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. This positive performance, however, disguises notable disparities in outcomes and access across gender, race/ethnicity, and geography. This section will explore these disparities in detail, starting with the leading causes of death.

Leading Causes of Death

Cancer remains the leading cause of death among women in Montgomery County, accounting for nearly a quarter of the total, followed closely by hear disease (22%) -- which is the leading cause of death for men (25%). Among the starkest difference by gender is the rate of accidents, with men being more than twice as likely to die of accidents than 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 (use the "share of" dropdown to select either hospital visits or ER visits).

Cancer

With cancer as the leading cause of death among County women, this section will provide more detailed breakdowns on County women's experience with Breast Cancer and Cervical Cancer. Note that the age-adjusted mortality rate for cancer for Montgomery County (both sexes) is about 70% the national and state averages.
Breast Cancer

The incidents of breast cancer has fluctuated over the past few years without a notable increase or decline. 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 2 years declined sharply from 80% in 2014 to 65% in 2016. It is important also to note the sharp disparities in incident and mortality by race and ethnicity. Hispanic and Asian women in the County have a third less chance of an incident than White and Black or African American (non-Hispanic) women. But while Black and White women have nearly the same rates of incidences, Black or African American women have a notably higher rate of mortality (22.1 vs. 17.7 per 100,000). The age-adjusted mortality rates for female breast cancer are diverging from national and state rates and about 20% below national rates.

Cervical Cancer

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 Test in the past three years has increased sharply to 94.4% by 2016. However, the data again shows sharp disparities by race and ethnicity, with Black or 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), with the rate for Black or African American women slightly above the average (14.5). Meanwhile, the birth rate among adolescents ("teen births") has fallen almost by half since 2010 (20.9 to 11.2), 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 Black or African American residents are 6 times more likely than White residents to have an adolescent birth. As a whole, the adolescent birth rate in Montgomery 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. 

Research reported in the New York Times shows that mothers in Montgomery County had their first child on average at the of 29.2 (3 years later than the national average of 26.3). Married mothers in Montgomery 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 continued to increase over the years, with 30.4% of birth today falling into this category, with higher rates among Asian and White women.
The share of births to unmarried women has not much increased, while 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 to alternative between the three categories). For instance, umarried mothers account for a majority of births (51.5%) among Hispanics, while this is the case for only 6.5% of births to Asian mothers. Similarly, births to Black or 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 umarried women in Montgomery County is around 70% the national and State average. 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 has remained largely consistent (2012-2016). Black or African American mothers have a notably higher rate of very low-weight (2.4% vs. 1.3% average) and low-weight births (9.9% vs. 7.4% average). The County's rates compare favorably to the national rate (slightly above 8%), while the State of Maryland as a whole performs slightly worse than the nation.
Infant mortality in the County was on the decline 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 Black or 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 Hospita, while 11% of Montgomery County babies are born in Washington, DC-based hospitals. The Social Security Administration reports that Ava, Olivia, Emma, Sophia and Charlotte were the five most popular baby girl names in the State of Maryland in 2017 (for boys, the most popular names were: Liam, Noah, James, Logan, and Jacob). 

Injuries, Drugs, Mental Health, and Suicide

Women in Montgomery County are far less likely than men to die of injuries (62% less likely) or to die of a drug-related event (58% less likely). Women are similarly less likely to die of suicide (63% less likely), but women are nearly 65% more likely to be hospitalized or more than twice as likely to visit the ER for incidences related to suicide attempts. Overall, the County shows significantly lower age-adjusted rates of suicide-related hospitalizations and ER visits compared to the State average.

Lastly, women are 18% more likely than men to visit the ER for mental health related issues.  

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, with women being more than twice as likely to have a Chlamydia infection -- in part due to much higher rates of screening -- while men are more than twice as likely to have a 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 in comparison to men. As a whole, the County's HIV incidence rate sits between the rates for the State (higher, but on a downward trend) and national (lower, largely steady -- at 11 per 100,000 vs. 15 per 100,000 for the County).

Disabilities

The US Census reports that 2% of girls under 18; 5% of women between the ages of 18 and 64; and 31% 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% vs. 25%), likely in part 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

Women are more likely than men to have health insurance, with women accounting for 45% of residents without health insurance, or 30,100 out of the 67,350 residents without health insurance. An estimated 5.6% of women are without health insurance, compared to 7.5% of men. Overall, the rate of the uninsured has dropped by nearly half, from 11.5% in 2009 to 6.5% 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% of residents without health insurance. Immigrants account for 72% of residents without health insurance, with most of these numbers coming from immigrants without citizenship (who alone account for 58% of the total). Most residents without health insurance work in service or construction/maintenance occupations, accounting for 61% of the total. (Data source: American Community Survey 2016). 
14.6% of women receive Medicaid, roughly on par with the 13.6% of men that do the same.