Report: Significant minority of women delaying or going without care
BY PAUL COLLINS
THE CHRONICLE
A new national survey by the
Kaiser Family Foundation found
a significant minority of women
report delaying or going without
care because of costs. And the
survey found significant differ
ences in health status by race and
ethnicity.
The report says: "The health
care system is not meeting the
health needs of a sizable share of
women. For women, affordability
of care is a major concern. A sig
nificant portion of women cannot
afford to go to the doctor and fill
their doctor's drug prescriptions -
even when they have insurance
coverage. Women with health
problems, who need health care
services the most, often have the
hardest time getting care because
of plan coverage policies, afford
ability concerns, and logistical
barriers, such as transportation.
"Women also have some
important concerns about the
quality of care they are receiving.
A substantial proportion of
women changed doctors because
of dissatisfaction with care and
concerns about quality. For many
women, coverage and access to
care is unstable. Health coverage,
involvement with health plans
and relationships with doctors
are often short lived, resulting in
care that can be spotty and frag
mented."
As far as racial and ethnic dif
ferences in health status of
women aged 18 to 64, the survey
found:
Despite being a younger
population, Latinas were the most
likely to report being in fair or
poor health (29 percent), fol
lowed by African Americans (20
percent), compared with 13 per
cent of white women.
? African-American women
were the most likely to have a
condition that limits their activity
(16 percent), compared with 10
percent of Latinas and 12 percent
of white women.
? African-American women
were nearly as likely as white
women (31 percent vs. 35 per
cent) to report a medical condi
tion that requires ongoing treat
ment. with Latinas the least likely
(10 percent).
? There were significant dif
ferences in the use of prescription
drugs by race and ethnicity. Fifty
five percent of white women, 43
percent of African-American
women and 33 percent of Latinas
reported that they took prescrip
tion drugs regularly.
The survey also found differ
ences in prevalence of chronic
health conditions, by race/ethnic
ity, in women aged 45 to 64.
African-American women had
the highest rates of reported
arthritis, 40 percent, compared
with 33 percent of Latinas and 32
percent of white women. African
American women also had the
highest rates of reported hyper
tension (57 percent), followed by
Latinas (35 percent) and white
women (28 percent).
I annus had the highest rates
of reported diabetes (17 percent),
followed closely by African
American women (16 percent),
with 9 percent of while women
reporting diabetes. White women
had the highest rates of obesity
(17 percent), followed closely by
African-American women (16
percent), with Latinas not far
behind (13 percent).
For some other chronic
health conditions in women aged
45 to 64. the results were: anxi
ety/depression: Latinas - 26 per
cent, white women - 23 percent,
African-American women - 19
percent; asthma: white women -
11 percent, African-American
women - 10 percent, Latinas - 9
percent; osteopomsi^: Latinas -
12 percent, white women - 10
percent and African-American
women - 4 percent.
The report says of the find
ings: "It should be noted that the
true prevalence of these chronic
health conditions could be under
stated because respondents were
asked to report only conditions
that were diagnosed by a doctor."
This nationally representative
survey was administered to
3,966 women aged 18 to 64 in the
spring and summer of 2001.
Women who were nonelderly
Latina, African American, unin
sured, low-income or on Medic
aid were oversampled to improve
understanding of the multifaceted
health issues and challenges fac
ing these often underserved
groups of women. Here are some
other survey findings.
? Costs related to health care
present significant problems for
nonelderly women. Twenty-four
percent of nonelderly women
delayed or went without care in
the past year because they could
not affoid it, compared with 16
percent of men. Twenty-eight
percent of women found out-of
pocket costs to be higher than
expected when they went to their
doctors, a rate similar to that of
men. Twenty-three percent of
women gave their plans low rat
ings on the out-of-pocket costs
they incurred.
? Affordability of prescrip
tion drugs is a primary concern
for a sizable share of nonelderly
women. Half of nonelderly
women used prescription drugs,
compared with 31 percent of
men. Twenty-one percent of
nonelderly women did not fill
prescriptions or medications
because of the costs, compared
with 13 percent of men. This was
a problem for 40 percent of unin
sured women, 27 percent of
women with Medicaid and 15
percent of privately insured
women.
? Women in fair or poor
health - who have the greatest
need for health care services -
often experience major problems
accessing care. Thirty-two per
cent of nonelderly wogven had
health conditions that required
ongoing medical treatments,
such as asthma, allergies, or
arthritis, compared with 26 per
cent of men. Of the 16 percent of
women in fair or poor health, 49
percent reported they needed to
go to the doctor in the past year,
but did not.
Transportation difficulties
resulted in delayed care for 21
percent of women in fair or poor
health, four times the rate of
women in better health (5 per
cent). Twenty-three percent of
women in fair or poor health
reported that their health plans
refused to approve or pay for
needed tests or treatments in the
past two years; 57 percent of
them either delayed care or never
got treatment.
? Low-income women were
likely to have poor health status
and activity limitations. Low
income women were twice as
Sec Report on C9
Actress
from page C3
of (he association of insulin
resistance with increased 'blood
clotting, high blood pressure and
abnormal blood lipid profile
("bad" cholesterol vs. "good"
cholesterol).
Insulin resistance affects
African Americans and Hispan
ic/Latino Americans at higher
rates than Caucasians, placing
these populations at increased
risk for type 2 diabetes and relat
ed complications, including car
diovascular disease, blindness,
kidney failure and amputation.
' "In a recent survey conducted
by our organization, we found
that nearly one out of two African
Americans and Hispanic/Latino
Americans with type 2 diabetes
does not consider heart disease
and diabetes to be related condi
tions," said Malcolm P. Taylor,
M.D., F.A.C.C. and ABC presi
dent. "The need for the Take Dia
betes to Heart! campaign is par
ticularly critical in these high-risk
populations."
Tight diabetes control is criti
cal to reducing the risk of com
plications such as heart disease.
The best indication of whether a
person is effectively managing
the disease is the A1C test. The
A1C test measures how well a
person's diabetes is being con
trolled over time, providing a
comprehensive picture of blood
sugar levels during a three-month
period.
The American Diabetes Asso
ciation recommends that patients
maintain an A1C target level
below 7 percent for good diabetes
control, while the AADH recently
adopted the American College of
Endocrinology and American
Association of Clinical Endocri
nologists' recommended A 1,C
target level of 6.5 percent.
"People with diabetes need to
understand the risk associated
with uncontrolled AIC levels.
For every I percent increase
above the target AIC level, a
patient's risk for developing heart
disease increases significantly."
said Kathy Berkowitz, R.N.,
C.S., F.N.P., C.D.E. and AADE
president. "It is therefore crucial
that people with type 2 diabetes
manage the disease through prop
er meal planning, physical activi
ty and, if necessary, medications,
including those that target insulin
resistance."
Throughout the summer and
fall Rashad. as campaign
spokesperson, will be visiting
cities with a high prevalence of
type 2 diabetes and heart disease
to educate people and challenge
them to Take Diabetes to Heart I
? In addition, people with diabetes
throughout the country can
access tips and tools for diabetes
management, as well as a free
cookbook by calling 1-800-307
7113 or by visiting
http://www.takediabetestoheart.c
oni/.
The Association of Black
Cardiologists Inc. (ABC) is an
inclusive organization and was
founded in 1974 to bring special
attention to the adverse impact of
cardiovascular disease on African
Americans. Membership is open
to all who are interested in assur
ing that African-American chil
dren know their grandparents and
become great-grandparents them
selves,.
Diabetes
. from page C3
recent European studies found
similar rates of inappropriate
use. (Horlen is now at Campbell
'University.)
The study is one of several
on diabetes published in a recent
issue of Journal of the American
Medical Association. It's the
first J AM A issue devoted entire
.ly to research on diabetes,
which has reached epidemic
levels and afflicts about 17 mil
lion people nationwide.
"1 can't imagine anybody in
- tne United States who doesn't
have someone in their family or
some close friend with diabetes.
It's such a big problem right
now," JAMA editor Dr. Cather
ine DeAngelis'said.
Diabetes impairs the body's
ability to produce or make prop
er use of insulin, resulting in
elevated blood sugar levels that
can damage the kidneys, heart,
eyes and other organs.
Glucophage helps the body
use insulin and is among the
most common drugs for Type II
diabetes, which is linked to obe
sity and is sometimes called
adult-onset, although it has
started showing up in children.
Bonnie Jacobs, a spokes
woman for Glucophage maker
Bristol-Myers Squibb Co., said
the warnings "are clearly out
lined" on the label.
Recent research from Har
vard Medical School and Public
Citizen Health Research Group
suggested that doctors don't pay
close enough attention to drug
warning labels, a problem also
raised by the Food and Drug
Administration.
Dr. Malcolm Taylor, presi
dent of the Association Of Black
Cardiologists, said patients' lack
of knowledge about diabetes
drugs might be partly to blame,
.and he said many are unaware
of diabetes' major complica
tions, which include heart dis
ease and kidney failure.
His group and the American
Association of Diabetes Educa
tors are launching a nationwide
education campaign this week,
including a new Web site to
raise awareness about the link
between diabetes and heart dis
ease, the leading cause of dia
betes-related death.
In other JAMA research,^
Kaiser Permanente study sug
gests that giving blacks and
whites similar health care access
can help ease racial disparities
in rates of complications such as
severe kidney disease, which
affects blacks disproportionate
ly
However, the study of
62,432 patients enrolled in a
Northern California Kaiser
insurance plan found some dif
ferences persisted despite equal
access, suggesting genetic dif
ferences may explain the racial
disparities. Kaiser scientist
Andrew Karter said.
In a JAMA editorial, Dr.
Christopher Saudek. president
of the American Diabetes Asso
ciation. said the featured studies
underscore the need for insurers
and policy-makers to adequately
address chronic diseases such as
diabetes, which require a life
time of treatment rather than a
quick fix.
"We should be paying to
keep people out of the hospital,
to keep them as pain-free as
possible and as free from com
plications," Saudek said.
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Each year, nearly twice as many women die of cardiovascular disease as from
all forms of cancer. But it doesn't have to happen to you. Forsyth Medical
Center, along with affiliated physicians nationwide, has developed a program
that can help. It's called Women's HeartAdvantage and it's designed to help
you learn about heart disease and ways to help prevent heart disease. You'll
find information on the signs and symptoms as well as the risk factors of
heart disease like high blood pressure, stress and obesity. Call toll free at
I -866-392-3972 to learn more, www.forsythmedicalcenter.org
Listen to your heart before it's too late.
Forsyth Medical Center
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