The Center for Women’s Health Research (CWHR) released our eleventh edition of the North Carolina Women’s Health Report Card on July 20, 2020. This document is a progress report on the health and health care needs of North Carolina’s 5+ million women. Research efforts that require the most attention are identified through the collection and analysis of data for the report card. Current areas of research targeted by the Center include prevention, cancers affecting women, chronic disease (including cardiovascular health, diabetes, and obesity), women’s mental health, and substance abuse. It is the only health report of its kind in North Carolina.

Previous editions have been released biennially and tracked the state’s female health statistics in two year increments. The 2020 edition presents data primarily from 2018. Previous editions of the report card are also available for comparison. Below you can find a summary of the key observations from the report card’s advisory board as well as the full data sets utilized for each section. Healthy People 2020 is often cited as a benchmark to determine how North Carolina is hitting targets set by a consortium of agencies.

2020 NC Women's Health Report Card cover

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Demographics

Preventative Health

  • Women 50-74 who reported receiving, within the recommended time interval, a mammogram or recommended colorectal cancer screening are exceeding the Healthy People 2020 targets.
  • Sleep impairment is implicated as a contributing causal factor in many chronic illnesses that are leading causes of morbidity and mortality worldwide including depression, cardiovascular disease, and metabolic disorders. Given that only 21% of high school females and only 63% of women aged 50-75 report adequate sleep, interventions aimed at improving sleep for women would be expected to exert significant benefit for mood and overall medical well-being.
  • Data Sources

Perinatal Health

  • More NC babies are born with a low birth weight (9.4%) than the Healthy People 2020 target of 7.8%. African American women are more likely than other ethnicities to experience premature birth and have babies with a lower birth weight. Preterm birth and low birth weight can have lifelong implications for the health and well-being of families.
  • While the average number of NC women who reported smoking during pregnancy is about 9%, the highest rates were in Graham (30%), Clay (29%), and Swain (26%) counties, with a total of 13 counties reporting over 20%.
  • Data sources

Chronic Disease & Obesity

  • After age 65, nearly half of North Carolina women are living with two or more chronic diseases. Chronic disease has a negative impact on the overall physical, mental, and financial well-being of women. Those with one chronic disease are at a higher risk of developing other chronic diseases.
  • 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 – and refrain from smoking – to decrease their risk of heart disease.
  • Diseases of the heart account for 19% of deaths (112,118 years of potential life lost per year), cerebrovascular diseases account for 6% of deaths (35,533 years of potential life lost per year), and chronic lower respiratory diseases account for 6% of deaths (42,589 years potential life lost per year).
  • 63% of NC women are overweight or obese. Obesity plays an important role in the risk factors for chronic diseases such as diabetes, cardiovascular disease, arthritis, and stroke. Particular attention to lifestyle factors such as diet and physical activity have been shown to have a positive impact on weight data.
  • African American women are 65% more likely than Non-Hispanic White 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.
  • Diabetes mellitus accounts for 3% of deaths annually (21,665 years of potential life lost per year).
  • Data sources

Mental Health & Substance Use Disorders

  • One in four NC women has been diagnosed with a depressive disorder and, unlike other chronic conditions, the rate of depression does not increase with age. So, even among young women, almost a quarter have suffered from some form of depression. Stressful life events contribute to both mental and physical illness. Assessing current stressful events as part of a clinical history may improve the clinical care and outcomes for women in NC and beyond.
  • A quarter of NC women reported three or more adverse childhood experiences – higher than national averages – and should be an area to highlight for intervention efforts. Depression in later life is a common consequence of childhood adversity.
  • Data Sources

Cancer

  • Effective strategies exist to combat the four most prevalent cancers amongst the state’s women, including education on lifestyle, activities, HPV vaccination, and screenings for breast, colorectal, and cervical cancer. NC ranks 3rd in cervical cancer screenings but 30th in HPV vaccination.
  • Although the incidence rates are nearly identical, minority women are 25% more likely to die of breast cancer than Non-Hispanic White women and twice as likely to die of cervical or uterine cancer.
  • Cancer, more than any other cause, accounts for 20% of deaths (163,105 years of potential life lost annually). Breast cancer alone accounts for 3% (28,352 years of potential life lost annually).
  • Data sources

Infectious Disease

  • At 46%, North Carolina continues to be well below the Healthy People 2020 goal of having 73.6% of all adolescents and adults tested for HIV, though still above the US average of 39%. African American women are much more likely to have been tested (63%) than Non-Hispanic White women (40%).
  • At the time of publication, the full impact of COVID-19 infections is not yet known. North Carolina has the 14th highest rate of cases in the country. Consistent with national data, the disease is disproportionately affecting African Americans in both incidence and mortality.
  • Data sources

Emerging Issues

Overall Data Sources

The following data sources were used in various sections throughout the 2020 NC Women’s Health Report Card.

Interpreting the Report Card

The North Carolina Women’s Health Report Card uses many different data sources to provide an accurate picture of women’s health. Data sources vary across years in collection methods, how often they ask certain questions, and sample size. Some sources, such as Pregnancy Risk Assessment Monitoring System (PRAMS), only report in two-year increments with the last released report for 2017 data. For this reason the 2020 North Carolina Women’s Health Report Card is a mix of data ranging from 2017-2018. The year for data is indicated by a small number beneath each section heading with any exceptions noted along with the data. Unless otherwise indicated, all data are for women age 18 years or older.

Due to rounding, some percentage breakdowns may not combine to exactly 100%. For all “NC Rankings” segments, a lower number indicates a positive trend.

A note on reporting data by race and ethnicity: There are advantages to showing data by race and ethnicity for targeting resources and interventions toward populations in need. Factors such as income, education, health care access, and where we live are known direct and indirect determinants of health outcomes and vary by racial/ethnic status. Few sources of health data record these types of socioeconomic variables, though most collect information on race and ethnicity.

Carolina Demography

CWHR utilized the services of Carolina Demography to collect the data found within this report card. Carolina Demography is a service of the Carolina Population Center at UNC Chapel Hill that focuses on population change. They provide a full array of demographic services for North Carolina businesses, foundations, government agencies, schools, not-for-profit organizations, and more. Get more information by visiting their website, ncdemography.org.

Data Sources

American Community Survey Data (1-year samples from IPUMS-USA); Behavioral Risk Factor Surveillance System (BRFSS); Carolina Demography; Healthy People 2020; NC Central Cancer Registry; NC 2018 HIV/STD Surveillance Report; NC Office of State Budget and Management Population, Census, Economic, and Social Statistics Publications; Pregnancy Risk Assessment Monitoring System (PRAMS).

Acknowledgements

The following UNC Chapel Hill faculty and staff were integral to the completion of this report card:

  • Carolina Population Center: Elliot Kent and Jessica Stanford
  • Gillings School of Global Public Health: Dr. Rebecca Fry and Dr. Hazel Nichols
  • School of Medicine: Dr. Victoria Bae-Jump, Dr. Susan Girdler, Dr. Hendree Jones, Dr. Samantha Meltzer-Brody, Dr. Paula Miller, Dr. Elizabeth Stringer, and Dr. Alison Stuebe
  • Thurston Arthritis Research Center: Dr. Leigh Callahan
  • Center for Women’s Health Research: Dr. Wendy Brewster and Michael Kerr