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PubMed2002

Racial differences in psychotic symptoms among combat veterans with PTSD.

We tested the hypothesis that race may influence clinical presentation and symptomatology in combat veterans with posttraumatic stress disorder (PTSD). African-American and Caucasian veterans were administered the Psychotic Screen Module of the Structured Clinical Interview for DSM, Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and other psychometric measures at a Veterans Affairs outpatient PTSD clinic. Subjects were consecutive referrals who were not matched for level of combat trauma or preexisting trauma; however, there were no group differences in other relevant demographic or diagnostic variables. Significant racial differences, with modest effect sizes, were found on clinician ratings of psychotic symptoms, MMPI-2 scale 6 ("paranoia"), and a measure of dissociation. No significant differences were found for the MMPI-2 scale 8 ("schizophrenia"), or on measures that might suggest comorbid depression or anxiety. African-Americans with PTSD endorsed more items suggesting positive symptoms of psychosis, without higher rates of primary psychosis, depression, or anxiety than Caucasians.

Comorbidity↗
PubMed2005

Racial differences in glaucoma care: the longitudinal pattern of care.

OBJECTIVE: To examine if racial differences exist in longitudinal care patterns for Medicare beneficiaries with glaucoma. METHODS: We analyzed national longitudinal Medicare claims data from January 1, 1991, through December 31, 1999 in 21 644 Medicare beneficiaries linked to the National Long-Term Care Survey. Logistic regression was used to predict whether a person underwent an eye examination or eye surgery during the year, and negative binomial regression was used to predict the number of eye examinations and surgical procedures for glaucoma per year. Annual use of eye examinations was nearly identical for black persons (1.85 per year) and white persons (1.89 per year), whereas surgery rates were higher among blacks (0.15) than whites (0.08, P<.001). RESULTS: Blacks were more likely than whites to have glaucoma diagnosed, but rates among whites were higher than in prior population-based studies. When we controlled for other factors, blacks were not significantly less likely to undergo eye examination during the year; however, blacks were 78% more likely to undergo surgery (P < .001) and had 76% higher rates of surgical procedures (P < .001). CONCLUSIONS: No systematic pattern was found of underuse among blacks relative to whites after glaucoma diagnosis. Higher rates of surgery among blacks may indicate delayed onset of care and/or greater disease severity.

Black People↗
PubMed1985

Is there a racial difference in physiologic cup size?

Although many clinicians believe that there is a racial difference in the size of the physiologic cup, this premise has not been studied. To evaluate this, we prospectively examined 100 black and 100 white volunteers. Stereoscopic optic disc photographs taken of each subject were masked to block out the fundus pigmentation, randomized, and then evaluated by an experienced clinician. The average cup/disc ratio in blacks (0.35) was significantly greater (P less than 0.0001) than that in whites (0.24) for both right and left eyes. Forty percent of the optic discs of blacks and 14% of the optic discs of whites had a cup/disc ratio greater than or equal to 0.4.

Adult↗
PubMed1998

Racial differences in ambulatory blood pressure and echocardiographic left ventricular geometry.

We examined the racial differences in left ventricular (LV) geometric pattern in relation to 24-hour ambulatory blood pressure (BP) monitoring and the presence or absence of a nocturnal BP dip. Our study confirms the blunting of nocturnal BP dip among black hypertensives. Body mass index, rather than race, was a major determinant of left ventricular hypertrophy. We did not observe a difference in prevalence of left ventricular hypertrophy by race. However, left ventricular adaptation to hypertension differed in hypertensive black and white individuals; whereas most of the white patients with Stage 1-2 hypertension had a normal ventricular pattern, LV concentric remodeling and concentric hypertrophy were the most common adaptive ventricular patterns in blacks with Stage 1-2 hypertension. A six-fold higher prevalence of concentric remodeling was observed in blacks as compared with whites. The impaired nocturnal BP dip in blacks may contribute to the different hemodynamic pattern. Determinants of myocardial oxygen consumption were significantly higher in black hypertensives.

Black People↗
PubMed2001

Ischemic stroke outcome: racial differences in the trial of danaparoid in acute stroke (TOAST).

OBJECTIVE: To determine racial differences in baseline stroke risk factors and other measures in the Trial of ORG 10172 in Acute Stroke Therapy (TOAST). Differences in these factors could influence response to acute stroke therapy and overall stroke outcome. METHODS: The authors compared baseline demographic, medical, stroke, physical examination, CT, laboratory, and neurologic factors among 292 African-American and 801 white patients who enrolled in the TOAST study. TOAST compared danaparoid (ORG 10172) with placebo among acute ischemic stroke patients who were treated within 24 hours of stroke onset. RESULTS: African-Americans were younger and more frequently had hypertension, diabetes mellitus, congestive heart failure, and prior strokes. In addition, African-Americans had higher mean diastolic blood pressure, more lacunar strokes, and more severe prestroke disability. There were no significant differences between African-Americans and white patients in outcomes at 7 days, overall number of adverse experiences, or occurrence of serious bleeds or hemorrhagic transformations. However, there was a trend toward a higher rate of favorable outcomes in white patients at 7 days. There was no significant difference in very favorable outcome at 3 months between African-American and white patients, but significantly more white patients had favorable outcome at 3 months. CONCLUSION: Although African-Americans possess a number of factors that should predict higher rates of poor stroke outcome after acute therapy, they have the capacity to respond similarly to white patients after acute stroke therapy. Perhaps younger age and presence of lacunar infarction are stronger predictors of good outcomes than was appreciated previously.

Anticoagulants↗
PubMed1991

What factors explain racial differences in lung volumes?

In order to examine the physical characteristics that may determine racial differences in lung volumes, we studied healthy, nonsmoking Caucasian, Chinese and Indian males of similar ages (range 18-51 yrs). We measured spirometric function, flow volume curves, lung volumes, inspiratory and expiratory muscle pressures, alveolar distensibility and diffusing capacity, together with height, weight and fat free mass. Chest shape was measured using radiographs. The mean total lung capacity and vital capacity in the Caucasian group, expressed as percentage predicted, were 5 and 10% higher than in the Chinese group and 17 and 20% higher than in the Indian group. Chinese values for these measurements were 12 and 10% greater than Indian. We found that Caucasians had higher fat free masses, higher inspiratory and expiratory muscle pressures and wider chests than the other races. The Caucasians and Chinese had longer chests than the Indians. There was no difference in alveolar distensibility or in the diffusion coefficient between the groups. These findings suggest that Caucasians have larger lung volumes than Chinese and Indians because they have increased numbers of alveoli and physically larger chest cavities, and not because of greater alveolar distensibility. Chest dimensions, together with height and race explained 90% of the variation in forced vital capacity and 86% of the variation in total lung capacity. Height multiplied by fat free mass, a "physique factor", previously suggested as the best predictive factor for forced vital capacity in Caucasians, did not account for much of the variation in forced vital capacity between Caucasians and Indians, presumably because it takes no account of differences in chest dimensions.

Adolescent↗
PubMed1984

Racial differences in susceptibility to tuberculosis: risk of disease after infection.

It is generally believed that certain racial groups are highly susceptible to tuberculosis disease while others have developed a "natural resistance." Epidemiological studies reporting differences in case rates among different racial groups, provide inconclusive evidence. Many factors influence the development of active tuberculosis including sex, age, body weight, and virulence of the infecting organism. These, as well as other factors, may be more important determinants which, up to now, have been confused with race.

Adolescent↗
PubMed1979

Racial differences of parameters associated with blood pressure levels in children--the Bogalusa heart study.

Racial differences in prevalence of essential hypertension are well known. In order to explore these differences at an early age in terms of etiology, we investigated schoolchildren in an entire, biracial community. A sample of 278 children, stratified by diastolic (fourth-phase) blood pressure and specific for age, race, and sex, was reexamined 1--2 yr after initial observation for the following: (1) a physical examination and urinalysis to exclude secondary hypertension; (2) 24-hr urine sodium, potassium, plasma renin activity, and serum dopamine beta-hydroxylase; (3) 1-hr oral glucose tolerance test; and (4) heart rate and blood pressure at rest and under standarized physical stress. We found that 24-hr urine sodium was positively associated with blood pressure level as measured on the same day for the high blood pressure strata of black children. Urine potassium excretion was lower in blacks than in whites, although their intakes seemed equal. In the high blood pressure strata especially, black boys had lower renin activity than whites, and the resting-supine and stressed systolic blood pressures were higher in black boys than in any other group. In these black boys, resting and stressed systolic pressures were negatively related to plasma renin activity. On the other hand, dopamine beta-hydroxylase levels in white children were higher than in blacks for all blood pressure strata, and in the high blood pressure strata white children had higher 1-hr glucose levels and faster resting heart rates than black children. Different mechanisms may play a role in and contribute to the early stage of essential hypertension.

Adolescent↗
PubMed2000

Racial differences in adolescents' perceived vulnerability to disease and injury.

This study examined gender and racial differences in adolescents' risk perceptions of major diseases and motor vehicle injury and whether these perceptions agree with national mortality rates and parental health history. Adolescent (N = 135; 55% African-American) boys and girls reported on their chances compared to other adolescents of developing specific diseases or experiencing a motor vehicle injury and their knowledge of parental health history. Logistic regression models revealed that girls' risk perceptions were similar to boys' ratings even though females are at less risk than males per national figures. Caucasian adolescents inaccurately perceived that they were at significantly greater risk than African-American peers for motor vehicle injury, stroke, cancer, and heart attack. Adolescents' knowledge of a father's diabetes was predictive of greater perceived vulnerability to diabetes.

Accidents, Traffic↗
PubMed2004

Racial differences in lipid-lowering agent use in medicaid patients with cardiovascular disease.

BACKGROUND: Racial differences in chronic cardiovascular disease (CVD) outcomes are well described, whereas less is known about the process of CVD preventive care and its potential contribution to disparate outcomes. OBJECTIVE: The objective of this study was to examine the association between race and 1) prior use of a lipid-lowering agent (LLA), 2) LLA initiation, and 3) LLA discontinuation among individuals with an incident medical claim for CVD. RESEARCH DESIGN: Retrospective claims analysis. SUBJECTS: We studied continuously enrolled, fee-for-service Medicaid recipients <65 with a new medical claim for 1 of 15 CVD-related diagnoses or procedures from 1993 to 1998 (n = 14,833). MEASURES: Pharmacy claims history reflecting previous, new, and ongoing LLA use were reviewed for the 24-month period around a new CVD claim. Multivariable logistic regression assessed the independent effect of minority status on new and ongoing LLA use controlling for clinical and demographic characteristics. RESULTS: A total of 3924 (26.4%) individuals submitted LLA pharmacy claims. A total of 3668 of 4668 (78.6%) previous or new users obtained > or =1 refill. Minorities were less likely to have previously used LLA (adjusted odds ratio [AOR], 0.64; 95% confidence interval [CI], 0.58-0.70), to receive a new prescription (AOR, 0.62; 95% CI, 0.54-0.71), or to continue use, as evidenced by subsequent refill claims (AOR, 0.74; 95% CI, 0.62-0.87). CONCLUSIONS: Publicly insured minorities with prescription coverage benefit less often from preventive care before or after a CVD diagnosis, resulting, in part, from providers' failure to initiate therapy and patients' failure to continue it. To reduce widening disparities in cardiovascular outcomes, strategies that target LLA underuse by minorities throughout the process of care are needed.

Adult↗
PubMed1994

Racial differences in the distribution of systemic sclerosis-related serum antinuclear antibodies.

OBJECTIVE: To determine racial differences in the frequencies of systemic sclerosis (SSc)-related serum antinuclear antibodies (ANA). METHODS: We tested serum samples from 275 Japanese, 416 North American Caucasian, and 24 North American black SSc patients for 8 SSc-related serum ANA, using indirect immunofluorescence, double immunodiffusion, and radioimmunoprecipitation assays. RESULTS: In comparing the 3 racial groups, we found that anti-U1 RNP, anti-RNA polymerase I, II, and III, and anti-U3 RNP antibodies were the most frequently detected antibodies in Japanese, Caucasian, and black patients, respectively. Anti-PM-Scl antibody was found exclusively in Caucasians. CONCLUSION: The production of SSc-related serum ANA is related to immunogenetic background.

Antibodies, Antinuclear↗
PubMedDate not supplied

Acetabular depth and race in young adults: a potential explanation of the differences in the prevalence of slipped capital femoral epiphysis between different racial groups?

Slipped capital femoral epiphysis (SCFE) is known to have a higher prevalence in blacks and Polynesians. It has been postulated that a deeper acetabulum increases the shearing forces on the proximal femoral physis, resulting in a higher incidence of SCFE. It was the purpose of this study to investigate acetabular depth in the normal adult population as a function of race. Anteroposterior pelvis radiographs from young polytrauma adults (<35 years) were identified. Race was classified according as white, black, Amerindian (Hispanic and Native American), and Asian. Acetabular depth was measured by Visser's modification of the center-edge (CE) angle and Sharp's angle. All measurements were made by one observer with the same goniometer and Mose circle. There were 167 patients with an average age of 24 +/- 4 years; there were 65 female (39%) and 102 male (61%) patients. There were 57 (34%) Amerindian, 50 (30%) white, 47 (28%) black, and 13 (8%) Asian people. The CE angle was 30.6 +/- 4.8 degrees for the Asian, 28.7 +/- 5.7 degrees for the black, 30.3 +/- 5.1 degrees for the Amerindian, and 28.0 +/- 4.3 degrees for the white racial groups. Sharp's angle was 39.8 +/- 3.0 degrees for the Asian, 39.9 +/- 3.6 degrees for the black, 37.4 +/- 3.4 degrees for the Amerindian, and 39.2 +/- 3.2 degrees for the white racial groups. These differences by race were statistically significant for both Sharp's and Visser's angles. If racial variation in acetabular depth is an explanation for the racial variability of SCFE, then the CE and Sharp's angle should vary by race. In this study of healthy adults without any underlying hip pathology, racial variability in the CE or Sharp's angle did not follow the racial prevalence of SCFE.

Acetabulum↗
PubMed1991

Sodium excretion and racial differences in ambulatory blood pressure patterns.

The influence of Na+ excretion and race on casual blood pressure and ambulatory blood pressure patterns was examined in a biracial sample of healthy, normotensive children and adolescents (10-18 years; n = 140). The slopes relating 24-hour urinary Na+ excretion to systolic blood pressure were different for both black and white subjects for casual blood pressure (p less than 0.001) and blood pressure during sleep (p less than 0.03). For casual blood pressure, the slope was significant for black subjects (beta = 0.17; p less than 0.001) but not for white subjects. For blood pressure during sleep, the slope was again significant for black subjects (beta = 0.08; p less than 0.01) but not for white subjects. Na+ excretion was also related to awake levels of systolic blood pressure for black subjects (beta = 0.08, r = 0.36; p less than 0.01), although the slopes for both black and white subjects were not significantly different. Further analyses indicated the results were not due to racial differences in 24-hour urinary K+ excretion. However, plasma renin activity was marginally related to Na+ excretion in white subjects (r = 0.22; p less than 0.06) but not black subjects, a finding that is consistent with previous studies. Na+ excretion was not associated with diastolic blood pressure or heart rate in either group under any condition. The results of this study support research that has demonstrated a stronger relation between Na+ handling and casual blood pressure in black subjects and extend these findings to blood pressure while the subject is both awake and asleep.

Adolescent↗
PubMed1983

Racial differences in cardiac adaptation to essential hypertension determined by echocardiographic indexes.

Epidemiologic data point to racial differences in cardiac adaptation to hypertension. In this study, echocardiography and measurement of systemic hemodynamics were performed in 30 black and 30 white patients with untreated essential hypertension. Each black patient was matched with a white patient for age, sex and mean arterial pressure. Wall thickness measurements were similar, but left ventricular mass index was significantly increased in blacks (probability [p] less than 0.05). There was a nonsignificant increase in the number of black patients with posterior wall thickness greater than 1.1 cm. Only in black patients was posterior wall thickness related to systolic (r = 0.45; p = 0.008) and diastolic (r = 0.44; p = 0.0042) pressure and to total peripheral resistance (r = 0.32; p less than 0.046). Thus, although ventricular wall thickness changes are similar in black and white patients, qualitative differences exist in the cardiac adaptive process to systemic hypertension.

Adaptation, Physiological↗
PubMed1997

Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center.

Racial differences have recently been described in hospital practice, most notably with regard to cardiac procedure utilization. To evaluate the possible reasons behind these differences, we analyzed statistics generated from a surgical referral conference at a large, tertiary care Veterans Affairs hospital between the years 1988 and 1996. In this setting, there is no financial incentive for physicians to recommend or perform invasive procedures, as all physicians are salaried employees of the Veterans Administration. Furthermore, all patients presented at conference have already had cardiac catheterization and are felt to be potential candidates for surgery or angioplasty. Cardiac therapeutic procedures (surgery or percutaneous transluminal coronary angioplasty) were recommended for 1075 of 1474 (72.9%) Caucasian patients and 207 of 322 (64.3%) African-American patients (odds ratio 1.497, 95% confidence interval 1.160 to 1.932, p = 0.0022). Of those patients presented with the option of an invasive procedure, 32 of 207 (15.4%) African-American patients and 89 of 1075 (8.3%) Caucasian patients refused any invasive procedure (odds ratio 2.026, 95% confidence interval 1.311 to 3.130, p = 0.0025). We conclude that reluctance by African-American patients to undergo invasive cardiac procedures may help explain observed disparities in race-related cardiac care.

Black or African American↗
PubMed2000

Racial differences in self-disclosure of suicidal ideation and reasons for living: implications for training.

Racial differences in suicidal self-disclosure and reasons for living were investigated in 2 separate studies. In Study 1, a random sample of archival client and therapist intake data from a university counseling center for 1 year was examined, and results indicate that ethnic minority clients do not self-disclose suicidal ideation as readily as their nonethnic minority peers. In addition, a significantly higher number of ethnic minority clients were deemed "hidden ideators" because their suicidal ideation only became evident when a counselor performed a suicide risk assessment. Only 1 of the 36 ethnic minority clients with suicidal ideation in the sample voluntarily self-disclosed this ideation at intake without an assessment by the therapist. Study 2 used the Reasons for Living Inventory (RFL) and compared African American and European American college students from an introductory psychology course. The RFL is a useful instrument to compare potential race differences in reasons people report for choosing not to kill themselves, because it does not require respondents to self-disclose (or to have) current suicidal ideation. The results from Study 2 indicate European Americans report fewer reasons for choosing not to kill themselves than their African American peers and that African Americans scored significantly higher than European Americans on the moral objections and survival and coping beliefs subscales of the RFL. Implications for training counselors in suicide risk assessment, prevention, and treatment with ethnic minorities are discussed.

Adaptation, Psychological↗
PubMed1995

Racial differences in nasal fossa dimensions determined by acoustic rhinometry.

Sixty acoustic rhinographs from subjects of three different ethnic groups (Caucasian [Europeans], Negro, and Oriental) were examined at baseline and after decongestion. The main parameters analysed were minimal cross-sectional area (MCA), the distance at which this occurred (D), nasal volume at 0-4 cm (Vol), mean cross-sectional area at 0-6 cm (MA), and the cross-sectional area at 10 points in the nose (0, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, and 6 cm) analysed as a series (A). Values from left and right were combined and mean values used. Analysis was carried out using multiple linear regression and grouped linear regression with analysis of covariance and, for A, multifactorial analysis of variance. For MCA, race was the main determining factor with Orientals and Caucasians significantly lower than Negroes: p<0.0001 (corrected means and 95% confidence intervals [c.i.]: Orientals: 0.63 cm2, 0.55-0.71 cm2; Caucasians: 0.69 cm2, 0.62-0.77 cm2; Negroes: 0.87 cm2, 0.79-0.95 cm2). Height alone correlated with D in the decongested state (p<0.0001); race as well as height in non-decongested noses (p = 0.018). There were significant racial differences in Vol in both decongested (p = 0.014), and non decongested noses (p<0.0001). In the non-decongested state MA was significantly different in all racial groups: p<0.0001 (corrected means and c.i.: Orientals: 3.89 cm2, 3.47-4.31 cm2; Caucasians: 4.67 cm2, 4.27-5.09 cm2; Negroes: 5.13 cm2, 4.72-5.53 cm2). In the decongested state there was a significant difference between Negroes and the other two groups (p = 0.015), and Orientals and Caucasians were a homogenous population. We conclude that race has a significant effect on acoustic rhinometry measurements and this needs to be taken into account.

Acoustics↗
PubMed2005

Racial differences in premenopausal endogenous hormones.

Differences in breast cancer incidence across racial groups are well documented. African Americans have the highest rates of premenopausal breast cancer and Asians have lower breast cancer rates across all age groups. We hypothesized that levels of premenopausal endogenous hormones and growth factors, risk factors that have been predictive of breast cancer, would differ by race. Using a cross-sectional study design, we tested this hypothesis in the Nurses' Health Study II. We assayed estradiol, progesterone, prolactin, sex hormone binding globulin (SHBG), insulin-like growth factor-I (IGF-I), and IGFBP-3 in 111 African American and 111 Asian American women, matched to 111 Caucasian women on age, day of luteal phase, and day, time, and fasting status at blood collection. We analyzed the association between race and hormone levels using robust linear regression methods. In multivariate models, compared with Caucasians, African Americans had 18% higher levels of estradiol (P < 0.01), 17% higher free estradiol (P < 0.01), 11% lower SHBG (P = 0.05), 11% higher IGF-I (P < 0.01), 25% higher free IGF-I (P < 0.01), and 9% lower IGFBP-3 (P < 0.01) levels. In multivariate models, compared with Caucasian women, Asian Americans had 22% higher calculated free estradiol (P < 0.01), 31% lower SHBG (P < 0.01), and 25% higher free IGF-I (P < 0.01) levels. No racial differences were found in progesterone and prolactin levels. Our study showed hormone differences consistent with breast cancer risk between Caucasians and African Americans but inconsistent with breast cancer risk between Asian Americans and Caucasians. Further research is needed to explore differences across racial groups and the link between endogenous hormones and breast cancer risk.

Adult↗