Risking Women’s Health

If I told you that breast cancer kills Pittsburgh women at a higher rate than women in other cities, and that Pittsburgh women die of heart attacks at a higher rate than women in other cities, what would you say? And what if I compounded the negativity by telling you that African American women are at particular risk?

“I just don’t believe it. Check your data.”

“There you go again, pointing out something bad about our region.”

Or, would you say, “That is something worth our attention”?

My choice would be the latter, but 30 years of experience reporting on another nagging regional problem—black infant mortality—suggests that, when it comes to matters of public health, most particularly women’s health, we Pittsburghers are slow to move the needle.

Dealing with the last subject first, here are a few facts that have been published on the Pittsburgh Regional Indicators Web site over the past three years:

The incidence of low-birthweight babies among black women in Pittsburgh is higher than the rate in any other benchmark region. At 14.6 percent, it exceeds the Minneapolis rate of 10.8 percent—the best among benchmark regions—by 26 percent.

The number of black women in the Pittsburgh region who report not smoking during pregnancy is 73.5 percent, a lower rate than in any other benchmark region. Charlotte rates highest of the 15 regions at 90.1 percent.

The incidence of pre-term deliveries, the leading cause of neonatal deaths not connected to birth defects, is slightly better; four benchmark regions (Detroit, Cleveland, St. Louis and Richmond) have higher rates of pre-term births than Pittsburgh. The benchmark average is 16.8 percent; the Pittsburgh rate is 18 percent.

It should be noted that smoking during pregnancy is higher in Pittsburgh than in any other benchmark region for both whites and blacks. This includes a separate measure for smoking by Pittsburgh teenagers, which is also a benchmark region high. Smoking is the highest known risk factor for low birthweight births, and Pittsburgh’s rate of low-weight births is topped by only Denver, Philadelphia, Baltimore and Cleveland. On the other hand, pre-term births among all Pittsburgh women occur at a lower rate than in all benchmark regions but three (Kansas City, St. Louis and Minneapolis). This dramatically underlines the particular regional problem with black infant mortality.

More recent data on two other major health issues—heart disease and cancer—present an equally grim picture for Pittsburgh women and black women in particular.

The rate of fatal heart attacks among relatively young Pittsburgh women in the most recent Indicator report (an average for the years 1999 to 2005) is very high, as are the rates for all Pittsburghers, male and female, black and white. Regional Indicators publishes data for two age groups, 35–64 and 35–54, because its health committee believed the region’s high average age might skew the numbers high.

Again, racial disparities are particularly disturbing. Black Pittsburgh women in both age groups have higher fatal heart attack rates than their counterparts in all benchmark regions but St. Louis. Their rates of 16.8 percent and 30.7 percent for both age groups, respectively, exceeded the average fatality rates for benchmark regions (11.1 and 21.0), as well as national averages (15.0 percent and 27.7 percent).

The overall fatal attack rates for both men and women, black and white, were high, but it was black women who had the highest rates among their peers in the eight categories measured over the seven-year period.

Now for cancer, the subject of the most recently published Health indicators. This sentence from the authors of the investigation gets right to the point: “Data from the nationwide Center for Disease Control telephone survey in 2006, show that we are worst among the 15 comparable regions in mammography rates for black women and 14th among white women. We also rank 14th among 15 cities for Pap smears, which test for early cervical cancer, among white women.” The data from the 2008 survey are not quite so bad for white women and mammography, showing us ranking just slightly below the benchmark and national averages. (Figure 1). But the rest of the bad news continues. The 2008 figures show that black women in the Pittsburgh area rank next to last among all comparison areas in mammography rates, and, for Pap smears, the rate for Pittsburgh area white women is at the bottom of the list. (Figure 2).

The authors are Dr. Bernard Goldstein and Tanya Kenkre. Goldstein is retired dean of the University of Pittsburgh’s Graduate School of Public Health, with which he and Kenkre are associated. Their essay and cancer data can be found on www.pittsburghtoday.org, the Indicator project Web site.

They found that black women in our area do far worse than white women in reported mammography rates. Nationally, black and white women had about the same usage rate in both of the two-year surveys they analyzed—about 75 percent. In benchmark regions, there was a slight difference between the black and white rates—77.1 to 74.5 in 2006; 74.8 to 73.8 in 2008. Pittsburgh, however, reflected a different and very negative story: Both white and black Pittsburghers were below national averages, and black women were very much below in mammography testing. The numbers are 72.5 for whites and 57.9 for blacks in 2006; and 74.5 percent for white women and 63.1 percent for black women in 2008.

There are legitimate questions about this report, which the authors concede. For example, how good are the data? Telephone surveys have limitations, and the CDC admits some problems with theirs. Sampling a proportion of the overall population results in fewer black than white women in the survey, which leads to the data for black women being less robust. Also, what are the relative conditions of Pittsburgh women, black and white, when it comes to health insurance coverage and economic circumstances? Again, available data are mixed and hardly determinative. Health insurance coverage in the Pittsburgh region is high by national and benchmark standards. On the other hand, black women in Pittsburgh report much higher rates of concern about the inhibiting nature of health care costs than do whites. Yet despite this negativity, black Pittsburgh women are more positive than their counterparts in other benchmark regions and the nation when their economic concerns relate to health.

But for all the extenuating circumstances, the reality of the data remains: The rates at which Pittsburgh women use proven tests that are unarguably helpful in the reduction of cancer deaths is low. And as Goldstein and Kenkre report, this makes a difference:

“Unfortunately, the breast cancer mortality rates in the Pittsburgh region are higher for both white and black women than for the rest of the United States and the benchmark regions. The mortality rate for white women in 2004 (the last year for which data are available) was 27.3 per 100,000, compared with the benchmark average of 24.9 and the national average of 23.8. For black women, the Pittsburgh MSA mortality rate for breast cancer was 34.2, as compared to the benchmark average of 31.7 and the national average of 32.3…”

“Data can be expected to move back and forth through the years, but the findings are consistent. Mammography is a proven preventive measure for the early detection of breast cancer when it is far more likely to be treatable. Low mammography rates predict that more women in our area will die of breast cancer—and that is what is happening.”