2016 NC Women’s Health Report Card

Source: Carolina Demography analysis of American Community Survey Data (1-year samples from IPUMS-USA). Life expectancy at birth from NC SCHS. County projections from North Carolina Office of State Budget and Management (OSBM). Download 2008-2014 Data

Observations

• The state’s female population is steadily growing and women are projected to outnumber men through 2020.
• Overall, the median age is increasing, particularly among Caucasian women who have an average age of 42.6. Asian and Hispanic women in NC have an average age of 28.7 and 26.3 respectively, and represent the youngest segments of the population.
• The average life expectancy, at birth, is 80.7 in NC, while the national average is 81.

The following data represents that reported by NC women in 2014:

Number of Women (all ages)	5,106,024
Life Expectancy at Birth	80.7
Age (Average all NC Women)	39.4
Caucasian	42.6
African American	37.3
Asian	34.1
Average Age: Other	28.7
Hispanic	26.3
Age (% by Years of Age)
Under 18	22%
18 to 29	16%
30 to 44	20%
45 to 59	20%
60 and older	22%
Race & Ethnicity %
Caucasian	64%
African American	22%
Asian	2%
Other	3%
Hispanic	8%
% Veteran (18+)	1.7%

Observations

• The number of married women has slowly decreased, and been replaced with higher numbers of women who report their marital status as single, widowed or divorced/separated.

The following data represents that reported by NC women in 2014:

Average family size
All Women	2.66
Caucasian (non-Hispanic)	2.52
African American (non-Hispanic)	2.77
Asian (non-Hispanic)	3.20
Other (non-Hispanic)	2.72
Hispanic	3.47
% with own children in home (regardless of child age)
All Women	37%
Caucasian (non-Hispanic)	34%
African American (non-Hispanic)	40%
Asian (non-Hispanic)	52%
Other (non-Hispanic)	36%
Hispanic	53%
Among those with children in the home:
Number of children (average)
All Women	1.73
Caucasian (non-Hispanic)	1.68
African American (non-Hispanic)	1.75
Asian (non-Hispanic)	1.67
Other (non-Hispanic)	1.70
Hispanic	2.09
Number of children <5 (average)
All Women	0.32
Caucasian (non-Hispanic)	0.31
African American (non-Hispanic)	0.28
Asian (non-Hispanic)	0.35
Other (non-Hispanic)	0.39
Hispanic	0.45
% giving birth in past year (ages 15-50)
All Women	5%
Caucasian (non-Hispanic)	5%
African American (non-Hispanic)	5%
Asian (non-Hispanic)	7%
Other (non-Hispanic)	7%
Hispanic	8%
Marital Status (15+)
Married	46%
Divorced/Separated	16%
Widowed	9%
Never Married/Single	29%

The following data represents that reported by NC women in 2014:

Among women 18+
% Living in Group Quarters (all types)	2%
% Living in Households	98%
If living in Households
% Living in Single-Female Headed Household
All NC Women		22%
All NC female children (age 0-17)		29%
All NC women age 18+		21%
Share of ALL NC households that are Single-female households	14%
% of 65+ living alone	33.9%
Caucasian (non-Hispanic)	34%
African American (non-Hispanic)	35%
% 18+ Living in HH receiving food stamps	16.9%
Caucasian (non-Hispanic)	11%
African American (non-Hispanic)	32%
Asian (non-Hispanic)	10%
Other (non-Hispanic)	30%
Hispanic	21%
Homelessness
Total Number of Homeless Women	4,520
with adults and children	2,565
w/o any children	1,923
child-only homeless	32
% of NC Female Population	0.09%

The following data represents that reported by NC women in 2014:

% with ANY health insurance (18-64)	83%
Caucasian (non-Hispanic)	87%
African American (non-Hispanic)	82%
Asian (non-Hispanic)	88%
Other (non-Hispanic)	81%
Hispanic	51%
% Women 18-64 with Private Health Insurance	71%
If receiving private health insurance
% with insurance from employer/union	80%
% who purchased insurance directly	19%
% with insurance through TRICARE	6%
% Women 18-64 with Public health insurance coverage	15%
If receiving public health insurance:
% with insurance through Medicaid	79%
% with insurance through Medicare	30%
% with insurance through VA	5%
% with insurance through Indian Health Services	0.3%
Note: Individuals can receive health insurance coverage from multiple sources

All NC Females	Caucasian Females	African American Females	Other Minority Females
Women with any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare	84.1%	86.6%	86.8%	55.1%
Eastern NC	84.6%
Piedmont	83.3%
Western	85.3%
Women who have Medicare (if have some form of health insurance)	33.4%	35.8%	29.8%	19.3%
Health insurance coverage (under age 65)	79.8%	82.3%	84.4%	52.1%
Health insurance coverage (under age 65) if employed for wages	85.7%	87.4%	87.2%	***
Among those without health insurance (~15%), how long since they have had any health insurance coverage
Less than a year	22.5%	26.9%	25.5%	***
1 – 3 years	14.4%	14.9%	22.3%	***
3+ years	34.0%	38.3%	***	14.6%
Have never had health insurance	29.1%	19.9%	***	69.3%
Women who had NO health insurance coverage at any point in past 12 months	8.4%	6.8%	12.4%	12.4%
Women who have one person they think of as personal doctor/health care provider
Yes, only one	66.1%	68.2%	66.6%	46.2%
Yes, more than one	15.8%	16.9%	15.4%	9.0%
Women who did not see a doctor when needed within past 12 months due to cost	19.0%	16.7%	20.7%	32.5%
Women who have delayed getting needed medical care within the past 12 months because:
Appointment not soon enough	5.6%	5.3%	6.1%	7.3%
Wait was too long	2.6%	2.1%	3.8%	4.4%
No transportation	3.2%	2.2%	4.8%	6.7%
Other	9.3%	8.9%	9.2%	12.8%
Did not delay/no medical care needed	79.2%	81.5%	76.1%	68.8%
Number of times women have been to a doctor, nurse, or other health professional in the past 12 months
1 visit	15.7%	14.9%	16.0%	21.4%
2 visits	19.1%	18.0%	20.3%	22.9%
3 visits	13.4%	13.5%	14.4%	10.4%
4 or more visits	42.5%	45.6%	39.8%	27.3%
Never	9.3%	8.0%	9.5%	18.0%
Women who did not take a medication as prescribed due to cost at some point in the past 12 months	13.1%	12.4%	15.5%	14.6%
Women who currently have medical bills that are being paid off over time	29.6%	26.0%	39.7%	30.6%

Observations

• On the whole, the economy is improving in North Carolina, which brings health benefits. However, the state is still far from pre-recession levels.
• There is an overall improvement in insurance status that doesn’t seem to be attributed to employer sponsored insurance or Medicare/Medicaid. However, minority women are 1.82 times as likely to have lacked health insurance at some point in the past year compared to Caucasian women.
• African American women were 1.24 times as likely to have not seen a doctor due to cost in the past year as Caucasian women. Despite this, African American women also report higher rates of medical debt than any other group. Other minority women citied not seeing a doctor in the past year due to cost 1.95 times more than Caucasian women

The following data represents that reported by NC women in 2014:

% in the labor force (among women 18-64)	70%
% unemployed (among women 18-64 and in the civilian labor force)	8.0%
Poverty Status among women 18+
% In Poverty	18%
% Extreme Poverty (<50% FPL)	9%
% Near Poverty (100-150% FPL)	11%
% Poverty by Race/Ethnicity
Caucasian (non-Hispanic)	14%
African American (non-Hispanic)	27%
Asian (non-Hispanic)	13%
Other (non-Hispanic)	28%
Hispanic	32%
Earned Income
% with any earned income (18+)	60%
Median earned income (if have earned income)	$24,700
% with earned income (18-64)	72%
Median earned income (18-64) (if have earnings)	$25,000
Any Disability (Ages 18+)	17.2%
Disability by Age (18+)
18 to 29	6%
30 to 44	7%
45 to 59	17%
60 and older	34%
Disability by Race/Ethnicity (18+)
Caucasian (non-Hispanic)	18%
African American (non-Hispanic)	20%
Asian (non-Hispanic)	6%
Other (non-Hispanic)	22%
Hispanic	7%
Speak English Less than “Very Well” (18+)	5%
Caucasian (non-Hispanic)	1%
African American (non-Hispanic)	1%
Asian (non-Hispanic)	38%
Other (non-Hispanic)	3%
Hispanic	48%

• Educational attainment has slightly increased with more women attending college and completing higher degrees.

The following data represents that reported by NC women in 2014:

Educational Attainment (25+)
Less than HS	12%
HS/GED	25%
Some College	33%
BA+	29%
Caucasian (non-Hispanic) Educational Attainment (25+)
Less than HS	8%
HS/GED	25%
Some College	34%
BA+	32%
African American (non-Hispanic) Educational Attainment (25+)
Less than HS	15%
HS/GED	27%
Some College	36%
BA+	22%
Asian (non-Hispanic) Educational Attainment (25+)
Less than HS	17%
HS/GED	16%
Some College	18%
BA+	48%
Other (non-Hispanic) Educational Attainment (25+)
Less than HS	16%
HS/GED	22%
Some College	36%
BA+	26%
Hispanic Educational Attainment (25+)
Less than HS	41%
HS/GED	23%
Some College	21%
BA+	15%
% Currently enrolled in school (18-29)	39.5%
Caucasian (non-Hispanic)	41%
African American (non-Hispanic)	39%
Asian (non-Hispanic)	50%
Other (non-Hispanic)	40%
Hispanic	31%

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Observations

• African American women lag behind women of other races in physical exercise.
• Healthy People 2020’s target for seasonal influenza (flu) vaccinations is 70%. Only 44.6% of NC women received a flu shot in 2014.
• The Healthy People 2020 goal for sleep is that 70.8% of women get 7+ hours a night. NC women fall short of that target at 68%, with only 60.5% of African American women and 66% of other minority women reporting 7+ hours of sleep a night. Sleep loss and untreated sleep disorders influence basic patterns of behavior that negatively affect family health and interpersonal relationships. Fatigue and sleepiness can reduce productivity and increase the chance for mishaps such as medical errors and motor vehicle or industrial accidents.
• Dental care is a weakness for all women, but particularly non-Caucasian women.
• The number of Caucasian women aged 50-74 who reported receiving a mammogram in the past two years (80.9%) is just below the Health People 2020 target of 81.1%. African American women in the state exceed the target (81.3%).
• North Carolina women are exceeding Healthy People 2020 targets for colorectal screenings.
• On the whole, Caucasian women are much more likely to be diagnosed with a range of illnesses, such as chronic disease, cardiovascular disease, and depression. They are also more likely to report cancer, and less likely to die from cancer. This suggests a racial health disparity in doctor willingness to diagnose or a lack of doctor access.
• Although data is often unavailable, Hispanic/Asian/Other women appear to have very low health screening rates.

The following data represents that reported by NC women in 2014:

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Observations

• Obesity plays an important role in the risk factors for diabetes, cardiovascular disease, and stroke.
• Medical screenings and interventions continue to increase. Particular attention to lifestyle factors such as diet and physical activity have been shown to have a positive impact on weight data.
• Heart disease is the number one killer of women. While it is a serious concern for women of all ages, rates of heart disease increase dramatically between age groups 55-64, 65-74, and 75+. Women should strive to maintain a healthy weight and diet while engaging in exercise to decrease their risk of heart disease.
• Arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia is common and experienced by 31.5% of the state’s women. After age 55, over half of women reported arthritis or a related disease. By age 75+, this was the most common chronic disease reported. Older women need to be especially careful about arthritis pain because it can lead to falls.
• The data shows that after age 65, over half of North Carolina women are living with two or more chronic diseases.
• African American women are nearly twice as likely as Caucasian women to meet criteria for obesity. This is undoubtedly a major contributor to the finding that 45% of the state’s African American women have been diagnosed with high blood pressure. It also reflects their increased risk for metabolic disorders, such as diabetes. Importantly, 69.5% of African American women are being appropriately screened for diabetes.
• Many women with diabetes are unaware that they have it, and discovery may not occur until after damage to the heart, eyes, kidneys and other organs has occurred. Risk increases rapidly from ages 35 to 64. Women should talk with their doctor about diabetes prevention and whether they need to be tested for diabetes. African American women in North Carolina have the highest prevalence and risk factors.

The following data represents that reported by NC women in 2014, unless otherwise noted:

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Observations

• One in four North Carolina women reported three or more adverse childhood experiences. This rate is higher than national averages and should be an area to highlight for intervention efforts. The data underscores not only the prevalence and problem of childhood adversity, but that it cuts across all socioeconomic and racial divides, especially childhood sexual abuse. Depression in later life is a common consequence of childhood adversity.
• Depression is common and must be part of regular health screening for women— both in the perinatal period and at all other times. There are effective treatments, and women should not hesitate to discuss their concerns with their primary care doctor.
• Women in minority groups have greater prevalence of depression at all ages and these groups should have targeted assessments and interventions. Rates of depression are substantially higher in North Carolina compared to national averages.
• Depression peaks in women aged 55-64 (31%), then decreases.
• Caucasian women in North Carolina are twice as likely to have been diagnosed with a depressive disorder as African American women. Research suggests this may be due to the heavily rural makeup of the state, however the racial difference in childhood adversity is also a likely causal factor.
• Caucasian women across the state are also somewhat more likely to suffer from two or more chronic diseases compared with African American women. Depression shares a common biological basis with many chronic diseases, including coronary heart disease, diabetes, and rheumatoid arthritis. Consequently, the higher rates of depression seen in Caucasian women may increase their risk for comorbidity of medical illnesses.
• North Carolina substance use data among women is slightly lower than national data and is generally in line with other states’ data. However, the need for effective prevention and treatment still exists.
• Smoking continues to be a big problem for Caucasian women, more than women of any other race. Caucasian women smoke more frequently, the lung cancer rate is much higher, and smoking during pregnancy is more common among Caucasian women.

The following data represents that reported by NC women in 2014:

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Observations

• North Carolina continues to be well below the Healthy People 2020 goal of having 73.6% of all adolescents and adults tested for HIV.

The following data represents that reported by NC women in 2014:

Source: Carolina Demography analysis of 2014 NC Live Births. Download

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Observations

• Reliable data for North Carolina with an adequate sample size has remained unavailable since 2011. Previous data and comments are available from the 2011 PRAMS Survey.
• More North Carolina babies are born with a low birth weight (8.9%) than the Healthy People 2020 target of 7.8%. African American women were more likely than other ethnicities to experience premature birth, and have babies with a lower birth weight. Preterm birth and low birthweight can both have lifelong implications for the health and well-being of families.

The following data is from 2014 NC Live Births:

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Observations

• Data on intimate partner violence (IPV) is challenging to quantify. Measurement tools vary in their definitions of IPV, making comparisons across groups and time difficult. Additionally, almost all of these measures rely on self-report which in turn depends upon accurate recall and willingness to report the violence.
• No amount of IPV is acceptable. IPV during pregnancy increases the risk of adverse birth outcomes and complications for women during and after pregnancy. It demonstrates the need for effectively targeted health, community, and criminal justice services for victims, their children, and perpetrators.
• Intentional efforts by medical providers, social service providers and policy makers have a direct impact on the prevention and treatment of intimate partner violence. Studies demonstrate that children who are exposed to violence may be at risk for repeating those patterns in their adult years.
• Reliable data for North Carolina with an adequate sample size has remained unavailable since 2011. Previous data and comments are available from the 2011 PRAMS Survey.