely to report being limited in their activities
than men (15.0 versus 12.6 percent).

The percentage of adults reporting at least one
activity limitation varied with age among both
men and women. Only 6.0 percent of women
aged 18–44 years reported any activity limitation,
compared to nearly 27 percent of women aged
65–74 years and 45.0 percent of women aged 75
years or older.
The percentage of women reporting that a
vision or hearing problem causes activity limitations also increased with age. Overall, 7.6 percent
of women with a limitation reported a vision
problem, and 3.7 percent reported that a hearing
problem caused their activity limitation. Only 4.0
percent of women aged 18–44 years reported
vision problems compared to 13.0 percent of

Adults Aged 18 and Older with at Least One Activity
Limitation,* by Age and Sex, 2006

women aged 75 years and older. Similarly, 3.0
percent of 18- to 44-year-old women reported a
hearing problem, compared to 7.4 percent of
women aged 75 years and older.
In 2006, the percentage of women reporting at
least one activity limitation varied by race and
ethnicity (data not shown). Non-Hispanic Black
women were most likely to report at least one
limitation (16.5 percent), followed by nonHispanic White women (16.0 percent). Asian
women were least likely to report any activity
limitation (7.0 percent). More than 9.5 percent of
Hispanic women also reported an activity
limitation.

Women Aged 18 and Older with Vision or Hearing Problems
Causing Activity Limitations,* by Age, 2006

Source II.1: Centers for Disease Control and Prevention, National Center for Health Statistics, Source II.1: Centers for Disease Control and Prevention, National Center for Health Statistics,
National Health Interview Survey
National Health Interview Survey

Percent of Adults

39.6

Female
Male

30
20

45.0

26.8

15.0

16.8

23.9

15.6

12.6

6.0

Total

13.1

5.6

18-44 Years

45-64 Years

65-74 Years

75 Years and Older

*Activity limitations are defined as conditions that cause difficulty performing certain physical, leisure,
and social activities.

Percent of Women with Limitations

Vision
Problem

Hearing
Problem

30
20

13.0
10

7.6
3.7
Total

4.0

7.4

6.2
3.0

2.2

18-44 Years

45-74 Years

75 Years and Older

*Activity limitations are defined as conditions that cause difficulty performing certain physical, leisure,
and social activities.

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

ARTHRITIS
Arthritis, the leading cause of disability among
Americans over 15 years of age, comprises more
than 100 different diseases that affect areas in or
around the joints. The most common type is
osteoarthritis, which is a degenerative joint disease
that causes pain and loss of movement due to
deterioration in the cartilage covering the ends of
bones in the joints. Types of arthritis that
primarily affect women include lupus arthritis,

fibromyalgia, and rheumatoid arthritis, which is
the most serious and disabling type of arthritis.11
In 2006, more than 21 percent of adults in the
United States reported that they had ever been
diagnosed with arthritis. Arthritis was more
common among women than men (24.4 versus
17.7 percent), and rates of arthritis increased
dramatically with age for both sexes. Fewer than
10 percent of women aged 18–44 years had been
diagnosed with arthritis, compared to 53.6

percent of women aged 65–74 years, and almost
55.2 percent of women aged 75 years and older.
In 2006, the rate of arthritis among women
varied by race and ethnicity. Arthritis was most
common among non-Hispanic White women
(27.2 percent), followed by non-Hispanic Black
women (23.5 percent). Asian and Hispanic
women were least likely to report having ever
been told that they have arthritis (11.5 and 14.3
percent, respectively).

Adults Aged 18 and Older with Arthritis,* by Age
and Sex, 2006

Women Aged 18 and Older with Arthritis,*
by Race/Ethnicity, 2006

Source II.1: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey

60
55.2

53.6
50

Female

45.3
41.5
Percent of Women

Percent of Adults

Male
40
31.8
30
25.5

24.4
20

17.7

27.2
23.5

15.5

14.3
11.5
8.4

10
5.5

Total

18-44 Years

45-64 Years

*Reported a health professional has ever told them they have arthritis.

65-74 Years

75 Years and Older

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian

Non-Hispanic
Other Races**

*Reported a health professional has ever told them they have arthritis. Rates reported are not age-adjusted.
**Includes American Indian/Alaska Natives, persons of more than one race, and persons of all other races
not specified.

HEALTH STATUS – HEALTH INDICATORS

ASTHMA
Asthma is a chronic inflammatory disorder of
the airway characterized by episodes of wheezing,
chest tightness, shortness of breath, and
coughing. This disorder may be aggravated by
allergens, tobacco smoke and other irritants,
exercise, and infections of the respiratory tract.
However, by taking certain precautions, persons
with asthma may be able to effectively manage
this disorder and participate in daily activities.
In 2006, women had higher rates of asthma
than men (89.3 per 1,000 women versus 55.7 per

WOMEN’S HEALTH USA 2008

1,000 men); this was true in every racial and
ethnic group. Among women, non-Hispanic
Black women had the highest asthma rate (94.7
per 1,000 women), followed by non-Hispanic
White women (92.0 per 1,000); Hispanic
women had the lowest asthma rate (73.8 per
1,000).
A visit to the emergency room due to asthma
may be an indication that the asthma is not
effectively controlled or treated. In 2006,
asthmatic women with family incomes below
poverty were more likely than women with higher

family incomes to have an emergency room visit
due to asthma. Among women with family
incomes less than 100 percent of poverty, 35.9
percent of those with asthma had visited the
emergency room in the past year, compared to
24.8 percent of asthmatic women with family
incomes of 300 percent or more of poverty.
Consistent use of medication can reduce the use
of hospital and emergency room care for people
with asthma.12

Adults Aged 18 and Older with Asthma,* by Race/Ethnicity
and Sex, 2006

Women Aged 18 and Older with an Emergency Room Visit
Due to Asthma in the Past Year, by Poverty Status,* 2006

Source II.1: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey

100

Male

80
Rate per 1,000 Adluts

100

Female

94.7

92.0

89.3
91.9

73.8

70
60

65.9
60.6
55.7

50
40

76.9

54.0
55.9

51.1

54.3
28.6

30
20
10
Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Non-Hispanic
Other Races**

*Reported that (1) a health professional has ever told them that they have asthma, and (2) they still have
asthma. Rates reported are not age-adjusted. **Includes Asian/Pacific Islanders, American Indian/Alaska
Natives, persons of more than one race, and persons of all other races not specified.

Percent of Women with Asthma

80
70
60
50
40
30

35.9
25.7
19.0

24.8

22.1

Total

Less Than 100%
of Poverty

100-199%
of Poverty

200-299%
of Poverty

300% or More
of Poverty

*Poverty level, defined by the U.S. Census Bureau, was $20,444 for a family of four in 2006.

WOMEN’S HEALTH USA 2008

CHRONIC FATIGUE
SYNDROME
While research indicates that any person may
develop chronic fatigue syndrome, women are
four times more likely to experience the disorder
than men. Chronic fatigue syndrome is characterized by extreme, sometimes disabling, fatigue
that does not improve with bed rest and may be
worsened by physical or mental activity. Since
there are no known causes of chronic fatigue
syndrome and no diagnostic laboratory tests to
identify the disorder, researchers have set strict
guidelines for diagnosing chronic fatigue
syndrome. Patients must have experienced severe
chronic fatigue lasting 6 months or longer (with
other known medical conditions excluded), and
at least four of the following symptoms: impairment in short-term memory or concentration;
sore throat; tender lymph nodes; muscle pain;
multi-joint pain (without swelling or redness);
headaches; unrefreshing sleep; and postexertional malaise lasting more than 24 hours. In
addition, these symptoms must have occurred
prior to the onset of the fatigue and have persisted
during at least 6 months of illness.13
While national population-based studies of
chronic fatigue syndrome prevalence have not
been conducted, research on the disorder has
been underway for over 20 years. The CDC
estimates that more than one million people in

HEALTH STATUS – HEALTH INDICATORS

the United States are affected by chronic fatigue
syndrome, while millions more experience
symptoms but do not meet the strict criteria
described above. A recent study conducted in the
State of Georgia estimated that approximately 2.5
percent of adults aged 18–59 years may have
chronic fatigue syndrome.14 Chronic fatigue

syndrome is more common among people in
their 40s and 50s than among other age groups.13
In addition, it appears that fewer than 20 percent
of persons with chronic fatigue syndrome have
ever received a diagnosis and treatment for the
illness.15

HEALTH STATUS – HEALTH INDICATORS

WOMEN’S HEALTH USA 2008

CANCER
It is estimated that 692,000 new cancer cases
will be diagnosed among females, and more than
271,000 females will die of cancer in 2008. Lung
and bronchus cancer is expected to be the leading
cause of cancer death among females with 71,030
deaths, accounting for 26 percent of all cancer
deaths, followed by breast cancer, which will be
responsible for 40,480, or 15 percent of deaths.
Colon and rectal cancer, pancreatic cancer, and
ovarian cancer will also be significant causes of
cancer deaths among females.

Due to the varying survival rates for different
types of cancer, the most common causes of
cancer death are not always the most common
types of cancer. For instance, although lung and
bronchus cancers cause the greatest number of
deaths, breast cancer is more commonly
diagnosed among women; there will be an
estimated 182,460 new breast cancer cases in
2008 versus 100,330 lung and bronchus cancer
cases. Other types of cancer that are commonly
diagnosed among females but are not among the
top 10 causes of cancer deaths include melanoma,

Leading Causes of Cancer Deaths Among Females,
by Site, 2008 Estimates

thyroid cancer, cancer of the kidney and renal
pelvis, and basal and sqamous cell skin cancer.
Cervical cancer screenings are recommended at
least every 3 years beginning within 3 years of
sexual activity or by age 21. In addition, a
vaccination for genital human papillomavirus
(the leading cause of cervical cancer) was
approved for use by the FDA in 2006 and is
recommended for adolescents and young women
aged 9–26 years.16 Cervical cancer rates increase
with age and vary by race and ethnicity. In
2000–2004, Hispanic women aged 20–44 and

New Cancer Cases Among Females, by Site, 2008 Estimates
Source II.7: American Cancer Society

Source II.7: American Cancer Society
Lung and
Bronchus

71,030

Breast
Colon and
Rectum

100,330
71,560

Uterus

16,790

Ovary

182,460

Colon and
Rectum

25,700

Pancreas

Breast
Lung and
Bronchus

40,480

Non-Hodgkin
Lymphoma

15,520

40,100
30,670

Non-Hodgkin
Lymphoma

9,370

Thyroid

28,410

Leukemia

9,250

Melanoma

27,530

Uterus
Liver and
Intrahepatic
Bile Duct
Brain and Other
Nervous System

7,740

Ovary

21,650

5,840

Kidney and
Renal Pelvis

21,260

5,650

Leukemia

10,000

20,000

30,000

40,000

50,000

Number of Females

60,000

70,000

80,000

19,090
36,000

72,000

108,000
Number of Females

144,000

180,000

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

45–64 years were more likely than women of
other races and ethnicities of the same age groups
to be diagnosed with cervical cancer (13.6 and
25.5 per 100,000 women, respectively). Black
and Hispanic women aged 65 years and older
were also more likely to be diagnosed with this
type of cancer (25.8 and 24.9 per 100,000,
respectively). Asian/Pacific Islander women aged
20–44 years were least likely to be diagnosed with
cervical cancer (5.9 per 100,000).

Survival rates for ovarian cancer vary depending
on how early it is discovered. For women
diagnosed with ovarian cancer in 1996–2003,
45.0 percent could expect to live 5 years or more;
however, this varied by race and the stage of the
cancer. More than 92 percent of women of all
races with cancer localized in the ovaries could
expect to live at least 5 years. Comparatively, 71.1
percent of White women and 49.8 percent of
Black women could expect the same when cancer

is in the regional stage (spread beyond the
primary site). Among women at the distant stage
(spread to distant organs or lymph nodes), only
30.0 percent of White women and 22.5 percent
of Black women could expect to live 5 more years.

Cervical Cancer Incidence, by Race/Ethnicity and Age,
2000–2004

Five-year Period Survival Rates for Ovarian Cancer, by Race*
and Stage,** 1996–2003

Source II.8: National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER)
Program

Source II.8: National Cancer Institute, Surveillance, Epidemiology, and End Results (SEER)
Program
100

Total*
20-44 Years
45-64 Years

25
Rate per 100,000 Women

25.8

65 Years
and Older
20

25.5

24.9

19.6
18.0
16.0

13.8 13.6
11.4 10.2

11.4
10

9.4

13.2
10.8

9.7
8.0

7.2

5.9

6.6 7.0

Non-Hispanic White

*Includes all ages.

Black

Hispanic

Asian/
Pacific Islander

American Indian/
Alaska Native

Percent of Women with Ovarian Cancer

90
80

92.6 92.2 92.2
All Races
White

70.5 71.1

Black

60
50
40

49.8
45.0 44.7
37.5
29.7 30.0

22.5

26.5 26.2

22.7

20
10
All Stages

Localized

Regional

Distant

Unstaged

*All Races includes American Indian/Alaska Natives, Asian/Pacific Islanders, Hispanics, persons of more than
one race, and persons of unspecified race. **Localized cancer is limited to the organ in which it began (no
evidence of spread); regional cancer has spread beyond the primary site; distant cancer has spread to distant
organs or lymph nodes; and unstaged indicates that there is not enough information to determine a stage.

HEALTH STATUS – HEALTH INDICATORS

DIABETES
Diabetes mellitus is a chronic condition and a
leading cause of death and disability in the United
States. Complications of diabetes are serious and
may include blindness, kidney damage, heart
disease, stroke, and nervous system disease.
Diabetes is becoming increasingly common
among children and young adults. The two main
types of diabetes are Type 1 (insulin dependent)
and Type 2 (non-insulin dependent). Type 1
diabetes is usually diagnosed in children and
young adults, and is commonly referred to as

WOMEN’S HEALTH USA 2008

“juvenile diabetes.” Type 2 diabetes is more
common; it is often diagnosed among adults but
is becoming increasingly common among
children. Risk factors for Type 2 diabetes include
obesity, physical inactivity, and a family history of
the disease.
In 2005–2006, 76.0 per 1,000 adults reported
that they had been told by a health professional
that they have diabetes. Women were more likely
than men to have diabetes overall (81.2 versus
70.4 per 1,000 adults) and in most racial and
ethnic groups. Among women, non-Hispanic

Blacks and Hispanics had higher rates of diabetes
(117.6 and 111.8 per 1,000, respectively) than
non-Hispanic Whites (69.4 per 1,000).
Diabetes prevalence generally increases with
age. In 2005–2006, among women aged 45 and
older, the highest rate of diabetes occurred among
women aged 65–74 years (197.5 per 1,000
women). In other words, nearly one in five
women in this age group have diabetes. Women
aged 55–64 and 75 years and older also had
relatively high rates of diabetes (155.5 and 153.4
per 1,000, respectively).

Adults Aged 18 and Older with Diabetes,* by Race/Ethnicity**
and Sex, 2005–2006

Adults Aged 45 and Older with Diabetes,* by Age and Sex,
2005–2006

Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey

200

180

180
Female
Male

140

120.7 117.6 124.6

120

111.8
93.7

100
80

76.0

186.2
Female
Male

160

Total

81.2
70.4

76.0

65.1 69.4 60.5

Rate per 1,000 Adults

160

197.5

100
80

20
Non-Hispanic Black

Hispanic

73.6

80.2

60
40

Non-Hispanic White

133.5

120

20
Total

153.4
142.7

140

*Reported a health professional has ever told them they have diabetes. **The sample of Asian/Pacific
Islanders, American Indian/Alaska Natives, persons of multiple races, and persons of other races
unspecified was too small to produce reliable results.

155.5

45-54 Years

55-64 Years

65-74 Years

*Reported a health professional has ever told them they have diabetes.

75 Years and Older

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

OVERWEIGHT AND OBESITY
Being overweight or obese is associated with an
increased risk of numerous diseases and
conditions, including high blood pressure, type 2
diabetes, heart disease, stroke, arthritis, cancer,
and poor reproductive health.17 In 2006, 29.4
percent of women in the United States were
overweight and an additional 24.4 percent were
obese. Measurements of overweight and obesity

are based on Body Mass Index (BMI), which is a
ratio of weight to height. Overweight is defined as
a BMI of 25.0–29.9, and obese is defined as a
BMI of 30.0 or more; a BMI of 18.5–24.9 is
considered normal, while a BMI below 18.5 is
considered underweight.
In the past decade, obesity among women has
increased nearly 50 percent: in 1996, only 16.7
percent of women were obese, and obesity rates

among women ranged from 10.7 percent in
Colorado to 21.4 percent in Louisiana. By 2006,
in 39 States and Washington, DC, more than
21.4 percent of women were obese and State rates
ranged from 17.6 percent in Colorado to 33.5
percent in Mississippi.

Women Aged 18 and Older Who Are Obese,* by State, 1996 and 2006
Source II.9: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System
1996

2006

WA
MT

SD
WY
UT

CA
AZ

NY
MI
PA

OR
ID

NH
VT
ME

IL
KS
OK

WV VA
NC

TN
AR

MN
WI

SD
WY

RI
CT
UT

CA
AZ

IA
IL

KS
OK

SC
AL

FL
FL

10.0 - 15.9%
*Body Mass Index (BMI) of 30.0 or more.

16.0 - 21.9%

22.0 - 27.9%

28.0 - 33.9%

RI
CT

DE
MD

AR
MS

KY
TN

GA
TX

NY
MI

DE
MD
DC

SC
MS

NH
VT
ME

HEALTH STATUS – HEALTH INDICATORS

WOMEN’S HEALTH USA 2008

HEART DISEASE
include facial, arm, or leg numbness, especially on
of Hispanics, and 4.7 percent of Asians. While
AND STROKE
one side of the body; severe headache; trouble
heart disease rates are highest among nonIn 2005, heart disease was the leading cause of
walking; dizziness; a loss of balance or coordinaHispanic White women, the death rate from
death among women. Heart disease describes any
tion; or trouble seeing in one or both eyes.18
heart disease is highest among non-Hispanic
disorder that prevents the heart from functioning
In 2006, adult women were slightly less likely
Black women.
normally. The most common type of heart disease
than men to have ever been told by a health
Hospital discharges due to heart disease varied
is coronary heart disease, in which the arteries of
professional that they have a heart condition or
by sex and age. Overall, men experienced a higher
the heart slowly narrow, reducing blood flow to
heart disease (10.5 versus 11.4 percent). This
rate of hospital discharges compared to women
the heart muscle. Risk factors include obesity, lack
varied by race and ethnicity. Among non(206.0 versus 174.8 hospital discharges per
of physical activity, smoking, high cholesterol,
Hispanic Whites and non-Hispanic other races,
10,000 adults). Rates of hospital discharge also
hypertension, and old age. While the most
men were more likely than women to have heart
increased with age; for instance, the hospital
common symptom of a heart attack is chest pain
disease. Among non-Hispanic Black, Hispanic,
discharge rate for women aged 75 years and older
or discomfort, women are more likely than men
was 905.5 per 10,000 women, compared to
and Asian adults, however, women were more
to have symptoms such as shortness of breath,
119.8 hospital discharges per 10,000 women
likely than men to have heart disease. Among
nausea and vomiting, and back or jaw pain.18
aged 45–64 years.
women, non-Hispanic Whites were most likely
Stroke is a type of heart disease that affects
to have heart disease (11.9 percent), compared to
blood flow. Warning signs are sudden and can
9.6 percent of non-Hispanic Blacks, 6.0 percent
Adults Aged 18 and Older with Heart Disease,* by
Discharges Due to Heart Disease* from Non-Federal,
Race/Ethnicity and Sex, 2006
Short-Stay Hospitals, by Age and Sex, 2005
Source II.1: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey

13.6
10.5

11.4

11.9

1,100

Female
Male
9.6

9.2

8.2

6.5

6.0

4.8

4.7

4.1

3
Total

Non-Hispanic Non-Hispanic
Hispanic
Asian
Non-Hispanic
White
Black
Other Races**
*Reported a health professional had ever told them they have a heart condition or heart disease. **Includes
American Indian/Alaska Natives, persons of more than one race, and persons of other races not specified.

Rate per 10,000 Adults

Percent of Adults

Source II.10: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Hospital Discharge Survey
1,026.3
905.5

900
Female
Male

700

639.0
430.5

500
300

174.8

223.9

206.0

100

119.8
17.3

Total

29.4

18-44 Years

45-64 Years

65-74 Years

75 Years
and Older
*First-listed diagnosis of heart disease (includes ICD-9-CM codes 391-392.0, 393-398, 402, 404, 410-416,
420-429).

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

HYPERTENSION
Hypertension, also known as high blood
pressure, is a risk factor for a number of
conditions, including heart disease and stroke. It
is defined as a systolic pressure (during heartbeats)
of 140 or higher, and/or a diastolic pressure
(between heartbeats) of 90 or higher. A study in
2005–2006 tested adults’ blood pressure and
found that men had higher overall rates of
hypertension than women (165.8 versus 152.7
per 1,000 population).
Rates of hypertension among women varied
significantly by race and ethnicity. For instance,
rates of hypertension were highest among non-

Hispanic Black women (179.2 per 1,000 women)
and non-Hispanic White women (157.0 per
1,000). The rates of hypertension among
Hispanic women and non-Hispanic women of
other races were fewer than 120 per 1,000
women.
Rates of hypertension increase substantially
with age and are highest among those aged 75
years and older, which demonstrates the chronic
nature of the disease. Nearly 25 per 1,000 women
aged 18–44 years had hypertension in 2005–
2006, compared to 374.7 per 1,000 women aged
65–74 years and 462.7 per 1,000 women aged 75
years and older. Nearly 200 per 1,000 women

aged 45–64 years had hypertension (data not
shown).
Among adults aged 45 years and older, 16.3
percent of women and 15.2 percent of men who
were found to have hypertension had never been
told by a health professional that they have
hypertension, or were undiagnosed at the time of
the examination. Undiagnosed hypertension also
increased with age among both women and men.
While more than 10 percent of women aged
45–64 years with hypertension had never been
diagnosed, 23.8 percent of women aged 65–74
years and 42.6 percent of women aged 75 years
and older had never been diagnosed.

Adults Aged 18 and Older with Hypertension,*
by Race/Ethnicity and Sex, 2005–2006

Adults Aged 45 and Older with Undiagnosed Hypertension,*
by Age and Sex, 2005–2006

Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey

Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey
100

Female

223.8

Rate per 1,000 Adults

Male
200
152.7

165.8

157.0

168.9

150.5

150
113.1
100

Female
Male

179.2

118.3
100.1

Percent of Adults

250

70
60
50
30
20

42.6

40
23.8
16.3

15.2
10.2

10
Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Non-Hispanic
Other Races**

*At the time of examination had a systolic pressure (during heartbeats) of 140 or higher, and/or a diastolic
pressure (between heartbeats) of 90 or higher. Rates are not age-adjusted. **Includes Asian/Pacific Islander,
American Indian/Alaska Native, persons of more than one race, and persons of other races not specified.

Total

19.2

25.4

13.2

45-64 Years

65-74 Years

75 Years and Older

*At the time of examination had a systolic pressure (during heartbeats) of 140 or higher, and/or a diastolic
pressure (between heartbeats) of 90 or higher AND had never been told by a health professional that they
had hypertension.

HEALTH STATUS – HEALTH INDICATORS

ORAL HEALTH AND DENTAL
CARE
Oral health conditions can cause chronic pain
of the mouth and face and can impair the ability
to eat normally. Regular dental care is particularly
important for women because there is some
evidence of an association between periodontal
disease and certain birth outcomes, such as
increased risk of preterm birth and low birth
weight.19 To prevent caries (tooth decay) and
periodontal (gum) disease, the American Dental
Association recommends maintaining a healthy
diet with plenty of water, and limiting eating and
drinking between meals.20 Other important
preventive measures include daily brushing and

WOMEN’S HEALTH USA 2008

flossing, regular dental cleanings to remove
plaque, and checkups to examine for caries or
other potential problems.21
In 2003–2004, women were less likely than
men to have untreated dental caries (23.9 versus
30.5 percent). Among women, non-Hispanic
Black and Hispanic women were most likely to
have untreated caries. Sealants—a hard, clear
substance applied to the surfaces of teeth— may
help to prevent caries, but only 21.2 percent of
women had sealants. Non-Hispanic Black and
Hispanic women were the least likely to have
sealants (7.7 and 11.4 percent, respectively).
The presence of untreated caries also varied by
poverty status. Women with household incomes

below 200 percent of the poverty level were more
than twice as likely as women with higher
incomes to have untreated dental caries (36.8
versus 15.6 percent, respectively; data not
shown).
Poverty status may also influence how often
women see a dentist. In 2003–2004, women with
incomes of 100–199 percent of the poverty level
were least likely to have seen a dentist in the past
year (44.9 percent), followed by women with
incomes of less than 100 percent of the poverty
level (51.4 percent). In comparison, nearly 75
percent of women with incomes of 300 percent or
more of poverty had seen a dentist in the past
year.

Time Since Last Seen a Dentist Among Women Aged 18
and Older, by Poverty Status,* 2003–2004

Source II.2: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey

Percent of Women

Untreated Dental Caries and Presence of Sealants Among
Women,* by Race/Ethnicity,** 2003–2004

100
90
80
70
60
50
40
30
20
10

1 Year or Less
51.4

More Than 1
Year to 5 Years

5 Years or More
(Including Never)

29.7

19.0

Less Than 100%
of Poverty

Caries

21.2

26.6
18.2

Non-Hispanic White

24.9

61.4

40.0

13.7

200-299%
of Poverty

7.7

74.6
7.7

Total

26.0

100-199%
of Poverty
40.2

23.9

29.1

44.9

Sealants

Non-Hispanic Black

11.4
Hispanic

*Caries are among women aged 18 years and older; sealants are among women aged 18–34. **The sample
of Asian/Pacific Islanders, Native American/Alaska Natives, persons of more than one race, and persons of
other races not specified was too small to produce reliable results.

18.9

6.5

300% or More
of Poverty
10

Percent of Women
*Poverty level, defined by the U.S. Census Bureau, was $19,307 for a family of four in 2004.

100

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

EYE HEALTH
women were most likely to have had glaucoma
Macular degeneration is a disease that affects
Vision is important to maintaining independ(9.4 percent), compared to non-Hispanic White
the macula (which allows one to see in fine detail)
ence and quality of life throughout a woman’s life.
and Hispanic women (5.7 and 2.0 percent,
usually resulting in partial vision loss. While there
A number of eye conditions and diseases disprorespectively; data not shown).
is no known cure for macular degeneration, early
portionately affect older women, including
A cataract occurs when protein builds up in the
detection and treatment can slow its effects.22 In
glaucoma, cataracts, and macular degeneration.
lens and causes clouding. Surgery to replace the
2005–2006, 4.3 percent of women aged 40 years
Glaucoma can damage the optic nerve and
lens has proven to be an effective treatment for
and older reported having been told by a health
result in vision loss or blindness.22 It is estimated
cataracts when blurring becomes severe enough
professional that they have macular degeneration.
to affect 5.6 percent of adults over 40 years of age,
to limit vision.22 In 2005–2006, among adults
This disease was more common among older
but this varies by sex, age, and race and ethnicity.
aged 65 years and older, 35.8 percent of women
women. Fewer than 2 percent of women aged
Among adults aged 65–74 years, men were
and 25.7 percent of men reported ever having had
40–64 years had macular degeneration compared
slightly more likely than females to have
cataract surgery. Older adults were more likely to
to 3.8 and 16.9 percent of women aged 65–74
glaucoma (11.6 versus 9.2 percent), while among
have had the surgery; 57.3 percent of women
and 75 years and older, respectively (data not
adults aged 75 and older, glaucoma was more
aged 75 years and older had the surgery compared
shown).
common in women than men (16.7 versus 13.4
to 17.4 percent of women aged 65–74 years.
percent). Among women, non-Hispanic Black
Glaucoma* Among Adults Aged 40 and Older, by Age
Cataract Surgery Among Adults Aged 65 and Older, by Age
and Sex, 2005–2006
and Sex, 2005–2006
Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey
60

Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey
60

Total
Female

Male
48

Male

Percent of Adults

48
36
24

15.4 16.7
10.3

12
5.6

5.7
Total

5.4

2.9

2.7

9.2

57.3

Female

11.6

41.3
36

35.8
25.7

24
17.4
14.4

13.4
12

3.1

40-64 Years

65-74 Years

*Reported that a health professional had ever told them they have glaucoma.

75 Years and Older

Total
*Reported that they had ever had cataract surgery.

65-74 Years

75 Years and Older

HEALTH STATUS – HEALTH INDICATORS

WOMEN’S HEALTH USA 2008

OSTEOPOROSIS
Osteoporosis is the most common underlying
cause of fractures in the elderly, but it is not
frequently diagnosed or treated, even among
individuals who have already suffered a fracture.
An estimated 10 million Americans now have
osteoporosis, while another 34 million have low
bone mass and are at risk for developing
osteoporosis; 80 percent of them are women.
Each year more than 1.5 million people suffer a
bone fracture related to osteoporosis, with the
most common breaks in the wrist, spine, and hip.
Fractures can have devastating consequences. For
example, hip fractures are associated with an
increased risk of mortality, and nearly 1 in 5 hip

fracture patients ends up in a nursing home
within a year. Direct care for osteoporotic
fractures costs $18 billion yearly.23
In 2003–2004, women aged 18 years and older
were more likely than men to report having been
told by a health professional that they have
osteoporosis (10.0 versus 1.7 percent, respectively.) The rate of osteoporosis among women
varied significantly with race and ethnicity. NonHispanic White women were most likely to have
osteoporosis (12.6 percent), compared to 3.2
percent of non-Hispanic Black women and 3.5
percent of Hispanic women.
In 2005 there were 215,000 hospital discharges
due to hip fractures among women aged 18 and

older, a rate of 18.8 per 10,000 women. Rates of
hospital discharges due to hip fractures varied by
age. Women aged 75 and older had 149.4
discharges per 10,000 women, compared to 29.6
discharges per 10,000 women aged 65–74 years.
Osteoporosis may be prevented and treated by
getting the recommended amounts of calcium,
vitamin D, and regular weight-bearing physical
activity (i.e. walking), and by taking prescription
medication when appropriate. Bone density tests
are recommended for women over 65 years and
for any man or woman who suffers a fracture after
age 50. Treatment for osteoporosis has been
shown to reduce the risk of subsequent fractures
by 30–65 percent.23

Women Aged 18 and Older with Osteoporosis, by
Race/Ethnicity,* 2003–2004

Hospital Discharges Due to Hip Fractures* Among Adults
Aged 18 and Older, by Age and Sex, 2005

Source II.2: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey

Source II.10: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Hospital Discharge Survey

160

10.1

5
3.2

3.5

Rate per 10,000 Adults

Percent of Women

12.6

120
100
80

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

Female

77.9

Male

60
40
20

*The sample of Asian/Pacific Islanders, Native American/Alaska Natives, persons of more than one race,
and persons of other races not specified was too small to produce reliable results.

149.4

140

29.6
18.8
8.0
Total

16.8
1.8

1.9

18-64 Years

*First-listed diagnosis of hip fracture (ICD-9CM code: 820).

65-74 Years

75 Years and Older

WOMEN’S HEALTH USA 2008

years (8.7 percent). Fewer than 4 percent of
women aged 18–24 and 25–34 years had ever
had an ulcer. Among adults who have ever had an
ulcer, 19.5 percent of men and 27.9 percent of
women reported that they had an ulcer in the past
year (data not shown).
There was little variation among women
reporting having ever had an ulcer by race and
ethnicity. Non-Hispanic White women were
most likely to report having had an ulcer (7.7
percent), followed by non-Hispanic Black
women (6.2 percent), and Hispanic women (5.8

percent). Women of other races, including
Asian/Pacific Islanders, American Indian/Alaska
Natives, and women of multiple races, were least
likely to report ever having had an ulcer (3.3
percent; data not shown).
According to the CDC, digestive system
symptoms accounted for 33.3 million visits to
doctor’s offices and 3.6 million visits to hospital
outpatient departments in 2005. In addition,
15.7 million visits to emergency departments
were attributed to a digestive system diagnosis
that year (data not shown).25

Women Aged 18 and Older Who Have Ever Had an Ulcer,* by Age, 2006
Source II.1: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview
Survey
9.8

10
9

8.7

8
Percent of Women

DIGESTIVE DISORDERS
Digestive disorders, or gastrointestinal diseases,
include a number of conditions that affect the
digestive system, including heartburn; constipation; hemorrhoids; irritable bowel syndrome;
ulcers; gallstones; celiac disease (a genetic disorder
in which consumption of gluten damages the
intestines); and inflammatory bowel diseases,
including Crohn’s disease (which causes ulcers to
form in the gastrointestinal tract). Digestive
disorders are estimated to affect 60–70 million
people in the United States.24
While recent data are not readily available on
the prevalence of many of these diseases by race
and ethnicity or sex, it is estimated that 8.5
million people in the United States are affected
by hemorrhoids each year; 2.1 million people are
affected by irritable bowel syndrome; and
gallstones affect 20.5 million people.24
Peptic ulcers are most commonly caused by a
bacterium called Helicobacter pylori (H. pylori).
H. pylori weakens the mucous coating of the
stomach and duodenum, allowing acids to irritate
the sensitive lining beneath. In 2006, 7.0 percent
of adults reported that they had ever been told by
a health professional that they have an ulcer. This
did not vary by sex, but did vary by age. Among
women, those aged 65 years and older were most
likely to have reported ever having had an ulcer
(9.8 percent), followed by women aged 45–64

HEALTH STATUS – HEALTH INDICATORS

7.1
6.5

6
5
3.9

4
3.3
3
2
1

Total

18-24 Years

25-34 Years

*Reported a health professional has ever told them they have an ulcer.

35-44 Years

45-64 Years

65 Years and Older

HEALTH STATUS – HEALTH INDICATORS

ENDOCRINE AND
METABOLIC DISORDERS
Endocrine disorders involve the body’s over- or
under-production of certain hormones, while
metabolic disorders affect the body’s ability to
process certain nutrients and vitamins. Endocrine
disorders include hyperthyroidism and hypothyroidism, congenital adrenal hyperplasia, diseases
of the parathyroid gland, diabetes mellitus,
diseases of the adrenal glands (including
Cushing’s syndrome and Addison’s disease), and
ovarian dysfunction (including polycystic ovarian
syndrome), among others. Some examples of
metabolic disorders include cystic fibrosis,
phenylketonuria (PKU), hyperlipidemia, gout,
and rickets.

WOMEN’S HEALTH USA 2008

Polycystic ovary syndrome (PCOS) is one of
the most common endocrine disorders among
women of reproductive age. PCOS is the most
common cause of endocrine-related female
infertility in the United States. An estimated 1 in
10 women of childbearing age has PCOS, and it
can occur in females as young as 11 years of age.
In addition, PCOS may put women at risk for
other health conditions, including high blood
pressure, heart disease, and diabetes.26
Hyperthyroidism and hypothyroidism are also
common endocrine disorders. In 2005–2006,
women were more likely than men to report
having ever been told by a health professional that
they have a thyroid problem (16.4 versus 3.4
percent). Among women, rates varied by race and

ethnicity. Non-Hispanic Whites were most likely
to report a thyroid problem (18.5 percent),
compared to non-Hispanic Blacks (10.7 percent),
and Hispanics (9.2 percent).
In 2005, the rate of physician visits due to
endocrine and metabolic disorders varied by sex.
Nearly 4 per 100 physician visits made by men
were for a disorder of an endocrine gland other
than the thyroid gland, compared to 3.1 per 100
visits made by women. Similarly, 2.9 per 100
visits made by men were due to a metabolic
disorder, versus 2.0 per 100 visits among women.
Women, however, had twice the rate of visits due
to disorders of the thyroid gland than men (1.5
versus 0.7 per 100 visits).

Thyroid Problems* Among Women Aged 18 and Older,
by Race/Ethnicity, 2005–2006

Physician Visits by Adults Aged 18 and Older Due
to Endocrine and Metabolic Disorders,* by Sex, 2005

Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey

Source II.11: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Ambulatory Medical Care Survey
5

18.5
16.4

15.7
10.7

9.2
8
4
Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Non-Hispanic
Other Races**

*Reported a health professional has ever told them they have a thyroid problem; includes hyperthyroidism
and hypothyroidism **Includes American Indian/Alaska Natives, Asian/Pacific Islanders, persons of more
than one race, and persons of all other races not specified.

Female
Rate per 100 Visits

Percent of Women

20
16

Male

3
2
1

3.9
3.1

2.9
2.0

1.5
0.7
Disorders of the
Thyroid Gland

Disorders of Other
Endocrine Glands

Metabolic and
Immunity Disorders

*Based on ICD-9-CM codes for disorders of the thyroid gland: 240-246; disorders of other endocrine glands:
250-259; other metabolic and immunity disorders: 270-279.

WOMEN’S HEALTH USA 2008

who had a heart attack before age 55 is a risk
factor for heart disease.
Type 2 diabetes is also a major cause of morbidity in women. Although obesity and reduced
physical activity are the most important risk
factors for type 2 diabetes, the greater the number
of relatives affected with diabetes the higher the
risk to family members.
Genetic testing is one way to identify the subset
of high-risk women who have inherited a

susceptibility to cancer. In 2005, 1.5 percent of
women reported having a genetic test for cancer
risk. Among these women, breast cancer risk was
most commonly tested (52.9 percent), followed
by ovarian cancer risk (38.0 percent) and colon or
rectal cancer risk (18.5 percent). Additionally,
nearly 24 percent had a genetic test for some
other cancer risk. [Respondents could report
more than one type of genetic test.]

Genetic Tests for Cancer Risk Among Women Aged 18 and Older Who Received
Any Genetic Test, by Cancer Site,* 2005
Source II.12: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health
Interview Survey
60
Percent of Women Who Received Genetic Testing

GENETICS AND WOMEN’S
HEALTH
Genes may play a role in the risk of many of the
most common causes of morbidity and mortality
among women, including cancer, cardiovascular
disease, and diabetes. The most reliable way to
identify those at risk for an inherited susceptibility to chronic disease is through their family
health histories.
Breast cancer affects 1 in 8 women over their
lifetime, and colon cancer affects 1 in 15 women.
Approximately 10 percent of breast, ovarian, and
colon cancer cases are due to inherited mutations
in specific genes that can be passed down from
either parent (mother or father) and greatly
increase the risk of cancer. The genetics of all
cancer is complex, and even those individuals in
whom single gene mutations cannot be identified
may still have an elevated risk for cancer,
emphasizing the importance of knowing one’s
family history.
Coronary heart disease is the leading cause of
death for women in the United States. Although
there are significant modifiable lifestyle risk
factors such as smoking, hypertension, and
obesity, genetics is important in identifying
women and men at risk for heart disease and
other chronic conditions. Having a male firstdegree relative (parent or sibling) who had a heart
attack or stroke before age 65 or a female relative

HEALTH STATUS – HEALTH INDICATORS

52.9
50

38.0

30
23.8
18.5

Breast Cancer Risk

Ovarian Cancer Risk

Colon or Rectal Cancer Risk

*Percentages do not add to 100 because respondents could report more than one type of genetic test.

Other Cancer Risk

HEALTH STATUS – HEALTH INDICATORS

WOMEN’S HEALTH USA 2008

HIV/AIDS
Acquired immunodeficiency syndrome (AIDS)
is the final stage of the human immunodeficiency
virus (HIV), which destroys or disables the cells
that are responsible for fighting infection. AIDS
is diagnosed when HIV has weakened the
immune system enough that the body has a
difficult time fighting infections.27 In 2006, there
were an estimated 10,537 new AIDS cases
reported among adolescent and adult females
aged 13 and older, compared to 28,378 new cases
among males of the same age group.
In 2006, high-risk heterosexual contact (including sex with an injection drug user, sex with men
who have sex with men, and sex with an HIVinfected person) accounted for 45.9 percent of

new AIDS cases among adolescent and adult
females, followed by injection drug use (17.3
percent). In 36.0 percent of cases, the transmission category was not reported or identified, and
an additional 0.6 percent of cases were due to
blood transfusions or receipt of blood components or tissue. High-risk heterosexual contact
was the most often cited transmission category for
AIDS cases, particularly among Hispanic females
(49.0 percent) and Asian/Pacific Islander females
(47.1 percent). Injection drug use accounted for
31.7 percent of new AIDS cases among American
Indian/Alaska Native females, and 27.9 percent
of cases among non-Hispanic White females.
In 2006, an estimated 131,195 adolescent and
adult females were living with HIV/AIDS.28

Nearly 84,000 non-Hispanic Black females were
living with HIV/AIDS in 2006, accounting for
63.9 percent of cases. Non-Hispanic White and
Hispanic females accounted for 25,050 and
20,004 cases, respectively.
HIV/AIDS disproportionately affects minorities. While being of a particular race or ethnicity
does not increase the likelihood of contracting
HIV, certain challenges exist for non-Hispanic
Black and Hispanic females putting them at
greater risk for infection: socioeconomic factors
such as limited access to quality health care;
language and cultural barriers, particularly for
Hispanics, which can affect the quality of health
care; high rates of STIs, which increase the risk of
HIV infection; and substance abuse.29

Adolescent and Adult Females Living with HIV/AIDS,*
Reported New AIDS Cases Among Adolescent and Adult
*
Females, by Race/Ethnicity and Transmission Category, 2006 by Race/Ethnicity, 2006

17.3

Injection
Drug Use

High-Risk
Heterosexual Contact

Other**
45.9

36.7

Total
27.9

30.0

42.0

Non-Hispanic White

39.4

46.0

14.6
Non-Hispanic Black

49.0

17.7

33.3

Hispanic
47.1

7.7

45.2

Asian/Pacific Islander
American Indian/
Alaska Native

31.7

36.6

31.7
10

100

Percent of New AIDS Cases Reported
*Percentages may not add to 100 percent due to rounding. **“Other” includes risk factors not reported or
not identified, blood transfusion, hemophilia/coagulation disorder, and perinatal exposure.

Source II.13: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report
Number of Females (in thousands)

Source II.13: Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report

140

131,195

120
100
80

83,809

30
25
20
15
10
5

25,050
20,004

Total**

Non-Hispanic Non-Hispanic
White
Black

Hispanic

703

578

Asian/
Pacific Islander

American Indian/
Alaska Native

*Includes persons with a diagnosis of HIV infection (not AIDS), a diagnosis of HIV infection and a later diagnosis of AIDS, or concurrent diagnoses of HIV infection and AIDS, in 33 States. Data do not reflect improved
estimates of HIV incidence released in August 2008. **Includes 1,051 females of unknown race/ethnicity.

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

SEXUALLY TRANSMITTED
INFECTIONS
Reported rates of sexually transmitted
infections (STIs) among females vary by a
number of factors, including age and race/ethnicity. Rates of chlamydia, gonorrhea, and syphilis
are highest among adolescents and young adults.
In 2006, there were 2,862.7 reported cases of
chlamydia and 647.9 cases of gonorrhea per
100,000 females aged 15–19 years, compared to
25.6 and 12.9 reported cases, respectively, per
100,000 females aged 45–54 years. Syphilis was
also most common among young women,
occurring at a rate of 2.9 per 100,000 females

aged 20–24 years; 2.5 per 100,000 females aged
25–29 years, and 2.3 per 100,000 females aged
15–19 years (data not shown).
Although these STIs are treatable with antibiotics, they can have serious health consequences.
Active infections can increase the likelihood of
contracting another STI, such as HIV, and
untreated STIs can lead to pelvic inflammatory
disease, infertility, and adverse pregnancy
outcomes.
Another STI, genital human papillomavirus
(HPV), has been estimated to affect at least 50
percent of the sexually active population at some
point in their lives.16 In 2003–2004, 27.5 percent

of females aged 18–59 years were found to have
HPV. This varied by race and ethnicity. NonHispanic Black women were most likely to have
HPV (39.6 percent), compared to non-Hispanic
White and Hispanic women (25.0 and 28.3
percent, respectively). There are many different
types of HPV, and some, which are referred to as
“high-risk,” can cause cancer. In 2006, the Food
and Drug Administration approved a vaccine that
protects women from four strains of HPV that
can be the source of cervical cancer, precancerous
lesions, and genital warts.16 Since 2006, 10
percent of women aged 18–26 years have received
this vaccine.30

Rates of Chlamydia and Gonorrhea Among Females Aged
15–54, by Age, 2006

Genital Human Pappillomavirus (HPV) Infection Among
Women Aged 18–59, by Race/Ethnicity,* 2003–2004

Source II.14: Centers for Disease Control and Prevention, Sexually Transmitted Disease
Surveillance

Source II.2: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey

2,862.7

2,797.0

39.6

40
2,500
Percent of Women

Rate per 100,000 Females

3,000

2,000
Chlamydia

1,500
1,141.2

Gonorrhea

1,000
647.9

605.7

500

294.9
15-19
Years

20-24
Years

25-29
Years

28.3

27.5
25.0

25
20
15
10

415.7
125.5 174.2 65.7
30-34
Years

35-39
Years

60.0 33.9
40-44
Years

5
25.6 12.9
45-54 Years

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

*The sample of Asian/Pacific Islanders, American Indian/Alaska Natives, persons of multiple races, and
persons of other races unspecified was too small to produce reliable results.

HEALTH STATUS – HEALTH INDICATORS

WOMEN’S HEALTH USA 2008

INJURY
Often, injuries can be controlled by either
preventing an event (such as a car crash) or lessening its impact. This can occur through education,
engineering and design of safety products,
enactment and enforcement of policies and laws,
economic incentives, and improvements in
emergency care. Some examples include the
design, oversight, and use of child safety seats and
seatbelts, workplace regulations regarding safety
practices, and tax incentives for fitting home
pools with fences.
In 2006, unintentional falls were the leading
cause of nonfatal injury among women of every
age group, and rates generally increased with age.

Unintentional and intentional injuries each
represented a higher proportion of emergency
department (ED) visits for men than women in
2005. Among women and men aged 18 years and
older, unintentional injuries accounted for 19.9
and 27.5 percent of ED visits, respectively, while
intentional injuries, or assault, represented 1.4
and 2.7 percent of visits, respectively. Among
both women and men, unintentional injury
accounted for a higher percentage of ED visits
among those living in non-metropolitan areas,
while adults living in metropolitan areas had a
slightly higher percentage of ED visits due to
intentional injury.

Women aged 65 years and older had the highest
rate of injury due to unintentional falls (59.7 per
1,000 women), while slightly more than 19 per
1,000 women aged 18–34 and 35–44 years
experienced fall-related injuries. Unintentional
injuries sustained as motor vehicle occupants
were the second leading cause of injury among
18- to 34-year-olds (18.7 per 1,000), while
unintentional overexertion was the second
leading cause of injury among women aged
35–44 and 45–64 years (13.7 and 9.3 per 1,000,
respectively). Among women aged 65 years and
older, being unintentionally struck by or against
an object was the second leading cause of injury
(5.7 per 1,000).

Leading Causes of Injury* Among Women Aged 18 and
Older, by Age, 2006

Injury-Related Emergency Department Visits Among Adults
Aged 18 and Older, by Area of Residence* and Sex, 2005

Source II.15: Centers for Disease Control and Prevention, National Center for Injury
Prevention and Control

Source II.16: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Hospital Ambulatory Medical Care Survey

59.7

Rate per 1,000 Women

Unintentional Injury

50
40
30
20

22.8
19.2
19.3

Intentional Injury

Total

18.7
15.3 13.7
7.8

12.7
9.3

4.6

5.2

Fall
Motor Vehicle
Overexertion
Occupant
*All of the leading causes of injury in 2006 were unintentional.

26.6
21.2

Non-MSA

MSA
10.9

27.5
19.7

MSA
18-34 Years
35-44 Years
45-64 Years
65 Years and Older

Non-MSA
9.8

7.2 5.7 7.6 5.8
4.4

Struck by/
Against Object

2.4

Cut/Pierce

Female
Male

19.9

Total

32.2
1.4
2.7
1.5
2.9
1.2
1.7
5

Percent of Emergency Department Visits
*Metropolitan Statistical Areas (MSA) include at least: one city with 50,000 or more inhabitants, or an
urbanized area of at least 50,000 inhabitants and a total metropolitan population of at least 100,000
(75,000 in New England).

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

OCCUPATIONAL INJURY
In 2006, there were nearly 1.2 million nonfatal
occupational injuries in the United States that
resulted in at least 1 day absent from work. Of
those, more than 34 percent of injuries occurred
among females aged 14 and older. While males
account for the majority of total injuries, the
distribution of injuries by age differs between
males and females. More than 36 percent of males
with occupational injuries were aged 20–34 years,
compared to 29.7 percent of females in the same
age group. In comparison, nearly 16 percent of

injuries among females occurred among women
aged 55 years and older, while males of this age
group accounted for 12.2 percent of injuries.
The distribution of nonfatal occupational
injuries by sex varies by occupational sector. In
2006, females accounted for 66.7 percent of
injuries occurring in management, professional,
and related occupations, despite making up only
51.1 percent of the workforce in that sector.
Similarly, females represented 56.5 percent of the
service workforce, but accounted for 61.9 percent
of injuries in that sector. Conversely, males were

somewhat overrepresented in injuries to sales and
office workers; males made up 36.9 percent of
that workforce, but accounted for 40.9 percent of
injuries in that sector. Injuries occurring among
males and females in the farming, fishing, and
forestry sector, as well as the construction, extraction, and maintenance sector were approximately
proportionate to their workforce representation.
(See page 18, “Women in the Labor Force,” for
data on workforce representation by occupational
sector and sex.)

Nonfatal Occupational Injuries and Illnesses of Workers
Aged 14 and Older, by Sex and Age,* 2006

Nonfatal Occupational Injuries and Illnesses, by
Occupational Sector and Sex, 2006

Source II.17: U.S. Department of Labor, Bureau of Labor Statistics

Female

Male

59.1

Female

40.9

Male

Sales and Office

35-44 Years
25.0%

61.9

38.1

66.7

33.3

18.8

81.2

20.7

79.3

2.5

97.5

Service
45-54 Years
25.2%

35-44 Years
25.8%

Management, Professional
and Related

55 Years and
Older 12.2%

55 Years and
Older 15.8%
20-34 Years
29.7%

45-54 Years
21.1%

20-34 Years
36.4%

Production, Transportation
and Material Moving
Farming, Fishing
and Forestry

14-19 Years
3.4%

Construction, Extraction,
and Maintenance

14-19 Years
3.3%
10
*Percentages do not equal 100 because age was not reported in 1.1 percent of cases and rounding.

40
50
60
70
Percent of Workers

100

HEALTH STATUS – HEALTH INDICATORS

ATTENTION DEFICIT
HYPERACTIVITY DISORDER
Attention deficit hyperactivity disorder
(ADHD) is a neurobehavioral, or psychiatric,
disorder that commonly appears in childhood
and often persists into adulthood. ADHD is
characterized by chronic inattention and/or
impulsive hyperactivity severe enough to interfere
with daily functioning. While professionals began
to use the term “attention deficit disorder” to
describe these characteristics in the 1970s, the
causes of the disorder are still unknown. It is
estimated that as many as half of those with
ADHD have other mental disorders, making it
more difficult to diagnose and presenting more
challenges for those affected.31,32
The best estimate of ADHD prevalence among
adults is from a 2001–2003 study which found
that 3.2 percent of women and 5.4 percent of
men had ADHD.33 Symptoms of ADHD in
adulthood can include distractibility, disorganization, forgetfulness, procrastination, chronic
boredom, chronic lateness, and employment
problems.34 Anxiety, depression, low self-esteem,
mood swings, and restlessness are other
symptoms that may easily mask ADHD, making
it more likely that affected individuals will be
diagnosed with depression. Many women with
ADHD may also feel disorganized, overwhelmed,
ashamed, inadequate, and out of control.32

WOMEN’S HEALTH USA 2008

Adults with ADHD may face particular
problems in the workplace, finding time management, problem solving, and environmental
distractions extremely challenging. An estimated
35 days of work are lost annually among adults
with ADHD due to their condition.33
While there is no cure for ADHD, diagnosing
the disorder in adults has many benefits.
Interventions and treatment can improve work
performance and skills and educational achievement, as well as self-esteem. Treatments may
include patient and family education, educational
or employment accommodations, medication,
and counseling. While medications are often used
to help individuals manage their symptoms, those
with resulting social problems may choose to
work with a therapist or coach to set goals to learn
and apply new social skills. In addition, some
adults with ADHD may choose to work with a
career counselor to address workplace issues that
arise as a result of their condition.

Common Adulthood Symptoms
of ADHD
Source II.18: Children and Adults with Attention
Deficit Hyperactivity Disorder, National Resource
Center on ADHD
• Poor attention; excessive distractibility

• Physical restlessness or hyperactivity

• Excessive forgetfulness

• Excessive impulsivity; saying or doing things
without thinking

• Excessive and chronic procrastination

• Difficulty getting started on tasks

• Difficulty completing tasks

• Frequently losing things

• Poor organization, planning, and time
management skills

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

MENTAL ILLNESS
AND SUICIDE
Mental illness affects both sexes, although many
types of mental disorders are more prevalent
among women.35 For instance, in 2006, 13.5
percent of women and 8.7 percent of men had
experienced serious psychological distress in the
past year. Similarly, 8.7 percent of women experienced a major depressive episode, compared to
5.2 percent of men.
Among women, the rate of serious psychological distress and major depressive episodes
decreases with age. Serious psychological distress
occurs among almost 21.9 percent of women

aged 18–25 years, compared to 17.5 percent of
women aged 26–34 years and 14.8 percent of
women aged 35–49 years. Similarly, approximately 11.5 and 11.6 percent of women aged
18–25 and 26–34 years, respectively, experienced
a major depressive episode, but that rate decreased
as age increased.
Serious psychological distress and major depressive episodes among women also vary by race and
ethnicity. In 2006, American Indian/Alaska
Native women were most likely to have experienced both disorders (26.8 and 16.6 percent,
respectively). Asian/Pacific Islanders were least
likely to have experienced serious psychological

Serious Psychological Distress and Major Depressive
Episode* Among Women Aged 18 and Older, by Age, 2006
Source II.3: Substance Abuse and Mental Health Services Administration, National Survey
on Drug Use and Health

Percent of Women

30
25

21.9
17.5
14.8

13.5
11.5

Source II.3: Substance Abuse and Mental Health Services Administration, National Survey
on Drug Use and Health

Serious Psychological Distress
Major Depressive Episode

11.6
9.7

8.7

8.2
6.0

distress (9.8 percent) and major depressive
episodes (3.6 percent) in the past year.
Although most people who suffer from mental
illness do not commit suicide, mental illness is a
major risk factor. In 2005, 5.7 per 100,000
women aged 18 and older committed suicide.
American Indian/Alaska Native and nonHispanic White women had the highest suicide
rates (7.0 and 6.9 per 100,000, respectively).
Hispanic and non-Hispanic Black women had
the lowest suicide rates among all racial and
ethnic groups (2.3 and 2.4 per 100,000, respectively; data not shown).36

Serious Psychological Distress and Major Depressive
Episode* Among Women Aged 18 and Older, by
Race/Ethnicity, 2006

Percent of Women

Serious Psychological Distress
Major Depressive Episode

26.8

20
16.6
15
10

13.7

12.7

12.4

9.8

9.6
6.5

6.8
3.6

5
Total

18-25 Years

26-34 Years

35-49 Years

50 Years
and Older

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian/Pacific
Islander

American Indian/
Alaska Native

*Serious psychological distress is an overall indicator of past year nonspecific psychological distress that is constructed from the K6 scale, which consists of six questions related to psychological distress. A major
depressive episode is a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of the symptoms for depression as described in the
DSM-IV, occurring in the past year.

HEALTH STATUS – HEALTH INDICATORS

INTIMATE PARTNER
VIOLENCE
Intimate partner violence (IPV) refers to any
physical, sexual, or emotional abuse, or threats
occurring between two people in a relationship.
Intimate partners include current or former
spouses, boyfriends, or girlfriends. According to
the National Crime Victimization Survey, which
estimates victimization rates based on household
and individual surveys, 4.2 per 1,000 females
aged 12 and older were victims of nonfatal IPV
between 2001 and 2005; this rate represents 21.5
percent of all nonfatal violent victimizations
committed against females, which include rape,
sexual assault, robbery, aggravated assault, and
simple assault. Additionally, between 1976 and
2005, intimate partners committed 30.1 percent

WOMEN’S HEALTH USA 2008

of homicides against females. IPV varies with a
number of factors including age, race/ ethnicity,
income, and marital status.
In 2001–2005, women aged 20–24 years had
the highest rate of IPV (11.3 per 1,000), followed
by women aged 25–34 years (8.1 per 1,000).
Women aged 50–64 years and 12–15 years were
least likely to have reported IPV (1.3 and 1.6 per
1,000, respectively).
American Indian/Alaska Native females experienced the highest rate of intimate partner
victimization (11.1 per 1,000 females). The
second highest rate occurred among Black
females (5.0 per 1,000), while Asian females were
least likely to be victims of IPV (1.4 per 1,000).
During this same time period, females in
households with annual incomes below $7,500

had the highest rate of intimate partner victimization (12.7 per 1,000), while those in
households with annual incomes of $50,000 or
more were least likely to have reported IPV (2.0
per 1,000; data not shown).
IPV may have negative effects on the health and
well-being of children whose mothers experience
violence. Children whose mothers experience
IPV are significantly more likely than other
children to visit the emergency department37 and
three times more likely to receive mental health
services after cessation of the violence.38 In
2001–2005, children were present in 216,490
(35.2 percent) households experiencing IPV (data
not shown).

Intimate Partner Violence Among Females Aged 12–64,
by Age, 2001–2005

Intimate Partner Violence Among Females Aged 12
and Older, by Race/Ethnicity, 2001–2005

Source II.19: U.S. Department of Justice, Bureau of Justice Statistics

Source II.19: U.S. Department of Justice, Bureau of Justice Statistics
12

11.3

Rate per 1,000 Females

8.1

8
6.3
6
4
2

1.6

12-15 Years

1.3
16-19 Years

20-24 Years

25-34 Years

50-64 Years

11.1

10
8
6
4

5.0
4.3

4.0

1.4
White*

*May include Hispanics.

Black*

Hispanic

Asian*

American Indian/
Alaska Native*

WOMEN’S HEALTH USA 2008

HEALTH STATUS – HEALTH INDICATORS

URO LOGIC DISORDERS
and is generally more common among women
with urinary leakage reported that it occurred a
Urologic disorders encompass illnesses and
than men.39 In 2005–2006, 38.4 percent of
few times a week and 17.2 percent experienced
diseases of the genitourinary tract. Some
leakage every day and/or night.
women and 11.7 percent of men aged 20 years
examples include urinary incontinence, urinary
Urinary incontinence also varied by race and
and older reported that they had ever had urinary
tract infection, sexually transmitted diseases,
ethnicity. More than 40 percent of non-Hispanic
leakage. Among women, urinary leakage was
urolithiasis (kidney stones), and kidney and
White women reported urinary leakage, followed
most common among women aged 45–64 and
bladder cancer. Many of these disorders affect a
by 36.6 percent of Hispanic women. Non65 years and older (49.1 and 46.4 percent, respeclarge number of adult women; annual Medicaid
Hispanic Black women were least likely to report
tively), compared to 27.8 percent of women aged
expenditures for urinary incontinence and
any leakage (29.4 percent; data not shown).
20–44 years. In addition, 21.6 percent of women
urinary tract infections among adult women total
Among women with urinary leakage, the
with urinary leakage reported that it affects their
more than $234 million and $956 million,
frequency of occurrence and effects on daily
daily activities at least a little, compared to 14.5
respectively. These same illnesses accounted for
activities did not vary by race and ethnicity,
percent of men (data not shown).
$39 million and $480 million in expenditures,
indicating that the impact of the condition is
Among women with urinary leakage, 38.7
respectively, for adult men.39
universal.
percent reported that it occurred less than once a
Urinary incontinence is one of the most
month, while 28.3 percent reported occurrence a
prevalent chronic diseases in the United States
few times a month. Nearly 16 percent of those
Adults Aged 20 and Older Reporting Urinary Leakage,
Frequency of Urinary Leakage Among Women Aged 20
by Age and Sex, 2005–2006
and Older Reporting Any Leakage,* 2005–2006
Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey
50

49.1

Female

46.4

Male
Percent of Adults

Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey
Every Day
and/or Night
17.2%

38.4

27.8

Less Than
Once a Month
38.7%

26.9
A Few Times
a Week
15.9%

20
14.7
11.7
10

4.9
Total

20-44 Years

45-64 Years

65 Years
and Older

A Few Times
a Month
28.3%
*Percentages do not equal 100 because of rounding.

HEALTH STATUS – HEALTH INDICATORS

GYNECOLOGICAL AND
REPRODUCTIVE DISORDERS
Gynecological disorders affect the internal and
external organs in a woman’s pelvic and abdominal areas and may affect a woman’s fertility. These
disorders include vulvodynia—unexplained
chronic discomfort or pain of the vulva—and
chronic pelvic pain—a consistent and severe pain
occurring mostly in the lower abdomen for at
least 6 months. While the causes of vulvodynia
are unknown, recent evidence suggests that it may
occur in up to 16 percent of women, usually
beginning before age 25, and that Hispanic
women are at greater risk for this disorder.40
Chronic pelvic pain may be symptomatic of an
infection or indicate a problem with one of the
organs in the pelvic area.41
Reproductive disorders may affect a woman’s
ability to get pregnant. Examples of these
disorders include polycystic ovary syndrome
(PCOS), endometriosis, and uterine fibroids.
PCOS occurs when immature follicles in the
ovaries form together to create a large cyst,
preventing mature eggs from being released. In
most cases, the failure of the follicles to release the
eggs results in a woman’s inability to become
pregnant. An estimated 1 in 10 women in the
United States are affected by PCOS.41
Endometriosis occurs when tissue resembling that
of the uterine lining grows outside of the uterus.

WOMEN’S HEALTH USA 2008

Uterine fibroids are non-cancerous tumors that
grow underneath the lining, between the muscles,
or on the outside of the uterus.
In 2005–2006, 9.3 percent of women aged
20–54 years had endometriosis and 12.6 percent
had uterine fibroids, but the prevalence of both
disorders varied with age. Of women aged 20–54
years, endometriosis was most common among
35- to 44-year-olds (13.4 percent), while uterine
fibroids were most common among 45- to 54year-olds (25.6 percent). Women aged 20–34
years were least likely to have either disorder (4.2
and 3.4 percent, respectively).

A hysterectomy—abdominal surgery to remove
the uterus—is one option to treat certain
conditions including chronic pelvic pain, uterine
fibroids, and endometriosis when symptoms are
severe.41 In 2005–2006, nearly 40 percent of
women aged 45–54 reported having had a
hysterectomy, though it is not clear how many of
these hysterectomies were to treat gynecological
or reproductive disorders (data not shown).

Endometriosis and Uterine Fibroids Among Women Aged 20–54, by Age,
2005–2006
Source I.4: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health
and Nutrition Examination Survey
30

25.6
25

Percent of Women

Endometriosis
Uterine Fibroids

13.4

12.6
10

11.7

12.1

9.3

4.2

Total (20-54 Years)

3.4

20-34 Years

35-44 Years

45-54 Years

WOMEN’S HEALTH USA 2008

HEALTH STATUS – MATERNAL HEALTH

LIVE BIRTHS
According to preliminary data, there were 4.3
million births in the United States in 2006, which
represents an increase of 3 percent from the
previous year, the largest single-year increase since
1989. The number of births rose in every racial
and ethnic group, most noticeably among nonHispanic Black women and American
Indian/Alaska Native women. Overall, the birth
rate was 14.2 per 1,000 population.
With regard to age, overall birth rates were
highest among those aged 25–29 years (116.8 per
1,000), followed by those aged 20–24 years
(105.9 per 1,000). The birth rate for non-

Hispanic Whites was highest in the 25–29 age
group (109.2 per 1,000), while the rates for nonHispanic Blacks, Hispanics, and American
Indian/Alaska Natives were highest in the 20–24
age group (133.1, 177.0, and 114.9 per 1,000,
respectively). The birth rate among Asian/Pacific
Islanders was highest among 30- to 34-year-olds
(116.5 per 1,000).
The percentage of births with a cesarean
delivery has been increasing steadily since 1996,
while vaginal births after a previous cesarean
(VBAC) have been decreasing. Among all births
in 2005, more than 30 percent were delivered by
cesarean, representing a 46 percent increase since

1996. Only 7.9 percent of women with a
previous cesarean delivery had a vaginal birth in
2005, compared to a high of 28.3 percent in
1996, a decrease of 72 percent. This trend is
maintained even when considering only low-risk
women.42 Additionally, induction of labor has
increased substantially since 1990. Nearly 23
percent of singleton births were induced in 2005,
which is nearly 2.5 times the percentage in 1990
(9.6 percent).
In 2005, 83.9 percent of women received
prenatal care during the first trimester of
pregnancy, while 3.5 percent of women received
care in the third trimester or not at all.43

Live Births per 1,000 Women, by Age and Race/Ethnicity,
2006*

Births Involving Cesarean Section, VBAC, and Induction
of Labor, by Maternal Risk Status,* 1990–2005**

Source II.20: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System

Source II.21, 22, 23: Centers for Disease Control and Prevention, National Center for
Health Statistics, National Vital Statistics System

Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian/
American Indian/
Alaska Native Pacific Islander

Cesarean Section (All Women)

25.6

41.9

26.6

63.7

83.0

54.7

16.7

20-24 Years

105.9

83.4

133.1

177.0

114.9

62.5

25-29 Years

116.8

109.2

107.1

152.4

97.2

107.8

30-34 Years

97.7

98.1

72.6

108.4

61.5

116.5

35-39 Years

47.3

46.3

36.0

55.6

28.2

62.8

40-44 Years

9.4

8.4

8.3

13.3

6.1

14.1

Percent of Births

25
15-19 Years

22.3
20
VBAC
(Low-Risk Women)

15
Cesarean Section
(Low-Risk Women)

10
5

Induction of Labor
(All Women)

1990

*Data are preliminary.

30.3

1995

VBAC
(All Women)

2000

8.3
7.9

2005

*A low-risk woman is defined as one with a full-term (at least 37 completed weeks of gestation), singleton
(not a multiple pregnancy), and vertex fetus (head facing in a downward position in the birth canal). **Data
after 2003 for C-sections and VBACs are from the 37 reporting areas using the 1989 Standard Certificate
of Live Birth (unrevised) to maintain comparability with previous years’ data.

HEALTH STATUS – MATERNAL HEALTH

WOMEN’S HEALTH USA 2008

BREASTFEEDING
Breastmilk benefits the health, growth,
immunity, and development of infants, and
mothers who breastfeed may have a decreased risk
of breast and ovarian cancers.44 Among infants
born in 2004, 73.8 percent were reported to have
ever been breastfed. Non-Hispanic Black infants
were the least likely to ever be breastfed (56.2
percent), while Asian/Pacific Islanders and
Hispanics were the most likely (81.7 and 81.0
percent, respectively).

The American Academy of Pediatrics
recommends that infants be exclusively breastfed—without supplemental solids or liquids—for
the first 6 months of life; however, only 11.3
percent of infants born in 2004 were exclusively
breastfed at 6 months, and only 41.5 percent of
infants were fed any breastmilk at 6 months.
Breastfeeding practices vary considerably by
maternal age, educational attainment, and marital
status. For instance, infants born to college
graduates were most likely to have ever been
breastfed (85.3 percent), while infants born to

mothers with a high school education or less were
least likely (65.7 and 67.7 percent, respectively.)
Research indicates that maternal employment
can also affect whether and for how long an infant
is breastfed; for instance, mothers working full
time are less likely to be breastfeeding at 6 months
than those working part time or not at all.45 In
2005, 49.5 percent of mothers with children
under 1 year of age were employed, and more
than two-thirds were employed full-time (data
not shown).46

Infants* Who Are Breastfed, by Race/Ethnicity and
Duration, 2004–2006

Infants* Who Are Breastfed, by Maternal Education and
Duration, 2004–2006

Source II.24: Centers for Disease Control and Prevention, National Immunization Survey

100
90
80

100

Ever Breastfed
Any at 6 Months
Exclusively at 6 Months**

90
81.7

81.0

77.5

73.9

73.8

56.2
51.8
41.5

45.1

42.5

42.3

40
30

26.3
11.3

Total

11.8

75.2
67.7

65.7

55.8

50
40.9
40

34.9

32.2

28.2

20
10

Percent of Infants

85.3

70
60

Ever Breastfed
Any at 6 Months
At 12 Months

7.5

Non-Hispanic Non-Hispanic
White
Black

11.6

15.8

18.5

16.8

18.5

11.4
10

Hispanic

Asian/
American Indian/
Pacific Islander Alaska Native

*Includes only infants born in 2004. **Exclusive breastfeeding is defined as only breastmilk—no solids, water,
or other liquids; data are not comparable to previous years’ data due to changes in data collection methods.

Less Than High School

*Includes only infants born in 2004.

High School

Some College

College Graduate

WOMEN’S HEALTH USA 2008

HEALTH STATUS – MATERNAL HEALTH

SMOKING DURING
PREGNANCY
Smoking during pregnancy can have a negative
impact on the health of infants and children by
increasing the risk of complications during
pregnancy, premature delivery, and low birth
weight—a leading cause of infant mortality.47
Maternal cigarette use data is captured on birth
certificates; however, data collection methods vary
due to revisions to the birth certificate in 2003. As
of 2005, the 1989 Standard Certificate of Live
Birth (unrevised) was used in 36 States, New York
City and Washington, DC, while 11 States used
the revised birth certificate.48
In 2005, 10.7 percent of all pregnant women
giving birth in areas using the unrevised birth

certificate smoked cigarettes during their
pregnancy. This varied by maternal race and
ethnicity.
Among women in the unrevised reporting
areas, American Indian/Alaska Native mothers
were most likely to have smoked during
pregnancy (18.1 percent), followed by nonHispanic White women (13.9 percent). Smoking
during pregnancy was higher among pregnant
women in areas using the revised birth certificate
(12.4 percent). Smoking was also most common
among American Indian/Alaska Native mothers
in these areas (24.6 percent). Asian/Pacific
Islanders and Hispanic women were least likely to
have smoked during pregnancy in both reporting
areas.

Cigarette use also varied by maternal age in
2005. Among women in the unrevised reporting
areas, women under 20 years of age were most
likely to have smoked cigarettes during pregnancy
(15.1 percent), followed by 13.0 percent of
women aged 20–29 years. Similarly, 16.4 percent
of women under 20 years of age in the revised
reporting areas smoked during pregnancy,
followed by 15.0 percent of women aged 20–29.
Smoking during the postpartum period has
negative consequences for the mother and infant.
In 2004, 17.9 percent of mothers smoked
postpartum (data not shown). Women at highest
risk were young mothers (under 20 years), White
mothers, and mothers whose pregnancy was
unintended.49

Cigarette Smoking During Pregnancy, by Maternal
Race/Ethnicity and Birth Certificate Type,* 2005

Cigarette Smoking During Pregnancy, by Maternal Age and
Birth Certificate Type,* 2005

Source II.23: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System

24.6

Unrevised

20
15

18.1

17.7

Revised
13.9
12.4
10.7

10.3

8.5

2.9
Total

Non-Hispanic
White

Non-Hispanic
Black

2.7

Hispanic

Percent of Women

Unrevised

Revised

20
15

15.1

16.4

15.0
13.0

10
6.2

7.1

6.9

8.0

5
2.1

2.3

Asian/
American Indian/
Pacific Islander Alaska Native

*The 1989 Standard Certificate of Live Birth (unrevised) was used in 36 reporting areas including
New York City and Washington, DC; the 2003 revised birth certificate was used in 11 reporting areas.

Under 20 Years

20-29 Years

30-39 Years

40-54 Years

*The 1989 Standard Certificate of Live Birth (unrevised) was used in 36 reporting areas including New
York City and Washington, DC; the 2003 revised birth certificate was used in 11 reporting areas.

HEALTH STATUS – MATERNAL HEALTH

WOMEN’S HEALTH USA 2008

MATERNAL MORBIDITY
AND RISK FACTORS IN
PREGNANCY
Since 1989, diabetes and hypertension have
been the most commonly reported health
conditions among pregnant women. Diabetes,
both chronic and gestational (developing only
during pregnancy), may pose health risks to the
mother and infant. Women with gestational
diabetes are at increased risk for developing
diabetes later in life.50 In 2005, diabetes during
pregnancy occurred at a rate of 38.5 per 1,000
live births and was similar across all racial and
ethnic groups (data not shown).

Hypertension during pregnancy can also be
All of these conditions are more common among
either chronic in nature or limited to the duration
non-Hispanic Black than non-Hispanic White
of pregnancy. Severe hypertension during
and Hispanic women, and among older mothers.
pregnancy can result in preeclampsia, fetal growth
Excessive or insufficient weight gain during
restriction, premature birth, placental abruption,
pregnancy can also influence birth outcomes. In
and stillbirth.51 Chronic hypertension was
2005, 10.7 percent of infants born to mothers
present in 10.4 per 1,000 live births in 2005. The
who gained less than 16 pounds were low birth
rate of pregnancy-associated hypertension was
weight, compared to 5.9 percent of infants born
even higher, occurring in 39.9 of every 1,000 live
to women gaining 36 to 40 pounds. Excessive
births.
weight gain (40 or more pounds) may elevate
Other illnesses or risk factors during pregnancy
the risk of gestational diabetes, preeclampsia,
can include eclampsia, which involves seizures
and large-for-gestational-age babies; more than
(usually preceded by a diagnosis of preeclampsia),
20 percent of pregnant women gained more
than 40 pounds in 2005 (data not shown).
and cervical insufficiency, which occurs when the
cervix opens or dilates before the fetus is full term.
Selected Maternal Morbidities and Risk Factors in
Selected Maternal Morbidities and Risk Factors in
Pregnancy, by Maternal Race/Ethnicity,* 2005
Pregnancy, by Maternal Age, 2005
Source II.21, 22: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System

100

Total
Non-Hispanic White
Non-Hispanic Black

90
80
70

Rate Per 1,000 Live Births

100

Hispanic

60
50
40
30

45.3 45.6
39.9
28.1
20.3

10.4 10.4

10
Pregnancy-Associated
Hypertension

5.3

Chronic
Hypertension

Source II.21, 22: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System

3.0 3.1 4.3 2.0

3.0 2.9 5.9 1.7

Eclampsia**

Cervical
Insufficiency

*Data not reported for American Indian/Alaska Natives, Asian/Pacific Islanders, and persons of more than
one race. **Eclampsia is characterized by seizures and generally follows preeclampsia, which is marked
by high blood pressure, weight gain, and protein in the urine.

Under 20 Years
20-29 Years
30-39 Years
40-54 Years

86.9

90
80
70
56.2

60
50
40
30
20

43.3
50.8
39.5
38.8

29.4

29.2
14.8

11.9

3.7
Diabetes*

7.7

Pregnancy-Associated
Chronic
Hypertension
Hypertension

3.9 2.8 2.8 4.0

4.8
1.5 2.5 4.0

Eclampsia**

Cervical
Insufficiency

*Includes gestational and chronic diabetes. **Eclampsia is characterized by seizures and generally
follows preeclampsia, which is marked by high blood pressure, weight gain, and protein in the urine.

WOMEN’S HEALTH USA 2008

HEALTH STATUS – MATERNAL HEALTH

MATERNAL MORTALITY
Maternal deaths are those reported on the death
certificate to be related to or aggravated by
pregnancy or pregnancy management that occur
within 42 days after the end of the pregnancy.
The maternal mortality rate has declined dramatically since 1950 when the rate was 83.3 deaths
per 100,000 live births; however, the maternal
mortality rate in 2005 (15.1 per 100,000 live
births) was 84 percent higher than the rate
reported in 1990 (8.2 per 100,000). According to
the National Center for Health Statistics, this
increase may largely be due to changes in how
pregnancy status is recorded on death certificates;

beginning in 1999, the cause of death was coded
according to International Classification of
Diseases, 10th Revision (ICD-10). Other
methodological changes in reporting and data
processing have been responsible for apparent
increases in more recent years.52
In 2005, there were a total of 623 maternal
deaths. This does not include the 137 deaths of
women due to complications during pregnancy
or childbirth after 42 days postpartum or the
deaths of pregnant women due to external causes
such as unintentional injury, homicide, or
suicide. In 2005, the maternal mortality rate
among non-Hispanic Black women (39.2 per

100,000 live births) was more than 3 times the
rate among non-Hispanic White women (11.7
per 100,000) and more than 4 times the rate
among Hispanic women (9.6 per 100,000).
The risk of maternal death increases with age
for women of all races and ethnicities. In 2005,
the maternal mortality rate was highest among
women aged 35 years and older (38.0 per
100,000 live births), compared to 7.4 per
100,000 live births to women under 20 years of
age and 10.7 per 100,000 live births among
women aged 20–24 years.

Maternal Mortality Rates, by Race/Ethnicity, 2005

Maternal Mortality Rates, by Age, 2005

Source II.5: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System

Source II.25: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System

39.2

30
25
20
15

38.0

15.1
11.7
9.6

Deaths per 100,000 Live Births

30
25
20
15
10

12.8
10.7

11.8

20-24 Years

25-29 Years

7.4

5
Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

*Data not reported for Asian/Pacific Islanders, American Indian/Alaska Natives, persons of more than one race,
and persons of other races not specified.

Under 20 Years

30-34 Years

35 Years and Older

HEALTH STATUS – SPECIAL POPULATIONS

WOMEN’S HEALTH USA 2008

OLDER WOMEN
In 2006, there were 37.2 million adults aged 65
and older in the United States, representing 12.4
percent of the total population. According to the
U.S. Census Bureau, the older population is
expected to grow to 72 million by 2030,
representing approximately 20 percent of the
population, due to the aging of the baby boom
generation. In 2006, older women composed 7.2
percent of the total population while men
accounted for 5.2 percent. Women represented a

larger proportion of the elderly population than
men within every age group.
More than 40 percent of women aged 65 or
older were married and living with a spouse in
2006, while another 38.4 percent lived alone.
Research has suggested that older adults who live
alone are more likely to live in poverty, which has
numerous health implications. Another 8.8
percent of older women were heads of their
household (with no spouse present), while 8.6
percent were living with relatives.

Employment plays a significant role in the lives
of many older Americans. In 2006, more than 2.2
million women aged 65 years and older were
working, accounting for 10.3 percent of women
in this age group. Nearly 18 percent of women
aged 65–74 years were employed during 2006,
while only 3.5 percent of women aged 75 and
older were employed. Less than 0.5 percent of
women aged 65 and older were unemployed and
looking for work (data not shown).

Representation of Adults Aged 65 and Older in the U.S.
Population,* by Age and Sex, 2006

Women Aged 65 and Older,* by Household Composition,
2006

Source I.1: U.S. Census Bureau, American Community Survey

Source I.2: U.S. Census Bureau, Current Population Survey

15
Living with
Relatives 8.6%
Total

12.4

Head of Household,
No Spouse
Present 8.8%

Percent of Population

5.2

Male

Living Alone
38.4%
6.3

6
2.9
7.2

Female

Married, Spouse
Present 41.9%

4.4
1.8

3
3.4

1.7
2.6

0.5
1.2

Total
*Civilian, non-institutionalized population.

65-74 Years

75-84 Years

Living with
Non-Relatives 2.3%

85 Years and Older
*Civilian, non-institutionalized population.

WOMEN’S HEALTH USA 2008

HEALTH STATUS – SPECIAL POPULATIONS

RURAL AND URBAN WOMEN
In 2005, more than 48 million people, or 16.6
percent of the population, lived in areas considered to be non-metropolitan. The number of
areas defined as metropolitan changes frequently
as the population grows and people move.
Residents of non-metropolitan areas tend to be
older, complete fewer years of education, have
public insurance or no health insurance, and live
farther from health care resources than their
metropolitan counterparts.

In 2005, 22.5 percent of women in nonmetropolitan areas were aged 65 years and older,
while only 17.2 percent of women in metropolitan areas were in the same age group. Fewer than
26 percent of women in non-metropolitan areas
were aged 18–34 years, compared to 30.6 percent
in metropolitan areas. Women aged 35–54 years
and 55–64 years accounted for approximately the
same percentage of the female population in nonmetropolitan and metropolitan areas.
In 2004–2006, the percentage of women
experiencing activity limitations due to a chronic

Women Aged 18 and Older, by Area of Residence* and Age,
2005
Source II.26: U.S. Agency for Healthcare Research and Quality, Medical Expenditure
Panel Survey
Non-MSA

MSA

condition was higher in non-metropolitan areas
(17.0 percent) than in metropolitan areas (13.4
percent), regardless of age. For instance, 30.2
percent of women aged 65–74 years living in
non-metropolitan areas had an activity limitation
due to a chronic condition, compared to 25.0
percent of women of the same age group in
metropolitan areas. As age increases, however, the
discrepancy narrows; among women aged 85
years and older, 63.3 percent in non-metropolitan
areas experienced an activity limitation, as did
61.9 percent in metropolitan areas.

Activity Limitations Due to a Chronic Condition Among
Women Aged 18 and Older, by Age and Area of Residence,*
2004–2006
Source II.27: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey
70

18-34 Years
25.6%

18-34 Years
30.6%
55-64 Years
14.4%

55-64 Years
14.7%
35-54 Years
37.2%

35-54 Years
37.8%

Percent of Women

65 Years and
Older 22.5%

63.3 61.9

65 Years and
Older 17.2%

50
41.7

Non-MSA
MSA

30.2

30
20

38.8

25.0
20.7
17.0

15.1

13.4
8.1

Total

5.6

18-44 Years

45-64 Years

65-74 Years

75-84 Years

85 Years
and Older

*A metropolitan statistical area (MSA) is defined as a core area containing a large population nucleus together with adjacent communities having a high degree of economic and social integration with that core. All counties
within a metropolitan statistical area are classified as metropolitan. Counties not within a metropolitan statistical area are considered non-metropolitan.

HEALTH SERVICES
UTILIZATION
Availability of and access to quality health care
services directly affects all aspects of women’s
health. For women who have poor health status,
disabilities, poverty, lack of insurance, and limited
access to a range of health services, preventive
treatment and rehabilitation can be critical in
preventing disease and improving quality of life.
This section presents data on women’s health
services utilization, including data on women’s
insurance coverage, usual source of care, satisfaction with care, use of medication, and use of
various services, such as preventive care, HIV
testing, hospitalization, and mental health
services. The contribution of HRSA to women’s
health across the country is highlighted as well.

WOMEN’S HEALTH USA 2008

HEALTH SERVICES UTILIZATION

USUAL SOURCE OF CARE
women of other races and non-Hispanic White
varied significantly by geographic region. Women
Women who have a usual source of care (a place
women were most likely to report a usual source
with incomes of less than 200 percent of poverty
they usually go when they are sick) are more likely
of care (92.1 and 91.6 percent, respectively).
in the South and West were least likely to have a
to receive preventive care,1 to have access to care
Among women, Hispanics were least likely to
usual source of care (77.3 and 80.0 percent,
(as indicated by use of a physician or emergency
report a usual source of care (74.8 percent).
respectively), while low-income women in the
department, or not delaying seeking care when
In 2006, the percentage of women with a usual
Northeast were most likely to have a usual source
needed),2 to receive continuous care, and to have
source of care varied by geographic region and
of care (91.3 percent).
lower rates of hospitalization and lower health
poverty level. Among women with household
care costs.3 In 2006, 89.1 percent of women
incomes of 200 percent or more of poverty, there
reported having a usual source of care. Women of
was little variation in having a usual source of care
all racial and ethnic groups were more likely than
by geographic region. Among women with lower
men to have a usual source of care. Non-Hispanic
incomes, however, having a usual source of care
Adults Aged 18 and Older with a Usual Source of Care,
Women Aged 18 and Older with a Usual Source of Care,
by Race/Ethnicity and Sex, 2006*
by Geographic Region and Poverty Level,* 2006
Source II.1: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey

Source II.1: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey
Less Than 200% of Poverty

Female
Male

100
90

79.5

92.1

88.7
83.2

86.6
80.8

83.4

70
60.1

60
50
40
30

Asian

Non-Hispanic
Other Races**

*Rates reported are not age-adjusted. **Includes American Indian/Alaska Natives, persons of more than
one race, and persons of all other races not specified.

91.6

91.1

84.6

81.6

77.3

80.0

40
30

10
Hispanic

200% or More of Poverty

Non-Hispanic
Black

93.5

10
Non-Hispanic
White

91.3

94.6

Total

92.4

75.1

74.8

Percent of Women

Percent of Adults

91.6

89.1

100

Total

Northeast

Midwest

South

West

*Poverty level, defined by the U.S. Census Bureau, was $20,444 for a family of four in 2006. Rates reported
are not age-adjusted.

HEALTH SERVICES UTILIZATION

WOMEN’S HEALTH USA 2008

HEALTH INSURANCE
People who are uninsured are less likely than
those with insurance to seek health care, which
can result in poor health outcomes and higher
health care costs. In 2006, 37.8 million adults
aged 18–64 years in the United States, representing 20.2 percent of that population, were
uninsured (data not shown).4 The percentage of
people who are uninsured varies considerably
across a number of categories, including age, sex,
race/ethnicity, income, and education.
In 2006, among adults aged 18 and older,
younger persons were most likely to lack health
insurance, and men were more likely than women

to be uninsured in every age group. The largest
percentage of uninsured persons occurred among
18- to 24-year-old males (32.4 percent), which
was significantly higher than the percentage for
women of the same age group (26.1 percent). The
lowest rate of uninsurance was among adults aged
65 and older, most of whom are eligible for
Medicare coverage. The next lowest percentage of
uninsured occurred among women and men aged
45–64 (13.6 and 14.8 percent, respectively); the
sex disparity in this age group was less
pronounced than in the younger age groups.
Among women aged 18–64 in 2006, 71.5
percent had private insurance, 14.4 percent had

public insurance, and 18.1 percent were
uninsured. This distribution varied by race and
ethnicity: non-Hispanic White females had the
highest rate of private insurance coverage (78.9
percent), followed by Asian/Pacific Islander
women (74.8 percent). Non-Hispanic Black
females had the highest rate of public insurance
(22.1 percent) followed closely by American
Indian/Alaska Native women (21.2 percent).
Hispanic females had the highest rate of uninsurance (38.7 percent), followed by American
Indian/Alaska Native women (36.0 percent).
[Respondents were able to report more than one
type of coverage.]

Adults Aged 18 and Older Without Health Insurance,
by Sex and Age, 2006

Health Insurance Coverage of Women Aged 18–64, by Type
of Coverage and Race/Ethnicity,* 2006

Source I.3: U.S. Census Bureau, Current Population Survey

Source I.3: U.S. Census Bureau, Current Population Survey
100

100
90

Female

Male

Percent of Women

Percent of Adults

60
50
40
29.3

30
20

Private
Public
Uninsured
78.9

Total

32.4
26.1

17.2 15.1 19.4

22.7

25.7
19.6

59.0

60
50

47.6

40
30
20

14.2 13.6 14.8

74.8

71.5

22.8
22.1

18.1
14.4

47.3

38.7
16.3

36.0
21.2
16.9
12.3

12.5 12.9
10

10
Total

18-24 Years

25-44 Years

45-64 Years

1.5 1.4 1.6
65 Years and Older

Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

American Indian/
Asian/
Pacific Islander Alaska Native

*Percentages may equal more than 100 because it was possible to report more than one type of coverage.

WOMEN’S HEALTH USA 2008

HEALTH SERVICES UTILIZATION

MEDICARE AND MEDICAID
Medicare is the Nation’s health insurance
program for people aged 65 and older, some
people under age 65 with disabilities, and those
with end-stage renal disease (permanent kidney
failure). Medicare has four components: Part A
covers hospital, skilled nursing, home health, and
hospice care; Part B covers physician services,
outpatient services, and durable medical
equipment; Part C (Medicare Advantage Plans)
allows beneficiaries to purchase additional
insurance coverage through private insurers, and
Part D allows coverage for prescription drugs
through private insurers.

In 2006, 55.8 percent of Medicare’s 43.3
million enrollees were female. As age increases the
proportion of female enrollees increases while the
proportion of male enrollees decreases. For
instance, among Medicare enrollees under 45
years of age, 45.2 percent were female while 54.8
percent were male. Among adults aged 85 years
and older, however, females accounted for 69.0
percent of enrollees, and males accounted for
31.0 percent.
Of the 16.7 million enrollees in the Medicare
Part D stand-alone prescription drug program in
2007, 61.5 percent were female. Females
accounted for a larger proportion of Part D

enrollees in every age group, excluding those
under 55 years, in which 46.5 percent were
female and 53.5 percent were male. Among
enrollees aged 75–89 years, 68.8 percent, or 4.0
million, were women.
Medicaid, jointly funded by Federal and State
governments, provides coverage for low-income
people and people with disabilities. In 2005,
Medicaid covered 58.7 million including
children; the aged, blind, and disabled; and adults
who were eligible for cash assistance programs.
Overall, 59.4 percent of all Medicaid enrollees
were female; of adults enrolled in Medicaid, 69.4
percent were women (data not shown).

Medicare Enrollees,* by Age and Sex, 2006

Medicare Part D Enrollees,* by Age and Sex, 2007

Source III.1: Centers for Medicare and Medicaid Services

55.8

54.8

53.4

52.4

41.0

46.4

31.0

100

Male

69.0

59.0
44.2

53.6

47.6

46.6

45.2

Female

Percent of Population

100

*Enrolled as of July 1, 2006.

65-74
Years

75-84
Years

85 Years
and Older

40.2

31.2

19.5

Male

80.5

Female

59.8
54.7
53.5

40
30

10
55-64
Years

61.5

10
45-54
Years

45.3

68.8

Under
45 Years

46.5

Total

38.5

Total

Under
55 Years

55-64 Years 65-74 Years 75-89 Years

*Enrollees in stand-alone prescription drug plans only, as of July 1, 2007.

90 Years
and Older

HEALTH SERVICES UTILIZATION

WOMEN’S HEALTH USA 2008

PREVENTIVE CARE
Counseling, education, and screening can help
prevent or minimize the effects of many serious
health conditions. In 2005, females of all ages
made 560 million physician office visits. Of these
visits, 19.7 percent were for preventive care,
including prenatal care, health screening, and
insurance examinations (data not shown).5
Routine Pap smears, which detect the early signs
of cervical cancer, are recommended at least every
3 years beginning within 3 years of initiation of
sexual activity, or by age 21.6 Among women aged
21 years and older in 2005, 51.8 percent received
a Pap smear in the past 3 years, while another
12.1 percent had received a Pap smear more than

3 but less than 5 years ago. More than 36 percent
of women aged 21 years and older had no Pap
smear within the past 5 years.
The percentage of women receiving a Pap smear
within the recommended timeframe decreases
with age. In 2005, women aged 21–34 years were
most likely to have had a Pap smear in the
previous 3 years (81.0 percent), and were least
likely to have not had a Pap test in the previous 5
years (9.7 percent). Women aged 65 years and
older were least likely to have received a Pap test
in the past 3 years (34.0 percent) and most likely
to have not had one in the past 5 years (53.8
percent). Nearly 25 percent of women aged
35–54 and 37.7 percent of women aged 55–64

had not had a Pap test in the previous 5 years.
High cholesterol is a risk factor for heart disease.
The Healthy People 2010 goal is to increase the
percentage of adults aged 20 and over who receive
a cholesterol screening at least every 5 years.7 In
2005, 72.1 percent of women aged 20 years and
older had received a cholesterol test within the
previous 5 years. Non-Hispanic White and nonHispanic Black women were more likely to have
had the test (75.7 and 71.3 percent, respectively),
compared to Hispanic women and non-Hispanic
women of other races (53.5 and 64.7 percent,
respectively).

Receipt of Pap Smears Among Women Aged 21 and Older,
by Age and Time Since Last Test, 2005

Receipt of Cholesterol Screening Among Women,* by
Race/Ethnicity and Time Since Last Test, 2005–2006

Source II.12: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey

Source I.4: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health and Nutrition Examination Survey

100

Within Past 3 Years

Percent of Women

More Than 3 Years
to 5 Years Ago

70
50

27.9

51.8

53.8

49.1
37.7

36.2

34.0

12.1
Total

9.4 9.7
21-34 Years

12.5
35-54 Years

13.2
55-64 Years

24.3
71.3

Non-Hispanic
Black

28.7

12.2
65 Years
and Older

Within Past 5 Years
More than 5 Years or Never

53.5

Hispanic

24.9

75.7

Non-Hispanic
White

62.7

40
20

72.1

Total

81.0

80
60

More Than 5 Years
Ago or Never

46.5
64.7

Non-Hispanic
Other Races**

35.3
10

100

Percent of Women
*Women aged 20 and older only. **Includes Asian/Pacific Islander, American Indian/Alaska Native, persons
of more than one race, and persons of all other races unspecified.

WOMEN’S HEALTH USA 2008

HEALTH SERVICES UTILIZATION

VACCINATION
Vaccination prevents the spread of infectious
diseases. Vaccination for influenza is recommended for young children, pregnant women,
persons with certain chronic medical conditions,
and adults aged 50 years or older.8 In 2006, nearly
40 percent of women aged 55–64 years and 64.6
percent of women aged 65 years and older
reported receiving a flu vaccine in the past year;
this varied, however, by race and ethnicity. NonHispanic White women were more likely than
women of other races and ethnicities to have
received the flu vaccine; 41.6 percent of 55- to
64-year-olds and 67.3 percent of those aged 65
years and older did so. Fewer than 48 percent of

non-Hispanic Black and Hispanic women aged
65 years and older received the flu vaccine.
Pneumonia vaccine is recommended for adults
aged 65 years and older and for people with
certain health conditions. In 2006, 60.0 percent
of women aged 65 and older reported ever receiving the vaccine. In this age group, Non-Hispanic
White women were most likely to have ever
received the pneumonia vaccine (64.0 percent),
compared to 34.4 percent of Hispanic women
and 42.2 percent of non-Hispanic Black women.
Hepatitis B vaccine is recommended to reduce
the spread of hepatitis B, which may result in
cirrhosis of the liver, liver cancer, liver failure, and
even death.9 Hepatitis B vaccination also varied

by race/ethnicity and age. Younger women were
most likely to have received at least one of the
three recommended doses, and non-Hispanic
White and non-Hispanic Black women in every
age group were more likely than Hispanic women
to have received the vaccine.
Genital human papillomavirus (HPV) can
cause cervical cancer and other diseases in
women. In 2006, the HPV vaccine was
recommended for adolescent females and young
women aged 9–26 years;10 since 2006, 10 percent
of women aged 18–26 years have been vaccinated
for HPV (data not shown).11

Receipt of Selected Vaccinations* Among Women Aged 18 and Older, by Race/Ethnicity** and Selected Age Group, 2006
Source II.1: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey

65 Years and Older

64.6

60
47.5

50
39.8

46.6

41.6
32.3

34.6

30
21.0

19.5

16.4

14.2

Non-Hispanic Non-Hispanic
White
Black

Hispanic

42.2

40
30

34.4
24.7

26.1

24.0
16.1

20
6.7
Total

7.3

6.6

Non-Hispanic Non-Hispanic
White
Black

18-54 Years

65 Years and Older

64.0

60.0

55-64 Years

65 Years and Older

10
Total

18-54 Years

67.3

Percent of Women

55-64 Years

4.2
Hispanic

Percent of Women

18-54 Years

100

100
55-64 Years

Hepatitis B Vaccine

Pneumonia Vaccine

Flu Vaccine
100

70
60
50
40

41.8

39.7

38.8

30.1

30
20

19.7
9.4

10
Total

19.8
9.6

20.1

16.0
8.3

Non-Hispanic Non-Hispanic
White
Black

6.8
Hispanic

*Having received the flu vaccine in the past 12 months; having ever received the pneumonia vaccine; and having ever received at least one dose of the three-dose hepatitis B vaccine. **Sample sizes for Asian/Pacific
Islanders, American Indian/Alaska Natives, persons of more than one race, and persons of all other races not specified were too small to produce reliable results. Totals include all races/ethnicities.

HEALTH SERVICES UTILIZATION

WOMEN’S HEALTH USA 2008

HOSPITALIZATIONS
Females represented 59.9 percent of the 34.7
million short-stay hospital discharges in 2005.
More than 19 percent of hospital stays for all
females were due to childbirth, while 14.6 percent
were due to diseases of the circulatory system.
Other common reasons for hospitalization
included diseases of the respiratory, digestive, and
genitourinary systems; injury and poisoning; and
mental disorders. Overall, females had a higher
hospital discharge rate than males in 2005

(1,382.2 versus 959.0 per 10,000 population;
data not shown).
Males and females also had different rates of
procedures for discharges from short-stay
hospitals. Overall procedure rates were 1,794.5
procedures per 10,000 females (this includes
456.5 obstetrical procedures per 10,000 females)
and 1,241.1 procedures per 10,000 males. Several
of the procedures for which females had a higher
hospital discharge rate than males included
operations on the digestive system (210.7 versus

166.5 per 10,000) and operations on the
reproductive organs, including hysterectomy
(130.9 versus 16.1 per 10,000). Males had a
higher rate than females for operations on the
cardiovascular system (280.2 versus 194.8 per
10,000). Among females, the highest rate of
procedures for discharges from short-stay
hospitals was obstetrical procedures (456.5 per
10,000).

Discharges from Non-Federal, Short-Stay Hospitals Among
Females of All Ages,* by Diagnosis, 2005

Discharges from Non-Federal, Short-Stay Hospitals, by Sex
and Procedure Category, All Ages,* 2005

Source III.2: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Hospital Discharge Survey

Circulatory System
Diseases 14.6%

Obstetrical Procedures

456.5

Other
28.3%

Respiratory System
Diseases 9.5%

Digestive System
Diseases 9.0%
Genitourinary
System Diseases
6.5%

Childbirth
19.4%

Injury and Poisoning
6.9%

194.8
280.2
130.9
16.1
144.2
136.0

Operations on the
Musculoskeletal System
Operations on the
Integumentary System (Skin)
Operations on the
Nervous System
Operations on the
Urinary System

Mental Disorders
5.8%
*Excludes newborn infants.

166.5

Operations on the
Cardiovascular System
Operations on the
Reproductive Organs
(Sex-Specific)

53.7
50.4
43.8
39.3
35.5
32.2
50

*Excludes newborn infants.

Female
Male

210.7

Operations on the
Digestive System

100

150

200
250
300
350
Rate per 10,000 Population

400

450

500

WOMEN’S HEALTH USA 2008

HEALTH SERVICES UTILIZATION

HEALTH CARE
EXPENDITURES
In 2005, the majority of health care expenses of
both women and men were covered by public or
private health insurance. Among women, more
than one-third of expenses were covered by either
Medicare or Medicaid, while 40.3 percent of
expenses were covered by private insurance.
Although the percentage of expenditures paid
through private insurance was similar for both
sexes, health care costs of women were more likely

than those of men to be paid by Medicaid or outof-pocket.
In 2005, 91.0 percent of women had at least
one health care expenditure, compared to 77.7
percent of men. Among those who had at least
one health care expense in 2005, the average per
person expenditure, including expenses covered
by insurance and those paid out-of-pocket, was
higher for women ($5,211) than for men
($4,514). However, men’s average expenditures
exceeded women’s for hospital inpatient services

($17,401 versus $12,556, respectively) and
hospital outpatient services ($2,440 versus
$1,909). Women’s expenditures exceeded men’s
in the categories of home health services, officebased medical services, and prescription drugs.
Overall per capita health care expenditures have
increased substantially and at about the same rate
for both men and women since the 1990’s. In
2005, the annual mean health care expenses for
both men and women were approximately 58
percent higher than in 1999.

Health Care Expenses of Adults Aged 18 and Older, by
Source of Payment and Sex, 2005

Mean Health Care Expenses of Adults Aged 18 and Older
with an Expense, by Sex and Category of Service, 2005

Source III.3: Agency for Healthcare Research and Quality, Medical Expenditure
Panel Survey

Female

Male

5,211
4,514

Total Health Care
Services

Female
Male
12,556

Hospital Inpatient
Services
Medicare
22.4%
Private Insurance
40.3%

Private Insurance
41.2%
Medicaid
12.8%

Out-of-Pocket
19.7%

Out-of-Pocket
17.8%

5,427
1,909
2,440

Hospital Outpatient
Services
Medicaid
5.5%

Other
11.2%
Other
4.8%

17,401
8,141*

Home Health
Services

Medicare
24.3%

Prescription
Medications

1,379
1,240

Office-Based
Medical Services

1,310
1,209

Dental
Services
Other Medical
Equipment/Services

609
556
388
376
3,000

6,000

9,000

12,000

15,000

18,000

Dollars per Person
*This statistic should be interpreted with caution; the relative standard error is greater than 30 percent.

HEALTH SERVICES UTILIZATION

MEDICATION USE
In 2005, medication was prescribed or provided
by a physician at nearly 680 million, or 70.5
percent of, physician office visits; multiple drug
prescriptions were recorded at 45.9 percent of all
visits. The percent of visits with one or more
drugs prescribed or provided was similar for males
and females (70.9 and 69.9 percent, respectively).
Among females of all ages, 29.1 percent of visits
did not involve prescribing or providing any
drugs, 24.9 percent of visits involved the prescription or provision of one drug, and 14.0 percent of
visits involved two drugs. An additional 32.1
percent of visits involved the prescription or
provision of 3 or more drugs.12
The prescription and provision of medications
to females varies by race/ethnicity and drug type.
In 2005, the rate of cardiovascular/renal drugs
prescribed or provided at physician office visits
was highest among non-Hispanic Black females
(41.6 per 100 office visits), while non-Hispanic
white females were most likely to receive central
nervous system drugs (anti-depressants, antipsychotics, sedatives, and anxiety medications; 27.9
per 100 visits). Hispanic females were the most
likely to have respiratory tract drugs provided or
prescribed (22.0 per 100 visits). There was little
variation between females of different races and
ethnicities in the use of hormone therapy drugs.

WOMEN’S HEALTH USA 2008

The rate of medications provided and
older were most likely to receive
prescribed to females during physician office visits
cardiovascular/renal drugs (85.9 per 100 visits)
also varies by age. For instance, women aged
and pain relief drugs (34.6 per 100 visits).
45–64 years were the most likely to have central
Respiratory drugs were most likely to be
nervous system drugs prescribed or provided
prescribed or provided to girls under 15 years of
(34.1 per 100 visits), while women aged 75 and
age (25.9 per 100 visits, data not shown).
*
Medications Reported During Physician Office Visits Among Females (All Ages),
by Race/Ethnicity, 2005
Source II.11: Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory
Medical Care Survey
50

Non-Hispanic White
Non-Hispanic Black

Hispanic

41.6

Non-Hispanic Other Races†

40
35
Rate per 100 Visits

34.3
29.8

30
25

27.9
25.0

24.4 24.1

23.8

24.4
22.4

21.4

23.1

19.9

18.0

22.0

20.7

19.8
16.6

15.6
15
11.4
10
5

Cardiovascular/
Renal Drugs

Central Nervous
System Drugs**

Hormone Therapy Drugs

Pain Relief Drugs

Respiratory Tract Drugs

*Medications that were prescribed, provided, or continued. **Includes antidepressants, antipsychotics, sedatives, and anxiety medications.
†Includes Asian/Pacific Islanders, American Indian/Alaska Natives, persons of more than one race, and persons of all other races not specified.

WOMEN’S HEALTH USA 2008

HEALTH SERVICES UTILIZATION

MENTAL HEALTH CARE
UTILIZATION
In 2006, more than 28 million adults in the
United States reported receiving mental health
treatment in the past year. Women represented
two-thirds of users of mental health services,
including inpatient and outpatient care and
prescription medications. More than 16 million
women reported using prescription medication
for treatment of a mental or emotional condition,
representing 14.2 percent of women aged 18 and
older, compared to 7.2 percent of men.
Outpatient treatment was reported by 8.4 percent
of women, and inpatient treatment was reported
by 0.7 percent of women.

Mental health services were needed, but not
received, by an estimated 10 million adults in the
United States. In 2006, 5.9 percent of women
and 3.2 percent of men reported an unmet need
for mental health treatment or counseling. Cost
or lack of adequate insurance coverage was the
most commonly reported reason for not receiving needed services, reported by 50.1 percent of
women and 43.7 percent of men with unmet
mental health treatment needs. Others
mentioned feeling that they could handle their
problems without treatment (reported by 28.5
percent of women and 33.3 percent of men with
unmet needs). In addition, stigma, including
concern about confidentiality or the opinions of

others, or the potential effect on employment,
prevented 20.4 percent of women and 29.6
percent of men with unmet needs from receiving
treatment.
Among women, unmet need for treatment
varied by race and ethnicity. Non-Hispanic
American Indian/Alaska Native women were
most likely to report an unmet need for treatment
(8.2 percent), followed by non-Hispanic White
women (6.4 percent). Additionally, 4.7 percent of
non-Hispanic Black women, and 4.1 percent of
Hispanic women had an unmet need for
treatment. Asian/Pacific Islander women were
least likely to report an unmet need for mental
health treatment (3.6 percent; data not shown).

Adults Aged 18 and Older Receiving Mental Health
Treatment/Counseling,* by Sex and Type, 2006

Reasons for Unmet Mental Health Treatment* Needs
Among Adults Aged 18 and Older, by Sex, 2006

Source II.4: Substance Abuse and Mental Health Services Administration, National
Survey on Drug Use and Health

Source II.3: Substance Abuse and Mental Health Services Administration, National
Survey on Drug Use and Health

Percent of Adults

16.6

43.7
28.5

Did Not Feel Need for Treatment/Could
Handle Problem Without Treatment

Male

14.2

50.1

Cost/Inadequate
or No Insurance

Female

33.3
20.4

Stigma
10

8.9

Did Not Know Where
to Go for Services

8.4
7.2

Did Not Have Time

4.8

Fear of Being Committed
0.7
Any Type of
Treatment/Counseling

Prescription
Medication

Outpatient

0.8

Inpatient

*Excludes treatment for alcohol or drug use. Respondents could report more than one type of treatment.

Female
Male

29.6
16.6
11.9
14.8
14.2
8.1
9.3
10
20
30
40
50
Percent of Adults Reporting an Unmet Treatment Need

*Excludes treatment for alcohol or drug use. Respondents could report more than one reason.

HEALTH SERVICES UTILIZATION

WOMEN’S HEALTH USA 2008

HIV TESTING
Today, people aware of and receiving appropriate care for their human immunodeficiency virus
(HIV) status may be able to live longer and
healthier lives because of newly available, effective
treatments. Testing for HIV, the virus that causes
AIDS, is essential so that infected individuals can
seek care and prevent the spread of HIV. HIV
testing requires only a simple blood or saliva test,
and it is often offered confidentially or
anonymously. It is recommended that people
who meet any of the following criteria be tested
periodically for HIV: those who have injected
drugs or steroids, or shared drug use equipment

(such as needles); have had unprotected sex with
men who have sex with men, anonymous
partners, or multiple partners; have exchanged sex
for drugs or money; have been diagnosed with
hepatitis, tuberculosis, or a sexually transmitted
infection; received a blood transfusion between
1978 and 1985; or have had unprotected sex with
anyone who meets any of these criteria.13 In
addition, the CDC recommends that all pregnant
women be tested for HIV during their pregnancy.
In 2006, new CDC guidelines were released that
recommend all health care providers include HIV
testing as part of their patients’ routine health
care. Counseling patients on ways to prevent HIV

infection or spreading the virus is part of good
primary care practice.
In 2006, nearly 36 percent of adults in the
United States had ever been tested for HIV.
Overall, women were more likely than men to
have been tested (37.8 versus 33.7 percent).
Women were more likely to have been tested at
younger ages, while men were more likely to have
been tested at older ages.
Among women, in 2006, non-Hispanic Blacks
were most likely to have ever been tested (53.7
percent), followed by Hispanics (46.1 percent),
while non-Hispanic White women were least
likely (33.5 percent).

Adults Aged 18 and Older Who Have Ever Been Tested
for HIV, by Sex and Age, 2006

Women Aged 18 and Older Who Have Ever Been Tested
for HIV, by Race/Ethnicity, 2006*

Source II.1: Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey

60
Percent of Adults

Female

63.5
Male

50
43.3

41.5
40

53.8
Percent of Women

44.9

37.8
33.7

33.3
28.6

25.4

53.7

46.1

36.7

33.5

38.5

30
20

13.8
9.6

10
Total

18-24 Years

25-34 Years

35-44 Years

45-64 Years

65 Years
and Older

10
Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian

Non-Hispanic
Other Races**

*Rates reported are not age-adjusted. **Includes American Indian/Alaska Natives, persons of more than
one race, and persons of all other races not specified.

WOMEN’S HEALTH USA 2008

HEALTH SERVICES UTILIZATION

ORGAN TRANSPLANTATION
Between January 1 and November 30, 2007,
26,021 organ transplants occurred in the United
States. In 2007, the sex distribution of organ
donors was nearly even (6,939 males and 6,284
females), though 57.8 percent of organs donated
by living people were from women, and 60.5
percent of organs from deceased donors were
from men. Since 1988, there have been 419,520
transplants.
The need for donated organs greatly exceeds
their availability, so waiting lists for organs are
growing. As of February 1, 2008, there were
97,686 people awaiting a life-saving organ
transplant. Females accounted for 41.9 percent of
those patients but made up only 36.8 percent of

those who received a transplant in 2007.14
Among women waiting for an organ transplant,
45.2 percent were White, 30.4 percent were
Black, and 16.2 percent were Hispanic. The
kidney was in highest demand, with 31,323
females awaiting this organ as of February 1,
2008.
The number of organs donated has increased
significantly since 1988, from 5,909 to 14,756 at
year’s end 2006. In 2003, the donation
community began to work together through the
Organ Donation Breakthrough Collaborative
and other grassroots efforts to increase donation.
From 2003 to 2006, organ donation among
deceased donors increased by an unprecedented
24.3 percent. One of the challenges of organ

Females on Organ Waiting List,* by Race/Ethnicity, 2008
Source III.4: Organ Procurement and Transplantation Network

donation is obtaining consent from the donor’s
family or legal surrogate. Consent rates may vary
due to religious beliefs, poor communication
between health care providers and grieving
families, perceived inequities in the allocation
system, and lack of knowledge of the wishes of
the deceased.15
The Organ Procurement and Transplantation
Network and the Scientific Registry of Transplant
Recipients are managed by HRSA’s Healthcare
Systems Bureau (HSB). Other HSB programs
include: the National Marrow Donor Program,
the National Vaccine Injury Compensation
Program, and the C.W. Bill Young Cell
Transplantation Program.

Female Transplant Recipients,* 2007, and Females on Organ
Waiting Lists,** 2008, by Organ
Source III.4: Organ Procurement and Transplantation Network
45,000

Black 30.4%

Asian/Pacific
Islander 6.8%
Hispanic 16.2%

Number of Females

White 45.2%

Other** 1.7%

40,913

40,000
35,000

31,323

30,000

Waiting List

25,000

Transplants

20,000
15,000
10,000

9,580
5,896

5,000

1,995
All Organs

*As of February 1, 2008. **Includes American Indian/Alaska Natives, persons of more than one race,
and persons of unspecified race.

6,664

Kidney

Liver

1,328 558
Lung

800 196
Pancreas

684 535

*Transplants occurring between January 1, 2007 and November 30, 2007, as of January 25, 2008.
**As of February 1, 2008.

Heart

HEALTH SERVICES UTILIZATION

WOMEN’S HEALTH USA 2008

QUALITY OF WOMEN’S
HEALTH CARE
Indicators of the quality of health care can
provide important information about the
effectiveness, safety, timeliness, and patientcenteredness of women’s health services.
Indicators used to monitor women’s health care
in managed care plans include screening for
chlamydia, screening for cervical cancer, and
receipt of mammograms.
In 2006, chlamydia screenings increased for
women aged 21–25 years enrolled in commercial
(private) health care plans or Medicaid. As in

tively). However, Medicare-enrolled women were
considerably less likely to have received a
mammogram at least once during the previous 2
years (49.1 percent).
Cervical cancer screenings appear to be more
accessible to women with commercial coverage
than to those covered by Medicaid. Cervical
cancer screenings were received at least once every
3 years by nearly 81.0 percent of commerciallyinsured women and 65.7 percent of women
covered by Medicaid.

previous years, females with Medicaid coverage
were more likely to have received a chlamydia
screening in the previous year than those with
private coverage (55.0 versus 38.0 percent, respectively). Since 2000, the percentage of sexually
active females screened for chlamydia has
increased by nearly 84 percent among those in
commercial plans and 45 percent among
Medicaid enrollees.
In 2006, receipt of mammograms for women
aged 40–69 was approximately the same for
women with private coverage and those covered
through Medicaid (68.9 and 69.5 percent, respec-

HEDIS®* Chlamydia** Screening Among Women Aged
21–25 Years, by Payer, 2000–2006

HEDIS®* Breast** and Cervical Cancer Screening,† by Payer,
2006

Source III.5: National Committee for Quality Assurance

Source III.5: National Committee for Quality Assurance
100

70
60

38.0

Percent of Women

Medicaid
Medicare

55.0

Commercial

Medicaid

68.9

69.5

81.0
65.7

60
49.1

50
40
30

Commercial

20
10

10
2000

2002

2004

2006

*Health Plan Employer Data and Information Set is a registered trademark of NCQA. **The percentage of
sexually active females who had at least one test for chlamydia in the past year.

Breast Cancer

Cervical Cancer

*Health Plan Employer Data and Information Set is a registered trademark of NCQA. **The percentage
of women aged 40–69 years who had at least one mammogram in the past 2 years. †The percentage of
women aged 21–64 years who had at least one Pap test in the past 3 years; Medicare data was not
available. Note: Data cannot be compared to previous years due to changes in the age range presented.

WOMEN’S HEALTH USA 2008

HEALTH SERVICES UTILIZATION

SATISFACTION WITH
HEALTH CARE
Patients’ utilization of health care is influenced
by the quality of care; those who are not satisfied
with their providers may be less likely to continue
with treatment or seek further services.16 Some
aspects of patients’ experience of care that may
contribute to better outcomes are patients’
perceptions of how well their doctors or other
health care providers communicate with them
and individuals’ experiences with their health
plans.
In 2006, 40.7 percent of women were not
satisfied with their experiences related to their
health plans, which could include health plan
customer service, understanding or finding

information related to their plan, and completing
or submitting paperwork for the plan. This varied
by race and ethnicity. Asian women were most
likely to be dissatisfied (46.5 percent), followed
by non-Hispanic White women (42.9 percent).
Fewer than 35 percent of non-Hispanic Black
women and 36.3 percent of Hispanic women
were unsatisfied with their experiences related to
their health plans.
Satisfaction with how well doctors communicate also varies by women’s race and ethnicity. In
2006, Hispanic women (25.9 percent) and Asian
women (24.0 percent) were more likely to be
dissatisfied with how well their doctors
communicate than women of other races. Fewer
than 20 percent of non-Hispanic Black women

and 15.7 percent of non-Hispanic White women
were not satisfied with aspects of communication
with their doctors.
More than 36 percent of women were not
satisfied with their experiences in getting the care
they need when they needed it, including seeing
specialists; getting necessary care, tests or
treatment; and delays in receiving care caused by
waiting for health plan approval. The percentage
of women reporting dissatisfaction was greatest
among Asian women (47.1 percent). Nearly 40
percent of Hispanic women and 34 percent each
of non-Hispanic Black and non-Hispanic White
women were also not satisfied with getting the
care they needed (data not shown).

Women’s Satisfaction with Experiences Related to
Health Plans,* by Race/Ethnicity, 2006

Women’s Satisfaction with How Well Doctors
Communicate,* by Race/Ethnicity, 2006

Source III.6: U.S. Agency for Healthcare Research and Quality, National CAHPS®
Benchmarking Database

Unsatisfied

40.7

Satisfied

59.3

Total
Non-Hispanic White
Non-Hispanic Black
Hispanic
Asian
Non-Hispanic
Other Races**

42.9

57.1

34.5

65.5

36.3

63.7

46.5

53.5

40.3

59.7
10

40
50
60
Percent of Women

*Based on questions related to respondents’ experiences with their health plans in the past 6 (Medicaid
respondents) or 12 months (commercial health plan respondents). **Includes American Indian/Alaska
Natives, all other races not specified, and multiple races.

100

Unsatisfied

19.4

Satisfied

80.6

Total
Non-Hispanic White
Non-Hispanic Black
Hispanic
Asian
Non-Hispanic
Other Races**

15.7

84.3

19.6

80.4

25.9

74.1

24.0

76.0

25.6

74.4
10

100

Percent of Women
*Based on questions related to care received from doctors or other health providers in the past 6 (Medicaid
respondents) or 12 months (commercial health plan respondents). **Includes American Indian/Alaska
Natives, all other races not specified, and multiple races.

HEALTH SERVICES UTILIZATION

HRSA PROGRAMS RELATED
TO WOMEN’S HEALTH
The U.S. Department of Health and Human
Services, Health Resources and Services Administration (HRSA) supports several programs that
promote access to health care for vulnerable
populations. HRSA’s Office of Women’s Health
(OWH) coordinates efforts that address women’s
health across their lifespan. The Bright Futures for
Women’s Health and Wellness Initiative provides
materials on topics such as physical activity and
healthy eating, emotional wellness, and maternal
wellness. These tools, data books, and research
reports can be found on the OWH Web site at
www.hrsa.gov/womenshealth.
The HRSA Web site, at www.hrsa.gov, provides
information about HRSA’s bureaus and offices.
HRSA’s Maternal and Child Health Bureau
(MCHB), online at www.mchb.hrsa.gov,
administers the MCH Block Grant, a FederalState partnership to improve the health of
mothers and children. Depression During and
After Pregnancy: A Resource for Women, Their
Partners, Family and Friends (2007) and The
Business Case for Breastfeeding: Steps for
Creating a Breastfeeding-Friendly Worksite are
two new HRSA publications available for
consumers.
The Bureau of Health Professions (BHP)
provides national leadership in the development,

WOMEN’S HEALTH USA 2008

distribution, and retention of a culturally
competent health workforce. In 2006, women
represented 62 percent of those who received
assistance from the Centers of Excellence and 71
percent of those involved with the Health Careers
Opportunity Programs.
The HIV/AIDS Bureau (HAB) addresses the
needs of women living with HIV/AIDS through
the Ryan White Program including Part D, which
targets services to women, infants, children,
youth, and their families. HAB aims to improve
access and retention in care through training and
technical assistance programs, culturally
competent border health initiatives, oral health
care programs, and Special Projects of National
Significance.
The new Bureau of Clinician Recruitment and
Services’ (BCRS) mission is to improve the health
of the Nation’s underserved communities by
coordinating recruitment and retention of health
professionals to build integrated and sustainable
systems of care. Clinicians participating in the
National Health Service Corps program provide
staffing support to Federally Qualified Health
Centers.
The Bureau of Primary Health Care (BPHC)
manages the Health Center Program, which
funds a national network of 1,002 grantees at over
3,800 comprehensive, primary health care service
delivery sites. Through community health

centers, school-based centers, and other centers
focused on migrant health, health care for the
homeless, and public housing, the Program
delivers preventive and primary care services to
patients regardless of their ability to pay. Almost
40 percent of patients have no insurance
coverage. Overall, the number of patients served
has risen from 10.3 million in 2001 to an
estimated 15 million in 2006. In 2006, 59
percent of patients served were women.
Health Centers Supported by the
Bureau of Primary Health Care, 2005
Source III.7: Uniform Data System, Bureau of Primary
Health Care, HRSA, HHS

Type

Number

Community Health Center

851

Migrant Health Center

135

Homeless Health Center

176

School-based Health Center

TOTAL

1,240

WOMEN’S HEALTH USA 2008

INDICATORS IN
PREVIOUS EDITIONS
Each edition of Women’s Health USA contains
the most current available data on health issues
important to women. If no updated data are
available, indicators may be replaced to make
room for information on new indicators.
For more information on the indicators listed
here, please reference previous editions of Women’s
Health USA which can be accessed online at
either of these Web sites:
www.hrsa.gov/womenshealth
www.mchb.hrsa.gov/data
Women’s Health USA 2007

Autoimmune Diseases
HIV in Pregnancy
Obstetrical Procedures and Complications
of Labor and Delivery
Sleep Disorders
Violence and Abuse
Weight Gain During Pregnancy
Women’s Health USA 2006

American Indian/Alaska Native Women
Contraception
Infertility Services
Postpartum Depression
Women and Crime

Women’s Health USA 2005

Women’s Health USA 2003

Adolescent Pregnancy
Border Health
Immigrant Health
Maternity Leave
Prenatal Care

Bleeding Disorders
Home Health and Hospice Care
Title V Abstinence Education Programs
Title X Family Planning Services
Vitamin and Mineral Supplement Uses

Women’s Health USA 2004

Women’s Health USA 2002

Complementary and Alternative Medicine Use
Eating Disorders
Services for Homeless Women
Women in NIH-Funded Clinical Research

Lupus
Non-Medical Use of Prescription Drugs
Nursing Home Care Utilization
Unintended Pregnancies

WOMEN’S HEALTH USA 2008

ENDNOTES
Population Characteristics
1. Centers for Disease Control and Prevention, Office of Minority
Health. Disease burden and risk factors. June 5, 2007.
http://www.cdc.gov/omhd/AMH/dbrf.htm, accessed 11/28/07.
2. The Census Bureau uses a set of money income thresholds that vary
by family size and composition to determine who is poor. If a
family’s total income is less than that family’s threshold, then that
family and every individual in it is considered to be poor. Examples
of 2006 poverty levels were $10,488 for an individual, and $20,444
for a family of four. These levels differ from the Federal Poverty
Level used to determine eligibility for Federal programs.
3. U.S. Department of Agriculture, Economic Research Service. Food
Security in the United States: Measuring Household Food Security,
[online] Nov 2007. http://www.ers.usda.gov/Briefing/FoodSecurity/
measurement.htm, accessed 07/31/08.
4. U.S. Census Bureau, Current Population Survey, Annual Social and
Economic Supplement, 2007.

Health Status
1. U.S. Department of Health and Human Services; U.S. Department
of Agriculture. Dietary Guidelines for Americans 2005.
Washington, DC: U.S. Government Printing Office, January 2005.
2. U.S. Department of Health and Human Services. Healthy People
2010. 2nd ed. With Understanding and Improving Health and
Objectives for Improving Health. 2 vols. Washington, DC: U.S.
Government Printing Office, November 2000.
3. Mayo clinic. Food and Nutrition, Alcohol and your health:
Weighing the pros and cons [online]. May 2006.
www.mayoclinic.com/health/Alcohol/SC00024, accessed 03/31/08.
4. U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. 2004.
5. Centers for Disease Control and Prevention, National Center for
Health Statistics, National Health Interview Survey, 2006. Analysis
conducted by the Maternal and Child Health Information Resource
Center.
6. Ranney L, Melvin C, Lux L, McClain E, Morgan L, Lohr K.
Tobacco Use: Prevention, Cessation, and Control. Evidence
Report/Technology Assessment No. 140. (Prepared by the RTI
International) University of North Carolina Evidence-Based
Practice Center under Contract No. 290-02-0016). AHRQ
Publication No. 06-E015. Rockville, MD: Agency for Healthcare
Research and Quality. June 2006.
7. National Institutes of Health, National Institute on Drug Abuse.
Drugs of Abuse Information: Drugs of Abuse/Related Topics

10.

11.
12.

13.

14.

15.

16.

17.

18.

19.

[online] Jan 2008. http://www.drugabuse.gov/drugpages.html,
accessed 03/31/08.
Johnston, LD, O’Malley, PM, Bachman, JG, & Schulenberg, JE.
Monitoring the Future national survey results on drug use: 19752006: Volume II, College students and adults ages 19-45 (NIH
Publication No. 07-6206] Bethesda, MD: National Institute on
Drug Abuse. 2007.
U.S. Department of Health and Human Services, Indian Health
Service. IHS Fact Sheets: Indian Population. January 2007 [online].
http://info.ihs.gov/, accessed 01/24/08.
U.S. Census Bureau, Population Division, National Projections
Program. Projected Life Expectancy at birth by Race and Hispanic
Origin, 1999 to 2100. January 13, 2000 [online].
http://www.census.gov/, accessed 01/24/08
Arthritis Foundation. Learn about arthritis. 2007.
http://www.arthritis.org, accessed 12/18/07.
Stern L, Berman J, Lumry W, Katz L, Wang L, Rosenblatt L, Doyle
JJ. Medication compliance and disease exacerbation in patients with
asthma: a retrospective study of managed care data. Annals of
Allergy, Asthma and Immunology. 2006; 97(3):402-408.
U.S. Centers for Disease Control and Prevention. Chronic Fatigue
Syndrome: Basic Facts. May 9, 2006. http://www.cdc.gov/cfs/
cfsbasicfacts.htm, accessed 2/5/08.
Reeves WC, Jones JF, Maloney E, Heim C, Hoaglin DC, Boneva
RS, Morrissey M, Devlin R. Prevalence of chronic fatigue syndrome
in metropolitan, urban, and rural Georgia. Population Health
Metrics. 2007; 5:5.
Reyes M, Nisenbaum R, Hoaglin DC, Unger ER, Emmons C,
Randall B, Stewart JA, Abbey S, Jones JF, Gantz N, Minden S,
Reeves WC. Prevalence and incidence of chronic fatigue syndrome
in Wichita, Kansas. Archives of Internal Medicine. 2003;
163:1530-1536.
Centers for Disease Control and Prevention. Sexually Transmitted
Diseases: HPV and HPV Vaccine - Information for Healthcare
Providers. Aug 2006. http://www.cdc.gov/std/hpv/default.htm,
accessed 01/16/08.
Centers for Disease Control and Prevention, National Center for
Chronic Disease Prevention and Health Promotion. Overweight
and obesity. November 2007 [online]. www.cdc.gov/nccdphp/
dnpa/obesity, accessed 01/24/08.
American Heart Association. Heart Attack, Stroke, and Cardiac
Arrest Warning Signs. 2007. www.americanheart.org/
presenter.jhtml?identifier=3053, accessed 02/15/08.
Brown A. (2007) Research to Policy and Practice Forum:
Periodontal Health and Birth Outcomes: Summary of a Meeting of
Maternal, Child, and Oral Health Experts. Washington, DC:

National Maternal and Child Oral Health Resource Center.
20. American Dental Association. Diet and oral health: overview
[online] http://www.ada.org/public/topics/diet.asp,
accessed 04/14/08.
21. American Dental Association. Preventing periodontal disease.
Journal of the American Dental Association 2001; 132: 1339.
22. National Institute of Health. NIH Senior Health [online]. April
2008. http://nihseniorhealth.gov/listoftopics.html, accessed
05/06/08.
23. U.S. Department of Health and Human Services. Bone Health and
Osteoporosis: A Report of the Surgeon General. Rockville, MD:
Office of the Surgeon General; 2004.
24. National Digestive Diseases Information Clearinghouse (NNDDIC). Digestive Diseases Statistics [online]. December 2005.
http://digestive.niddk.nih.gov/statistics/statistics.htm, accessed
02/06/08.
25. Centers for Disease Control and Prevention, National Center for
Health Statistics. NCHS – FastStats: Digestive Disorders [online]
November 20, 2007. http://www.cdc.gov/nchs/fastats/digestiv.htm,
accessed 02/06/08.
26. U.S. Department of Health and Human Services, Office on
Women’s Health, National Women’s Health Information Center.
Polycystic Ovary Syndrome (PCOS). [online] April 2007.
http://www.4women.gov/faq/pcos.htm#b, accessed 02/22/08.
27. Centers for Disease Control and Prevention. HIV/AIDS Basic
Information [online] April 2007.
http://www.cdc.gov/hiv/topics/basic/index.htm, accessed 04/22/08.
28. Includes persons with a diagnosis of HIV infection (not AIDS), a
diagnosis of HIV infection and a later diagnosis of AIDS, or concurrent diagnoses of HIV infection and AIDS, in 33 States. Data
do not reflect improved estimates of HIV incidence released in
August 2008; www.cdc.gov/hiv/topics/surveillance/incidence.htm.
29. Centers for Disease Control and Prevention. HIV/AIDS in the
United States: A Picture of Today’s Epidemic. [online] March 2008.
http://www.cdc.gov/hiv/resources/factsheets/us.htm, accessed
04/22/08.
30. Fox, Maggie. “Too few US adults get their shots, survey shows.”
Reuters. January 23, 2008 [online]. http://www.reuters.com/
article/idUSN23640678, accessed 03/26/08.
31. U.S. Centers for Disease Control and Prevention. AttentionDeficit/Hyperactivity Disorder [online]. September 20, 2005.
http://www.cdc.gov/ncbddd/adhd/what.htm, accessed 02/25/08.
32. U.S. Department of Health and Human Services, Office on
Women’s Health. Attention Deficit Hyperactivity Disorder [online].
May 2007. http://www.4woman.gov/mh/conditions/
adhd.cfm?style=large, accessed 02/25/08.

WOMEN’S HEALTH USA 2008

33. Kessler RC, Adler L, Ames M, Barkley RA, Birnbaum H,
Greenberg P, Johnston JA, Spencer T, Ustun TB. The Prevalence
and Effects of Adult Attention Deficit/ Hyperactivity Disorder on
Work Performance in a Nationally Representative Sample of
Workers. Journal of Occupational & Environmental Medicine.
2005; 47(6): 565-572.
34. Mental Health America. Factsheet: AD/HD and Adults [online].
Jan 9, 2007. http://mentalhealthamerica.net/go/information/
get-info/ad/hd/ad/hd-and-adults, accessed 02/25/08.
35. Kessler RC, Berglund PA, Demler O, Jin R, Merikangas KR,
Walters EE. Lifetime prevalence and age-of-onset distributions of
DSM-IV disorders in the National Comorbidity Survey
Replication. Arch Gen Psychiatry 2003 Jun;62(6):593-602.
36. Centers for Disease Control and Prevention, National Center for
Injury Prevention and Control. Web-Based Injury Statistics Query
and Reporting System (WISQARS™). Injury Mortality Report
[online]. (2005). Available from URL: www.cdc.gov/ncipc/wisqars,
accessed 02/05/08.
37. Bair-Merritt MH, Feudtner C, Localio AR, Feinstein JA, Rubin D,
Holmes WC. Health Care Use of Children Whose Female Caregivers Have Intimate Partner Violence Histories. Archives of Pediatrics
& Adolescent Medicine. [online] 2008; 162(2): 134-139. http://archpedi.highwire.org/cgi/content/full/162/2/134, accessed 02/26/08.
38. Rivara FP, Anderson ML, Fushman P, Bonomi AE, Reid RJ, Carrell
D, Thompson RS. Intimate Partner Violence and Health Care
Costs and Utilization for Children Living in the Home. Pediatrics.
2007; 120(6): 1270-1277.
39. Litwin MS, Saigal CS, editors. Urologic Diseases in America. U.S.
Department of Health and Human Services, Public Health Service,
National Institutes of Health, National Institute of Diabetes and
Digestive and Kidney Diseases. Washington, DC: U.S. Government
Printing Office, 2007; NIH Publication No. 07-5512.
40. Harlow et al. A Population-Based Assessment of Chronic
Unexplained Vulvar Pain: Have we underestimated the prevalence
of vulvodynia? JAMWA. 2003; 58: 82-88.
41. U.S. Department of Health and Human Services, Office on
Women’s Health, National Women’s Health Information Resource
Center. Health Topics: Pregnancy and Reproductive Health.
www.womenshealth.gov/faq, accessed 04/01/08.
42. A low-risk woman is defined as one with a full-term (at least 37
completed weeks of gestation), singleton (not a multiple pregnancy), and vertex fetus (head facing in a downward position in the
birth canal).
43. In the 37 reporting areas (including New York City and
Washington, DC) using the 1989 Standard Certificate of Live Birth
(unrevised).

ENDNOTES

44. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D,
Trikalinos T, Lau J. Breastfeeding and Maternal and Infant Health
Outcomes in Developed Countries. Evidence Report/Technology
Assessment No. 153 (Prepared by Tufts-New England Medical
Center Evidence-based Practice Center, under Contract No. 29002-0022). AHRQ Publication No. 07-E0007. Rockville, MD:
Agency for Healthcare Research and Quality. April 2007.
45. Ryan AS, Zhou W, Arensberg MB. The Effect of Employment
Status on Breastfeeding in the United States. Women’s Health
Issues. 2006; 16: 243-251.
46. U.S. Department of Labor, Bureau of Labor Statistics. Employment
characteristics of families in 2006 (USDL 07-0673). Washington,
DC: The Department; May 2007. [Table 6] http://www.bls.gov/
news.release/pdf/famee.pdf, accessed 12/11/07.
47. U.S. Department of Health and Human Services. The health
consequences of smoking: a report of the Surgeon General. 2004.
48. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F,
Kirmeyer S, Munson ML. Births: Final data for 2005. National
vital statistics reports; vol 56 no 6. Hyattsville, MD: National
Center for Health Statistics. 2007; Data for three states were not
comparable to either the unrevised or revised birth certificate data.
49. Centers for Disease Control and Prevention. Preconception and
Interconception Health Status of Women Who Recently Gave Birth
to a Live-Born Infant – Pregnancy Risk Assessment Monitoring
System (PRAMS), United States, 26 Reporting Areas, 2004.
Surveillance Summaries, Dec 14, 2007. MMWR 2007; 56
(No SS-10).
50. American Diabetes Association. Gestational Diabetes.
http://www.diabetes.org/gestational-diabetes.jsp, accessed 04/01/08.
51. U.S. Agency for Healthcare Research and Quality. Evidence
Report/Technology Assessment Number 14: Management of chronic hypertension during pregnancy. Publication #00E011; Aug 2000.
52. National Center for Health Statistics. Health, United States, 2007
with Chartbook on Trends in the Health of Americans. Hyattsville,
MD: 2007. http://www.cdc.gov/nchs/hus.htm, accessed 04/01/08.

Health Services Utilization
1. DeVoe JE, Fryer GE, Phillips R, Green LA. Receipt of Preventive
Care Among Adults: Insurance Status and Usual Source of Care.
AJPH. 2003;93(5):786-791.
2. Fryer GE, Dovey SM, Green LA. The importance of having a usual
source of health care. Am Fam Physician. 2000;62:477.
3. Weiss LJ, Blustein J. Faithful patients: the effect of long-term physician-patient relationships on the cost and use of health care by
older Americans. AJPH 1996;86(12):1742-7.

4. This statistic does not include adults aged 65 and older because that
is the age when people become eligible for Medicare coverage based
on age.
5. Cherry DK, Woodwell DA, Rechtsteiner EA. National Ambulatory
Medical Care Survey: 2005 Summary. Advance data from vital and
health statistics; no 387. Hyattsville, MD: National Center for
Health Statistics. 2007. www.cdc.gov, accessed 01/16/08.
6. Centers for Disease Control and Prevention. Cervical Cancer:
Screening Recommendations. [online]
http://www.cdc.gov/cancer/cervical/basic_info/screening/
recommendations.htm, accessed 01/16/08.
7. Centers for Disease Control and Prevention. Trends in Cholesterol
Screening and Awareness of High Blood Cholesterol — United
States, 1991—2003. MMWR, Sept 9, 2005: 54(35); 865-870.
http://www.cdc.gov/MMWR/, accessed 01/16/08.
8. Centers for Disease Control and Prevention. Prevention and
Control of Influenza: Recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR, July 28,
2006: 55(RR10); 1-42. http://www.cdc.gov/MMWR/, accessed
01/16/08.
9. Centers for Disease Control and Prevention. A Comprehensive
Immunization Strategy to Eliminate Transmission of Hepatitis B
Virus Infection in the United States. MMWR, Dec 8, 2006:
55(RR16); 1-25. http://www.cdc.gov/MMWR/, accessed 01/16/08.
10. Centers for Disease Control and Prevention. Sexually Transmitted
Diseases: HPV and HPV Vaccine – Information for Healthcare
Providers. Aug 2006. http://www.cdc.gov/std/hpv/default.htm,
accessed 01/16/08.
11. Fox, Maggie. “Too few US adults get their shots, survey shows.”
Reuters. January 23, 2008 [online] http://www.reuters.com/
article/idUSN23640678, accessed 01/24/08.
12. Cherry DK, Woodwell DA, Rechtsteiner EA. National Ambulatory
Medical Care Survey: 2005 Summary. Advance data from vital and
health statistics; no 387. Hyattsville, MD: National Center for
Health Statistics. 2007. http://www.cdc.gov/nchs/about/major/
ahcd/adata.htm, accessed 01/14/08.
13. Centers for Disease Control and Prevention, National HIV Testing
Resources. Frequently asked questions about HIV and HIV testing.
http://www.hivtest.org, accessed 01/02/08.
14. 2007 data are from January 1–November 30, 2007.
15. 2003 OPTN/SRTR Annual Report: Transplant Data 1992-2002.
HHS/HRSA/SPB/DOT; UNOS; URREA.
16. Fan VS, Burman M, McDonnell MB, Fihn SD. Continuity of Care
and Other Determinants of Patient Satisfaction with Primary Care.
Journal of General Internal Medicine. 2005; 20:226-233.

WOMEN’S HEALTH USA 2008

DATA SOURCES
Population Characteristics

I.1
I.2

I.3

I.4

I.5

I.6

I.7

I.8

U.S. Census Bureau, American FactFinder. 2006 American Community Survey.
http://factfinder.census.gov, accessed 11/28/07.
U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement.
America’s Families and Living Arrangements, 2006. March 2007. http://www.census.gov,
accessed 12/4/07.
U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement,
2007. Current Population Survey Table Creator. Available online at
http://www.census.gov/hhes/www/cpstc/cps_table_creator.html, accessed 12/3/07.
Centers for Disease Control and Prevention, National Center for Health Statistics, National
Health and Nutrition Examination Survey, 2005-2006. Analysis conducted by the Maternal
and Child Health Information Resource Center.
Nord M, Andrews M, Carlson S. Household Food Security in the United States, 2006.
ERR-49, U.S. Department of Agriculture, Econ. Res. Serv. November 2007.
www.ers.usda.gov/publications/err49/, accessed 03/17/08.
U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition
and Evaluation, Characteristics of Food Stamp Households: Fiscal Year 2006, FSP-07CHAR, by Kari Wolkowitz. Project Officer, Jerry Genser. Alexandria, VA: 2007.
U.S. Department of Agriculture, Women, Infants, and Children Program Data. Monthly
Data – National Level, FY 2004- September 2007.
http://www.fns.usda.gov/pd/wicmain.htm, accessed 12/17/07.
American Association of Colleges of Osteopathic Medicine, Annual Osteopathic Medical
School Questionnaires, 2004-2005 through 2006-07 academic years. (Table 9A). 2007;
American Association of Colleges of Pharmacy, Fall 2006 Profile of Pharmacy Students,
(Table 40). 2007. http://www.aacp.org; American Dental Association, Survey Center, 20052006 Survey of Dental Education; Association of American Medical Colleges, Data
Warehouse. Facts—Applicants, Matriculants, and Graduates (Table 27), 2007.
www.aamc.org; Association of Schools & Colleges of Optometry, Annual Student Data
Report, Academic Year 2006-2007 (Table 2.2). 2007; Association of Schools of Public
Health, 2006 Annual Data Report, (Table 3-1). http://www.asph.org; Commission on
Accreditation for Dietetics Education, 2007 Annual Report; Council on Social Work
Education. Research Brief: 2006 Annual Survey of Social Work Programs. Alexandria, VA:
Council on Social Work Education, 2007; Fang, D, Wilsey-Wisniewski, SJ, Bednash, GD.
2006-2007 Enrollment and Graduations in Baccalaureate and Graduate Programs in
Nursing. Washington DC: American Association of Colleges of Nursing, (Table 8), 2007.
Web sites accessed 02/27/08.

I.9

U.S. Department of Education, National Center for Education Statistics. Digest of
Education Statistics Tables and Figures, 2006. [Tables 232,251]. http://nces.ed.gov, accessed
12/4/07.
I.10 U.S. Department of Defense, Defense Manpower Data Center, Statistical Information
Analysis Center. Military Personnel Statistics, Active Duty Military Personnel by
Rank/Grade. September 2006 and September 2006 (Women Only) reports.
http://siadapp.dmdc.osd.mil/personnel/MILITARY/Miltop.htm, accessed 12/4/07.
Health Status

II.1 Centers for Disease Control and Prevention, National Center for Health Statistics, National
Health Interview Survey, 2006. Analysis conducted by the Maternal and Child Health
Information Resource Center.
II.2 Centers for Disease Control and Prevention, National Center for Health Statistics, National
Health and Nutrition Examination Survey, 2003-2004. Analysis conducted by the Maternal
and Child Health Information Resource Center.
II.3 U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services
Administration, Office of Applied Studies. NATIONAL SURVEY ON DRUG USE AND
HEALTH, 2006 [Computer file]. ICPSR21240-v2. Research Triangle Park, NC: Research
Triangle Institute [producer], 2007. Ann Arbor, MI: Inter-university Consortium for
Political and Social Research [distributor], 2007-12-03.
II.4 Substance Abuse and Mental Health Services Administration. (2007). Results from the 2006
National Survey on Drug Use and Health: National Findings (Office of Applied Studies,
NSDUH Series H-32, DHHS Publication No. SMA 07-4293). Rockville, MD.
http://www.oas.samhsa.gov/nsduhlatest.htm, accessed 01/08/08.
II.5 Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final data for 2005. National vital statistics reports; vol 56 no 10. Hyattsville, MD: National Center for Health Statistics. 2008.
II.6 Centers for Disease Control and Prevention, National Center for Injury Prevention and
Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Analysis of
National Vial Statistics System 2005 data. [online]. www.cdc.gov/ncipc/wisqars, accessed
01/28/08.
II.7 American Cancer Society. Cancer Facts & Figures 2008. Atlanta: American Cancer Society;
2008.
II.8 Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov)
SEER*Stat Database: Incidence - SEER 17 Regs Limited-Use, Nov 2006 Sub (1973-2004
varying), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer
Statistics Branch, released April 2007, based on the November 2006 submission.
II.9 Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance
System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services,

WOMEN’S HEALTH USA 2008

Centers for Disease Control and Prevention, 1996 & 2006. Analysis conducted by the
Maternal and Child Health Information Resource Center.
II.10 Centers for Disease Control and Prevention, National Center for Health Statistics, National
Hospital Discharge Survey, 2005. Unpublished data.
II.11 Centers for Disease Control and Prevention, National Center for Health Statistics, National
Ambulatory Medical Care Survey: 2005 . Analysis conducted by the Maternal and Child
Health Information Resource Center.
II.12 Centers for Disease Control and Prevention, National Center for Health Statistics, National
Health Interview Survey, 2005. Analysis conducted by the Maternal and Child Health
Information Resource Center.
II.13 Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2006. Vol 18.
Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention; 2007. http://www.cdc.gov, accessed 04/18/08.
II.14 Centers for Disease Control and Prevention. Sexually Transmitted Disease surveillance,
2006. Atlanta, GA: U.S. Department of Health and Human Services; 2007.
II.15 Centers for Disease Control and Prevention, National Center for Injury Prevention and
Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Nonfatal
[online]. (2005). Available from URL: www.cdc.gov/ncipc/wisqars, accessed 01/15/08.
II.16 Centers for Disease Control and Prevention, National Center for Health Statistics, National
Hospital Ambulatory Medical Care Survey 2005. Analysis conducted by the Maternal and
Child Health Information Resource Center.
II.17 U.S. Department of Labor, Bureau of Labor Statistics. Case and Demographic
Characteristics for Work-related Injuries and Illnesses Involving Days Away From Work,
Supplemental Tables, 2006. [Table 1b] http://www.bls.gov/iif/oshcdnew.htm, accessed
01/28/08.
II.18 Children and Adults with Attention Deficit/Hyperactivity Disorder, National Resource
Center on AD/HD. Living with AD/HD: A lifespan disorder [online].
http://www.help4adhd.org/en/living/workplace, accessed 02/25/08.
II.19 Catalano, S. Bureau of Justice Statistics. Intimate Partner Violence in the United States.
December 2007. http://www.ojp.usdoj.gov/bjs/intimate/ipv.htm, accessed 01/14/08.
II.20 Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2006. National vital statistics reports; vol 56 no 7. Hyattsville, MD: National Center for Health Statistics. 2007.
http://www.cdc.gov/nchs/births.htm, accessed 12/12/07.
II.21 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S, Munson ML.
Births: Final data for 2005. National vital statistics reports; vol 56 no 6. Hyattsville, MD:
National Center for Health Statistics. 2007. http://www.cdc.gov/nchs/births.htm, accessed
12/12/07.

DATA SOURCES

II.22 Menacker F. Trends in cesarean rates for first births and repeat cesarean rates for low-risk
women: United States, 1990–2003. National vital statistics reports; vol 54 no 4. Hyattsville,
MD: National Center for Health Statistics. 2005. http://www.cdc.gov/nchs/births.htm,
accessed 12/12/07.
II.23 Centers for Disease Control and Prevention. National Center for Health Statistics.
VitalStats. http://www.cdc.gov/nchs/vitalstats.htm, accessed 12/12/07.
II.24 Centers for Disease Control and Prevention. Breastfeeding practices—results from the
National Immunization Survey. 2006. http://www.cdc.gov/breastfeeding/data/NIS_data/
data_2004.htm, accessed 12/11/07.
II.25 Centers for Disease Control and Prevention. National Center for Health Statistics. National
Vital Statistics System, 2005. Unpublished data.
II.26 U.S. Agency for Health Care Research and Quality. Medical Expenditure Panel Survey
(MEPS) 2005. Analysis conducted by the Maternal and Child Health Information Resource
Center.
II.27 Centers for Disease Control and Prevention, National Center for Health Statistics, National
Health Interview Survey. Unpublished data.
Health Services Utilization

III.1 U.S. Centers for Medicare and Medicaid Services. Unpublished data.
III.2 DeFrances CJ, Hall MJ. 2005 National Hospital Discharge Survey. Advance data from vital
and health statistics; no 385. Hyattsville, MD: National Center for Health Statistics. 2007.
III.3 U.S. Agency for Healthcare Research and Quality. Total Health Services-Mean and Median
Expenses per Person With Expense and Distribution of Expenses by Source of Payment:
United States, 2005. Medical Expenditure Panel Survey Component Data. Generated interactively. (January 14, 2008).
III.4 Organ Procurement and Transplantation Network. National Data, and Advanced Reports.
http://www.optn.org, accessed 02/04/08.
III.5 National Committee for Quality Assurance. The State of Health Care Quality 2007.
Washington, DC: NCQA, 2007.
III.6 U.S. Agency for Healthcare Research and Quality, Consumer Assessment of Healthcare
Providers and Systems (CAHPS®), 2006. The CAHPS® data used in this analysis were provided by the National CAHPS® Benchmarking Database (NCBD). The NCBD is funded by
the U.S. Agency for Healthcare Research and Quality and administered by Westat under
Contract No. 290-01-0003. Analysis conducted by the Maternal and Child Health
Information Resource Center.
III.7 U.S Department of Health and Human Services, Health Resources and Services
Administration, Bureau of Primary Health Care. Uniform Data System. 2005. Unpublished
data.

WOMEN’S HEALTH USA 2008

CONTRIBUTORS
This publication was prepared for the Health
Resources and Services Administration’s Maternal
and Child Health Bureau (MCHB) and Office of
Women’s Health, by the MCHB’s Maternal and
Child Health Information Resource Center.
Federal Contributors within the U.S.
Department of Health and Human
Services

Agency for Healthcare Research and Quality
Centers for Disease Control and Prevention
Centers for Medicare and Medicaid Services
Health Resources and Services Administration
Indian Health Service
National Institutes of Health
Office on Women’s Health
Substance Abuse and Mental Health Services
Administration
Other Federal Contributors

U.S. Department of Agriculture
U.S. Department of Defense
U.S. Department of Education
U.S. Department of Justice
U.S. Department of Labor
U.S. Department of Commerce
Non-Governmental Contributors

American Academy of Pediatrics
American Association of Colleges of Nursing

American Association of Colleges of
Osteopathic Medicine
American Association of Colleges of Pharmacy
American Cancer Society
American Dental Association
American Heart Association
Association of American Medical Colleges
Arthritis Foundation
Association of Schools and Colleges of
Optometry
All photos used in this publication are copyright istockphoto.com

Association of Schools of Public Health
Children and Adults with Attention
Deficit/Hyperactivity Disorder
Commission on Accreditation for Dietetics
Education
Council on Social Work Education
Mental Health America
National Committee on Quality Assurance
United Network for Organ Sharing
Urban Institute

File Type	application/pdf
File Title	whusa2008.090408.qxp
Author	JJordan
File Modified	2008-09-05
File Created	2008-09-05