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PubMed2004

Racial differences in survival among men with prostate cancer and comorbidity at time of diagnosis.

OBJECTIVES: This study evaluated the effect of comorbidity at diagnosis on racial differences in survival among men with prostate cancer. METHODS: Clinical and demographic data were abstracted from records of 864 patients diagnosed at 4 Chicago area hospitals between 1986 and 1990. Comorbidity was scored on the basis of clinical information in the Charlson index. Cause-specific relative mortality adjusted for age, stage, differentiation, and treatment was compared across Charlson scores with Cox proportional hazards functions. RESULTS: Blacks had significantly greater mortality from prostate cancer and other causes (vs Whites, relative risk [95% confidence interval] = 1.84 [1.22, 2.79] and 1.69 [1.33, 2.29], respectively; P <.001). However, differences disappeared as initial comorbidity increased (1.75 [1.33, 2.31] vs 0.90 [0.59, 1.29] for scores = 0 and > or =5, respectively). CONCLUSIONS: Absence of a significant preexisting medical diagnosis is associated with a higher risk for excess mortality among Black men diagnosed with prostate cancer.

Adenocarcinoma↗
PubMed1999

Racial differences in birthweight for gestational age and infant mortality in extremely-low-risk US populations.

Using national data, we develop and contrast the birth-weight percentiles for gestational age by infants of extremely-low-risk (ELR) White and African-American women and examine racial differences in the proportion of small-for-gestational-age (SGA) births. We then scrutinise racial variations in infant mortality rates of the infants of ELR women. We further compare the infant mortality rates of infants at or below the 10th percentile of birthweight for gestational age of each race group to determine whether infants with similar restricted fetal growth have comparable risks of subsequent mortality. Single live births, 34-42 weeks' gestation, to White and African-American US-resident mothers were selected from the 1990-91 US Linked Live Birth--Infant Death File (n = 4,360,829). Extremely-low-risk mothers were defined as: married, aged 20-34 years, 13+ years of education, multiparae, with average parity for age, adequate prenatal care, vaginal delivery, and no reports of medical risk factors, tobacco use or alcohol use during pregnancy. Marked racial variation in birthweight percentiles by gestational age was evident. Compared with ELR White mothers, the risk of an SGA infant was 2.64 times greater for ELR African-American mothers and the risk of infant mortality was 1.61 times greater. For the ELR group, the infant mortality rates of African-American and White infants at or below the 10th percentile of birthweight for gestational age of their respective maternal race group were essentially identical after controlling for gestational age. In conclusion, race differences in fetal growth patterns remained after controlling for risk status. Efforts to remove racial disparities in infant mortality will need to develop aetiological pathways that can explain why African-Americans have relatively higher rates of preterm birth and higher infant mortality rates among term and non-SGA infants.

Adult↗
PubMed1982

Racial difference in salivary sodium-potassium ratio in low renin essential hypertension.

We have studied the relationship between plasma renin activity (PRA) and the salivary sodium-potassium (Na-K) ratio, an index of mineralocorticoid effect, in 223 patients with essential hypertension. In 24 white patients with low PRA, the median Na-K ratio was 0.74, which was significantly lower than the ratio of 1.40 in 54 normal white subjects and the ratio of 1.10 in 34 white hypertensive patients with normal PRA. The Na-K ratio in 71 black patients with low PRA was 1.06, which was not significantly lower than the ratio of 1.50 in 38 black normal subjects or the ratio of 1.56 in 94 black hypertensive patients with normal PRA. These findings indicate a difference in salivary Na-K ratios between white and black patients with low renin essential hypertension and suggest a racial difference in the pathophysiology of this form of hypertension.

Adult↗
PubMed2003

Racial differences in glucagon-like peptide-1 (GLP-1) concentrations and insulin dynamics during oral glucose tolerance test in obese subjects.

Obese African-American (AA) subjects have higher resting and stimulated insulin concentrations than obese Caucasians (C), which could not be explained by the severity of obesity or the degree of insulin sensitivity. We investigated whether differences in glucagon-like peptide-1 (GLP-1), the most potent incretin that regulates insulin secretion, might explain racial differences in insulin response. Accordingly, we measured fasting and stimulated glucose, insulin, and GLP-1 levels during a 3-h oral glucose tolerance test (OGTT) in 26 obese C (age 38+/-2 y, body mass index 44+/-1 kg/m(2)) and 16 obese AA (age 36+/-2 y, BMI 46+/-2 kg/m(2)) subjects. Corrected insulin response (CIR(30)), a measure of beta-cell activity, whole body insulin sensitivity index (WBISI), and area under the curve (AUC) for insulin, GLP-1, and C-peptide/insulin ratio were computed from the OGTT. Glucose levels, fasting and during the OGTT, were similar between racial groups; 32% of the C and 31% of the AA subjects had impaired glucose tolerance. With a similar WBISI, AAs had significantly higher CIR(30) (2.3+/-0.4 vs 1.01+/-0.1), insulin response (IAUC: 23 974+/-4828 vs 14 478+/-1463), and lower insulin clearance (0.07+/-0.01 vs 0.11+/-0.01) than C (all, P<0.01). Obese AAs also had higher fasting GLP-1 (6.7+/-2.5 vs 4.5+/-1.1) and GLP-1AUC (1174.7+/-412 vs 822.4+/-191) than C (both, P<0.02). Our results indicate that obese AAs had higher concentrations of GLP-1 both at fasting and during the OGTT than obese C. The increased GLP-1 concentration could explain the greater insulin concentration and the increased prevalence of hyperinsulinemia-associated disorders including obesity and type 2 diabetes in AAs.

Adult↗
PubMed1994

Racial differences in rural adults' attitudes toward issues of adolescent sexuality.

This study, based on a random sample of adults in a rural North Carolina county, demonstrates racial differences in rural adults' attitudes relating to adolescent sexual issues. Blacks were 50% more likely than Whites to indicate that public schools should provide general health care services, including pregnancy testing and treatment of sexually transmitted diseases, to teenagers; however, they were only half as likely as Whites to approve of sexual experimentation by adolescents. The local community's attitudes must be considered in the implementation of rural adolescent health programs, including acquired immunodeficiency syndrome education.

Abortion, Induced↗
PubMed2000

Racial differences in reported Lyme disease incidence.

In the United States, the incidence of Lyme disease is considered to be disproportionately high among Whites because of risk of exposure. For assessment of racial differences in Lyme disease incidence and the role of risk exposure, incidence rate ratios (IRRs) for Lyme disease and its manifestations between Whites and African Americans in Maryland and in its focus of endemicity, the Upper Eastern Shore, were calculated. Calculations were based on reported cases of Lyme disease in Maryland during the years 1992-1996. The IRR for Lyme disease between Whites and African Americans was 6.3 (95% confidence interval (CI): 5.0, 8.0), decreasing to 1.8 (95% CI: 1.2, 2.7) for the Upper Eastern Shore. Statewide, there was a significant difference between the White to African American IRR for erythema migrans and for Lyme disease-associated arthritis, at 17.7 (95% CI: 11.2, 27.8) and 2.3 (95% CI: 1.7, 3.2), respectively. On the Upper Eastern Shore, the IRR for arthritis reversed, indicating higher incidence among African Americans than among Whites: IRR = 5.7 (95% CI: 2.4, 13.9) for erythema migrans and IRR = 0.7 (95% CI: 0.4, 1.1) for arthritis. White patients were more likely to have erythema migrans (risk ratio = 2.8, 95% CI: 1.9, 4.1) and less likely to have arthritis than were African Americans (risk ratio = 0.4, 95% CI: 0.3, 0.5). Among all patients, there was a significant negative association between arthritis and erythema migrans. Although much of the racial disparity in incidence rates diminishes in a rural, endemic area, consistent with exposure risk being responsible for much of the variation, a difference remains. This may be due to failure to recognize early disease (erythema migrans) among African Americans, resulting in increased rates of late manifestations. Geographic spread of the disease warrants efforts to increase awareness of Lyme disease and its manifestations among people of color and the health care providers who serve them.

Arthritis↗
PubMed2003

Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer.

BACKGROUND: Prostate cancer mortality is higher among black American men than among white American men. We investigated whether racial disparities in outcomes of clinically localized prostate cancer vary by treatment (surgery, radiation therapy, or nonaggressive treatment). METHODS: Merged Surveillance, Epidemiology, and End Results Program (SEER) and Medicare files provided data (on treatment modality, age, race, cancer stage, tumor grade, census tract socioeconomic status, and date of death) on 5747 black and 38 242 white patients diagnosed at age 65-84 years with clinically localized prostate cancer between 1986 and 1996 in five SEER sites. Patients were followed through 1998. Racial differences in survival outcomes were assessed using Kaplan-Meier survival curves and Cox regression models. RESULTS: The median survival time for black patients was 1.7 years (95% confidence interval [CI] = 1.6 to 1.9 years) less than that for white patients. Median survival in black patients relative to white patients was 1.8 years (95% CI = 1.5 to 2.0 years) less among those who had surgery, 0.7 years (95% CI = 0.5 to 1.0 years) less among those who had radiation therapy, and 1.0 years (95% CI = 0.7 to 1.1 years) less among those who had nonaggressive treatment. Racial disparities were evident both in overall survival and in prostate cancer-specific survival, before and after statistical adjustment for covariates. CONCLUSIONS: Black patients' poorer overall survival from localized prostate cancer varies by initial treatment, with the survival gap being largest among patients undergoing surgery. Investigating these treatment-specific differences may clarify the mechanisms underlying worse outcomes for black patients in the health care system.

Aged↗
PubMed1995

Racial differences in the prevalence of microalbuminuria in hypertension.

One hundred nine patients with essential hypertension and without either diabetes mellitus or clinical proteinuria were examined to investigate possible racial differences in urinary albumin excretion rates. The black hypertensive patients were found to have significantly higher urinary albumin excretion rates compared with the white patients; in addition, a significantly greater proportion of the black patients than the white patients (32% v 14%) had microalbuminuria, defined as a urinary albumin excretion rate greater than 30 micrograms/min. These differences could not be explained by age, blood pressure, body mass index, glycosylated hemoglobin, serum creatinine, duration of hypertension, or type of hypertension treatment. Hypertensive renal failure occurs six to 18 times more frequently in blacks than in whites; to our knowledge, these data are the first to indicate that microalbuminuria may be more prevalent during the course of hypertension in black patients and thus may be an early marker for end-organ damage susceptibility among hypertensive patients.

Albuminuria↗
PubMed2002

Racial differences in use of colonoscopy, sigmoidoscopy, and barium enema in Medicare beneficiaries.

Colorectal cancer is often diagnosed at a later stage in blacks. We wanted to know if racial differences existed in the use of tests for detection of colorectal cancer. A 5% random sample was obtained of all Medicare beneficiaries with Part B coverage, aged 65 years and older and classified as white or black race. The numbers of colonoscopies, flexible sigmoidoscopies, and barium enemas were determined from the Physician/Supplier file. Blacks were 18% less likely to receive colonoscopy and 39% less likely to receive flexible sigmoidoscopy after controlling for age, sex, income, and access to care in a multivariable logistic regression model. Barium enema was not significantly different between the races. Black men had 25% lower use of colonoscopy and 50% decreased use of flexible sigmoidoscopy. Blacks receive less colonoscopy and flexible sigmoidoscopy than whites. Black men are particularly vulnerable to the under-use of these tests.

Black or African American↗
PubMed1983

The racially different psychiatrist--implications for psychotherapy.

The race of the therapist can play a significant role in the manifestation of transference and counter-transference phenomena in inter-racial psychotherapy. References to the race of therapist may be the first sign of a developing transference relationship. Failure to appreciate the impact of racial difference can impede therapeutic progress while sensitive confrontation may be a valuable tool in the recognition and communication of emotionally charged feelings in therapy. Dream material is influenced by the race of the therapist who may be less easy to disguise in dreams, and the therapist may avoid certain dream interpretations because of unacknowledged discomfort about race. These observations have implications for the supervisory process in training and for the general issue of the influence of the person of the therapist on the process of psychotherapy.

Adult↗
PubMed2005

Racial differences in the progression of cognitive decline in Alzheimer disease.

OBJECTIVE: Alzheimer disease (AD) is the leading cause of dementia in older persons, but little is known about racial differences in its clinical manifestations. The purpose of the current study was to examine the association of race with rate of cognitive decline in AD. METHODS: Older persons with clinically diagnosed AD were recruited from healthcare settings. At 6-month intervals for up to 4 years, they completed a battery of nine cognitive tests from which a previously established measure of global cognition was derived. Follow-up data were available on 452 participants (27.6% African American, 68.8% women), 88.1% of those eligible. RESULTS: A growth curve approach was used to estimate individual paths of change in global cognition. In a model that controlled for age and education, African Americans had a lower level of global cognition at baseline than non-African Americans, but declined at a 25% slower rate on average. In additional models, there was no indication that the association of race with cognitive decline varied by age, gender, or education. CONCLUSION: The rate of cognitive decline in AD appears to be slower in African Americans than non-African Americans.

Adult↗
PubMed1997

Lack of gender and racial differences in surgery and mortality in hospitalized Medicare beneficiaries with bleeding peptic ulcer.

OBJECTIVE: Determine the relation of race and gender to outcome from bleeding peptic ulcer. DESIGN: Retrospective cohort study. SETTING: All acute care hospitals in the United States. PATIENTS: A 100% sample of hospitalized Medicare beneficiaries older than 64 years (n = 82,868) with a primary discharge diagnosis of peptic ulcer with hemorrhage. MEASUREMENTS AND MAIN RESULTS: Surgical treatment was performed in 6.9% of patients, 30-day mortality was 8.5%, and average length of stay was 9.4 days. Surgery was somewhat more common in men than women (7.3% vs 6.5%, p < .001), and in whites than African Americans (6.9% vs 6.3%, p < .001), but neither race nor gender was associated with surgery in multivariable analysis adjusting for potentially confounding factors. Mortality rates were similar in African Americans and whites (8.5%), and somewhat higher in men than women (10.7% vs 9.3%, p < .001). In multivariable analysis, there was no difference in mortality across gender and racial groups. Although unadjusted and adjusted lengths of stay were longer for African Americans and shorter for men, the differences were modest (i.e., 16% increase and 6% decrease in multivariable analysis, respectively, p < .0001). CONCLUSIONS: In this national sample, there is no significant gender or racial difference in therapy and outcome for patients with hemorrhagic peptic ulcer. The findings raise the possibility that studies that have shown race and gender differences in management of coronary artery disease and cancer may not be generalizable to other common diagnoses.

Black or African American↗
PubMed1990

Racial differences in pharmacodynamic response to nicotinates in vivo in human skin: black and white.

This study evaluated the vasodilation induced in young whites and blacks by topical application of two nicotinates, methylnicotinate (MN) and hexylnicotinate (HN) at the same concentration and in the same vehicle. To assess the influence of skin surface lipids and water content of the stratum corneum on the penetration of the substances, the drugs were applied on the back, on untreated skin and pre-occluded and pre-delipidized sites. Skin blood flow was monitored with laser Doppler velocimetry. The initial response recorded at 15 min (IR), the peak response (PR) and the area under the curve (AUC) were used to characterize the pharmacodynamic response. Statistically significant racial differences in the penetration of nicotinates were detected for the area under the response curve in the untreated and occluded sites, for the initial response and peak response in the pre-occluded site. Occlusion increased (even though not significantly) penetration, except for blacks in the methylnicotinate experiment. Delipidization elicited significantly lower responses for the IR and PR in the MN study, rendering the penetration similar in the two groups. No major differences were recorded between the two nicotinates. The effect of delipidization was most noticeable in blacks in the MN study. We suggest that there are racial (blacks vs. whites) differences in percutaneous penetration of nicotinates, with decreased levels in black skin recorded in all sites investigated.

Administration, Topical↗
PubMed2003

Racial differences in the prevalence of hypertensive retinopathy.

Few population-based data support the hypothesis that hypertensive retinopathy is more common in African Americans than in whites. We examined racial differences in the prevalence of and risk factors for hypertensive retinopathy in a population-based sample of 1860 African Americans and 7874 white persons, aged 49 to 73 years, without diabetes. Retinal photographs were taken of one randomly selected eye and evaluated for the presence of retinopathy (flame and blot-shaped retinal hemorrhages, microaneurysms, and soft exudates) according to standardized protocols by graders masked to participant characteristics. The prevalence of retinopathy was 2 times higher in African Americans than in whites (7.7% versus 4.1%, age- and gender-adjusted odds ratio [OR] 2.03, 95% confidence intervals [CI] 1.65, 2.49). After controlling for 6-year mean arterial blood pressure, use of antihypertensive medications and left ventricular hypertrophy by ECG criteria, the excess prevalence of retinopathy in African Americans was reduced by 40% (adjusted OR 1.61, 95% CI 1.26, 2.06). Further adjustment for other vascular risk factors, common carotid artery intima-media thickness, and serum creatinine levels reduced the excess prevalence in African Americans by another 13% (adjusted OR 1.48, 95% CI 1.08, 2.03). We conclude that hypertensive retinopathy is twice as frequent in African Americans compared with whites without diabetes and that the excess prevalence of retinopathy in African Americans is associated with blood pressure and severity of hypertension.

Aged↗
PubMed1992

Racial differences in mortality from cardiovascular disease in Atlanta, 1979-1985.

Mortality from cardiovascular disease (CVD) for the period 1979 to 1985 in the Atlanta metropolitan population was reviewed for racial differences. About 28% of the population was black in 1980. Of 22,585 deaths from hypertension, stroke, ischemic heart disease, and atherosclerosis, 78.7% occurred among whites and 21.3% among blacks. Overall, ischemic heart disease accounted for 47.7% of these four types of CVD deaths for both races and sexes. Age-specific and age-adjusted rates were compared. Among these four causes of death, blacks have the greatest excess of deaths from hypertension over whites for both males and females; the excesses were more than 200% when the rates were age-adjusted. The excess risk of death from hypertension occurred for all ages in blacks, with an excess of about 10 times in 30- to 49-year-olds. An excess risk from stroke also occurred in blacks below the age of 75; the risk reversed afterward. The age-specific mortality rates revealed an excess from ischemic heart disease only between the ages of 30 and 59 years and from atherosclerosis between 40 and 59 years of age for black men. This age-related crossover in females did not occur until the age of 75 years for deaths attributed to these causes. These data suggest that blacks were at highest risk for all four causes at younger age groups.

Adult↗
PubMedDate not supplied

Racial differences in the relation of birth weight and gestational age to neonatal mortality.

Utilizing South Carolina live birth-infant death cohort files for the period 1975-80, this study examines the bivariate distribution of birth weight-gestational age (BW-GA), intrauterine growth curves, and BW-GA specific neonatal mortality rates (NMRs) by race. Comparison of BW-GA distributions revealed an appreciable shift between racial subgroups. Nonwhites, on the average, were born 1 week earlier and 270 grams lighter in weight than whites. In addition to racial differences in rates of intrauterine growth, nonwhites experienced lower BW-GA NMRs than whites in BW-GA categories less than 3,000 grams and less than 38 weeks. However, the improved mortality experience of nonwhites at more immature BW-GA categories was not consistently present when different cause-specific NMRs were considered. These persistent racial variations highlight continuing issues regarding both the use of a single norm for defining low birth weight or prematurity and the role of nonsocioeconomic factors related to racial BW-GA distribution and mortality disparities. As birth weight and gestational age represent empirical indicators of the maturity and survivability of an infant at birth, these data and previous supporting research raise further concerns regarding the ability of these indicators to accurately reflect equivalent fetal development and subsequent risk of mortality among racial groups.

Birth Weight↗
PubMed2006

Racial differences in beliefs about genetic screening among patients at inner-city neighborhood health centers.

BACKGROUND: Genetic testing has the potential to identify persons at high risk for disease. Given the history of racial disparities in screening, early detection and accessing treatment, understanding racial differences in beliefs about genetics is essential to preventing disparities in some conditions. METHODS: In 2004, a sample of older adult patients from four inner-city health centers was surveyed to assess beliefs about genetic determinants of disease, genetic testing and religion. Logistic regression determined which beliefs were associated with race. RESULTS: Of the 314 respondents, 50% were African Americans. Most respondents thought that sickle cell disease, cystic fibrosis and diabetes are primarily genetic. African Americans were more likely than Caucasians to believe that genetic testing will lead to racial discrimination (Odds ratio (OR): 3.02, 95% confidence interval (CI): 1.5-6.0) and to think that all pregnant women should have genetic tests (OR=3.8, 95% CI: 1.7-8.6). African Americans were more likely to believe that God's Word is the most important source for moral decisions (OR: 3.6, 95% CI :1.5-8.7). CONCLUSION: African Americans and Caucasians differ in beliefs about genetic testing and the basis for moral decision-making. Acknowledging and understanding these differences may lead to better medical care.

Black or African American↗
PubMedDate not supplied

Racial differences in hospitalization rates among navy enlisted men.

Similarities and differences in hospitalization rates among five racial groups serving in the Navy during a 3-year period (1973-75) were examined, and the differences in terms of sociological and occupational factors were evaluated. Overall annual hospitalization rates per 10,000 men were blacks, 1,413; whites, 1,109; American Indians, 923; Asian-Americans, 683; and Malaysians (Filipinos), 508.Explanations for the low Malaysian hospitalization rate included selection of the fittest for service, age and job experience, and a low percentage of assignments to physically arduous occupations. Although blacks had the highest rates for many medical conditions, their rates for injuries, respiratory diseases, and infective disorders were comparable with those for whites. Blacks had the highest rates for several non-life-threatening conditions that required surgical procedures; this finding suggested that the Navy Medical Department had filled a longstanding need for corrective treatment.Although the results of this study should be useful to military medical planners responsible for the health care of all naval personnel, the authors conclude that detailed longitudinal studies are needed to establish more clearly the underlying biological and sociological factors associated with racial differences in morbidity.

Asian People↗