15.

Heart disease is the leading cause of death in African American, Latino, American Indian/Alaska native and white populations. More than 61 million Americans have some type of heart disease, including high blood pressure, coronary heart disease, stroke, congestive heart failure, and other related conditions. More than 950,000 Americans die each year of heart disease, or one person every 33 seconds.

In 1999, more women in the United States died of heart disease and stroke compared to all forms of cancer. Of these women, 11% were African American, 3% were of Hispanic origin (who may be of any race), 88% were white, 1% were Asian American/Pacific Islander women, and less then 1% were American Indian/Alaska native women. Several risk factors contribute to the likelihood of women getting heart disease: smoking, high blood pressure (hypertension), high blood cholesterol, obesity, physical inactivity, and a family history of the disease. Age-adjusted death rates from heart disease among females in minority populations vary greatly, from a low of 113.8 per 100,000 persons (Asian American or Pacific Islanders) to a high of 284.1 (African Americans).

Although the term heart disease can refer to any heart ailment, it is usually associated with coronary heart disease. Blocked arteries in the heart severely restrict the amount of blood that can flow to the heart. In turn, this insufficient blood flow deprives the heart muscle of much-needed oxygen and nutrients. When the blood supply is interrupted, the muscle cells of the heart suffer irreversible injury and die. This condition is known as a heart attack.

• African American women have the highest mortality rate from heart disease (284.1 per
  100,000) of all American women. Of this minority population, 36.4% have elevated blood
  pressure, in contrast to 19.7% of white women. In addition, 21.4% of African American
  women 18 years of age and over reported currently smoking cigarettes in 1997-1999, whereas
  24.0% of white women in this age group smoke. A significant contributing factor for heart 
  disease in African American women is weight. More than one-half (50.8%) of women in this
  minority group are obese — defined as having a Body Mass Index (BMI) greater than or equal
  to 30—in contrast to slightly less than one-third (30.6%) of their white counterparts.

• American Indian/Alaska Native women have significantly lower death rates from heart disease
   (129.4 per 100,000) than do white women (210.4 per 100,000). However, when the data are
   age-adjusted to compensate for the miscoding of Indian race on death certificates, American
   Indian/Alaska Native women have a higher mortality rate than white women, reports the Indian
   Health Service, an agency within the U.S. Department of Health and Human Services. 
   (Persons identified as American Indian, Asian, or Hispanic are sometimes misreported as white
   or non-Hispanic on the death certificate, causing death rates to be underestimated by 21% for
   American Indians, roughly 11% for Asians, and about 2% for persons of Hispanic origin.)
   Almost one-third (31.7%) of American Indian/Alaska Native women smoke.

• Hispanic women have lower death rates from heart disease (137.1 per 100,000) than do white
   women. Yet Hispanic women, especially those in certain subgroups, have significantly high
   rates of obesity, physical inactivity, elevated blood pressure, and high blood cholesterol. In
   addition, 13.1% of Hispanic women smoke, which increases their risk of heart disease.

• Asian American/Pacific Islander women have the lowest mortality rate from heart disease of all
   population groups (113.8 per 100,000). Only 10.2% of Asian American/Pacific Islander
   smoke. However, heart disease ranks as the number one cause of death among these minority
   women. One-fourth (25.7%) of these women’s deaths can be attributed to heart disease.

In 1999, almost one-third of deaths of African American women (29.4%), over one-quarter of deaths of Hispanic or Latina women (26.9%) and Asian American/Pacific Islander women (25.7%), and one-fifth of deaths of American Indian/Alaska Native women (21.1%) were attributed to heart disease. (Thirty-one percent of white women died from heart disease in 1999, the largest percentage of any group of women.)

• African American women have the highest death rate from stroke of all women, at 78.1 deaths
   per 100,000 (in contrast to 57.8 for white women).

• Asian American/Pacific Islander women have a mortality rate from stroke of 48.6 per 100,000
   women.

• American Indian/Alaska Native women have the second lowest mortality rate from stroke, at
   39.1 deaths per 100,000.

• Hispanic women have the lowest death rate from stroke (36.4 deaths per 100,000 persons).

All cancers combined is the leading cause of death for Asian American/Pacific Islander women, and the second leading cause of death among other American women of color. Cancers occur when specific cells in the body malfunction and begin to divide uncontrollably; the resulting mass of cells forms a tumor. If the tumor continues to grow unchecked, it begins to invade the normally functioning cells of vital organs and can then become life threatening. For all cancers combined in 1999, death rates for African American women were highest of all women (200 deaths per 100,000). white women were a close second (169 per 100,000), followed by American Indian/Alaska Native women (109 per 100,000); Asian American/Pacific Islander (104 per 100,000); and Latino women, who had the fewest deaths from all cancers combined (101 per 100,000).

1) Lung cancer. The incidence of lung cancer, the leading cancer killer of women, is on the rise.
    This increase can be attributed primarily to the increase in smoking among women. Between
    1960 and 1990, female deaths from lung cancer increased by more than 400%, exceeding that
    of breast cancer deaths in the mid-1980s. In addition, an estimated 3,000 adults die each year
    from lung cancer attributed to secondhand smoke.

• African American women have the highest mortality rate from lung cancer (40.2 per 100,000)
   among all minority groups, but this rate is slightly lower than that of white women (42.8 per
   100,000 persons).

• American Indian/Alaska Native women have a mortality rate from lung cancer of 25.6 per
  100,000 persons, 169 the second highest rate among all minority women.

• Asian American/Pacific Islander women and Hispanic women have the lowest death rates from
   lung cancer among all minority women, 18.8 and 13.1 per 100,000 persons, respectively.

2) Breast cancer. The second leading cause of cancer death among all American women is
    breast cancer. The incidence rate of breast cancer–defined as the number of new cases in a
    given year per 100,000 persons–rose dramatically in the years between 1940 and 1990.
    Between 1990 and 1997, white women reported the highest incidence of breast cancer (114
    per 100,000) and African American women reported the second highest incidence rate (100
    per 100,000). For most American women, the mortality rate of breast cancer has steadily 
    declined. However, for older African American women–those 75 years of age and above–the
     mortality rate has increased since 1990.

• African American women have the highest mortality rate from breast cancer of all population
   groups (34.9 per 100,000), which is higher than that of white women (26.6 per 100,000).
   Researchers are trying to find out why African American women are more likely than white
   women to die of breast cancer. Some reasons may be that tumors are found at a later (more
   advanced) stage so there are less treatment options, or patients do not follow up after 
   getting abnormal test results. Other reasons might include problems seeing breast lumps due to
   being overweight, or other potential barriers to care such as access to mammography facilities
   and transportation. African American women (except those who are 20-24 years of age) are
   more likely than white women to get breast cancer before age 40. However, they are less likely
   than white women to get breast cancer after age 40.

• Hispanic women have the second highest mortality rate from breast cancer of minority
   populations (15.8 per 100,000), but that rate is less than half that of African American women.
   One study found that more Hispanic women tend to be diagnosed in the advanced stages of
   breast cancer than do white women. Therefore, although incidence rates of breast cancer are
   lower in Hispanic women than in white women, Hispanic women diagnosed with breast cancer
   are more likely to die from the disease.

• American Indian/Alaskan Native women have high mortality rates from breast cancer (14.7 per
   100,000), second only to lung cancer. American Indian/Alaskan Native women have a lower
    incidence of breast cancer between 1990 and 1997 (33.0 per 100,000).

• And between 1990 and 1997, Asian American/Pacific Islander women have consistently
   reported the lowest mortality rates from breast cancer (12.7 per 100,000, respectively).
   However, their reported incidence of breast cancer is 77 per 100,000.

3.) Cervical Cancer. Cancer of the cervix, a very common kind of cancer in women, is a
     disease in which cancer cells are found in the tissues of the cervix. The cervix is the opening 
     of the uterus, or womb. It connects the uterus to the vagina (the birth canal). Cancer of the
     cervix usually grows slowly over a period of time. Before cancer cells are found on the cervix,
     the tissues of the cervix go through changes in which abnormal cells begin to appear (a
     condition called dysplasia). Later, cancer starts to grow and spread more deeply into the
     cervix and to surrounding areas. Study results show that the number of new cases of invasive
     cervical cancer among Hispanic American/Latino women (age 30 years and older) is about
     twice that for non- Hispanic women. But, Hispanic American/Latino women in the Southwest
     and Midwest have similar rates to non-Hispanics. Overall, the death rate from cervical 
     cancer is 40% higher among Hispanic American/Latino women than non-Hispanic women.
     Although invasive cervical cancer can be prevented by regular screening, Hispanic
     American/Latino women have a low rate of Pap testing.

The most common symptom of cervical cancer is abnormal bleeding. Many ethnic groups share the things that can make you more likely to get cervical cancer, such as having more than one sexual partner, starting sexual intercourse at a young age, and other dangerous sexual behavior. You can help find cervical cancer early, when it is most treatable, by getting regular Pap tests and pelvic exams. Pap tests should begin about three years after a woman begins having sexual intercourse, but no later than at 21 years old. Women should then have Pap tests at least once every three years. You should talk with your health care provider about how often you should have a Pap test and pelvic exam.

1) Maternal mortality. Maternal mortality rates are based on the number of maternal deaths due
    to complications from pregnancy, childbirth, and the puerperium (the time immediately
    following the delivery of a child) per 100,000 live births. According to Health, United States,
    2002, rates have not been calculated for American Indian/Alaska Native mothers and Asian
    American/Pacific Islander mothers because mortality rates based on fewer than 20 deaths  are
    unreliable.

• In 2000, African American women of all ages had a maternal mortality rate of 20.1 per
  100,000 live births, which was more than three times higher than that of white women (6.2 per
  100,00 live births). While the maternal mortality rate of African American women has     
  decreased significantly over the last four decades, the striking disparity between these women
  and white women remains. For example, in 1960, African American women of all ages had a   
  maternal mortality rate of 92.0, compared with 22.4 for white women. Furthermore, African
  American women aged 35 years and over had a maternal mortality rate of 299.5 that same
  year, in contrast to 73.9 for white women.

• Hispanic women of all ages had a maternal mortality rate of 9.0 per 100,000 live births in
  2000, which was higher than that of white women, but more than 50% lower than that of
  African American women. (Note: Data for Hispanic women does not include data from states
  lacking a Hispanic-origin item on their death and birth certificates. Consequently, the rates could
  be higher than reflected. )

• African American women have the highest infant mortality rate (14.1 per 1,000 births), while
   the mortality rate of infants born to white mothers was 5.7.

• Native/Part Hawaiian women have the second highest infant mortality rate (9.6), followed by
  American Indian/Alaska Native women (9.3).

• Hispanic women have an overall infant mortality rate of 5.8. Within this group of women,
  Cuban women have the lowest infant mortality rate (3.6).

• Asian American/Pacific Islander women have an infant mortality rate of 5.6, the lowest of all
  ethnic groups. Within this group, women of Japanese origin have the lowest infant mortality rate
  (3.8).

3) Low-birth-weight live births. Low-birth-weight infants are born weighing less than 2,500
    grams, or roughly less than 5.5 pounds. These infants are less likely to survive, and they have a
    higher risk of disability if they live. The incidence of low-birth-weight infants varies
    considerably by the race/ethnicity of the mothers of these infants, with non-Hispanic African
    American women having the highest incidence (13%). Mothers of Chinese descent have the 
    lowest percentage of low-birth-weight babies.

• In 2000, African American women had the highest incidence of low-birth-weight babies of any
   racial or ethnic group. Almost 13% of these infants were low-birth weight, compared with
   almost 7% of white infants. This factor contributes to the high infant mortality rate of African
   American infants, which is more than 2 times that of white infants.

• Of Hispanic/Latina women, 6.4% of all babies born to these mothers were-low birth-weight
   babies. Among this population, the highest percentage of low-birth-weight babies were born to
   mothers of Puerto Rican descent (9.3%), while women of Mexican descent had the lowest
   percentage of low-birth-weight babies of all Hispanic/Latina women (6.1%).

• Of Asian American/Pacific Islander women, 7.3% of all babies are of low-birth-weight.
   Chinese women have the lowest percentage of low-birth-weight babies of all women.
   However, 8.5% of babies born to Filipino women are low-birth-weight babies.

• In 2000, 6.8% of infants born to American Indian/Alaska Native women were
   low-birth-weight.

Currently, an estimated 800,000 to 900,000 people are living with HIV, Human Immunodeficiency Virus, in the United States, and approximately 40,000 new infections will occur every year. In addition, 774,467 cases of AIDS, Acquired Immunodeficiency Syndrome (the advanced stages of HIV) have been reported in the United States, including 134,441 cases among women. Approximately a half million people have died from AIDS in this country since the epidemic has been reported.

Long considered a man’s disease, HIV/AIDS is a rapidly growing public health problem among women, particularly minority women. Since 1985, the proportion of AIDS cases among adolescent and adult women has more than tripled, from 7% in 1985 to 25% in 1999. One-fourth of all American women are African American and Hispanic/Latina, but more than three-fourths of all AIDS cases in the United States occur in African American and Hispanic/Latina women. In 2000, 80% of new AIDS cases in women occurred among African American and Hispanic/Latina females.

Among women, two major forms of HIV transmission include intravenous (IV) drug use and heterosexual contact. In 2000, 38% of women with AIDS were infected through heterosexual exposure to HIV, and 25% said they had contracted it through IV drug use. Many women report that they did not know they were at risk for HIV/AIDS when they contracted the disease.

• African American women accounted for 58% of all AIDS cases among women reported
   through December 2000, although African American women make up only 13% of the U.S.
   female population. This year, the death rate from AIDS in African American women was the
   highest of any group of American women, at 13 per 100,000. In contrast, the mortality rate
   from AIDS for white, non-Hispanic females were less than one death (0.7) per 100,000.

• Hispanic/Latina women are at least 3 times more likely to die from HIV/AIDS than are white
   women, and have the second highest mortality rate from AIDS (3 per 100,000). HIV/AIDS is
   the fourth leading cause of death for Latina women aged 25-44.

• American Indian/Alaska Native women had 426 cases of AIDS between 1985 and present.

• HIV/AIDS rates in Asian American/Pacific Islander women are less than 20 deaths per
   100,000, and are therefore not listed as a death rate. In 2000, 0.5% of all AIDS cases, and
   0.4% of all HIV infections were attributed to this population.

Other Sexually Transmited Diseases

In the United States, more than 65 million people are currently living with an incurable sexually transmitted disease (STD). An additional 15 million people become infected with one or more STDs each year. Many people underestimate the prevalence of STDs and know little about the facts, the warning signs, and their risk of contracting one or more STDs.

In addition, the health impact of STDs is severe for women, particularly for minority women. Because the infections often cause few or no symptoms and may go untreated, women are at risk for complications from STDs, including ectopic (tubal) pregnancy, infertility, chronic pelvic pain, and poor pregnancy outcomes. These diseases include chlamydia, pelvic inflammatory disease, gonorrhea, human immunodeficiency virus (HIV), herpes simplex virus, human papillomavirus (HPV), and syphilis. Latex condoms, when used consistently and correctly, are effective in decreasing one’s chances of contracting many, but not all, of these diseases.

Teenagers are the age group that has the highest risk of contracting STDs. Each year an estimated 3 million teenagers contract one or more STDs. They are more likely to engage in high-risk behaviors that increase their chances of contracting STDs, such as multiple partners, unprotected sex, and for young women, choosing sexual partners older than themselves. In addition, teenage girls have a higher chance of contracting some STDs (such as chlamydia, gonorrhea, and HIV) than do teenage males because of the biological makeup of female bodies.

1) Chlamydia. Chlamydia is the most commonly reported bacterial STD in the United States. It
     is very dangerous because three-quarters of women and one-half of infected men have no
     symptoms. It is transmitted during vaginal, anal, and oral sex and causes an estimated 3 million
     infections annually, primarily among adolescents and young adults. Seventy-five percent of
     individuals who reported having chlamydia were under age 25. By age 30, it is estimated that
     50% of sexually active women may have had chlamydia at some point in their lives. Without
     treatment, as many as 40% of women with chlamydia may develop pelvic inflammatory
     disease (PID).

Minority women reported one-third of all PID cases. Among African American women, the incidence of ectopic pregnancy is 1.5 times higher than that of all other women of color.

3) Gonorrhea and Syphilis. Gonorrhea and syphilis are common bacterial infections that can be
     treated with antibiotics. Gonorrhea and syphilis are spread through vaginal, oral, and anal sex.
     Syphilis spreads by contact with syphilis sore, and sores are mainly found on the external
     genitals and anus, or within the vagina and rectum. Syphilis rates have decreased greatly in
     recent years. Current rates of syphilis are highest among young women of all ethnicities
     between the ages 20 and 29. However, the rate of syphilis in all African Americans is almost
     30 
     times that of whites.

Many women who contract gonorrhea do not show symptoms, and sometimes symptoms are so mild that they are mistaken for a bladder or vaginal infection. Gonorrhea infections that occur in the throat usually do not have symptoms and often go undetected. Adolescent females between the ages of 15 and 19 have the highest rates of gonorrhea.

Gonorrhea:

• In 1999, 75% of reported gonorrhea cases occurred among African American women, 19% of
  cases were reported by white women, and 7% by Hispanic/Latina women. Rates of gonorrhea
  for African American women, 764 cases per 100,000 in 1999, are considerably greater than
  among other groups of women. The rate of gonorrhea among African American women
  between ages 35 to 39 (332 per 100,000) was more than 15 times the rate among white 
  women (22 per 100,000) in the same age group.

• One percent of American Indian/Alaska Native women and Asian American/Pacific Islander
   women between the ages of 20 and 44 had reported a case of gonorrhea, a distant second to
   the rate among African American women.

• Seven percent of Hispanic women in this age group contracted gonorrhea. The rate of
   gonorrhea was 77 per 100,000 people, considerably lower than that of African American
   women, but more than double that of white women.

Syphilis:

• Syphilis rates were the lowest among white non-Hispanic women (less than one per 100,000)
   in 1999.

• Between 1991 and 1994, the rates of syphilis declined in Hispanic women by two-thirds and
  dropped by approximately one-half among African American, American Indian/Alaska Native,
  Asian American, and white women.

• The overall rate of syphilis among minority women in 1999 was highest among African
   American women (more than 12 reported cases among 100,000 persons).

• Almost one per 100,000 Hispanic/Latina women contracted syphilis in 1999.

4) Genital Herpes. Genital herpes is caused by the herpes simplex virus (HSV), a highly
     contagious STD. Once HSV is in the body, it never fully goes away, and it can reoccur at any
     time. Two types of HSV can occur. HSV type 1 most commonly causes sores on the lips
     (known as fever blisters or cold sores), but it can also infect the genital area. HSV type 2
     most commonly causes genital sores, but it can also infect the mouth. Both types are 
     transmitted sexually. A person who has sexual contact with someone with HSV type 2, 
     even if no sores are present, will usually contract the disease. A person who is exposed to the
     saliva of a person with a "cold sore" will probably contract the disease –and this is true for
     both oral-to-oral contact and oral-to-genital contact.

In the United States, 1 out of 5 (or 45 million people) ages 12 and over have genital herpes (HSV type 2). Of these people, almost 46% are of African American descent, compared to 18% of white Americans. African American women are three times more likely than white women to be infected with genital herpes (HSV type 2).

Most of the people infected with HSV never recognize the symptoms of genital herpes, so they do not know they are infected. Among women, HSV is frequently more severe in individuals with weakened immune systems, including those infected with HIV. Though there are treatments for genital herpes, it has no cure.

5) Human papillomavirus (HPV). HPV refers to a group of more than 100 different viruses,
    some of which cause genital warts. In many cases, HPV infects women without causing
    noticeable symptoms because there is no pain and the warts can be small. Genital warts are
    spread easily during vaginal, anal, and oral sex. Some types of HPV are considered
    "high-risk," meaning they may carry risks associated with cervical cancer, which causes 4,500 
    deaths among women each year. Approximately 50-75% of sexually active men and women
    will get HPV at some point during their lives. Seventy-five percent of people with HPV are
    asymptomatic, and therefore most people who have the disease do not know are carriers.
    Topical treatments from a health care provider may help with HPV, but it is a virus with no
    current cure.

Diabetes Mellitus

Diabetes mellitus ranks among the top 10 causes of death among all women. More than one-half of all Americans with diabetes are women. From 1990 to 1998, diabetes rates increased 70% for women between the ages of 30 and 39. It is much more prevalent among minority females than among their white counterparts.

In 2000, this disease was the fourth most common cause of death for African American, American Indian/Alaskan Native, and Hispanic females. (Among white women, diabetes was the seventh leading cause of death in 2000, responsible for 2.8% of deaths from all causes.) Although a cure for diabetes does not yet exist, this disease is treatable. 

Type I Diabetes.. Type I diabetes, in which the body stops producing insulin, requires insulin injections. Type I diabetes was previously called juvenile-onset diabetes or insulin-dependent diabetes. In Type 1 diabetes, the body destroys the cells that produce insulin. Autoimmune, genetic, and environmental factors are involved in the development of this type of diabetes. Type 1 diabetes may account for 5-10% of all diagnosed cases of diabetes.

Type II Diabetes. In Type II diabetes, formerly known as adult-onset diabetes or non-insulin-dependent diabetes, the body produces insulin, but in insufficient quantities. Type II diabetes may account for 90-95% of all diagnosed cases. Risk factors include older age, obesity, physical inactivity, and race/ethnicity. Minority women are 2-3 times more likely than non-Hispanic, white women to have Type II diabetes.

Gestational Diabetes. Gestational diabetes is a type of diabetes which develops during pregnancy. The body becomes intolerant towards sugar. During pregnancy, treatment is needed to normalize the mother’s blood to avoid complications with the infant. Gestational diabetes is common among obese women and those with a family history of diabetes.

• In American Indian/Alaska Native women, diabetes was the fourth leading cause of death in
  2000, responsible for 341 deaths, or 6.6% of deaths from all causes. Variations exist among
  ethnic groups: One study stated 41% of Navajo women ages 45-64 have diabetes. Among
  Pima Indian women ages 45-64, one study found, as many as 70% have diabetes.

• Among all Hispanic women, diabetes was the fourth most common cause of death in 2000,
   responsible for 2,821 deaths, or 6.0% of deaths from all causes. Older Mexican American
   women are the second most likely racial/ethnic group to have diabetes (after American
   Indian/Alaska Native women). They have the highest incidence rate of this disease among 
   all Hispanic women. Almost one-third (30%) of these women suffer from the disorder. For this
   subpopulation, however, with greater acculturation comes reduced obesity and a lower
   prevalence of diabetes.

• Among African American women, diabetes was the fourth leading cause of death in 2000,
   responsible for 7,250 deaths, or 5.2% of deaths from all causes. The health outcomes of
   African American women who have diabetes are far worse than those of white women who
   have this disease. These minority women are more likely to be blinded, become amputees,
   develop end-stage renal impairment, and die from diabetes than are their white counterparts.

• For Asian American/Pacific Islander women, diabetes was the fifth most common cause of
  death in 2000, responsible for 621 deaths, or 3.5% of deaths from all causes.

Tuberculosis is the single leading cause of worldwide deaths among women of reproductive age. Long considered a disease of the old, tuberculosis (TB) accounts for 750,000 deaths worldwide among women ages 15-44.

Bacteria called Mycobacterium tuberculosis cause TB. TB can attack the body in a number of places, but it usually attacks the lungs. Only individuals who are sick with TB of the lungs are infectious. Like the common cold, tuberculosis spreads through the air when a patient with untreated TB disease coughs, sneezes, or spits. Common symptoms of TB disease include a cough that persists for weeks or months, chest pain, fever (particularly at night), weight loss, and loss of appetite. In 2002,15,078 cases of TB were reported to the Centers for Disease Control and Prevention in the United States.

• United States-born African Americans have the highest rates of TB in this country. Of people
   who have TB who were born in the United States, almost 50% of the cases occur in people of
   African American descent (46.7%). African Americans have TB rates 7.5 times higher than
   that of whites and 2.1 times higher than that of Hispanics.

• Foreign-born Americans have much higher TB rates. Black, non-Hispanic foreign-born
  Americans have TB rates (49.9 per 100,000 persons) 5 times that of black, non-Hispanic
  Americans born in the United States (9.8 per 100,000), and more than 37 times that of white
  Americans (1.3 per 100,000) born in this county. Foreign-born Asian Americans/Pacific
  Islanders have the second highest rates of TB, 41.3 per 100,000.

• Among females with TB, 81% of reported cases occurred in minority populations. Of these
   cases of TB, almost 30% occurred among African American women, 26% among
   Asian/Pacific Islander women, and 24% among Hispanic females (compared to 19% among
   white women).

Psychiatric diseases and conditions can be the result of a behavioral, psychological, or biological (physical) dysfunction. About 22-23% of the United States adult population–or 44 million people–have psychiatric disorders that would be diagnosable if they had visited a mental health provider. Only about 1 in 4 actually receive the care they need. In the United States, mental disorders collectively account for more than 15% of the overall burden of disease (measured in lost years of healthy life) from all causes and slightly more than the burden associated with all forms of cancer.

Nearly 12.4 million women (12.0%) in this country are affected by a depressive disorder each year. Depressive disorders include major depression, dysthymic disorder (a less severe but more chronic form of depression), and bipolar disorder (manic-depressive illness). Depressive disorders can increase the risk of suicide. Although men are 4 times more likely than women to die by suicide, women report attempting suicide about 2 to 3 times as often as do men. Major depression, for example, afflicts an estimated 5% of Americans. However, nearly twice as many women suffer from major depression than do men (6.5% verses 3.3%). Among minority women, depression may be worsened by factors such as low education and income levels, lack of employment, acculturation difficulties for immigrants, marital and family problems, racism, and single parenthood.

Several psychiatric disorders, including anxiety disorders and mood disorders, disproportionately strike females. Approximately twice as many females as males suffer from these disorders. However, men and women are equally affected by social phobias (overwhelming anxiety in everyday social situations) and obsessive-compulsive disorder.

In addition, more than 90% of those afflicted with eating disorders are women, and 86% report the onset of these disorder by the time they are 20. Eating disorders–anorexia nervosa, bulimia nervosa, and binge eating disorder–are often perceived to be an affliction of white girls and young women in middle and upper socio-economic classes. However, women and girls (and increasingly, men) of all ethnic groups are susceptible. A recent study has shown that African American women were more likely to binge eat more often, and they reported fasting, laxative abuse, or diuretic abuse more often than did their white counterparts.

Eating disorders among ethnically and culturally diverse girls may be underreported due to the lack of population-based studies that include representatives from these groups. The mistaken perception that non-white females are at decreased risk for eating disorders may also contribute to the lack of detection.

1) Depression.

• Hispanic/Latino women have the highest lifetime prevalence of depression (24%) among all
   women. Nearly twice as many Hispanic women reported being depressed (11%) as African
   American women (6%) and white women (5%). A 1993 survey found that Hispanic women
   were more likely to report having suffered from severe depression within the past week (53%)
   than white women (37%).

• African American women are less likely to have this disorder (16%) than white women (22%).
   However, of those suffering from depression, almost half (47%) of African American women
   are afflicted with severe depression.

• Among American Indian/Alaska Native female adolescents, one study found 14% were
   characterized as extremely sad and hopeless, and 6% displayed signs of serious emotional
   stress.

2) Suicide.

• In 2000, American Indian/Alaska Native women of all ages (except women 65 years and
  older) had the highest mortality rate from suicide (4.6) of the other three minority populations.
  Of all women and within all age groups, the highest suicide rate occurred among American
   Indian/Alaskan Native women between the ages of 25 and 44 (9.1 per 100,000).

• In 2000, Asian American/Pacific Islander women of all ages had the second highest mortality
   rate from suicide (3.0) among minority women. Among all women over 65 years of age, Asian
   American/Pacific Islander women had the highest mortality rate from suicide (5.4) in 2000.

• That same year, African American women of all ages had a mortality rate from suicide of 1.8.
   Among all women over 65 years of age, African American women had one of the lowest
   mortality rates from suicide (1.3) of all women in 2000.

• Only American Indian/Alaska Native women in this age group had a lower mortality rate, which
   was not calculated because it was fewer than 20 deaths.

• Hispanic women had a mortality rate from suicide of 1.8 (as did African American women) in
  2000. However, Hispanic teenagers were twice as likely (19%) to attempt suicide than either
  African American (8%) or white (9%) girls. Suicide rates for young women ages 15 to 24 are
  lowest among Hispanic and African American (both 2 per 100,000) compared to white young
  females of the same age (5 per 100,000). (White, non-Hispanic women have the highest
  mortality rate (4.7) from suicide of all women.)

Violent crimes against women are a major public health problem in our country. These acts include homicide, rapes, sexual assaults, robberies, and both aggravated and simple assaults. In a 1996 survey, at least half of all women reported having been physically assaulted at some point in their lifetime. Each year, about 1 million women are stalked in this country, and about 4 million women are physically abused by their spouses or live-in partners.

Persons who are known to the victims commit 6 out of 10 of all rapes and sexual assaults against women. In 1998, an estimated 900,000 women reported acts of non-lethal violence by intimate partners: current or former spouses, boyfriends, or girlfriends (whether heterosexual or same-sex partners). The consequences of non-lethal physical or sexual violence, whether actual or threatened, and of psychological/emotional abuse, can include post-traumatic stress disorder, clinical depression, substance abuse, dissociative disorders, and suicide attempts; and physical consequences may include fractured and broken bones, scarring, bruising, lacerations, organ damage, and miscarriages. In 2001, intimate partner violence made up 20% of all nonfatal cases of violent crime experienced by women.

Women living in households with an annual household income of less than $10,000 experience intimate partner violence at significantly higher rates than women in households with annual incomes of $10,000 or more. Violence is not linked specifically to racial or ethnic factors. However, it is linked to socioeconomic status.

• Fifty-two percent of African American women are subject to physical assault at some point in
   their lifetimes, compared to 53% of Hispanic/Latino women, and 51% of white women.

• Among American Indians/Alaska Native women of all ages, 61% stated they had been victims
   of a physical assault. This group of women had the highest percentage, 34%, of rapes. This
   rate was almost twice that found among white (18%) and African American women (19%).

• Among all women, Hispanic women are the least likely group to be victims of rape. Hispanic
   women (53%) were more likely than non-Hispanic women (52%) to be victims of physical
   assault.

• Asian American/Pacific Islander women are the least likely group to be victims of physical
  assault during their lifetimes (50%) among all women. They are the least likely to be victims of
  stalking (5%) or rape (7%).

What types of care coverage exist? How do I find out about them?