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PubMed1990

Histomorphometry of iliac crest bone in 346 normal black and white South African adults.

We examined undecalcified transiliac bone samples from 346 normal black and white South African adults (age range 21-83 years) by routine histomorphometry. The results were analysed for race-, age- and sex-dependent characteristics of trabecular microstructure (bone volume, trabecular thickness, trabecular number, trabecular separation) and static bone turnover variables (osteoid surface, osteoid volume, osteoid thickness, erosion surface). Trabecular thickness was greater in blacks than in whites, and bone volume was greater in black males, but not in black females, than in their white counterparts. Values for osteoid surface, volume and thickness, and for erosion surface were greater in blacks than in whites. Age-related changes were: a decline in bone volume in all race/sex groups; a decline in trabecular thickness in all groups except black males; a decline in trabecular number in all groups except black females; and a rise in trabecular separation in all groups except black females. There was an increase with age in osteoid surface in all groups except white males, in osteoid volume in all groups, and in erosion surface in blacks only. When correcting for age there were no sex-dependent differences in microstructure but values of some osteoid variables were greater in males than in females. If the greater osteoid and erosion values in blacks reflect greater bone turnover, then trabecular bone in blacks would be renewed more frequently, be subjected to fewer loading cycles and be less prone to fatigue failure. Blacks may thus have trabecular bone of better quality and sturdier microarchitecture. These features could contribute to the lower spontaneous fracture rate in blacks.

Adult↗
PubMed2006

Older black women differ in calcium intake source compared to age- and socioeconomic status-matched white women.

Racial disparity in osteoporosis between older black and white women is well established; however, less is known regarding daily dietary and supplemental calcium intake in these populations. Moreover, racial differences in calcium intake are confounded by differences in socioeconomic status (SES). The objective of this study was to assess calcium intake and source in older black women (n=33) and white women (n=33), matched in age and SES. Calcium intake and source were evaluated by interview using a 46-item calcium food frequency questionnaire including all food groups and supplements. Black and white women were identical in SES and matched on age (black women 66.9+/-6.2 years vs white women 67.1+/-5.5 years [mean+/-standard deviation], P=0.85). No significant difference existed for dietary calcium intake between black and white women (974+/-524 vs 1,070+/-600 mg/day; P=0.65) or total calcium intake between black and white women (1,485+/-979 vs 1,791+/-887 mg/day; P=0.15). Dairy foods contributed most to dietary calcium intake in black and white women and differed by race (black women 402+/-269 mg/day, white women, 603+/-376 mg/day; P=0.02). Calcium intake from grains differed by race (black women 205+/-201 mg/day vs white women 130+/-234 mg/day; P=0.010) and fortified cereals were a major source of calcium for black women. Calcium supplementation contributed substantially to total calcium intake in both groups, with more white women (n=23, 70%) using supplements than black women did (n=19, 58%). However, no racial difference existed in supplemented calcium intake (black women, n=19; 889+/-605 vs white women, n=23; 1,034+/-460 mg/day; P=0.20). Our data suggest that total daily dietary and supplemental calcium intakes do not differ, but calcium intake from dairy foods and from grains differ in older black and white women matched in age and SES.

Black or African American↗
PubMed1992

Mortality among infants of black as compared with white college-educated parents.

BACKGROUND: In the United States, black infants are twice as likely to die as white infants; this difference reflects both black infants' higher rates of low birth weight and the higher mortality among black infants of normal birth weight. We studied mortality in infants born to college-educated parents in order to investigate this gap while controlling for sociodemographic variables. METHODS: We used the National Linked Birth and Infant Death Files for 1983 through 1985 to calculate infant mortality rates for children born to college-educated parents. The study population consisted of 865, 128 white infants and 42,230 black infants. A separate effect of birth weight was assessed by examining mortality rates before and after the exclusion of infants weighing less than 2500 g at birth (low-birth-weight infants). RESULTS: In this population, the infant mortality rate was 10.2 per 1000 live births for black infants and 5.4 per 1000 live births for white infants; the adjusted odds ratio for death among black infants was 1.82 (95 percent confidence interval, 1.64 to 2.01). The rate of low birth weight was more than twice as high among blacks (7 percent) as among whites (3 percent), although the mortality rate in this group was not higher among blacks than among whites. Black infants were three times as likely as white infants to die of causes attributable to perinatal events, including prematurity. They were no more likely to die of the sudden infant death syndrome. After the exclusion of low-birth-weight infants, the mortality rates for black and white infants were equal. CONCLUSIONS: In contrast to black infants in the general population, black infants born to college-educated parents have higher mortality rates than similar white infants only because of their higher rates of low birth weight. Black and white infants of normal birth weight have equivalent mortality rates.

Black or African American↗
PubMed1997

Effect of administered potassium on the renin-aldosterone axis in young blacks compared with whites.

BACKGROUND: We had observed previously that the aldosterone excretion rate and plasma aldosterone concentration were lower for black children than they were for white children. We did not know whether this was secondary to a lower intake of potassium or to suppression of the renin-angiotensin system in blacks. OBJECTIVE: To test the hypothesis that the secretion of aldosterone in response to potassium would be different in blacks than in a control group of whites. DESIGN: Black and white subjects were selected on the basis of their having aldosterone excretion rates that were in the lowest quartile for the entire original cohort. Since the blacks typically had lower aldosterone excretion rates than did the whites, the black participants were represented primarily by those with average rates of aldosterone production among blacks, whereas the whites were represented by those with the lowest aldosterone production rates among whites. The protocol consisted of a placebo-controlled, randomized cross-over study design. METHODS: Twelve blacks and 12 whites, aged 14.1 +/- 1.6 (mean +/- SD) and 15.4 +/- 2.1 years, respectively, were allocated randomly to double-blind treatment either with placebo or with 40 mmol/day potassium chloride for 7 days and then the alternate treatment Measurements of the plasma renin activity (PRA), plasma aldosterone concentration, and urinary aldosterone excretion were performed in an inpatient research unit at the end of the treatment. The blood pressure was monitored for 24 h. RESULTS: Treatment with potassium increased the plasma aldosterone concentration (P = 0.0006) and the urinary excretion of aldosterone (P = 0.0002) significantly both for blacks and for whites. There was no significant racial difference in the response to potassium. The PRA was overall 1.605-fold lower in the blacks than it was in the whites (P = 0.0124). The lowest PRA levels, such as those in the blacks when they were supine, tended to be increased with the potassium treatment. The blood pressure did not change significantly with the potassium supplement for either racial group. CONCLUSIONS: After we had supplemented the intake of potassium, aldosterone production increased in the blacks and in the control group of whites to the same extent The potassium treatment appeared to increase lower PRA levels. A lower intake of potassium could at least partially account for the suppression of the renin-aldosterone system in blacks.

Adolescent↗
PubMed1995

Methylprednisolone pharmacokinetics, cortisol response, and adverse effects in black and white renal transplant recipients.

It is generally assumed that chronic glucocorticoid therapy is similar pharmacologically when administered to either black or white renal transplant recipients, resulting in adrenal suppression, low circulating plasma cortisol concentrations, and a similar degree of drug exposure and toxicity. To examine this theory and to investigate the relationship of glucocorticoid metabolism to steroid-induced adverse effects among specific ethnic groups of renal transplant recipients, 9 black and 9 white male patients chronically receiving methylprednisolone were enrolled. All patients had stable renal function and were matched for age, weight, and time since transplant. Standard pharmacokinetic parameters for methylprednisolone were determined and cortisol responses were characterized by total cortisol area under the concentration curve (AUC), return cortisol AUC, and cortisol suppression half-life. All patients received their daily oral dose of methylprednisolone (mean daily dose = 11 mg for blacks and 11 mg for whites) as an intravenous infusion with serial plasma samples obtained over 24 h. The patients were assessed for the presence of specific cushingoid manifestations (buffalo hump, moon facies) and steroid-associated diabetes. Methylprednisolone and cortisol were analyzed via HPLC. In the black patients, the mean clearance of methylprednisolone (206 +/- 70 ml/hr/kg) was significantly slower with a smaller volume of distribution (0.95 +/- 0.32 L/kg) when compared with the white group (327 +/- 129 ml/hr/kg, P = 0.03; volume of distribution = 1.33 +/- 0.27 L/kg, P = 0.015). Despite chronic methylprednisolone therapy, a definite 24-hr cortisol response pattern was noted in 15 of the 18 patients with a mean total cortisol AUC of 732 +/- 443 ng.hr/ml in blacks and 539 +/- 361 ng.hr/ml in whites (P = 0.17, black vs. white). The mean cortisol suppression half-life was 4.31 +/- 1.54 hr in black recipients and 4.11 +/- 1.49 hr in whites (P = 0.48). The mean return cortisol AUC for the black patients was 327 +/- 279 ng.hr/ml and 370 +/- 207 ng.hr/ml for white patients (P = 0.28). The serum cortisol nadir for black patients was 12.3 +/- 7.2 ng/ml, which was significantly higher than the cortisol nadir in white patients (6.4 +/- 4.4 ng/ml; P = 0.03). A majority (94%) of patients (9 black, 8 white) had moon facies and 27% of patients (3 black, 1 white) had a buffalo hump. While 5 of 9 black patients had steroid-associated diabetes, no white patients manifested this adverse effect. The black patients with diabetes had higher cortisol AUCs with lower methylprednisolone clearances than the white group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1997

Resistance to bone resorbing effects of PTH in black women.

Black women have a lower incidence of vertebral and hip fractures than white women, possibly due to differences in skeletal and mineral metabolism. One suggested mechanism is that blacks have decreased skeletal sensitivity to parathyroid hormone (PTH). To test this hypothesis, we infused h(1-34)PTH in healthy premenopausal black (n = 15) and white (n = 18) women over 24 h and measured serum and urine indices of bone turnover and calcium metabolism throughout the infusion. At baseline, the mean 25-hydroxyvitamin D (25(OH)D) concentration was significantly lower in black women (46%). There were also nearly significant trends toward higher PTH and lower urinary calcium and pyridinoline levels in black women. During infusion, there were no racial differences in the mean (1-34)PTH levels achieved or in resultant elevations of serum calcium or 1,25-dihydroxyvitamin D (1,25(OH)2D) levels. Endogenous parathyroid suppression (measured by (1-84)PTH levels) was also similar between blacks and whites. There was an initial decline in urinary calcium/creatinine in both groups with a greater reduction in black women early in the infusion period (p < 0.05 at 8 h). Furthermore, blacks had lower levels of urinary calcium/creatinine throughout the infusion (p < 0.05 group difference). Bone formation markers (carboxy-terminal propeptide of type I procollagen and osteocalcin) decreased within 8 h and continued to decline throughout the infusion with no distinguishable racial differences (p < 0.05 time trend for both). The most dramatic difference between black and white women in response to PTH infusion was represented by the bone resorption markers. Three separate metabolites of bone resorption (cross-linked N-telopeptide of type I collagen, cross-linked C-telopeptide of type I collagen, and free pyridinoline) all showed substantially greater elevations in white (mean peak increments 399, 725, and 43%) compared with black women (mean peak increments 317, 369, and 17%) during the infusion (p < 0.05 group differences for all three variables). These data strongly suggest that blacks have decreased skeletal sensitivity to the acute resorptive effects of increased PTH. This finding indicates that calcium homeostasis may be accomplished in blacks (during times of relative calcium deficiency) by greater conservation of calcium from nonskeletal sources (most likely renal) with relative preservation of skeletal tissue. These differences in calcium economy could account, at least in part, for the increased bone mass and lower incidence of osteoporotic fractures in black women.

Adult↗
PubMed1994

Autosomal dominant polycystic kidney disease in blacks: clinical course and effects of sickle-cell hemoglobin.

Autosomal dominant polycystic kidney disease (ADPKD) is a frequent cause of ESRD, but its frequency in blacks has not been well delineated and its course and the effects of sickle hemoglobin in this disease in blacks have not been previously reported. The occurrence of ADPKD in blacks and whites was determined in two ESRD populations: all ESRD patients seen over a 16-yr period in one area of Southeast Tennessee and all ESRD patients in 15 hemodialysis units in Tennessee and Atlanta, GA. The frequency of sickle hemoglobin was determined and compared in a group of nonrelated blacks with ESRD with and without ADPKD. The age at onset of ESRD and factors that might affect ADPKD such as gender, hypertension, and hemoglobin type were examined. ADPKD was a less frequent cause of ESRD in blacks than whites (1.4 versus 6.8%). However, after adjusting for the population rate, the incidence rates in blacks and whites were similar (0.48 and 0.47 of 100,000). There was a higher incidence of sickle hemoglobin in nonrelated blacks with ADPKD versus other black ESRD patients (50 versus 7.5%; P < 0.005). Blacks had an earlier onset of ESRD than whites (43.2 versus 55.4 yr; P < 0.0001), as did blacks with sickle-cell trait versus blacks without (38.2 versus 48.1 yr; P < 0.003). In this population, hypertension and gender had no effect on the onset of ESRD. ADPKD accounted for a smaller percentage of blacks than whites with ESRD because of the high percentage of blacks with renal disease from other causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

The mental health of Black Caribbean immigrants: results from the National Survey of American Life.

OBJECTIVES: We examined the prevalence of psychiatric disorders among Black Caribbean immigrant ("Caribbean Black") and African American populations and the correlates of psychiatric disorders among the Caribbean Black population. METHODS: We conducted descriptive and age-adjusted analyses of the data from the National Survey of American Life--an in-person household mental health survey of noninstitutionalized US Blacks. We assessed psychiatric disorders as defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria with the Composite International Diagnostic Interview. RESULTS: Compared with African American men, Caribbean Black men had higher risks for 12-month rates of psychiatric disorders. Caribbean Black women had lower odds for 12-month and lifetime psychiatric disorders compared with African American women. Risks varied by ethnicity, immigration history, and generation status within the Caribbean sample. First-generation Caribbean Blacks had lower rates of psychiatric disorders compared with second- or third-generation Caribbean Blacks, and, compared with first-generation Caribbean Blacks, third-generation Caribbean Blacks had markedly elevated rates of psychiatric disorders. CONCLUSIONS: Mental health risks were associated with ethnic diversity within the US Black population. Increased exposure to minority status in the United States was associated with higher risks for psychiatric disorders among Black Caribbean immigrants, which possibly reflects increased societal stress and downward social mobility associated with being Black in America.

Adolescent↗
PubMed1992

Left ventricular hypertrophy in black and white hypertensives. Standard electrocardiographic criteria overestimate racial differences in prevalence.

OBJECTIVE: To assess racial differences in the accuracy of standard electrocardiographic (ECG) criteria in the diagnosis of left ventricular hypertrophy (LVH). DESIGN: The sensitivity and specificity of standard ECG criteria were compared in blacks and whites using echocardiographic LVH as the reference standard. SETTING: Eight worksite-based hypertension clinics in New York, NY. PATIENTS: A sample of 122 black and 148 white hypertensive patients. RESULTS: The prevalence of ECG-LVH was two to six times higher in blacks than in whites, depending on the criteria used (range, 6% to 24% in blacks vs 1% to 7% in whites; P = .0005 to .19 for black-white comparisons). The difference in prevalence of echocardiographic LVH [corrected], however, was less striking and did not attain statistical significance (26% in blacks and 20% in whites; P greater than .2). The sensitivity of the ECG was low (range, 3% to 17%) and did not differ significantly between the two races for any of the conventional criteria; specificity, however, was lower in blacks for all criteria (range, 73% to 94% vs 95% to 100% for whites; P = .0001 to .09). The predictive value of a positive ECG was consistently, although not significantly, lower in the black subjects. Black race was the strongest independent predictor of decreased ECG specificity in multiple logistic regression analysis that also considered age, gender, body mass index, left ventricular mass index, and smoking. CONCLUSIONS: Commonly used ECG criteria for the detection of LVH have a poor sensitivity in both black and white hypertensives and a lower specificity in blacks than in whites; this may lead to a greater number of false-positive diagnoses in black patients, as well as to an overestimation of black-white difference in LVH prevalence.

Black People↗
PubMedDate not supplied

Cigarette advertising and black-white differences in brand preference.

Anecdotal evidence indicates that the cigarette industry is targeting the sale of specific brands, notably menthol cigarettes, to black consumers. This paper presents data on the types of cigarettes smoked by white and black smokers. The cigarette brand preferences of two populations of smokers were examined. The first comprised 70 white and 365 black adult smokers seen at the Deaconness Family Medicine Center located in Buffalo, NY. The second population included 1,070 white and 92 black smokers who called a Stop Smoking Hotline in Buffalo. The results showed that, in both populations, blacks were twice as likely to smoke mentholated cigarettes compared with whites. In an attempt to evaluate the targeting of cigarette ads to black smokers as a possible explanation for black-white differences in brand preferences, cigarette ads appearing in magazines targeted to predominantly white or black readers were compared. Cigarette ads appearing in seven magazines were reviewed, four directed to predominantly white readers (Newsweek, Time, People, Mademoiselle) and three with wide circulation among black audiences (Jet, Ebony, Essence). The results showed that the magazines targeted to black readers contained significantly more cigarette ads and more ads for menthol brand cigarettes than magazines similar in content but targeted to white readers. The observation that a higher percentage of blacks smoke menthol cigarettes than do whites is consistent with the findings regarding differences in the type of cigarette ads appearing in magazines intended for black or white readers. However, it is not possible to determine from this study whether cigarette advertising is the cause of the differences in preference of cigarette brands between white and black smokers. Future research focusing on understanding the reasons for cigarette brand preferences may provide ideas for anti smoking campaigns aimed at specific target groups.

Adolescent↗
PubMed1994

Homicide among black males in Jefferson County, Alabama 1978-1989.

This study examined 1505 of 1573 (96%) homicides occurring in Jefferson County, Alabama, between 1978 and 1989, that were investigated by the Coroner/Medical Examiners' Office. During this 12 year period, Jefferson County's average annual homicide rate was 18.9 per 100,000 compared to an 11.3 per 100,000 State of Alabama's rate and a 9.3 per 100,000 US rate. In Jefferson County, the average annual homicide rate among blacks (41.4) was almost six times the rate among whites (7.1). The highest average annual race-specific homicide rate was in black males (75.9), followed by black females (12.4), white males (10.4) and white females (4.1). Black males in the 25-34 year age group had the highest rate (159.7), followed by black males in the 35-44 year age group (151.7) and then by black males in the 15-24 year age group (96.2). These rates ranged from almost eight to over eleven times the rates of similarly aged, black females or white males and were over 33 times higher than the rates for white females of the same age. Our results emphasize the high rates of black male on black male violence, the acquaintance of the black male victim and perpetrator, and the importance of arguments as an inciting event. Moreover, we determined that while the raw numbers and rates for black homicides were and are staggering, the average annual homicide rate for black males was actually declining at a greater rate than for all other race-sex groups. Further, our results suggest that a number of hypothesized determinants commonly believed to be associated with the increase in the homicide rate among black males between 15 and 24 years of age, such as drug use, increased availability of firearms and increased child abuse were not, in fact, major determinants of the change in homicide rates.

Adolescent↗
PubMed1997

Epiluminescence videomicroscopy: black dots and brown globules revisited by stripping the stratum corneum.

BACKGROUND: The pattern and distribution of several elementary structures, such as black dots and brown globules, observed by epiluminescence microscopy (ELM) are valuable to the diagnosis of pigmented lesions. Black dots are considered to be focal accumulations of melanin in the stratum corneum, and brown globules are thought to be clusters of nevocytes at the dermoepidermal junction. Because of their distinct locations within the layers of the skin, black dots might be removed by stripping of the stratum corneum whereas brown globules should not. OBJECTIVE: Our purpose was to evaluate the efficacy of ELM features to identify brown globules and black dots and to analyze the relation of these structures within the pigmented network. METHOD: The distribution and number of black dots and brown globules from 27 benign melanocytic lesions were analyzed by videomicroscopy before and after a stripping procedure. Several lesions were observed for months to see whether the pattern before stripping is reconstituted. RESULTS: Before stripping, 549 black dots and 214 brown globules were identified by means of three criteria: color, contour, and size. Ninety-eight percent of black dots were superimposed on the gridlines of the pigmented network. Stripping removed 56% of black dots and only 10% of brown globules. Eighty-two percent of the black dots that could be stripped were superimposed on the gridlines of the pigmented network. On follow-up, both black dots and brown globule-like structures previously removed by stripping were restored at their initial locations within a few months after stripping. CONCLUSION: The close association of black dots with the gridlines of pigmented network should be taken as one criterion to identify black dots. Half the structures identified as black dots by ELM are not localized in the stratum corneum but rather correspond to vertical stacking of pigment within the epidermis. Accumulation of melanosomes in the stratum corneum may take the appearance of brown globules.

Humans↗
PubMed2003

Black cohosh acts as a mixed competitive ligand and partial agonist of the serotonin receptor.

Extracts of the rhizome of black cohosh [Actaea racemosa L., formerly called Cimicifuga racemosa (L.) Nutt.] were evaluated for potential mechanisms of action in the alleviation of menopausal hot flashes. Ovariectomized Sprague-Dawley rats were administered a 40% 2-propanol extract of black cohosh [4, 40, and 400 mg/(kg.day)] by gavage for 2 weeks with or without estradiol [50 microg/(kg.day)] to determine if black cohosh could act as an estrogen or antiestrogen on the basis of an increase in uterine weight or vaginal cellular cornification. No effects were observed on uterine weight or on vaginal cellular cornification in rats treated with black cohosh alone or in combination with 17beta-estradiol, indicating this black cohosh extract had no estrogenic or antiestrogenic properties in the ovariectomized rat model. To evaluate other potential pathways by which black cohosh might reduce menopausal hot flashes, serotonin activity was first assessed by the inhibition of radioligand binding to cell membrane preparations containing recombinant human serotonin receptor (5-HT) subtypes. A 40% 2-propanol extract of black cohosh was tested against 10 subtypes of the serotonin receptor, revealing the presence of compounds with strong binding to the 5-HT(1A), 5-HT(1D), and 5-HT(7) subtypes. Subsequent binding studies were carried out using 5-HT(1A) and 5-HT(7) receptors because of their association with the hypothalamus, which has been implicated in the generation of hot flashes. The black cohosh 40% 2-propanol extract inhibited [(3)H]lysergic acid diethylamide (LSD) binding to the human 5-HT(7) receptor (IC(50) = 2.4 +/- 0.4 microg/mL) with greater potency than binding of [(3)H]-8-hydroxy-2-(di-N-propylamino)tetralin to the rat 5-HT(1A) receptor (IC(50) = 13.9 +/- 0.6 microg/mL). Analysis of ligand binding data indicated that components of a black cohosh methanol extract functioned as a mixed competitive ligand of the 5-HT(7) receptor. In addition, a black cohosh methanol extract elevated cAMP levels in 293T-5-HT(7)-transfected HEK cells, suggesting the extract acted as a partial agonist at the receptor. The elevation in cAMP mediated by the black cohosh extract could be reversed in the presence of the antagonist methiothepin, indicating a receptor-mediated process. These data suggest that reductions in hot flashes in some women taking black cohosh may not be due to estrogenic properties. This study identifies other possible biological targets of black cohosh that could account for reported biological effects.

Animals↗
PubMed1997

Influence of nativity on cancer mortality among black New Yorkers.

BACKGROUND: Cancer is the second leading cause of death in U. S., and blacks have higher cancer death rates than whites. The authors conducted an analysis to determine the influence of birthplace on cancer mortality among blacks in New York City. METHODS: Death records for New York City from 1988 through 1992 were linked to the 1990 U. S. Census data. Age-adjusted cancer death rates by race and birthplace were computed. The experience of black residents born in the South and Northeast of the U. S. and in Caribbean countries were compared with that of New York City whites. RESULTS: The cancer mortality rate of blacks exceeded that of whites for males (512.6 vs. 385.6 per 100,000 per year), but was similar for females (270.8 vs. 270.6). However, cancer death rates of Southern-born black males (615.7) were substantially higher than those of black males born in the Northeast (419.1) or the Caribbean (352.4). Carcinomas of the lung, prostate, breast, and colon/rectum accounted for >50% of all cancer deaths. Lung carcinoma mortality varied greatly by birthplace, with Caribbean-born blacks (63.5 and 19.2 for males and females, respectively) having approximately one-third the death rates of Southern-born blacks (187.8 and 52.5 for males and females, respectively), and <50% that of New York City whites (108.7 and 53.2 for males and females, respectively). These differences were present in each age category, but were most pronounced among those age 45-64 years. In striking contrast, death rates from prostate carcinoma were highest in Caribbean-born black men, and this was especially apparent in persons age > or = 65 years. CONCLUSIONS: The generally higher cancer mortality of blacks compared with whites masks even greater intraracial heterogeneity revealed through stratification by birthplace. In general, Caribbean-born blacks are at lower risk of cancer mortality than other blacks, and whites, but their advantage does not hold for prostate carcinoma, for which Caribbean-born men had the highest mortality rate.

Adult↗
PubMed1982

Cancer among blacks in Newark, New Jersey, 1970-1976: a national and international comparison.

Newark black men had age-adjusted cancer rates comparable to those of Washington, D. C., but lower than the other three American city blacks. Rates for Newark black women were generally similar to other American black women. American blacks, like those of Newark, had cancer rates higher than the African blacks in three out of four countries studied. Only blacks of Rhodesia had cancer experience like that of American blacks. Except for cancer of the cervix, the African blacks had generally lower rates compared to the American blacks for the ten sites investigated. However, high rates did occur for certain sites, e.g., esophagus and bladder cancers in Bulawayo, Rhodesia. Newark blacks also had higher rates for certain sites (prostate, lung, breast and cervix) compared to Washington, D. C., and certain other U. S. cities. Thus, the total risk of malignancies to develop among Newark blacks was no greater than that expected, based upon the four U. S. cities' experience.

Adolescent↗
PubMed1990

Validation of reported myocardial infarction mortality in blacks and whites. A report from the Community Cardiovascular Surveillance Program.

It is widely believed that blacks experience a higher mortality due to coronary heart disease (CHD) than do whites. To determine whether this reported difference in mortality between blacks and whites is real, we studied the question in the context of the Community Cardiovascular Surveillance Program (CCSP). Fatal and nonfatal cases of CHD were reviewed in 12 US communities. Standardized criteria were applied to classify these cases as possible CHD, definite CHD, possible myocardial infarction (MI), or definite MI. The annual age-adjusted mortality rate per 100,000 ascribed to definite MI by the CCSP criteria was higher in blacks than in whites: 47 in white men (95% confidence interval, 36 to 58), 18 in white women (95% confidence interval, 8 to 28), 95 in black men (95% confidence interval, 10 to 180), and 41 for black women (95% confidence interval, 0 to 99). The proportion of definite MI to all fatal CHD events was higher in blacks (16%) than in whites (12%). For nonfatal events, however, the rate of definite MI was higher in whites than in blacks: 322 in white men (95% confidence interval, 293 to 351), 225 in black men (95% confidence interval, 160 to 290), 82 in black women (95% confidence interval, 43 to 121), and 103 in white women (95% confidence interval, 88 to 118). The proportion of definite MI to all nonfatal CHD events was lower in blacks (16%) than in whites (30%). Thus, the overall rate for fatal and nonfatal definite MI was lower in blacks (215/100,000) than in whites (244/100,000). These observations suggest that a combination of high case-fatality ratio and misclassification of cause and death may contribute to the reported higher rate of CHD mortality among blacks.

Adult↗
PubMed1993

Low birthweight in twins: black and white differences.

Washington State birth certificate data for the years 1984-1988 were analyzed for 2,804 mothers of twins in order to determine whether black mothers of twins have a higher risk of delivering a low birthweight twin infant than white mothers. Seventy four percent of black mothers of twins gave birth to an infant weighing < 2500 grams (white 52.9%), while slightly less than 20% gave birth to an infant weighing < 1500 grams (white 9.4%). After adjustment for maternal age, parity and marital status, the risk of black mothers giving birth to at least one twin infant < 2500 grams relative to white mothers was 1.3 (95% confidence interval, 1.2, 1.5). When this analysis was restricted to very low birthweight babies (< 1500 grams), the relative risk for infants of black mothers compared to white mothers adjusted for the same factors was 2.1 (95% confidence interval, 1.5, 3.0). The frequency of neonatal mortality in the study population was also assessed. The overall frequency of mortality in black twin infants was double that in white twin infants. When stratified by birthweight category, the frequency was higher in white infants (30.2%) than in black infants (24.1%) weighing less than 1500 grams at birth. However, within higher birthweight categories, (> or = 1500 grams to < 2500 grams and > 2500 grams), relative frequencies of neonatal mortality were higher in black infants. This analysis reveals that black mothers of twins are more likely to deliver low birthweight twin infants than white mothers. The increased risk is even more pronounced in very low birthweight twin pairs. However, the additional risks for low birthweight black twin pairs and very low birthweight twin pairs found in this study are lower than the risk increase commonly reported for the respective birthweight categories in black singleton infants relative to white singleton infants. This implies that while black twin pregnancies require many of the same special antepartum considerations given to black singleton pregnancies, the increased baseline risks associated with low birthweight and very low birthweight twin deliveries offset racial disparities traditionally seen in singleton infants.

Adolescent↗
PubMed1998

Cause-specific trends in neonatal mortality among black and white infants, United States, 1980-1995.

OBJECTIVE: Although neonatal mortality has been declining more rapidly than postneonatal mortality in recent decades, neonatal mortality continues to account for close to two-thirds of all infant deaths. This report uses U.S. vital statistics data to describe national trends in the major causes of neonatal mortality among black and white infants from 1980 to 1995. METHODS: Mortality rates were estimated as the number of deaths due to each cause (based on International Classification of Diseases, 9th Revision, codes) divided by the number of live births during the same time period. Linear regression models and smoothed rates were used to describe trends. RESULTS: During the study period, neonatal mortality declined 4.0% per year for white infants and 2.2% per year for black infants, and the black-white gap increased from 2.0 to 2.4. By 1995, disorders relating to short gestation and low birth weight were the number one cause of neonatal death for black infants and the number two cause for white infants, had the highest black-white disparity (4.6, up from 3.3 in 1980), and accounted for almost 40% of excess deaths to black infants (up from 24% in 1980). Congenital anomalies were the number two cause of neonatal death for black infants and the highest ranked cause for white infants in 1995, and it is the only cause for which there was not a substantial excess risk to black infants. CONCLUSIONS: Large declines in neonatal mortality have been achieved in recent years, but not in the black-white gap, which has increased. Declines were slower for black than white infants overall and for almost all causes. Prevention of preterm delivery and low birth weight continue to be a priority for reducing neonatal mortality, particularly among black infants. Although congenital anomalies do not contribute substantially to the black-white gap, their diagnosis, treatment, and prevention is critical to reducing overall neonatal mortality.

Black People↗