Diabetes Risk Factors of U.S. Women (continued)
Women at High Risk for Diabetes: Access and Quality of Health Care, 2003-2006
Population Size and Growth
In 2005, 51.4% of the estimated population age 18 years and over were women.6 From 2005-2050, through the combination of low birth rates, declining death rates, and net international migration, the population of women age 18 years and older is projected to grow by 59 million.7-9 This growth will increase the number of women at high risk for developing diabetes. The number of women diagnosed with diabetes is projected to reach 27.5 million by 2050; of these, more than one-third will be age 75 or older.10
Demographic and Socioeconomic Profile
Age and race/ethnicity are strongly associated with risk of developing or having diabetes.11-13 In 2005, 48.8% of women were in the reproductive years (18-44); 32.6% were in the middle years (45-64); and 18.7% were age 65 and older (numbers do not add to 100 due to rounding).6
The female population is racially and ethnically heterogeneous.14 Among U.S. women reporting a single race in 2005, an estimated 70% were non-Hispanic white; 12.4% were non-Hispanic black, 11.8% were Hispanic of any race, 4.5% were Asian, 0.9% were American Indian or Alaska Native, and 0.2% were Pacific Islander. From 2005-2050, the number of nonwhite minority females is projected to increase from approximately 30% to nearly 60% of the total female population.15 Since minorities can be at greater risk for diabetes than non-Hispanic whites, the projected growth in the number of minority women suggests that increasing numbers of minority women will be diagnosed with diabetes.10
Socioeconomic position, as measured by education, income, or occupation, is strongly associated with prevalence and incidence of diabetes.12,16-21 Among women age 18 years and over in 2005, approximately 15% had not completed high school and only about one-quarter had completed college or higher; estimates for older women were 25.4% and 14.9%, respectively.22 Regardless of level of education attained, earnings for women are about three-quarters of that for men even when they work full time and year round.23 Therefore, poverty is a major concern for women across the lifespan.
In 2005, more than 14 million (13%) women lived below the Federal poverty threshold, accounting for 3 out of every 5 poor adults age 18 years and over.24 About 59% of poor women are in the reproductive years but nearly 24% of women are in the middle years and 17% of older women live below the poverty threshold. In 2005, 1 in 4 black women and 1 in 5 Hispanic women lived in poverty; there was very little variation with age. A substantial proportion of American women of all racial and ethnic origins are exposed to socioeconomic circumstances that put them at increased risk of developing diabetes.
In addition to nonmodifiable factors such as age and race, a number of potentially modifiable biologic and behavioral factors are associated with an increased risk of type 2 diabetes.
- Obesity, hypertension, physical inactivity, and high-calorie diets.
- Excessive alcohol use and tobacco use.
- Psychosocial factors such as depression and poor mental health status.13
Increased physical activity and weight loss can prevent or delay the onset of type 2 diabetes among high-risk adults of both sexes, different ages, and racial and ethnic origins.4,25-27 Furthermore, the effect of such lifestyle modification on the incidence of type 2 diabetes might be sustainable.28-30 However, the demographic and socioeconomic profiles of women at greater risk for diabetes are similar to the profile of those with inadequate access to health care and low levels of evidence-based preventive health care services, such as advice regarding lifestyle modification.31-33