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PubMed2004

Racial differences in oral and pharyngeal cancer treatment and survival in Florida.

OBJECTIVE: This study examined racial differences in treatment and survival for blacks and whites in Florida diagnosed with oral or pharyngeal cancer. METHODS: Data for 21,481 malignancies of the oral cavity or pharynx diagnosed from 1988 to 1998 were derived from the Florida Cancer Data System. Type of cancer treatment was compared by race, stratified by anatomic site and summary stage at diagnosis. Kaplan-Meier survival curves were used to compare survival rates and Cox regression models were used to estimate hazard ratios for race. Covariates included age, sex, census tract income, and treatment. RESULTS: Stratifying by tumor site and stage, blacks consistently had poorer survival rates than whites. Across tumor stages, blacks with oral cavity cancer were consistently more likely than whites to have received only radiotherapy and less likely to have received cancer-directed surgery. Trends were similar for pharyngeal cancer, although statistically significant only for regional stages. Across site and stage, blacks consistently had elevated hazard ratios (range: 1.20-1.53) relative to whites. CONCLUSIONS: In Florida, there were racial differences in patient treatment for oral or pharyngeal cancer. Blacks had lower survival rates than whites, but differences in treatment did not entirely account for racial disparities in survival.

Adult↗
PubMed1993

Racial differences in clinical and social variables among patients evaluated in a dementia assessment center.

Despite increased interest in dementia and the concomitant creation of dementia assessment centers, there has been a paucity of reports examining racial differences in the social and clinical presentation of dementia. Such information can enhance knowledge about dementia and assist in the planning of diagnostic centers located in areas with large minority populations. This study reviewed the charts of patients evaluated at a dementia assessment center in New York City. The sample comprised 102 white and 68 black patients. There were no racial differences in types of dementia nor reported length of illness. However, bivariate analysis revealed many significant differences between the groups in social, medical, and psychiatric variables. Most notably, a stepwise discriminant analysis identified seven variables--Medicaid recipient, gender, age, sleep disturbances, delusions of stealing, hypertension, and concentration--as correctly being able to classify 75% of cases. Racial differences in cognitive and behavioral symptoms may reflect the interaction of dementia with physical health, premorbid history, environment, or some basic difference in disease course.

Aged↗
PubMed2005

Diabetes status and racial differences in post-myocardial infarction mortality.

BACKGROUND: Prior studies regarding the effect of racial status on post-myocardial infarction (MI) in subjects with diabetes have yielded conflicting results. We evaluated the effect of diabetes status on racial differences in post-MI mortality and morbidity for a 7-year period, from 1990 through 1997. METHODS: All patients discharged with the primary diagnosis of acute MI from any Veterans Affairs Medical Center in the country between October 1990 and September 1997 were identified. Demographic, comorbid conditions, inpatient, outpatient, mortality, and readmission data were extracted. Mortality, revascularization, readmissions, and length of hospital stay for MI were compared for the group with diabetes and that without diabetes. Comparison was made between black and white patients. Independent predictors of survival using a Cox regression model were examined. RESULTS: We identified 67,889 patients with MI of whom 17,756 (26%) had diabetes. Race status was known for 66,506 subjects of whom 55,731 (84%) were white and 8437 (13%) were black. Regardless of the race, the diabetic patients tended to have higher mortality than nondiabetic patients. The post-MI mortality during the entire follow-up period tended to be similar between blacks and whites for the nondiabetic patients, whereas the mortality tended to be lower in blacks than in whites in diabetic patients. CONCLUSIONS: Mortality from post-MI is significantly lower in blacks with diabetes than in whites with diabetes. In contrast, no racial difference in long-term mortality was seen among subjects without diabetes. Thus, it appears that diabetes status determines racial variation in post-MI mortality. The reasons for better survival post-MI of blacks in general and among subjects with diabetes in particular need to be further investigated.

Aged↗
PubMedDate not supplied

Can obesity explain the racial difference in stage of breast cancer at diagnosis between black and white women?

OBJECTIVE: Black women are more likely to be diagnosed at a more advanced stage of breast cancer than are white women. Traditionally, this has been attributed in part to social or cultural factors. Given that black women are more likely to be obese than white women and that being obese is associated with a more advanced stage at diagnosis, this study aims to assess to what extent the racial difference in stage at diagnosis can be explained by racial differences in obesity. METHODS: Incident cases of breast cancer between 1991 and 1997 (white, n = 585; black, n = 381) were identified from hospitals in the Baltimore metropolitan area. Information, including age, race, weight, height, and pathology reports, was obtained from hospital medical records. RESULTS: Black women were more likely than white women to be diagnosed with breast cancer at tumor-node-metastasis (TNM) stage II or greater (age-adjusted odds ratio [OR] = 1.51, 95% confidence interval [CI] 1.15-1.99). Further, black women were more likely than white women to be overweight or obese. A high body mass index (BMI) was significantly associated with an advanced stage of breast cancer at diagnosis. Adjustment for the higher prevalence of obesity in black women attenuated the risk estimate of more advanced stage of breast cancer at diagnosis in black women compared with white women by approximately 30%. CONCLUSIONS: Our results suggest that the higher prevalence of obesity among black women plays an important role in explaining their relative disadvantage in stage at diagnosis of breast cancer. Nonetheless, a racial difference in stage of breast cancer at diagnosis persists after adjustment for obesity.

Adult↗
PubMed2002

Racial differences in how patients perceive physician communication regarding cardiac testing.

OBJECTIVES: Recent studies documenting racial variation in the use of cardiac procedures highlight the need to understand if there are racial differences in processes of communication and decision making. Investigations of patients' perceptions of their interaction with providers regarding cardiac testing were conducted. METHODS: Four focus groups were convened with 13 patients who had undergone cardiac stress testing with positive results, stratified by race (white vs. black). Verbatim transcripts of discussions of their interactions with providers relating to their cardiac problems were analyzed qualitatively by a team of behavioral scientists and general internists to identify significant dimensions of communication and patient-provider relationships. RESULTS: Four domains of communication were identified that appeared to bear on patients' comfort and preferences regarding cardiac procedures. First, the substance of the information that was provided by physicians and other providers was described as incomplete, vague, ambiguous, and unclear. Second, some recommendations either were inconsistent with expectations or awakened fears based on distressing previous experiences. Third, patients said they needed to be convinced of the need for additional, invasive tests and therapeutic procedures, and in some cases providers' arguments failed in this regard. Fourth, the patients highlighted the importance of trusting their provider. Although there were no apparent differences by race in patients' perception of the information they received, black patients consistently expressed a preference for building a relationship with physicians (trust) before agreeing to an invasive cardiac procedure, and just as consistently complained that trust was lacking. Conversely, white patients tended to emphasize that they were inadequately convinced of the need for recommended procedures. CONCLUSIONS: This study provided qualitative information regarding patients' perceptions of physician-patient communication and racial differences in such perceptions. For both black and white patients, we found problematic aspects of the patients' experiences regarding communication about cardiac testing. Our findings suggest that although patients desire clarity from physicians, they are often confused regarding the information received. Both a lack of substance and vagueness of the information received may be linked to feelings of mistrust toward physicians when considering further diagnostic testing. Mistrust may be a source of some of the documented racial variation in health care utilization.

Black or African American↗
PubMed2006

Ethnic or racial differences revisited: impact of dosage regimen and dosage form on pharmacokinetics and pharmacodynamics.

Ethnic or racial differences in pharmacokinetics and pharmacodynamics have been attributed to the distinctions in the genetic, physiological and pathological factors between ethnic/racial groups. These pharmacokinetic/pharmacodynamic differences are also known to be influenced by several extrinsic factors such as socioeconomic background, culture, diet and environment. However, it is noted that other factors related to dosage regimen and dosage form have largely been ignored or overlooked when conducting or analysing pharmacokinetic/pharmacodynamic studies in relation to ethnicity/race. Potential interactions can arise between the characteristics of ethnicity/race and a unique feature of dosage regimen or dosage form used in the study, which may partly account for the observed pharmacokinetic/pharmacodynamic differences between ethnic/racial groups. Ethnic/racial differences in pharmacokinetics/pharmacodynamics can occur from drug administration through a specific route that imparts distinct pattern of absorption, distribution, transport, metabolism or excretion. For example, racial differences in the first-pass metabolism of a drug following oral administration may not be relevant when the drug is applied to the skin. On the other hand, ethnic/racial difference in pharmacokinetics/pharmacodynamics can also happen via two different routes of drug delivery, with varying levels of dissimilarity between routes. For example, greater ethnic/racial differences were observed in oral clearance than in systemic clearance of some drugs, which might be explained by the pre-systemic factors involved in the oral administration as opposed to the intravenous administration. Similarly, changes in the dose frequency and/or duration may have profound impact on the ethnic/racial differences in pharmacokinetic/pharmacodynamic outcome. Saturation of enzymes, transporters or receptors at high drug concentrations is a possible reason for many observed ethnic/racial discrepancies between single- and multiple-dose regimens, or between low- and high-dose administrations. The presence of genetic polymorphism of enzymes and/or transporters can further complicate the analysis of pharmacokinetic/pharmacodynamic data in ethnic/racial populations. Even within the same dosage regimen, the use of different dosage forms may trigger significantly different pharmacokinetic/pharmacodynamic responses in various ethnic/racial groups, given that different dosage forms may exhibit different rates of drug release, may release the drug at different sites, and/or have different retention times at specific sites of the body. It is thus cautioned that the pharmacokinetic/pharmacodynamic data obtained from different ethnic/racial groups cannot be indiscriminately compared or combined for analysis if there is a lack of homogeneity in the apparent 'extrinsic' factors, including dosage regimen and dosage form.

Cross-Cultural Comparison↗
PubMed1990

Racial differences in prevalence of phobic disorders.

Few community-based field studies have examined racial differences in the prevalence of phobia disorders. Using data from two sites of a large epidemiologic survey, this study investigates risk factors associated with the one-month prevalence of phobia disorders from 2340 black and 3936 white respondents. Findings indicate that recent prevalence is higher for blacks than whites, with racial differences remaining even when demographic and socioeconomic factors are held constant. Additional significant risk factors for recent phobia pertained to site and being female, being young, and having low education attainment.

Adolescent↗
PubMed2002

Racial differences in treatment and survival from early-stage breast carcinoma.

BACKGROUND: African-American women have a significantly worse prognosis from breast carcinoma compared with white women, even when the stage at diagnosis is equivalent. The purpose of this study was to analyze racial differences in the treatment (use of breast-conserving surgery and radiation therapy) of women with early-stage breast carcinoma and the resulting effects on survival rates. METHODS: Subjects included 10,073 African-American and 123,127 white women diagnosed with Stage I, IIA, or IIB breast carcinoma in the National Cancer Institute's Surveillance, Epidemiology, and End Results program between 1988 and 1998. Comparisons were made by race with treatment, age, hormone receptor status, and stage at the time of diagnosis. Survival analyses were conducted to compare risk of death for African-American and white women while controlling for age, stage, and hormone receptor status. RESULTS: Among women diagnosed with early-stage breast carcinoma who receive breast-conserving surgery, African-American women were significantly less likely to receive follow-up radiation therapy in every 10-year age group except in the older than 85 age group. Whether treatment was equivalent or suboptimal, survival for African-American women with early-stage breast carcinoma was significantly worse. However, when treatment was equivalent, the effects of racial differences on survival were significantly less compared with survival associated with suboptimal treatment. CONCLUSIONS: Significant racial differences exist in the treatment of women with early-stage breast carcinoma. Public health efforts to eliminate suboptimal treatment would reduce, but not eliminate, racial disparity in survival.

Adult↗
PubMedDate not supplied

Racial differences in late prenatal care visits.

The purpose of this study was to examine potential racial disparities in the use of prenatal care beyond what could be measured by the Kessner Index. The data were obtained from the 1986 Massachusetts Prenatal Care Survey, a follow-back study of 2587 postpartum women, which had as its primary objective the identification of barriers to adequate use of prenatal care. This investigation examined the number of prenatal visits reported for each month of pregnancy and found that white women reported significantly more visits than black women only in the eighth and ninth months of pregnancy. This racial difference remained after we controlled for gestational age, sociodemographic factors, reported barriers to care, payor status, and access to care. This study suggests that racial differences in use of late prenatal visits need direct attention if the gaps in use of prenatal care and adverse birth outcomes are to be lessened.

Adolescent↗
PubMed1986

Racial differences in drug responses--a comparative study of trimazosin and alpha 1-adrenoceptor responses in normotensive Caucasians and West Africans.

The possible racial differences in alpha 1-adrenoceptor responsiveness and the blood pressure and heart rate responses following alpha 1-adrenoceptor antagonism with trimazosin have been investigated in matched groups of six Caucasians and six Nigerians. There were no significant differences between the racial groups in the blood pressure and heart rate responses to oral (200 mg) and intravenous (100 mg) trimazosin. alpha 1-adrenoceptor responsiveness was similar in both groups after placebo and following both active treatments. There were only minor pharmacokinetic differences with the Caucasians having a larger volume of distribution, and a longer terminal elimination half-life for the metabolite, 1-hydroxy-trimazosin. These results suggest a similarity in peripheral vascular alpha 1-adrenoceptor mechanisms and show no major significant racial differences in the pharmacokinetics and pharmacodynamics of trimazosin.

Adult↗
PubMed2005

Racial differences in the tracking of childhood BMI to adulthood.

OBJECTIVE: The possibility that there are racial differences in the patterns of BMI (kilograms per meter squared) change throughout life has not been examined. For example, the high prevalence of obesity among black women could result from a higher prevalence of obesity among black girls or because normal-weight black girls experience larger BMI increases in adolescence or adulthood than do their white counterparts. Therefore, we examined the tracking of childhood BMI into adulthood in a biracial (36% black) sample. RESEARCH METHODS AND PROCEDURES: Five- to 14-year-old children (2392) were followed for (mean) 17 years. Childhood overweight was defined as BMI > or = 95th percentile, and adult obesity was defined as BMI > or = 30 kg/m(2). RESULTS: The tracking of childhood BMI differed between whites and blacks. Among overweight children, 65% of white girls vs. 84% of black girls became obese adults, and predictive values among boys were 71% (whites) vs. 82% (blacks). These racial differences reflected contrasting patterns in the rate of BMI change. Although the initial BMI of black children was not higher than that of white children, BMI increases with age were larger among black girls and overweight black boys than among their white counterparts. In contrast, relatively thin (BMI < 50th percentile) white boys were more likely to become overweight adults than were their black counterparts. DISCUSSION: These findings emphasize the black/white differences in BMI changes with age. Because of the adult health consequences of childhood-onset obesity, early prevention should be given additional emphasis.

Adolescent↗
PubMed2001

Racial differences in the sums of skinfolds and percentage of body fat estimated from impedance in black and white girls, 9 to 19 years of age: the National Heart, Lung, and Blood Institute Growth and Health Study.

OBJECTIVES: This National Heart, Lung, and Blood Institute Growth and Health Study report assesses racial differences in fat patterning in black and white girls ages 9 to 19 years, comparing the sum of triceps and subscapular skinfolds (SSFs) and percentage of body fat (%BF) from impedance as two indices of adiposity. It is hypothesized that racial differences in fat patterning manifest during puberty. RESEARCH METHODS AND PROCEDURES: SSF and %BF were measured annually. Racial differences in SSF and %BF were evaluated by age. Associations between %BF and SSF were evaluated using the Pearson's correlations coefficient. Classification agreement was evaluated using the kappa-statistic. Effects of pubertal stage and race on classification agreement were examined using multivariate models. RESULTS: White girls had a greater mean %BF at 9 to 12 years of age; black girls had a greater %BF thereafter. Black girls had a greater mean SSF at every age. The correlation coefficient between SSF and %BF was 0.79, and there was good agreement between %BF and SSF in separating high (>85th percentile) from not high (kappa = 0.60 for whites and 0.66 for blacks). SSF associated more with %BF in prepuberty and early puberty than in late puberty. DISCUSSION: Despite good correlations between %BF and SSF, the two methods indicate different fat patterns in black and white girls.

Adipose Tissue↗
PubMed1990

Racial differences in acceptability and availability of drugs and early initiation of substance use.

This paper examines differences among three racial groups in exposure to three risk factors for drug use (availability of drugs, acceptability of drug use, and peer alcohol use), and the relationship of these factors to drug use initiation in a sample of preadolescent urban youths. Tobacco and alcohol initiation rates were highest among Whites, lower among Blacks, and lowest among Asian-Americans. Paralleling these differences, White youths reported the greatest access to marijuana, greatest parental tolerance of substance use, and greatest intentions to use drugs as adults. Blacks somewhat less, and Asian-Americans the least. No racial differences appear in the proportion who reported that their peers used alcohol. Marijuana availability and peer use predicted substance initiation for all three racial groups. However, intentions to use substances as an adult and perceived parental tolerance of substance use predicted drug use only for White and Asian-American youths, while the expectation of punishment for drug use predicted lower drug use only among Black youths. Implications for prevention are discussed.

Adolescent↗
PubMed1992

Racial differences in pre- and postmenopausal bone homeostasis: association with bone density.

The disparity in fracture incidence and bone mass in women of European (white) and African (black) ancestry is of unknown etiology. To determine if racial differences in bone mass reflected racial differences in the mechanisms of bone turnover underlying bone mineral loss, we measured serum osteocalcin, serum alkaline phosphatase, fasting urinary calcium and hydroxyproline excretion, 24 h urinary excretion of calcium and sodium, and dietary intakes of calcium and vitamin D in 263 healthy pre-, peri-, and postmenopausal white and black women. In addition, radial and spinal bone density were measured cross-sectionally for comparison with biochemical measures of bone turnover. The biochemical parameters thought to reflect bone resorption (fasting urinary calcium and hydroxyproline excretions) were lower in black than in white women throughout the age and menopausal stages studied. The parameters thought to reflect bone formation (alkaline phosphatase and osteocalcin), were similar in the two racial groups among the premenopausal women, but osteocalcin was significantly lower among the peri- and postmenopausal blacks. Cross sectionally measured radial bone density increased with age in premenopausal black women, but it did not change with age in the white premenopausal subjects, a statistically significant difference. In peri- and postmenopausal women radial density declined significantly with years after menopause in both racial groups, but the rate of decline was significantly slower in the black women. Lumbar bone density in premenopausal white and black women did not change with age. After menopause lumbar bone density declined significantly and similarly in both racial groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Racial differences in cesareans: an analysis of U.S. 2001 National Inpatient Sample Data.

OBJECTIVE: To evaluate racial differences in potentially unnecessary cesareans in the United States. METHODS: The 2001 Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze various maternal demographic and clinical parameters among women having cesarean deliveries. For the purpose of our study, if there were no diagnoses related to cesarean delivery on the discharge certificate, the cesarean was classified as potentially unnecessary RESULTS: Using our methodology, 11% of 540,174 primary and 65% of 371,863 repeat cesareans for the year 2001 in the United States were classified as potentially unnecessary. After controlling for age, payment source, ZIP income, admission day, region of the country, and hospital size, location, and teaching status, black women had a higher likelihood of having potentially unnecessary primary cesareans when compared with white (P < .001) or Hispanic women (P < .001). White women had a higher likelihood of having potentially unnecessary repeat cesareans than black women (P < .001), although the magnitude of the odds ratio for race was not as striking as in primary cesarean. Potentially unnecessary primary cesareans were also more likely to occur in women aged 35 years or older, Medicare patients, weekend admissions, or those residing in the South or Northeast. Potentially unnecessary repeat cesareans were more likely to occur in women younger than 35 years, in rural hospitals, and in weekday admissions. CONCLUSION: In the United States, racial differences exist in the proportion of cesarean deliveries that are potentially unnecessary. Further exploration of these differences is warranted. LEVEL OF EVIDENCE: III.

Adult↗
PubMed2004

Racial differences in aortic atheroma in patients undergoing transesophageal echocardiography for unexplained stroke or transient ischemic attack.

Racial differences in the prevalence of complex thoracic aortic atheroma were evaluated in 318 patients referred for transesophageal echocardiography after unexplained stroke or transient ischemic attack. African-Americans were found to have fewer complex thoracic aortic atheroma and fewer combined cardiac sources of embolus than Caucasian patients. This finding persists after adjusting for racial differences in atherosclerotic risk factors.

Adult↗
PubMed2006

Racial differences in coping with the need for kidney transplantation and willingness to ask for live organ donation.

BACKGROUND: Disparities in African-American live donor kidney transplantation continue to grow. How patients cope with the reality of end-stage renal disease and the ensuing need for dialysis or a kidney transplant may directly affect the course of their disease, quality of life, and willingness to ask for live kidney donation. Racial differences in coping may exist and relate to the willingness to ask for live kidney donation. METHODS: The Brief COPE and Living Organ Donor Survey instruments were administered prospectively to potential kidney transplant recipients. The 14 different coping mechanisms were analyzed by race to look for differences. Willingness to ask for live kidney donation was analyzed to look for possible correlations with coping mechanisms and possible predictors analyzed by means of logistic regression. RESULTS: Three hundred thirty-three potential kidney transplant recipients were administered the surveys, with 61% African Americans. Racial differences were seen in the following coping mechanisms: acceptance, humor, religion, denial, and behavioral disengagement. Although racial differences did not exist in overall willingness to ask for donation, positive coping strategies were related to increased willingness to ask for donation. CONCLUSION: African Americans cope with the need for a kidney transplant differently than non-African Americans. Potential African-American kidney recipients are more likely to deny the need for a transplant and are less accepting of their situation. This may affect their perception of the need for transplantation and their persuasiveness in asking for live donations. Transplant programs should ensure that counseling and education programs aim to modify unrealistic expectations and improve recipient coping skills.

Adaptation, Psychological↗
PubMed1988

Racial differences in sports performance.

The purpose of this paper is twofold: (a) to present data on racial differences in sport performance and (b) to comment briefly on theories, hypotheses and studies, whether they be biological, psychological or sociological in nature, that have attempted to explain the observed differences. Available data are mainly drawn from studies focusing on American professional sports. The results indicate that Afro-American athletes largely dominate the sport scene in a few sports and across a wide range of performance indicators. Although it is impossible at this time to conclude with satisfaction on the causes of racial differences, sociological explanations seem best to explain the observed performance differentials.

Black People↗