North Carolina Diabetes Prevention and Control Fact Sheet November 2012 Women and Diabetes Highlights Diagnosed diabetes among women in North Carolina doubled from 5 percent in 1995 to 10 percent in 2010 1. 370,000 adult women in North Carolina have diagnosed diabetes. One in 10 North Carolina women had diabetes in 2010. Approximately one-third of women of childbearing age have undiagnosed diabetes. For women, age-adjusted incidence (new cases) of diagnosed diabetes was over 2 times higher in 2010 than in 1980 in the United States. In 2010, the age-adjusted incidence was 7.3 per 1,000 population among women 2. Obesity, weight gain, poor eating habits and physical inactivity are major risk factors for type 2 diabetes among women. More than one in four women in the state was obese in 2009. Diabetes prevalence among African American and Native American women is two times more than white women Females with less than high school education have four times higher diabetes prevalence than college graduates. Women with less than $15,000 household income have five times more diabetes prevalence than women with $75,000 or more income. Gestational Diabetes affects two to ten percent of all pregnant women. Diabetes prevalence was highest in Eastern North Carolina, followed by Western North Carolina. Piedmont region had the lowest diabetes prevalence. Similarly, diabetes mortality rate among women was highest in Eastern North Carolina in 2010. Women with diagnosed diabetes are three times more likely to report disability status than women without diabetes. Good glycemic control is important for protection against the development of major cardiovascular disease in the long term as well as for the prevention of the renal and metabolic complications of diabetes.
Diabetes prevalence Diabetes prevalence has doubled among women in North Carolina over the last decade. About 370,000 adult women were diagnosed with diabetes in the state in 2010. Diabetes occurs among all ages and races, but women, elderly and certain racial groups, such as African Americans, are affected disproportionately. Figure 1: Prevalence of diagnosed diabetes by gender and total, North Caolina, 2000-2010 Source: N.C. Behavioral Risk Factor Surveillance System (BRFSS) 2000-2010, North Carolina State Center for Health Statistics Prevalence by age In general, diabetes prevalence increases with age. With the increasing life span of women, diabetes prevalence increases as they age. One in five women, aged 65 and older, was diagnosed with diabetes in the state in 2010. Figure 2: Female diabetes prevalence by age, North Carolina, 2010 Source: N.C. Behavioral Risk Factor Surveillance System (BRFSS) 2010. North Carolina State Center for Health Statistics North Carolina Diabetes Prevention and Control Fact Sheet, WOMEN AND DIABETES 2 2
Prevalence by race Women in minority racial and ethnic groups are the hardest hit by type 2 diabetes; the prevalence is about two to four times higher among black, Hispanic, American Indian, and Asian Pacific Islander women than white women. In 2010, the diabetes prevalence in North Carolina in black women was almost twice as high as in white women (16.3% vs. 8.5%). Figure 3: Female diabetes prevalence by race, North Carolina, 2010 Source: N.C. Behavioral Risk Factor Surveillance System (BRFSS) 2010. North Carolina State Center for Health Statistics Prevalence by education In general, women with less than high school education have higher prevalence of diabetes than women with higher education. In 2010, one in five women with less than a high school diploma was diagnosed with diabetes in North Carolina (21.8%). Women with less than high school education were four times more likely to be with diabetes than college graduates (21.8% vs. 4.8%). Figure 4: Female diabetes by education, North Carolina, 2010 Source: N.C. Behavioral Risk Factor Surveillance System (BRFSS) 2010. North Carolina State Center for Health Statistics 3 North Carolina Diabetes Prevention and Control Fact Sheet, WOMEN AND DIABETES
Prevalence by household income Diabetes prevalence among women with less than $15,000 household income is more than five times higher, compared to women with $75,000 or more income (22% vs. 3.9%). Figure 5: Female diabetes prevalence by household income, North Carolina, 2010 Source: N.C. Behavioral Risk Factor Surveillance System (BRFSS) 2010. North Carolina State Center for Health Statistics Prediabetes People with prediabetes a condition in which blood glucose levels are higher than normal but not high enough to be classified as diabetes are at increased risk for developing type 2 diabetes, heart disease and stroke. However, lifestyle changes such as diet and exercise can prevent or delay development of diabetes and its complications. The U.S. Centers for Disease Control and Prevention (CDC) found that 35% of American adults have prediabetes (50% of those aged 65 years or older) 3. Many are unaware of prediabetes and do not enough take action to reduce their risk. 4 In North Carolina, 8.2 percent of adult women had been diagnosed with prediabetes in 2010 5. The prediabetes prevalence was higher among black women compared to white women (10.3% vs. 7.6%). One in ten women aged 65 and older (10.2%) was diagnosed with prediabetes in the state. Gestational Diabetes Gestational diabetes occurs in pregnant women who never had diabetes before but have high glucose levels during pregnancy. Reported rates of gestational diabetes range from 2 percent to ten percent of pregnancies. Although gestational diabetes goes away after pregnancy in majority of cases, type 2 diabetes occurs in 5 to 10 percent of women immediately. North Carolina Diabetes Prevention and Control Fact Sheet, WOMEN AND DIABETES 4
Table 1: Diabetes Prevalence among women in North Carolina 2010 Demographic Characteristic Prevalence Rate (%) C.I.(95%)* Number of adults (weighted) Female, Total 10.0 9.1-10.9 370,000 Race White 8.5 7.6-9.3 224,000 African American 16.3 13.6-18.9 123,000 Native American 15.6 8.8-22.4 7,000 Other minorities 5.3 2.3-8.3 11,000 Ethnicity Hispanic 6.6 3.2-9.9 13,000 Age 18-24 NA 25-34 3.6 1.7-5.5 21,000 35-44 4.6 3.0-6.2 32,000 45-54 11.5 9.1-13.8 77,000 55-64 16.3 14.0-8.16 90,000 65-74 22.5 19.3-25.6 82,000 75+ 19.1 16.1-22.0 64,000 Education Less than H.S. 21.3 17.4-25.1 91,000 H.S. or G.E.D 11.7 10.0-13.4 126,000 Some post-h.s. 9.5 7.8-11.1 93,000 College Graduate 4.8 3.8-5.8 57,000 Household Income Less than $15,000 22.0 18.2-25.7 78,000 $15,000-24,999 15.6 12.6-18.7 85,000 $25,000-34,999 9.7 7.1-12.4 34,000 $35,000-49,000 9.6 7.3-11.9 42,000 $50,000-74,999 7.2 5.2-9.3 34,000 $75,000+ 3.9 2.8-5.1 31,000 Region Eastern NC 11.8 9.9-13.8 122,000 Piedmont NC 8.9 7.9-9.9 194,000 Western NC 11.2 9.1-13.3 52,000 Disability Status Yes 18.5 16.6-20.5 219,000 No 6.0 5.1-6.8 140,000 *C.I. denotes Confidence Interval Source: N.C. Behavioral Risk Factor Surveillance System (BRFSS) 2010, North Carolina State Center for Health Statistics 5 North Carolina Diabetes Prevention and Control Fact Sheet, WOMEN AND DIABETES
Gestational Diabetes, continued 35%-60% of women with gestational diabetes develop type 2 diabetes in the next 10-20 years. It is important to treat gestational diabetes as it poses risks to both the mother and the child. Treatment for gestational diabetes includes special meal planning, scheduled physical activity, daily blood glucose testing and, if needed, insulin injections. Gestational diabetes prevalence among women participating in the North Carolina WIC program was 13.7 percent in 2009. Lifestyle changes such as losing weight, exercising, and making healthy food choices may help prevent diabetes in these women after gestational diabetes. Economic and Social Factors Women have an increased risk of diabetes and its complications due to some social and economic trends 6. More women with diabetes: live in poverty. Women age 65 and older are twice as likely as men to be poor, are employed in small companies with fewer benefits and lower pay than larger companies, and often struggle to balance job and family responsibilities, are uninsured and lack access to health care (nationally, one in seven women lacks health insurance), live alone, particularly as they get older (women live an average of 7 years longer than men; by age 75, women outnumber men by a ratio of 2 to 1), and are members of racial and ethnic minority populations (who tend to be diagnosed with type 2 diabetes more often). Risk Factors and Complications Sedentary lifestyle, poor eating habits and overweight are major risk factors for diabetes among women. In 2009, 58% of women in North Carolina did not engage in moderate physical activity in the prior month. In 2009, only 24 percent of women consumed five or more fruits or vegetables per day. Nearly 60% of women are overweight or obese in North Carolina. African American women are two times more likely to be obese than Hispanic women. Black women are almost two times more likely to be obese than white females in the state (48% vs. 26% in 2009). North Carolina Diabetes Prevention and Control Fact Sheet, WOMEN AND DIABETES 6
Risk Factors and Complications, continued Chronic stress and environmental toxins contribute to weight gain and diabetes among women. Diabetes is a major contributor to health problems such as heart disease, stroke, blindness, kidney disease, and non-traumatic leg and foot amputations. Women are at greater risk for blindness due to diabetes than men. Women with diabetes are at greater risk for heart disease than women without diabetes. These findings may provide useful information for monitoring the NC female population for risk factors that could lead to diabetes. Morbidity and Mortality There were 8,918 hospital discharges among women after receiving care with a primary diagnosis of diabetes in 2010 with an age-adjusted rate of 172.2 per 100,000 population 7. For people age 65 and above, more females were hospitalized for diabetes than males. Diabetes was the sixth leading cause of death for women in North Carolina in 2010 8. Although the total number of deaths due to diabetes among women has slightly declined from 1,144 in 2006 to 993 in 2010, death rates among African American and American Indian women have still remained high. The diabetes mortality rates for African American and American Indian women were three times higher than for white women in the state in 2010 (46.9% and 50.9% vs. 16.3%). 7 North Carolina Diabetes Prevention and Control Fact Sheet, WOMEN AND DIABETES
Table 2: Age-adjusted Diabetes death rate per 100,000 women, ages 15 and over, by race in North Carolina, 2006-2010 Race 2006 2010 Percentage change in ageadjusted rate 2006-2010 All 27.9 21.8-21.9% White, Non-Hispanic 20.6 16.3-20.9% African American, Non-Hispanic 60.6 46.9-22.6% American Indian, Non-Hispanic 72.9 50.9-30.2% Source: N.C. resident death certificates data, N.C. State Center for Health Statistics Projections Projections indicate that women will account for the majority of diabetes cases by year 2050. The number of women with diabetes is projected to increase by 220% from 8.59 million in 2005 to 27.47 million by 2050 The number of women age 75 years and older with diabetes will rise 470% from 1.72 million in 2005 to 9.8 million by 2050. There is an urgent need for care for women with or at risk for diabetes through community intervention efforts and policy development. 1 North Carolina Behavioral Risk Factor Surveillance Survey (BRFSS) 2010, NC State Center for Health Statistics 2 U.S. Centers for Disease Control and Prevention (CDC) 3 National Diabetes Fact Sheet, 2011 4 U.S. Centers for Disease Control and Prevention, news release, Nov. 6, 2008 5 NC BRFSS 2010 Prediabetes Module, State Center for Health Statistics 6 A National Public Health Initiative on Diabetes and Women s Health, Centers for Disease Control and Prevention (CDC) 7 NC Hospital Discharge data, 2010, NC State Center for Health Statistics 8 NC Resident Death Certificates data, NC State Center for Health Statistics North Carolina Division of Public Health Diabetes Prevention and Control www.ncdhhs.gov www.ncdiabetes.org NC DHHS is an equal opportunity employer and provider. 11/12 North Carolina Diabetes Prevention and Control Fact Sheet, WOMEN AND DIABETES 8