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PubMed1994

Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable.

OBJECTIVE: This article addresses the definitional and methodological problems associated with the most common uses of race as a variable in health research. PRINCIPAL FINDINGS: Although often used in health services research, race is a poorly understood concept because it lacks conceptual clarity. Moreover, the measurement problems with race have not yet been adequately addressed. As a result, many quantitative models that attempt to explain race differences are inadequate to inform health or social policy. CONCLUSIONS: Researchers should treat the race variable with the same degree of caution and skepticism with which it treats any other variable.

Bias↗
PubMedDate not supplied

The concept of race and health status in America.

Race is an unscientific, societally constructed taxonomy that is based on an ideology that views some human population groups as inherently superior to others on the basis of external physical characteristics or geographic origin. The concept of race is socially meaningful but of limited biological significance. Racial or ethnic variations in health status result primarily from variations among races in exposure or vulnerability to behavioral, psychosocial, material, and environmental risk factors and resources. Additional data that capture the specific factors that contribute to group differences in disease must be collected. However, reductions in racial disparities in health will ultimately require change in the larger societal institutions and structures that determine exposure to pathogenic conditions. More attention needs to be given to the ways that racism, in its multiple forms, affects health status. Socio-economic status is a central determinant of health status, overlaps the concept of race, but is not equivalent to race. Inadequate attention has been given to the range of variation in social, cultural, and health characteristics within and between racial or ethnic minority populations. There is a growing emphasis, both within and without the Federal Government, on the collection of racial or ethnic identifiers in health data systems, but noncoverage of the Asian and Pacific Islander population, Native Americans, and subgroups of the Hispanic population is still a major problem. However, for all racial or ethnic groups, we need not only more data but better data. We must be more active in directly measuring the health-related aspects of belonging to these social categories.

Cultural Characteristics↗
PubMed1996

Effects of gender, age, and race on the pharmacokinetics of etoposide after intravenous administration of etoposide phosphate in cancer patients.

The influence of gender, age, and race on the pharmacokinetics of etoposide and on the extent of conversion of etoposide phosphate (Etopophos; Bristol-Myers Squibb Company, Princeton, NJ) to etoposide are summarized. Included in the integrated statistical analyses were 192 patients from six phase I/II studies (102 men and 90 women, 128 aged < or = 65 years and 64 aged > 65 years; 134 were white, 18 were other races, and race was not recorded for 40). The dose of etoposide phosphate ranged from 25 to 200 mg/m2 of etoposide equivalents and was administered as 5-(bolus) to 210-minute intravenous infusions. Total body clearance of etoposide was comparable between men and women. However, significantly lower steady-state volumes of distribution and shorter half-lives were observed in women relative to men. Patients who were older than 65 years had significantly lower etoposide total body clearance and longer half-lives than younger patients. The gender- and age-related differences observed in the pharmacokinetic parameters of etoposide were significant but generally of a small magnitude (< or = 13%), indicating no need for dose adjustment in these patient populations. There were no significant race-related differences in the pharmacokinetic parameters of etoposide. All patients showed rapid conversion of etoposide phosphate to etoposide. The individual area under the plasma concentration-time curve ratio of etoposide phosphate/etoposide was < or = 0.0324, indicating that etoposide was the major circulating moiety after infusion of etoposide phosphate. Significant gender-, age-, or race-related differences in the area under the plasma concentration-time curve ratios were not observed. An evaluation of the area under the plasma concentration-time curve ratios with respect to infusion time suggested that the conversion of etoposide phosphate to etoposide was independent of infusion time.

Adult↗
PubMed1997

Effect of race on outcome following kidney and kidney-pancreas transplantation in type I diabetics: the South-Eastern Organ Procurement Foundation experience.

In this study we analyze the South-Eastern Organ Procurement Foundation (SEOPF) experience with kidney and kidney-pancreas transplantation in IDDM recipients and evaluate the impact of racial disparity on patient and graft outcome. Data obtained from 4413 kidney-alone and 884 pancreas transplants performed in White and Black type I diabetics at member institutions of SEOPF between 10/1/87 and 7/25/96 were analyzed. Survival data from 15,827 transplants performed during the same period of time in non-diabetics were available for comparison. A lesser proportion of pancreas recipients were Black compared to kidney-alone (12% vs 23%, p < 0.0005). Recipient race had no effect on patient survival in any of the groups studied. Kidney graft survival, on the other hand, was adversely affected by Black race in both non-diabetic and diabetic recipients of a kidney transplant but not in diabetics who received a combined pancreas-kidney transplant. As was the case for patient survival in diabetics, recipient race had no effect on pancreas graft survival. Cox Regression analysis showed that kidney-pancreas transplant (p = 0.034, RR = 0.49) and female recipient gender (p = 0.046, RR = 0.68) were associated with a lower risk of failure of the pancreas graft. The following factors were independent predictors of kidney graft outcome: Donor age (p = 0.0001, RR = 0.95), kidney-pancreas transplant (p = 0.0004, RR = 0.58), AB match (p = 0.001, RR = 0.86), DR match (p = 0.006, RR = 0.82), preservation time (p = 0.012, RR = 1.01), Black recipient race (p = 0.047, RR = 1.23) and living donor (p = 0.06, RR = 0.73). Our findings suggest that the effect of race on graft outcome observed in non-diabetic and, to a lesser extent, diabetic kidney-alone transplant recipients, is not present after kidney-pancreas transplantation.

ABO Blood-Group System↗
PubMed1998

[The effect of a race 4 hours in duration on the production of beta-endorphin and adrenocorticotropic hormone].

BACKGROUND: Physiological hormone adaptation to a prolonged and submaximum exercise is not well known. The present study was designed to evaluate changes in plasma levels of beta-endorphin and ACTH before and after a 4 hour pedestrian race. SUBJECTS AND METHOD: Fourteen amateur athletes enrolled in a 4-hour race were studied. Beta-endorphin and ACTH determinations were performed (double antibody IRMA) 10 minutes before and after the race. Simultaneously, heart rate and blood pressure were registered. RESULTS: After the race beta-endorphin level increased 2.8 times with respect to basal values (X [DE]) (42.2 [20,5] VS 14.9 [5.1] pM/I; p < 0.0001), and ACTH level increased 3.5 times (110.8 [72.9] vs 31.4 [14.2] pg/ml; p < 0.0001). There was a positive correlation between the increase of beta-endorphin and ACTH and the distance covered by each athlete (r = 0.617, p < 0.001 and r = 0.533, p < 0.05, respectively), and between the increase of basal and post-race values of both hormones (r = 0.935; p < 0.001). CONCLUSION: Prolonged and submaximum exercise provokes beta-endorphin and ACTH increase, and is related to the amount of performed exercise. There is a positive correlation between the increase of plasma levels of both hormones. Therefore, exercise amount could be one of the main modulator mechanism of beta-endorphin and ACTH release.

Adrenocorticotropic Hormone↗
PubMed1984

A note on the biologic concept of race and its application in epidemiologic research.

Use of the category of race in epidemiologic research presupposes scientific validity for a system that divides man into subspecies. Although the significance of race may be clear-cut in many practical situations, an adequate theoretical construct based on biologic principles does not exist. Anthropologists have in large measure abandoned the biologic concept of race, and its persistent widespread use in epidemiology is a scientific anachronism. The assumption that race designates important genetic factors in a population is in most cases false. Racial definitions should be seen as primarily social in origin and should be clues to environmental-rather than genetic-causes of disease. An understanding of the social forces leading to racial differentials in health will give further direction to preventive campaigns.

Adult↗
PubMed2025

Intersectionality in a sociogenomic world: How do race, disability, socioeconomic status, and polygenic prediction interact to affect perceptions of educational trajectories?

PURPOSE: Education is important for lifelong skills and economic growth; however, student placement decisions may be shaped by social biases. As genomic information captured via polygenic scores becomes more available, it may also inform student placement decisions. We assessed the intersectional effects of polygenic scores, race, disability, and socioeconomic status on US adults' views of educational trajectories using an online experimental survey design. METHODS: A total of 1367 US adults were randomized to one of 16 conditions and prompted to read a short vignette about a boy named Michael, also depicted in an image. Each condition varied Michael's race (Black/White), disability (wheelchair user/no), socioeconomic status (high/low), and polygenic score (high/low) for educational attainment (EA-PGS). After reading the vignette, the respondents were asked to answer multichoice questions about Michael's immediate and long-term educational trajectories. RESULTS: Variation in Michael's EA-PGS strongly influenced participants' expectations regarding (1) the most appropriate immediate educational program for Michael (ie, general, special, or gifted education), (2) whether he would graduate high school, and, if so, (3) the highest educational degree he would complete in his lifetime (associate, bachelor, master, or PhD). Across these responses, high EA-PGS was associated with more socially desirable outcomes, whereas the opposite was true for low EA-PGS. Depicting Michael in a wheelchair significantly influenced respondents' expectations that his most appropriate immediate educational trajectory would be special. There were significant interactions between Michael's race, disability, socioeconomic status, and the EA-PGS. CONCLUSION: Information about children's EA-PGS may affect their views about their immediate and long-term educational trajectories. The negative effects of low EA-PGS were comparable to those of high EA-PGS. The EA-PGS may be interpreted in ways that compound the existing stereotypes related to a child's race, disability, and socioeconomic status.

Humans↗
PubMed1998

Promoting same-race adoption for children of color.

Opponents of policies that protect same-race adoption assert that children of color are languishing in out-of-home care because they are being restricted from entering transracial adoption arrangements. This article argues that transracial adoption is not necessary to ensure that children of color are adopted in a timely manner and sets forth alternative arguments around six issues: (1) policies favoring adoption by foster parents, (2) the availability of same-race families to adopt children of color, (3) the abundance of children in out-of-home care unavailable for adoption or with special needs, (4) disparities in child welfare services related to ethnicity, (5) misleading data on the numbers of children of color who are in foster care, and (6) poverty as an underlying cause of out-of-home placements. This article briefly presents the history of the transracial adoption controversy and discusses its current status; counters assertions typically used to oppose same-race adoption policies for children of color; summarizes the positions of several social work organizations regarding adoption and race; and makes recommendations for education, policy, research, and practice.

Adoption↗
PubMedDate not supplied

[Reasons for banishing the concept of race from Brazilian medicine].

As part of medicine's canonical framework, the concept of race has been associated with the idea that color and/or biological ancestry are relevant indicators of a predisposition to a certain disease or reaction to drugs. This stance derives from a typological view of human races. The low level of genetic variability and of structuring of the human species is incompatible with the existence of races as biological entities and tells us that color and/or geographical ancestry have little or nothing useful to contribute to medical practice, particularly when it comes to caring for an individual patient. We show that even so-called racial diseases like sickle cell anemia are really the product of evolutionary strategies used by populations exposed to specific infectious agents, whose territories have no unequivocal relation with either color or continental origin. Furthermore, in the words of sociologist Paul Gilroy, the social concept of race is "toxic," contaminating society as a whole, and it has been used to oppress and to foster injustice, even within a medical context.

Brazil↗
PubMed2001

Race and sex differences in consistency of care with national asthma guidelines in managed care organizations.

BACKGROUND: In the United States, morbidity from asthma disproportionately affects African Americans and women. Although inadequate care contributes to overall asthma morbidity, less is known about differences in asthma care by race and sex. SUBJECTS AND METHODS: To examine the relationships of race and sex with asthma care, we analyzed responses to questionnaires administered to adults enrolled in 16 managed care organizations participating in the Outcomes Management System Asthma Study between September and December 1993. Indicators of care consistent with National Asthma Education and Prevention Program (1991) recommendations were assessed. Of a random sample of 8640 patients asked to participate, 6612 (77%) completed the survey. This study focused on 5062 (14% African American, 72% women) patients with at least moderate asthma symptom severity. RESULTS: Fewer African Americans than whites reported care consistent with recommendations for medication use (eg, daily inhaled corticosteroid use, 34.9% vs 54.4%; P =.001), self-management education (eg, action plan, 42.0% vs 53.8%; P =.001), avoiding triggers (37.6% vs 53.6%; P =.001), and specialist care (28.3% vs 41.0%; P =.001). Differences in asthma care by sex were smaller and tended to favor women except for daily inhaled corticosteroid use (women vs men: 49.6% vs 58.3%; P =.001) and having specialist care (37.7% vs 43.1%; P =.001). Similar race and sex differences were observed after adjusting for age, education, employment, and symptom frequency. CONCLUSIONS: Even among patients with health insurance, disparities in asthma care for African Americans compared with whites exist and may contribute to race disparities in outcomes. Women generally reported better asthma care but may benefit from greater use of inhaled corticosteroids.

Adrenal Cortex Hormones↗
PubMed2005

Is Pacific race a retinopathy of prematurity risk factor?

BACKGROUND: Black race affords some protection from retinopathy of prematurity (ROP), but more ROP was previously found in another darkly pigmented race, the Alaskan natives. DESIGN: From fall 1989 through summer 2003, all Alaskan infants with a birth weight of 1500 g or less were examined, documenting mother's stated race, prenatal care, and neonatal intensive care unit course. RESULTS: Retinopathy of prematurity was classified as to predefined threshold for peripheral ablative treatment (region of avascular retina and fibrovascular ridge and vessel tortuosity) in 873 infants. Threshold ROP was more prevalent in Alaskan natives (24.9%) and Asians (15.9%) (10% overall), with no significant difference between Alaskan natives and Asians (P = .24). Alaskan native males had more threshold ROP (69%) compared with non-Alaskan native males (51%). Compared with threshold nonnatives, Alaskan native threshold infants had greater birth weights (829 +/- 222 vs 704 +/- 186 g), required less time on ventilation (46 +/- 22 vs 70 +/- 75 days), and progressed to treatment at a younger age (35.5 +/- 2.2 vs 36.2 +/- 2.6 weeks' gestational age) (data are given as mean +/- SD). CONCLUSIONS: In this limited study, we find increased risk of threshold ROP in 2 northern Pacific races. Threshold Alaskan natives had similar or better prenatal and neonatal intensive care unit variables than did threshold nonnatives; however, Alaskan native males were still at a greater risk.

Alaska↗
PubMed1998

Dose of hemodialysis and survival: differences by race and sex.

CONTEXT: Although blacks receive lower doses of hemodialysis than whites, their survival when receiving dialysis treatment is better than that for whites. Previous studies of the relationship between the dose of dialysis and patient survival have not controlled for differences in patient characteristics. OBJECTIVE: To examine the association of mortality with the dose of hemodialysis for clusters of patients categorized by race and sex. DESIGN: Retrospective analysis of laboratory data and mortality outcomes from 1994, using a national database of hemodialysis patients. PATIENTS: A total of 18144 black and white patients receiving hemodialysis 3 times weekly who either lived the entire year receiving hemodialysis or died. MAIN OUTCOME MEASURES: The fractional reduction of urea in a single dialysis session as the measured hemodialysis dose (urea reduction ratio [URR]) after controlling for race, sex, age, and diabetes mellitus. Mortality was determined by strata of URRs and albumin and creatinine levels. RESULTS: Across all age categories, blacks had lower URRs than whites, and men had lower URRs than women. In an age-adjusted model for evaluating interactions among URRs, race, sex, and diabetes, the association of URR with mortality risk was weak among blacks, particularly black men. After adjustment for age and diabetes, death probability curves were most steep for white women with URR values less than 60%. The death probability curves were least steep for black men. There was no meaningful difference between death probability and albumin or creatinine concentration among the race by sex clusters. CONCLUSION: Using URR, the usual measure of hemodialysis dose, the assumption that the association between dialysis dose and survival is uniform across demographic groups appears incorrect. Comparisons of the quality of dialysis patient care should not rely on URR alone to predict patient survival.

Black or African American↗
PubMed2003

Impact of quality improvement efforts on race and sex disparities in hemodialysis.

CONTEXT: By improving the process of care, quality improvement efforts have the potential to reduce race and sex disparities. However, little is known about whether reductions actually occur. National quality improvement activities targeting hemodialysis patients provide an opportunity to examine this issue. OBJECTIVE: To determine the effect of quality improvement efforts on race and sex disparities among hemodialysis patients. DESIGN, SETTING, AND SUBJECTS: Longitudinal study of 58 700 randomly selected hemodialysis patients from throughout the United States in 1993 through 2000. INTERVENTION: Medicare-funded quality improvement project involving monitoring of patient outcomes, feedback of performance data, and education of clinicians at dialysis centers. MAIN OUTCOME MEASURES: Changes in hemodialysis dose (Kt/V), anemia management (hemoglobin level), and nutritional status (albumin level). RESULTS: The proportion of all patients with an adequate hemodialysis dose increased 2-fold. In 1993, 46% of white patients and 36% of black patients received an adequate hemodialysis dose compared with 2000 when the proportions were 87% and 84%, respectively. Thus, the gap between white and black patients decreased from 10% to 3% (P<.001). The gap between female and male patients decreased from 23% to 9% over the same period (P =.008). The proportion of all patients with adequate hemoglobin levels increased 3-fold. The proportion of all patients with adequate albumin levels remained unchanged. Race and sex disparities in anemia management and nutritional status did not change significantly. CONCLUSIONS: Quality improvement efforts have a variable impact on race and sex disparities in health outcomes. Further work is needed to determine how quality improvement methods can be targeted to reduce health disparities.

Adult↗
PubMed1997

The relation of age, race, and gender to the subsite location of colorectal carcinoma.

BACKGROUND: Characteristics that determine the anatomic site within the colorectum where carcinoma is most likely to occur would be useful in choosing optimal modalities for cancer screening and in the study of etiology. The aim of this study was to identify any association of gender, race, or age with colorectal carcinoma in the proximal or distal colorectum. METHODS: A descriptive, population-based epidemiologic study was conducted on colorectal carcinoma (CRC) cases identified through the Illinois Tumor Registry. Among CRC patients diagnosed between 1986 and 1991, age at diagnosis (40-90 years), gender, white or African American race, and subsite of CRC location were identified. Incidence rates were determined with demographic data from the 1990 Illinois census. Logistic regression was used to identify significant subsite specific risk factors for CRC. RESULTS: During the study period, 38,931 cases of CRC occurred in Illinois among whites and African Americans between the ages of 40 and 90 years. Age, race, and gender were independently significantly associated with both proximal and distal CRC risk (P < 0.0001). The greatest risk for white males was for distal CRC, followed by the risk for African American males of developing CRC in the distal colorectum. African Americans were more likely than whites to develop proximal CRC (odds ratio [OR] = 1.19), whereas whites were more likely to have distal CRC than African Americans (OR = 1.26). Regarding the development of CRC anywhere in the colorectum, male incidence rates adjusted for age and race were greater than rates for females (OR = 1.32 for proximal and 1.68 for distal). CONCLUSIONS: The division of the colorectum anatomically in these analyses at the junction of the descending and sigmoid colon, and including the rectum above the anal canal with "distal" CRC, demonstrated a predominance of African Americans among those at risk for proximal colon carcinoma and a predominance of white males among those at risk for distal CRC; these predominances were clearer than in previous reports. These findings may have a role in the selection of optimal CRC screening strategies for each gender or racial group.

Adult↗
PubMed1983

Multiple discriminant function analysis of sex and race in the postcranial skeleton.

Terry Collection femora and innominates of 260 American Whites and Blacks (65 males and 65 females of each race) were analyzed by multiple discriminant function analysis. A stepwise procedure produced three optimal discriminant functions using 15 of our 32 measurements. These functions correctly identified 95% of the sample. The first two-one for sex and one for race-are statistically and biologically significant and form the basis of our analysis. The sexing function manifested both size and shape elements. Prominent among the former was joint size--acetabular diameter and epicondylar diameter of the femur. The shape elements included form of the greater sciatic notch and of the inferomedial aspect of the pubic body. The racing function highlighted a pattern of greater innominate dimensions, exclusive of the acetabular joint, in Whites. This was in contrast to the greater length of the Black femur. Overall, the function seems to express the established differences between the races in the ratio of lower limb length to torso length. While these functions have been applied successfully to forensic cases with confirmed identifications, questions regarding the breadth of applicability of discriminant functions make it desirable to validate our results on new material from the Terry and other collections.

Analysis of Variance↗
PubMed2004

Race: scientific nonproblem, cultural quagmire.

The matter of biological differentiation among human beings has been a perennial concern of physical anthropologists, whose profession grew out of the monogenist/polygenist debates of the 18th century, and who periodically feel impelled to issue sonorous pronouncements on the subject. In spite of (or perhaps because of) the extensive and difficult cultural ramifications of the race issue, such pronouncements have usually presented the matter of race as one that requires extensive bioanthropological exegesis. In reality, however, race is the most banal of biological issues. Within any species, including Homo sapiens, two biological processes are possible: physical differentiation (as routinely occurs in small population isolates) and reintegration (should the resulting differentiated populations come together in the absence of any barrier to mating). The history of Homo sapiens reflects both of these processes: initial differentiation among small, scattered populations in the later part of the Pleistocene, and subsequent reintegration as the human population expanded and these populations came together once more. It is for this reason that, while certain modal physical types can be recognized on any urban street today (differentiation), it is impossible to recognize any clear boundaries between them (reintegration). All of this is perfectly unremarkable in evolutionary terms, and requires no special explanation. The complexities of the race issue are real, of course, and it is important that we come to terms with them; but they will not be resolved by biologists.

Anthropology↗
PubMed1997

The relationship of socioeconomic status, race, and modifiable risk factors to outcomes in patients with systemic lupus erythematosus.

OBJECTIVE: To study the relationship of race, socioeconomic status (SES), clinical factors, and psychosocial factors to outcomes in patients with systemic lupus erythematosus (SLE). METHODS: A retrospective cohort was assembled, comprising 200 patients with SLE from 5 centers. This cohort was balanced in terms of race and SES. Patients provided information on socioeconomic factors, access to health care, nutrition, self-efficacy for disease management, health locus of control, social support, compliance, knowledge about SLE, and satisfaction with medical care. Outcome measures included disease activity (measured by the Systemic Lupus Activity Measure), damage (measured by the SLICC/ACR damage index), and health status (measured by the SF-36). RESULTS: In multivariate models that were controlled for race, SES, center, psychosocial factors, and clinical factors, lower self-efficacy for disease management (P < or = 0.0001), less social support (P < 0.005), and younger age at diagnosis (P < 0.007) were associated with greater disease activity. Older age at diagnosis (P < or = 0.0001), longer duration of SLE (P < or = 0.0001), poor nutrition (P < 0.002), and higher disease activity at diagnosis (P < 0.007) were associated with more damage. Lower self-efficacy for disease management was associated with worse physical function (P < or = 0.0001) and worse mental health status (P < or = 0.0001). CONCLUSION: Disease activity and health status were most strongly associated with potentially modifiable psychosocial factors such as self-efficacy for disease management. Cumulative organ damage was most highly associated with clinical factors such as age and duration of disease. None of the outcomes measured were associated with race. These results suggest that education and counseling, coordinated with medical care, might improve outcomes in patients with SLE.

Adult↗
PubMed2005

Race modifies the association between breast carcinoma pathologic prognostic indicators and the positive status for HER-2/neu.

BACKGROUND: Inferences about the variations in the biology of breast carcinoma between African-Americans and Caucasians have been reported. The difference in the prevalence of positive HER-2/neu breast carcinoma was evaluated and the race-specific risk was assessed for positive HER-2/neu among a cohort of women diagnosed with their first primary breast carcinoma, given the accepted prognostic pathologic indicators for positive HER-2/neu status. METHODS: Demographic, clinical, and pathologic data were collected from existing databases. The status of HER-2/neu was considered positive if the immunohistochemistry score was 3+ or if the fluorescent in situ hybridization indicated a ratio greater than 2. Multivariable logistic regression was used to determine the race-specific risk for HER-2/neu positive breast carcinoma. RESULTS: The difference in the prevalence of HER-2/neu-positive status between African-American and Caucasian women was not statistically significant (P = 0.46). For Caucasian women the likelihood for positive HER-2/neu was statistically significant and increased almost linearly within each stage with nuclear grade dedifferentiation relative to the reference group, women with Stage 1, Grade 1 carcinomas. For African-American women, this risk was not significantly associated with stage, nuclear grade, their interaction term, or other pathologic prognostic indicators. CONCLUSIONS: The findings suggest that race modifies the association between the pathologic prognostic indicators of breast carcinoma and the likelihood of HER-2/neu-positive carcinoma. So far, clinical correlative studies of HER-2/neu have not included race as an independent variable. Concerns about the limited generalizability and the need for validation of the findings across racial lines have been expressed previously.

Black or African American↗