Women and Health

In 2018, the Montgomery County Department of Health and Human Services released a first-of-its-kind Status of Health in Montgomery County Report. This report, together with the HealthMontgomery portal, served as the main source of information for this section. 
The report notes that Montgomery County overall has significantly lower morbidity and mortality rates than both the state and the nation. However, this positive performance disguises notable disparities in outcomes and access across gender, race/ethnicity, and geography. This section will explore these disparities in detail

Leading Causes of Death

Cancer remains the leading killer of women in Montgomery County, accounting for nearly a quarter of total deaths, followed closely by heart disease, which is responsible for 22 percent of deaths among women. Heart disease is the leading cause of death for men, at 25 percent of deaths. Among the starkest differences by gender is the accident rate: men are more than twice as likely to die of accidents as women. Overall, the age-adjusted mortality rate for all causes of death is significantly below the national and state average (at roughly two-thirds the national and state rate). This trend largely persists across individual causes of death, except where noted below.
The chart below documents the leading causes of death, the age-adjusted mortality rates, and the reasons for hospital and ER visits by gender (viewers can use the "share of" dropdown to select either hospital visits or ER visits).

Cancer

This section provides more detailed breakdowns on county women's experience with breast and cervical cancer. Note that the age-adjusted mortality rate for cancer for Montgomery County (both sexes) is about 70 percent the national and state averages.
Breast Cancer

The incidents of breast cancer have fluctuated over the past few years without a notable change. Breast cancer mortality rates, however, do appear to have fallen since 2010. Discouragingly, the percent of women over 50 who have received a mammogram in the past two years declined sharply from 80 percent in 2014 to 65 percent in 2016. The age-adjusted mortality rates for female breast cancer are about 20 percent below national rates.

It is important to note the sharp disparities in cancer incidents and mortality by race and ethnicity. Using data from HealthyMontgomery.org, Hispanic and Asian women in the county have a one-third less chance of an incident than non-Hispanic White and African American women. But while African American and White women have nearly the same rates of incidences, African American women have a notably higher rate of mortality (22.1 vs. 17.7 per 100,000). 
Cervical Cancer

Using data from HealthyMontgomery.org, rates for cervical cancer incidents also appear to be on the decline among county women, while the share of adult women who have received a Pap smear test in the past three years increased sharply to 94 percent in 2016. However, the data again shows sharp disparities by race and ethnicity, with African American and Hispanic women being nearly twice as likely as White and Asian women to experience an incident.

Child Birth

The birth rate in Montgomery County has continued to decline, from 13.7 per 1,000 women in 2010 to 12.5 in 2016 -- slightly above the US and state average. Hispanic residents have nearly double the birth rate of White residents (18.3 vs. 9.3 per 1,000), with the rate for African American women slightly above the average (14.5 per 1,000). Meanwhile, the birth rate among adolescents ("teen births") has fallen almost by half since 2010, from 20.9 to 11.2 per 1,000, with a particularly sharp decline among Hispanic residents. The adolescent birth rate differs dramatically by race and ethnicity, with the rate for Hispanic residents being more than 18 times the rate of White residents, while African American residents are six times more likely than White residents to have an adolescent birth. As a whole, the adolescent birth rate in Montgomery County is nearly half the national average and two-thirds the state average.

The map below, produced by the Montgomery County Chief Epidemiologist, shows the teen birth rate by zip code. 

Mothers in Montgomery County delay the birth of their first child longer than the national average. Research covered in the New York Times shows that mothers in our county had their first child on average at the of 29.2, three years later than the national average of 26.3. Married mothers in the county have their first child at 30.9 on average (vs. 28.8 nationally), while mothers with college degrees have their first child at 31.6 on average (compared to 30.3 nationally). 

Accordingly, the percent of all county births attributed to women aged 35-44 has grown over the years, with 30.4 percent of births today falling into this category. Birth rates to this age cohort are highest among Asian and White women.
The share of births to unmarried women has not increased much. The share of births with late or no prenatal care has declined slightly. Both rates show significant disparities by race and ethnicity (use the "breakdown" dropdown in the chart below to alternative between the three categories).  However, unmarried mothers account for a majority of births (51.5 percent) among Hispanics, while only 6.5 percent of Asian residents who give birth are unmarried. Births to African American mothers are 2.5 times more likely to occur with late or no prenatal care than births to White mothers. The percent of births to unmarried women in Montgomery County is around 70 percent of the national and state average, while the percent of births with late or no prenatal care is only slightly below the state average.
The share of births that are low weight births has remained largely consistent (2012-2016). African American mothers have a notably higher rate of very low weight (2.4 percent vs. 1.3 percent county average) and low weight births (9.9 percent vs. 7.4 percent county average). The county rate compares favorably to the national rate, which is slightly above 8 percent. The state of Maryland as a whole performs slightly worse than the nation.
Infant mortality in the county declined between 2008 and 2014, but has unfortunately increased in the last two years of available data (2015 and 2016). Disparities by race and ethnicity again persist, with African American mothers being 65% more likely than the average to suffer the anguish of infant mortality. The county's rate is slightly below the state rate and catching up with the national rate.
Data reported in Bethesda Magazine suggests that 64% of births to Montgomery County residents occur at Holy Cross Hospital, while 11% of Montgomery County babies are born in Washington, DC-based hospitals.

Injuries, Drugs, Mental Health, and Suicide

Women in Montgomery County die of suicide at 28 percent the rate of men, die of injuries at 38 percent the rate of men, and die of drug-related events at 42 percent the rate of men. However, women are nearly 65 percent more likely to be hospitalized and more than twice as likely to visit the emergency room (ER) for incidences related to suicide attempts. Women are also 18 percent more likely than men to visit the ER for mental health-related issues. Overall, the county rate of suicide-related hospitalizations and ER visits are much below the state average. 

Sexually Transmitted Infections

In August of 2018, the Montgomery County Public Health Officer declared a public health crisis due to rising rates of sexually transmitted infections, particularly for chlamydia and gonorrhea -- with rates reaching their highest levels in a decade. STIs can lead to long-term health consequences, including infertility. While these increases are in line with national and state trends, the increases in Montgomery County occurred at roughly twice the rate of the state's increase in 2017. 

STI rates in Montgomery County differ quite dramatically by gender. Women are more than twice as likely as men to have a documented chlamydia infection -- in part due to much higher rates of screening -- while men are more than twice as likely to have a documented gonorrhea infection. The county's incidence rates for chlamydia, gonorrhea, and syphilis are nevertheless sharply below state and national averages.
Of particular concern, women experience nearly double the age-adjusted rate of HIV infections compared to men. As a whole, the county's HIV incidence rate sits between the rates for the state (which is higher, but on a downward trend) and the rate for the nation (which is lower and trending steady -- at 11 per 100,000 for the nation vs. 15 per 100,000 for the county).

Disabilities

The US Census reports that 2 percent of girls under eighteen, 5 percent of women aged 18 and 64, and 31 percent of women aged 65 and over had at least one disability in 2017. Among residents 65 and over, women have a higher rate of disabilities (31 percent vs. 25 percent), likely partly because they live longer on average. Men have a slightly higher rate of disabilities between the ages of 18 and 64, but this difference is within the margin of error. 

Health Insurance

According to the US Census American Community Survey of 2016, women are more likely than men to have health insurance, with women accounting for 45 percent of residents without health insurance, or 30,100 out of the 67,350 residents without health insurance. An estimated 5.6 percent of women are without health insurance, compared to 7.5 percent of men. Overall, the rate of the uninsured has dropped by nearly half, from 11.5 percent in 2009 to 6.5 percent in 2016, a trend observed in roughly equal measure between women and men.
Among age groups, 25-44 year-olds are most likely to lack health insurance, accounting for half of all residents without insurance. Hispanic residents account for 56 percent of residents without health insurance. Immigrants account for 72 percent of residents without health insurance, particularly immigrants without citizenship, who account for 58 percent of the total. Residents without health insurance are most likely to work in service or construction/maintenance occupations, accounting for 61 percent of the total.