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Healthy People 2010 – Women's and Men's Health: A Comparison of Select Indicators

Access to Health Care

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People use health care services for many reasons:

• To treat illnesses, injuries, and health conditions.
• To prevent or delay future health care problems.
• To reduce pain and increase quality of life.
• To obtain information about their health status and progress.⁴

The seven objectives discussed below are indicators of women's and men's ability to access and use the health care system to meet specific needs.

Health insurance is one of the most discussed topics in American media, business, government, and personal conversations. Among the many issues are the availability of insurance coverage, specific features and costs, and the consequences of no insurance or underinsurance. Access to health services, including preventive care, depends in part on whether a person has health insurance. For example, uninsured women are less likely to receive cancer screening such as mammograms, more likely to be diagnosed at an advanced disease stage, and less likely to survive cancer than privately insured individuals.⁵

In 2006, nearly 44 million Americans under 65 years of age were uninsured.⁶ (Virtually all persons aged 65 years and older are covered by Medicare, although the types of supplemental coverage in this age group vary by demographic characteristics.⁷)

Rates of health insurance coverage[†] for persons under age 65 years were stable during the period 1989 to 2006. However, this stability masks changes in the ages of the insured population and the types of insurance coverage. Between 1989 and 2006, the percentage of children under age 18 with insurance increased, while the percentage of adults aged 18 to 64 years with insurance declined.⁶ In addition, the mix of private versus public coverage has been changing, with the percentage of persons under age 65 with private health insurance declining, while the percentage covered by public programs (for example, Medicaid) has increased.⁶

Between 1989 and 2000, the proportion of females in this age group with health insurance fluctuated between 86 percent and 84 percent. The proportion has stabilized at 85 percent since 2001 (figure 1). During the same period, rates for males under age 65 years were slightly below those for females, ranging from 83 percent to 81 percent.

Figure 1. Persons Under Age 65 years With Health Insurance, by Gender (1989 — 2006)

Healthy People 2010 Target (100%)*

Percent	1989	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006
Females	86					84	85	85	84	84	85	84	85	85	85	85	85	85
Males	83					81	83	82	81	82	83	82	83	82	82	82	82	81

* The Healthy People 2010 target calls for an increase in this measure.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Disparities in rates of health insurance coverage vary by age group, with the 18- to 24-year-old population group having the lowest rates for both women and men (figure 2). Men in this age group are less likely to be insured than are women — 66 percent, compared with 75 percent in 2004 — 2006. Children and adolescents are more likely to be covered by insurance than adults. Ninety-one percent of girls and boys under 18 years of age are insured, compared with 83 percent of women and 78 percent of men aged 18 to 64 years.

Figure 2. Persons Under Age 65 years With Health Insurance, by Age and Gender (2004 — 06)

Healthy People 2010 Target (100%)*

Percent	Age in years: 55 — 64	Age in years: 45 — 54	Age in years: 35 — 44	Age in years: 25 — 34	Age in years: 18 — 24	Age in years: 0 — 17
Males	89	85	80	70	66	91
Females	89	87	84	78	75	91

95% confidence interval

* The Healthy People 2010 target calls for an increase in this measure.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Among racial and ethnic and gender groups, American Indian and Hispanic males are the least likely to have health insurance; 63 percent of males in each group had insurance in 2004 — 2006. American Indian and Hispanic females are also less likely to be insured than persons in other racial and ethnic groups. In 2004 — 2006, 67 percent of American Indian females and 69 percent of Hispanic females had insurance. At 89 percent, white non-Hispanic females were the most likely to be insured.

Income is a key determinant of health insurance status. Poor and near-poor males were the least likely to be insured in 2004 — 2006 (67 percent and 68 percent, respectively). Poor and near-poor females had higher rates (72 percent and 74 percent) but were well below the rates for middle-/high-income males and females (88 percent and 91 percent, respectively).

Source of Care

Access to health care depends in part on access to a source of ongoing care. Women's access to regular and consistent medical care is important to their receipt of preventive services, such as mammograms and Pap smears, as well as to their quality of life and life expectancy. More than 12 million women aged 18 years and older have no particular doctor's office, clinic, health center, or other place where they go regularly for health care advice.⁸

Women are more likely than men to have a specific source of ongoing care. Between 1998 and 2006, the proportion of women with a source of care fluctuated between 88 percent and 90 percent (figure 3). For men, the range was 78 percent to 82 percent.

Figure 3. Persons Aged 18 Years and Older With a Source of Ongoing Care, by Gender (1998 — 2006)

Healthy People 2010 Target (96%)*

Age-adjusted percent	1998	1999	2000	2001	2002	2003	2004	2005	2006
Women	90	89	90	90	90	90	88	89	88
Men	81	78	80	82	81	81	80	80	79

* The Healthy People 2010 target calls for an increase in this measure.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Racial and ethnic disparities persist in access to a source of ongoing care. The Hispanic population group has the lowest rates among both genders. In 2004 — 2006, 78 percent of Hispanic women and 65 percent of Hispanic men had a source of ongoing care.

The proportion of adults with a source of ongoing care increases with age. The proportion ranges from 78 percent of women aged 18 to 24 years to 97 percent of women aged 65 years and older (figure 4). The range by age group for men is dramatic, going from 63 percent (aged 18 to 24 years) to 96 percent (aged 65 years and older).

Figure 4. Persons Aged 18 Years and Older With a Source of Care, by Age and Gender (2004 — 06)

Healthy People 2010 Target (96%)*

Age in years	65+	45 — 64	25 — 44	18 — 24
Men	96	87	72	63
Women	97	92	86	78

95% confidence interval

* The Healthy People 2010 target calls for an increase in this measure.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Insurance coverage plays a role in having a source of ongoing care. In 2005 — 2006, 90 percent of persons aged 18 to 64 years with insurance had a source of ongoing care, compared with 47 percent of persons who were without insurance at the time of survey. Among persons who had been without insurance for 12 months or more, the rate was 42 percent.⁶ Various factors, such as employment status, can affect the rates of insurance coverage.

Differences are seen by income for both men and women. Poor and near-poor adults are less likely to have a source of ongoing care than middle/high-income adults. Poor men had the lowest percentage (66 percent) in 2004 — 2006, compared with 92 percent for middle/high-income women.

Mammograms

Breast cancer is the most common type of cancer in women and the second leading cause of female cancer death (after lung cancer). In 2004 (the most recent year that data were available), more than 186,000 American women learned they had this disease.⁹ Regular use of screening mammograms, followed by timely treatment when breast cancer is diagnosed, can help reduce the chances of dying from breast cancer.¹⁰ Because of early detection and treatment, female breast cancer deaths have declined since 1991. About 41,000 females died from breast cancer in 2005.¹¹

The percentage of women aged 40 years and older who received mammography screening within the past 2 years increased from 52 percent in 1990 to 67 percent in 1998 (figure 5). This objective achieved the 2010 target in 1999, and the trend remained stable at 70 percent through 2003, due in part to changes in the survey methods. The questions asked between 1999 and 2003 may have overestimated the proportion of women who received mammograms within the recommended 2-year period. Therefore, the 2005 estimate of 67 percent may be a more accurate figure.⁶ (See the Technical Appendix for more information.)

Figure 5. Women Aged 40 Years and Older Who Received a Mammogram Within the Past 2 Years (1990 — 2005, Selected Years)

Healthy People 2010 Target (70%)*

Age-adjusted percent	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005
Females	52	55		60	61				67	70	70			70		67

* The Healthy People 2010 target calls for an increase in this measure.
NOTE: Survey question content differed slightly during the tracking period; see Technical Appendix.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Disparities exist between racial and ethnic populations. In 2005, Asian and Hispanic women were the least likely to have had a mammogram within the past 2 years (54 percent and 59 percent, respectively). White non-Hispanic women were the most likely to have had screening (68 percent in 2005).

Mammography rates vary by age group. In 2005, women between the ages of 50 and 74 years were more likely to have had a mammogram within the past 2 years than were younger (aged 40 — 49 years) or older women. Women aged 75 years and older were least likely to receive mammograms within the past 2 years (55 percent).

The receipt of mammography screening increases with education and income. Poor women have the lowest rate of any population group. Only 48 percent received mammograms within the recommended 2-year interval in 2005 (figure 6). Women with less than a high school education are also less likely to have had a mammogram within the past 2 years (54 percent in 2005). The 2010 target of 70 percent has been achieved for middle/high-income women as well as for women with at least some college.

Figure 6. Women Aged 40 years and Older Who Received a Mammogram Within the Past 2 Years, by Family Income (2005)

Healthy People 2010 Target (95%)*

Family Income	Middle/high	Near poor	Poor
Age-adjusted percent	72	55	48

95% confidence interval

* The Healthy People 2010 target calls for an increase in this measure.
NOTE: Poor is a family income below the Federal poverty level. Near poor is an income between 100-199% of poverty; middle/high is at least 200% of poverty.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Women under age 65 years who have health insurance are more likely to receive mammography screening than those without insurance. Among women aged 40 to 64 years, 73 percent of those with health insurance in 2005 had a mammogram within the past 2 years, compared with 38 percent of women who were uninsured at the time of survey interview. Among women who had been uninsured for at least 12 months, the rate was 33 percent.⁶

Influenza and Pneumonia Vaccinations

In 2005, pneumococcal infections caused about 61,000 deaths¹¹ and 1.3 million hospitalizations¹² in the United States. An additional 1,800 deaths were caused by influenza infections.¹¹ Data from earlier years indicate that influenza is the cause of 200,000 hospitalizations annually.¹³ Both types of infections occur in all age groups, but about 90 percent of influenza and pneumonia deaths occur among persons aged 65 years and older.¹⁴

Vaccination is an effective strategy to reduce illness and death due to pneumococcal disease and influenza. Because influenza and pneumococcal vaccinations are covered by Medicare, vaccinating a high proportion of both women and men aged 65 years and older should be possible. However, vaccination rates for both groups remain well below the Healthy People 2010 target of 90 percent (figure 7).

No appreciable differences existed between noninstitutionalized women and men aged 65 years and older in the receipt of an annual influenza or a one-time pneumococcal vaccination (figure 7). Between 1998 and 2006, the proportion of women aged 65 years and older who received an influenza vaccination within the past 12 months fluctuated between 60 percent and 65 percent. The comparable range for men was between 60 percent and 68 percent.

Figure 7. Noninstitutionalized Persons Aged 65 years and Older Who Received Influenza* and Pneumococcal† Vaccinations, by Gender (1998 — 2006)

Healthy People 2010 Target (90%)†

Age-adjusted percent	1998	1999	2000	2001	2002	2003	2004	2005	2006
Women, influenza vaccination	63	65	63	62	65	65	65	60	64
Men, influenza vaccination	64	68	67	65	68	67	65	60	66
Women, pneumococcal vaccination	46	49	54	54	56	57	59	58	59
Men, pneumococcal vaccination	47	51	53	55	57	54	55	54	55

* Influenza vaccination in the past 12 months.
† Pneumococcal vaccination ever received.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

The proportion of women aged 65 years and older who have had a pneumococcal vaccination increased from 49 percent in 1998 to 59 percent in 2004 and remained stable. In 2006, 59 percent of women and 55 percent of men aged 65 years and older reported having ever received a pneumococcal vaccination.

With the aging of the U.S. population, even greater numbers of persons will need vaccination against influenza and pneumonia. Women and men of any age with high-risk conditions (that is, heart disease, diabetes, and chronic respiratory disease) are at increased risk of these infections. Persons living in institutional settings such as nursing homes also are at increased risk. Immunization is recommended for these groups and their caregivers and health providers.^{15, 16}

Prenatal Care

Good preconception and prenatal care can help reduce or prevent maternal and infant illness, disability, and death. Such care addresses behaviors and conditions that contribute to poor infant and maternal health, including maternal smoking and alcohol use, weight gain, and gestational diabetes.

Prenatal care is more likely to be effective if women begin receiving care early in pregnancy — in the first trimester. The American College of Obstetrics and Gynecology recommends that all pregnant women receive at least 13 prenatal visits during a full-term pregnancy.¹⁷

The proportion of mothers who begin prenatal care in the first trimester increased from 76 percent in 1990 to 83 percent in 1997. The rate remained essentially stable at 83 percent to 84 percent through 2005, below the Healthy People 2010 target of 90 percent (figure 8).

Figure 8. Mothers Who Received Prenatal Care in the First Trimester of Pregnancy (1990 — 2005)

Healthy People 2010 Target (90%)*

Age-adjusted percent	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005
Percent of live births	76	76	78	79	80	81	82	83	83	83	83	83	84	84	84	84

* The Healthy People 2010 target calls for an increase in this measure.
NOTE: Data for 2003 exclude births from 2 States; 2004 data exclude 9 States; 2005 data exclude 13 States. See Technical Appendix for more information.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System — Natality.

White non-Hispanic mothers had the highest rate of early prenatal care in 2005 (89 percent), followed by Asian or Pacific Islander mothers (85 percent) (figure 9). In 2005, American Indian or Alaska Native mothers had the lowest early prenatal care rate. Only 70 percent started care in the first trimester.

Figure 9. Prenatal Care Within the First Trimester of Pregnancy, by Mother's Race/Ethnicity (2005)

Healthy People 2010 Target (90%)*

Race/Ethnicity	White non- Hispanic	Black non- Hispanic	Hispanic	Asian or Pacific Islander	American Indian or Alaska Native
Percent of live births	89	76	78	85	70

95% confidence interval

* The Healthy People 2010 target calls for an increase in this measure.
NOTE: Data are based on birth certificates filed in 37 States, New York City, and the District of Columbia. See Technical Appendix for more information.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System — Natality.

Young mothers are least likely to receive early prenatal care (figure 10). In 2005, only 48 percent of mothers under age 15 years started prenatal care in the first trimester. Receipt of early prenatal care increases with age. In 2005, the proportion moved from 71 percent for 15- to 19-year-old mothers to 89 percent for those aged 35 years and older.

Figure 10. Prenatal Care Within the First Trimester of Pregnancy, by Mother's Age (2005)

Healthy People 2010 Target (90%)*

Mother's age	35+	30 — 34	25 — 29	20 — 24	15 — 19	Under 15
Percent of live births	89	89	86	79	71	48

95% confidence interval

* The Healthy People 2010 target calls for an increase in this measure.
NOTE: Data are based on birth certificates filed in 37 States, New York City, and the District of Columbia. See Technical Appendix for more information.
Source: U.S. Department of Justice, Bureau of Justice Statistics, National Crime Victimization Survey.

Early prenatal care also increases with education. In 2005, 73 percent of mothers aged 20 years or older with less than a high school education received care in the first trimester, compared with 91 percent of those with at least some college. Mothers with at least some college have had rates higher than the Healthy People 2010 target of 90 percent since 1998.

Treatment of Depression

Depression can strike anyone regardless of age, racial and ethnic background, socioeconomic status, or gender. Recent estimates suggest that depressive illnesses affect approximately 12 percent of women and 8 percent of men in any 12-month period.¹⁸

The causes of depression range from genetic and biochemical factors to environmental stressors to psychological and social characteristics. Women who are victims of sexual and physical abuse are at much greater risk for depression.¹⁹ Depression can put women and men at risk for suicide. Although more men than women die from suicide, women attempt suicide about twice as often as men do.²⁰

Depression is highly treatable with antidepressant medication, psychotherapy, or a combination of the two. Researchers continue to explore how special issues unique to women — biological, life cycle, and psychosocial — may be associated with women's higher rate of depression.

Although depression has been identified as a serious problem for women, data to track the receipt of needed treatment are limited. Only one data point is currently available in the data source used for Healthy People 2010. In 2002, 62 percent of women and 52 percent of men with depression received treatment for their condition.

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Content last updated July 1, 2009.

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