1. Chapter 11
Other Chronic
Diseases and
Conditions

2. Chronic Diseases: What Are They,
and Why Are They Important?
• Diseases that persist for a long time
• Rarely cured completely
• Chronic diseases (including heart disease
and cancer) cause more than half of deaths
around the world.
• Almost all women will be affected by at least
one chronic disease.

3. Chronic Diseases Are Common, and
They Also Affect Women More Than Men
• Chronic diseases are responsible for 70% of
deaths in the U.S. (men and women).
• Women have greater rates of arthritis,
autoimmune diseases, Alzheimer’s disease, and:
– Osteoporosis (4x more common)
– Lupus (9x more common)
– Hypothyroidism (50x more common)
– Fibromyalgia (7x more common)
• Women are also more likely to be caretakers for
other people with chronic diseases.

4. Racial/Ethnic and
Socioeconomic Dimensions
• White and Asian women have osteoporosis more
often than African American women.
• African American women are more likely than White
women to die following a hip fracture.
• American Indians and Alaska Natives have the
highest prevalence rates of diabetes.
• Blacks and Whites have somewhat equal rates of
arthritis, but Blacks have a higher rate of activity
limitations due to arthritis and a higher prevalence
of severe pain.

5. Economic Dimensions
Estimated Annual Costs
Conditions Costs
Arthritis $128 billion
Diabetes $245 billion
Alzheimer’s disease
and dementia
$226 billion
Bone fractures $19 billion

6. Diabetes Mellitus
30 million cases of diabetes in the U.S., equally
common in men and women
Types of diabetes:
• Type 1: Usually appears during childhood; occurs
when the body can’t produce insulin
• Type 2: The most common form of diabetes develops
during adulthood and when the body becomes
insensitive to insulin
• Gestational diabetes: Develops in 2 to 5% of
pregnant women; a sometimes-temporary form of
insulin resistance similar to type 2

7. Risk Factors for Diabetes
• Having a first-degree relative with diabetes
• Being overweight
• Not getting regular exercise
• Unhealthful diet
• Having hypertension, abnormal high-density
lipoprotein (HDL) or triglyceride levels
• Racial groups: African Americans, Hispanics,
American Indians/Alaska Natives

8. Diabetes in the U.S. by Race
and Ethnicity
Figure 11.1 Percentage of U.S. adults aged 18 years or older with
diagnosed diabetes, by racial and ethnic group, 2013–2015.
Data from Centers for Disease Control and Prevention (CDC). (2018). Diabetes Report Card 2017. Atlanta, GA: CDC, U.S. Department of
Health and Human Services. https://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014.pdf

9. Symptoms of Diabetes
Type 1
• Frequent urination
• Unusual thirst
• Extreme hunger
• Weight loss
• Extreme fatigue
• Blurred vision
Type 2
• Any type 1 symptoms
• Frequent infections
• Cuts/bruises that are
hard to heal

10. Complications of Diabetes
• Poorly managed, diabetes
can damage many organs in
the body, reduce quality of
life, and cause early death.
• Managed well (healthful diet
with balanced amounts of
carbohydrate, blood sugar
monitored regularly, and
regular exercise), people
with diabetes can live long,
healthy lives.

11. Diagnosis of Diabetes
• Routine tests
– Fasting plasma glucose test/oral glucose
tolerance test
– Normal blood sugar level = 70–110 mg/dL; level
above 126 mg/dL on at least two occasions
• Treatment and prevention of diabetes
– Daily insulin injections
– Diet control
– Physical activity
– Home blood glucose testing several times a day

12. Osteoporosis (1 of 2)
• Literally “porous bone”
• Caused by gradual loss of calcium that weakens
bone structure
• Usually occurs without symptoms
Figure 11.2. A–B. Left to right,
healthy bone vs. osteoporotic
bone. “Osteoporosis” literally
means “porous bone.”
© Nucleus Medical Art/Visuals Unlimited/Getty Images

13. Osteoporosis (2 of 2)
Osteoporosis in the vertebra can cause women
to lose height and a curving of the spine.

14. Nonmodifiable Risk Factors
for Osteoporosis
• Being female
• Increased age/postmenopausal
• Small frame and thin-boned
• White or Asian ethnicity
• Family history of osteoporosis or fractures

15. Modifiable Risk Factors
for Osteoporosis
• Diet low in calcium and vitamin D
• Sedentary lifestyle
• Cigarette smoking
• Estrogen deficiency
• Low weight and body mass index
• Certain medications
– Glucocorticoids, anticonvulsants
• Amenorrhea
• Anorexia nervosa or bulimia

16. Screening and Diagnosis
for Osteoporosis
Women who should be tested:
• All postmenopausal women younger than age 65 who
have one or more additional risk factors for osteoporosis
besides menopause
• All women age 65 and older
• Women 50 and older with fractures
• Women with a condition or taking a medication
associated with low bone mass or bone loss
• Women who are considering therapy for osteoporosis or
who want to monitor the effectiveness of certain
osteoporosis treatments

17. Treatment and Prevention
of Osteoporosis
• Adequate supply of calcium (ideally from food)
• Vitamin D
• Participate in weight-bearing and muscle-
strengthening exercises
• Estrogen replacement therapy
• Drugs: alendronate (Fosamax), risedronate
(Actonel), raloxifene (Evista), teriparatide (Forteo),
nasal calcitonin spray
• Fall-prevention strategies

18. Arthritis (1 of 2)
• Arthritis—inflammation of the joints—affects
an estimated 50 million Americans (1 in 5
adults).
– Osteoarthritis: degenerative joint disease
– Rheumatoid: chronic inflammatory disease
– Gout: excess uric acid in the body

19. Arthritis (2 of 2)
Arthritis affects at least 1 in 6 adults in every state.
Figure 11.4 Age-adjusted prevalence of arthritis among women and men, 2015.
Reproduced from Centers for Disease Control and Prevention. (2018). Geographic variations in arthritis prevalence, health-related characteristics, and
management—United States, 2015. Morbidity and Mortality Weekly Report. 67(4);1–28. Available at: https://www.cdc.gov/mmwr/volumes/67/ss/ss6704a1.htm

20. Healthy Joint versus Osteoarthritic
Joint versus Rheumatoid Arthritis
Figure 11-3: Left to right: healthy joint, joint affected by osteoarthritis, and
joint affected by rheumatoid arthritis.

21. Risk Factors for Arthritis

22. Symptoms of Arthritis
• Achy, stiff joints
• Small bony knobs on fingers (osteoarthritis)
Diagnosis of arthritis
• No single test can diagnose arthritis.
• Family history and physical exam to check
joints, reflexes, and muscle strength
• Radiographs
• Blood tests
• Joint aspiration
Arthritis can be physically debilitating as well as painful.
© Xalanx/Dreamstime.com

23. Prevention and Treatment
of Arthritis
• Maintaining weight through diet and exercise
• Avoiding contact sports and repetitive joint motion
• Preventing Lyme disease (vaccine, insect repellent)
• Treatment may consist of
drugs (NSAIDs, topical
pain relievers,
corticosteroids,
immunosuppressants) or
surgery. Infected deer ticks can transmit bacteria by biting
humans, causing Lyme disease, which has many
possible adverse outcomes, including arthritis.
Courtesy of Jim Gathany/CDC

24. Fibromyalgia
• Disease characterized by constant, widespread
pain
• Still poorly understood
• Treatment focuses on improving quality of life
and reducing symptoms (regular exercise,
therapy to cope with pain and adjust,
antidepressants).
• Most likely to appear in women and during
middle age

25. Autoimmune Diseases (1 of 2)
• Diseases in which the body’s immune system
turns inward rather than outward
• More than 80 different illnesses, usually
occurring among women
• Fourth largest cause of disability among
women in the United States

26. Autoimmune Diseases (2 of 2)
Lupus: a poorly understood disease
• Immune system forms antibodies that target
healthy tissues and organs.
• Primarily a disease of young women of childbearing
age (affects women 10 to 15 times more often than
men), more likely to affect African American women
• Symptoms can go away and then return.
• Types:
– Discoid (cutaneous) lupus
– Systemic lupus erythematosus (SLE)
– Drug-induced lupus

27. Lupus (1 of 3)
Exact cause(s) unknown; genetic, hormonal, and
environmental factors appear to be involved.
Symptoms
• Painful, swollen joints or arthritis
• Skin rash
– Butterfly-shaped across face
– Triggered by sun exposure
• Frequent fevers
• Prolonged or extreme fatigue
• Anemia
• Kidney involvement
A rash is a common symptom of
lupus.
© Custom Medical Stock Photo/Alamy Stock Photo

28. Lupus (2 of 3)
Diagnosis of lupus
• Take note of symptoms
– Skin rash, joint pain, chest pain, seizures,
photosensitivity, review of history of medications
• Complete blood count
• Antinuclear antibody test (ANA)
• Urinalysis

29. Lupus (3 of 3)
Treatment and prevention of lupus
• Avoid sun exposure and use sunscreen
• Exercise
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Antimalarial agents
• Immunosuppressant drugs

30. Thyroid Disease
Thyroiditis: inflammation of the thyroid, the gland
controlling the body’s metabolism
Two forms
• Hypothyroidism:
underactive thyroid—
body burns energy too
quickly
• Hyperthyroidism:
overactive thyroid—
body burns energy too
slowly
Figure 11.6 Thyroiditis.

31. Risk Factors for Thyroid
Disease
• Age and gender (women older than age 20)
• Family history of a family member with thyroid
disease
• Previous thyroid concerns or conditions

32. Symptoms of Hashimoto’s
Disease and Graves’ Disease
Hashimoto’s Disease (Hypo) Graves’ Disease (Hyper)
• Weight gain • Weight loss
• Fatigue and listlessness • Increased energy expenditure
• Difficulty concentrating • Nervousness and irritability
• Dry skin • Sweating more than normal
• Sensitivity to cold • Heat intolerance
• Constipation • Diarrhea
• Goiter • Bulging of the eyes

33. Diagnosing and Treating
Thyroid Disease
Diagnosis of thyroid disease
• Thyroid-stimulating hormone (TSH) test
• Blood tests measuring levels of thyroxine (T4)
can confirm presence of disease.
Treatment and prevention of thyroid disease
• Annual checkups
• Thyroxine for Hashimoto’s disease
• Antithyroid drugs for Graves’ disease

34. Alzheimer’s Disease (1 of 4)
Alzheimer’s disease is a devastating disease that results in memory loss,
behavior and personality changes, and a decline in cognitive abilities.
© Keith Brofsky/Photodisc/Getty Images

35. Alzheimer’s Disease (2 of 4)
Risk factors for Alzheimer’s disease
• Age
• Female gender (related to women living
longer?)
• Genetic background
– Familial Alzheimer’s disease (FAD)
• Other possible factors
– Lifestyle
– Severe or repeated head injuries
– Lower education levels
– Environmental agents

36. Alzheimer’s Disease (3 of 4)
Symptoms of Alzheimer’s disease
• Memory loss
• Decline in ability to perform simple tasks
• Less clear thinking and forgetfulness
• Affected language and reasoning skills
• Lack of ability to make judgments
• Personality changes
• Emotional outbursts
• Wandering and agitation

37. Alzheimer’s Disease (4 of 4)
Diagnosis of Alzheimer’s disease
• Medical and family history; complete physical
exam; various laboratory tests; brain scans;
tests for measuring memory, language skills,
and other brain activities
Treatment of Alzheimer’s disease
• Controlling symptoms and delaying memory
loss with drugs
• Maintaining a calm, safe, structured
environment

38. Discussion: Informed Decision Making
• Prevention, when possible
• If prevention is not possible, find the disease
early, and manage it to reduce symptoms and
promote healthier living.
• Examples?
• Does anyone know anyone living with a chronic
condition? What strategies do they use?