Chronic disabling conditions

In part because they live longer than men, women are more likely to be affected by such chronic disabling conditions as diabetes, osteoporosis, osteoarthritis, obesity, urinary incontinence, Alzheimer's disease fibromyalgia, and chronic fatigue syndrome. These conditions not only limit function but over time may be life-threatening. Each of these disorders is characterized by a long trajectory of increasing impairment. Chronic illnesses exert an untoward effect not only upon the person experiencing them but also upon family members and other care givers. More research is needed to determine whether specific gender-related factors contribute to the increased incidence of these illnesses in women.

Diabetes mellitus. An estimated 16 million Americans have diabetes, but only 10.3 million cases are diagnosed, of which 8.1 million are women [59]. The prevalence of diabetes is 2-4 times higher among Black, Hispanic, American Indian and Asian pacific Islander women than among white women. Diabetes is the fourth leading cause of death in African American, Native American, and Hispanic women, the sixth leading cause in Asian American women, and the seventh cause in white women [59]. Left untreated, diabetes can lead to severe vision loss, heart disease, stroke, kidney disease, and amputation of the lower limbs. Diabetes can be controlled through a proper diet, weight loss, exercise, or the use of medications.

Osteoporosis is a disorder characterized by the thinning and increasing brittleness of the bones that can lead to bone fracture. It afflicts more than 25 million Americans-80 percent of whom are women60. More than half of all women over age 65 suffer from this condition61. Each year, osteoporosis causes 1.5 million fractures of the hip, wrist, vertebrae, and other bones, and it accounts for 70 percent of all the fractures occurring annually in people over age 45. Twenty percent of the women who suffer a hip fracture die within one year of that event. The annual costs associated with osteoporosis are estimated at over $10 billion, and it is a major cause of admission to nursing homes61. Although osteoporosis is typically viewed as a geriatric concern, the prevention of osteoporosis spans the entire life course. Approximately 60 percent of a woman's final bone mass is acquired by the time she is 18, and peak bone density is achieved by age 35 [60]. To build and maintain healthy bones, girls and women of all ages need to consume calcium-rich foods, get regular exercise, and avoid tobacco and the excessive consumption of alcohol or caffeine. Further treatment strategies include calcium and vitamin D supplementation, estrogen replacement therapy at menopause, and nonhormonal medication to stem bone loss.

An estimated 4 million people in the United States suffer from Alzheimer's disease, and in 1995, there were over 13,600 women who died of this disease [62]. It is the most common cause of dementia for individuals over age 65. Alzheimer's disease places a heavy burden on society - costing society an estimated $80 to $100 billion each year - and on the individuals (primarily women) who take care of people with Alzheimer's [62].

Urinary incontinence (the unintentional loss of urine) affects 13 million Americans-11 million of them women. Although half of all elderly people experience episodes of incontinence, it is not exclusively a problem among the elderly. In fact, 1 in 4 women ages 30 to 59 experiences urinary incontinence. Women are most likely to develop this problem during pregnancy, childbirth, and physical activity, or after menopause, due to weakened pelvic muscles, or pelvic trauma. Incontinence is treatable in 8 out of 10 cases, but fewer than half of the people who experience this problem discuss it with a health care professional [63].

Since the 1970s, female obesity has risen more than a fourth to a rate of 36 percent [1]. The rate is particularly high among African American women (52.3 percent) and Mexican-American women (50.1 percent). Much of the rising rate is attributed to increasing lack of physical activity and overeating. Being overweight increases women's risks of heart disease, diabetes, high blood pressure, arthritis, and some types of cancer.

Nearly 26.4 million of the 42.7 million Americans with arthritis are women64. It is the most common and disabling chronic condition reported by women. An estimated 4.6 million (4.6 percent) of American women report that arthritis limits their daily activities, with higher rates among African American (6.5 percent) and Native American women (6.9 percent) than among white women (4.2 percent) [1]. Although arthritis is more common among the elderly, half of all people affected by the disease are under the age of 65 [65]. There are over 100 different types of arthritis ranging from mild to severe. It most commonly causes pain or stiffness in the joints of the hands, feet, knees, and hips. Risk factors including increasing age, injury, obesity, and genetic predisposition66. Treatment for arthritis includes medication, exercise, use of heat or cold, weight control, and surgery.

Fibromyalgia. The American College of Rheumatology reports fibromyalgia affects 3 to 6 million Americans. An estimated 80% of sufferers are women- most of whom are of childbearing age. Fibromyalgia is a common disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points in the neck, spine, shoulders, and hips. People with fibromyalgia may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety and other symptoms.

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) is characterized by persistent and debilitating fatigue and additional nonspecific symptoms such as sore throat, headache, tender muscles, joint pain difficulty thinking and loss of short term memory. It is estimated to affect as many as a half a million people in the United States and approximately 80 percent of those diagnosed with CFIDS are women.

Environmental health

Environmental factors contribute substantially to the cause of many diseases in women. Adverse environmental conditions range from water, air, and soil pollution to contamination through the workplace. Occupational hazards include exposure to lead, chemicals, pesticides, tobacco smoke, and continuous noise. Home and community environmental factors-from radon, lead-based paints, electromagnetic fields, food, and cosmetics to heatstroke, hypothermia, and violence-affect women's health. The ways in which environmental factors may disrupt women's endocrine, reproductive, central nervous, and immune systems and cause specific diseases such as cancer, autoimmune diseases, endometriosis, and osteoporosis are only beginning to be understood.