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PubMed2004

Racial differences in health-related quality of life among hemodialysis patients.

UNLABELLED: BACKGROUND; Despite technical progress in therapy, hemodialysis patients continue to report health-related quality of life (HRQOL) substantially lower than that of the general population. While African Americans with end-stage renal disease (ESRD) survive longer than members of other races, few studies have compared the HRQOL of African Americans with that of non-African Americans. METHODS: We examined differences in sociodemographic, clinical, and HRQOL variables by race. A multiple regression model assessed the extent to which race was associated with differences in HRQOL scores after adjustment for sociodemographic and clinical variables. Racial differences in the relationship between comorbid disease severity and HRQOL were explored. RESULTS; In adjusted models, African Americans had higher scores in the Index of Well-Being and burden of kidney disease, but lower scores in cognitive function (all P < 0.05). For scales reflecting symptoms and effects of kidney disease, sleep quality, and the Physical Component Summary, the fall in HRQOL with increasing comorbidity was significantly greater in non-African Americans (all P < 0.05). After adjustment, there were no racial differences in scores on the Mental Component Summary, social support, dialysis staff encouragement, or patient satisfaction. CONCLUSION: To our knowledge, ESRD is the only chronic illness for which African Americans report significantly better psychologic well being and a lower burden of disease than non-African Americans. Further research is needed to understand whether these experiences affect health care utilization, medical decision making, and patient survival. Clarification of the reasons for race differences may suggest measures to improve HRQOL for all patients with ESRD.

Adult↗
PubMed1999

Racial differences in metabolic predictors of obesity among postmenopausal women.

OBJECTIVE: This study determined whether there are racial differences in resting metabolic rate (RMR), fat oxidation, and maximal oxygen consumption (VO2max) in obese [body mass index (BMI = 34+/-2 kg/m2)], postmenopausal (58+/-2 years) women. RESEARCH METHODS AND PROCEDURES: Twenty black and 20 white women were matched for fat mass and lean mass (LM), as determined by dual energy X-ray absorptiometry. RMR and fat oxidation were measured by indirect calorimetry in the early morning after a 12-hour fast using the ventilated hood technique. VO2max was measured on a treadmill during a progressive exercise test to voluntary exhaustion. RESULTS: RMR, adjusted for differences in LM, was 5% higher in white than black women (1566+/-27 and 1490+/-26 kcal/day, respectively; p<0.05); and fat oxidation rate was 17% higher in white than black women (87+/-4 and 72+/-3 g/day, respectively; p<0.01). VO2max (L/minute) was 150 mL per minute (8%) higher (p<0.05) in white than black women. VO2max correlated with LM in black (r=0.44, p=0.05) and white (r=0.53, p<0.05) women, but the intercept of the regression line was higher in white than black women (p<0.05), with no significant difference in slopes. In a multiple regression model including race, body weight, LM, and age, LM was the only independent predictor of RMR (r2 = 0.46, p<0.0001), whereas race was the only independent predictor of fat oxidation (r2 = 0.18, p<0.05). The best predictors of VO2max were LM (r2 = 0.22, p<0.05) and race (cumulative r2 = 0.30, p<0.05). DISCUSSION: These results show there are racial differences in metabolic predictors of obesity. Determination of whether these ethnic differences lead to, or are an effect of, obesity status or other lifestyle factors requires further study.

Basal Metabolism↗
PubMed1979

Outcome of normal and dysfunctional labor in different racial groups.

Spontaneous labor in patients of different racial groups has been studied relating progress and outcome to whether labor was dysfunctional as defined by the partogram and action line. Forty-three percent of primigravidas and 17.6 to 25.8% of multigravidas passed the action line and had a lower admission cervical dilatation and a longer observed first stage than those patients whose labor progress remained to the left of the action line. White and black primigravidas whose labor progressed to the right of the action line had lower 1 and 5 minute Apgar scores and delivered heavier babies than those to the left. The cesarean section rates were 1.6% and 1.4% (left) and 7.6% and 18.2% (right) in white and black primigravidas, respectively. The cesarean section rate was significantly higher in black primigravidas irrespective of the relationship to the action line due to the high incidence of the complications of hypertension such as fetal distress and abruptio placentae in those in normal labor as well as those in dysfunctional labor due to cephalopelvic disproportion in those patients whose cervimetric progress went to the right of the action line.

Age Factors↗
PubMedDate not supplied

Racial differences in the relaxation response of hypertensives.

Racial differences in the relaxation response of hypertensives maintained on diuretic were investigated by comparing blood pressure, muscle tension, and hand temperature changes occurring with biofeedback assisted relaxation. Resting blood pressures were not different in blacks compared with whites. Both black and white subjects decreased diastolic blood pressure significantly from baseline values, but only whites significantly decreased systolic blood pressure. Though both blacks and whites significantly decreased forehead muscle tension, black subjects showed no changes in finger temperature while whites increased temperature significantly. The lack of change in finger temperature in blacks may be a reflection of the increased peripheral resistance previously associated with the greater incidence of hypertension in the American black population.

Adrenergic beta-Antagonists↗
PubMed1994

Prostate cancer: are racial differences in clinical stage and survival explained by differences in symptoms?

PURPOSE: To better understand racial differences in data for patients referred for definitive treatment of biopsy-proved adenocarcinoma of the prostate gland. MATERIALS AND METHODS: Two groups of patients were defined for further analysis. Group 1 comprised all patients who received definitive external beam irradiation of prostatic carcinoma; group 2 comprised all patients with prostatic carcinoma referred between January 1988 and December 1992 for examination at the first clinical indication of adenocarcinoma of the prostate. All patients were evaluated for age, race (black vs white), differentiation of tumor, date of diagnosis, and clinical stage. RESULTS: In group 1, black patients were significantly younger and presented with disease at higher clinical stage but equivalent grade and survival compared with white patients. In group 2, black patients were significantly younger and had similar differentiation of tumor but with significantly higher clinical stage compared with white patients and more often had obstructive symptoms and less often had been screened for elevated prostate-specific antigen levels. CONCLUSION: Black patients should undergo earlier screening for prostate cancer.

Adenocarcinoma↗
PubMed1994

Racial differences in cervical cancer mortality in Chicago.

Racial differences in cervical cancer mortality in Chicago were examined. Age-adjusted mortality in Blacks (10.0/100,000) was over twice the rate found in Whites (4.6/100,000). Age-specific rates also showed significant excess mortality among Blacks. After stratification by a group-level defined poverty indicator, the race differential in age-adjusted rates remained significant. The race differential in age-specific rates diminished in the group with more than 30% living below the national poverty level, in contrast to the group with 30% or fewer living below the national poverty level, in whom race differences were more marked. Methodological issues concerning hysterectomy prevalence, Hispanic ethnicity, and social class must be considered with respect to interpretation of these findings.

Adolescent↗
PubMed2006

Religiosity, religious coping styles, and health service use: racial differences among elderly women.

This study explored racial differences in the effects of religiosity and religious coping styles on health service use. The sample (N = 274) consisted of a cross-section of women ages 55 and older living in publicly subsidized high-rise dwellings in Nashville, Tennessee (1999 to 2000) and included 159 White and 115 African American women. The results suggested the effects of religiosity on health service use are generally negative for both groups. However, the effects of religious coping styles on health service use differed by race. The self-directing coping style was associated with higher levels of use for White women, but with lower levels of use for African American women. The deferring coping style was associated with greater physician visits and inpatient days among White women, but with fewer inpatient days among African American women. The collaborative coping style was associated with higher inpatient days among African American women, but had no significant effect on use patterns for White women. Conducting assessments of religiosity and religious coping styles would enhance holistic nursing practice.

Adaptation, Psychological↗
PubMed2006

Intrinsic racial differences in the risk of cesarean delivery are not explained by differences in caregivers or hospital site of delivery.

OBJECTIVE: This study was undertaken to assess whether racial differences in the risk of cesarean delivery result from differing practices of their caregivers or the hospitals at which they deliver. STUDY DESIGN: A retrospective cohort study was performed using the Perinatal Database of the Memorial Health Care System. Logistic regression was used to estimate the risk of primary cesarean delivery among patients eligible for labor. The contribution of hospital and physician level cluster correlation was evaluated using fixed and random effects regression models. RESULTS: Compared with white patients, black and Hispanic patients were 75% and 22% more likely to undergo primary cesarean delivery. Further adjustment for hospital and physician level cluster correlation resulted in persistently increased risks of primary cesarean delivery in black (54%) and Hispanic patients (12%). CONCLUSION: Hospital site of delivery and individual physician practices do not fully explain racial differences in the risk of primary cesarean delivery.

Adult↗
PubMed2004

Neighborhood context and racial differences in early adolescent sexual activity.

Evidence suggests that African American youths initiate sexual activity at earlier ages than do European American or Latino youths. Using data from a multilevel study in Chicago, we developed and tested a neighborhood-based model of the timing of first adolescent intercourse that emphasizes the impact of neighborhood structural disadvantage and collective efficacy on early sexual activity (at ages 11 to 16). In turn, we explored the extent to which neighborhood factors account for racial differences in the timing of first intercourse. The findings indicate that demographic background, family processes, peer influences, and developmental risk factors account for about 30% of the baseline increased likelihood of early sexual onset for African American youths compared with European American youths. However, a significant residual racial difference remained even after we considered a host of micro-level factors. Neighborhood-level concentrated poverty largely explained this residual racial difference. Collective efficacy also independently contributed to the delay of sexual onset. No significant baseline difference in age of sexual initiation was found between Latino and European American youths.

Adolescent↗
PubMed2004

Elimination of racial differences in invasive pneumococcal disease in young children after introduction of the conjugate pneumococcal vaccine.

BACKGROUND: Racial differences in the epidemiology of invasive pneumococcal disease (IPD) have been widely recognized, but the impact of conjugate pneumococcal vaccine (PCV) introduction in 2000 on these differences has not been extensively studied. METHODS: IPD episodes in 5 Tennessee counties from January 1995 through December 2002 were collected prospectively using the Centers for Disease Control and Prevention's Active Bacterial Core Surveillance system (ABCs). Trained nurses collected clinical data, and antibiotic susceptibility testing was performed on available isolates. RESULTS: Before vaccine licensure, IPD rates were highest in children younger than 2 years and in blacks. The disparity in IPD rates between blacks and whites younger than 2 years of age substantially diminished after PCV introduction. In 1999, the IPD rate in black children younger than 2 years was 340.2 per 100,000, representing 176.5 more events per 100,000 than in white children (P < 0.001). In 2002, this rate had decreased 83% to 57.4 per 100,000, similar to the rate in white children (39.6 per 100,000; P = 0.31). Before vaccine licensure, a higher percentage of isolates from whites were antibiotic-nonsusceptible. In 2002, the proportion of antibiotic-nonsusceptible pneumococcal isolates was similar in whites and blacks of all ages for the first time during the study period (P > 0.05 for separate comparisons of penicillin, cephalosporin and erythromycin nonsusceptibility). These changes occurred despite a lower PCV vaccination coverage in Tennessee in blacks than in whites (31.2% versus 47.6%). CONCLUSIONS: With conjugate pneumococcal vaccine introduction in Tennessee, racial differences in the incidence rates of IPD have largely been eliminated, particularly in young children.

Adolescent↗
PubMed1989

Racial differences in stress-induced cardiovascular reactivity and hypertension: current status and substantive issues.

Essential hypertension is perhaps the number-one health problem of Black Americans. Research has indicated that stress-induced cardiovascular hyperreactivity may be a significant contributor to essential hypertension. The high prevalence of hypertension among Blacks suggests that this group, in comparison with Whites, may be particularly susceptible to cardiovascular hyperreactivity. The first portion of this article reviews research to date that has examined racial differences in resting and stressor-induced cardiovascular activity. The second half of this article overviews some critical methodological and conceptual issues involved in the study of racial differences in reactivity. These issues include the effects of Black-White differences in plasma renin levels and sodium excretion, the effects of experimenter race, and differences in perceptions of the laboratory environment. Additionally, the issue of racial group classification and the implications this has for interpreting Black-White differences in reactivity is discussed. Two perspectives on racial group classification, the genetic and the sociocultural, are addressed in some detail, and the relevance of each to research on racial differences in stress reactivity is presented.

Black or African American↗
PubMed1995

Racial differences in treatment of psychiatric inpatients.

OBJECTIVE: The study examined several aspects of inpatient psychiatric treatment to determine if differences existed between treatment of African-American and white patients. METHODS: Using a structured chart review, data were collected on 76 African-American and 88 white patients consecutively admitted to an acute inpatient setting with a principal axis I diagnosis of a major mood or psychotic disorder. Racial differences in treatment were examined using analysis of variance and logistic regression to assess the effects of diagnosis and socioeconomic status. RESULTS: Nonpsychotic African-American patients had shorter lengths of stay than white patients with similar disorders. White patients were more likely to be on one-to-one observational status. Clinicians were more likely to order urine drug screens for African-American patients with high socioeconomic status than for comparable white patients. African-American patients with schizophrenic disorders received higher neuroleptic dosages than white patients with similar diagnoses. CONCLUSIONS: Most racial differences cited in earlier studies of psychotic patients were not found or were not statistically significant once socio-economic status and diagnosis were accounted for. However, racial differences related to the detection, phenomenology, treatment, and course of psychotic disorders and the diagnosis and management of alcohol and drug use disorders and personality disorders were found.

Adolescent↗
PubMed1984

Racial differences in the distribution of anterior circulation occlusive disease.

We compared clinical and angiographic features of 26 white and 45 black patients with symptomatic occlusive cerebrovascular disease. White patients had more transient ischemic attacks, carotid bruits, and more severe occlusive disease of the internal carotid artery origin. Blacks had more severe disease of the middle cerebral artery stem and supraclinoid internal carotid arteries. Differences were not explained by racial differences in the prevalence of hypertension, diabetes, hypercholesterolemia, or ischemic heart disease. Since the middle cerebral artery lesions in blacks do not correlate with other accepted epidemiologic, clinical, and laboratory markers of atherosclerosis, the lesions may arise from a disorder that differs from atherosclerosis.

Aged↗
PubMed2006

A secondary analysis of racial differences in periodic leg movements in sleep and ferritin in hemodialysis patients.

BACKGROUND AND OBJECTIVE: Hemodialysis (HD) is associated with restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS), but the mechanisms underlying these relationships remain unclear. African-American HD patients have been reported previously to have a reduced likelihood of RLS. Alterations in iron metabolism, known to be a risk factor for idiopathic forms of RLS, could represent the basis for these racial differences. PATIENTS AND METHODS: In secondary data analyses from a previously published study, we examined raw and log-transformed values for plasma ferritin and polysomnographically recorded PLMS in Caucasian and African-American HD patients. RESULTS: African-American (n=36) HD patients had higher ferritin and lower PLMS than Caucasians (n=10). However, within the African-American population, ferritin levels were unrelated to PLMS. CONCLUSIONS: These results are compatible with previously reported racial differences in RLS to the extent that PLMS were less common in the African-American population. However, they suggest that if a differential genetic vulnerability underlies those racial differences, it may not manifest as a deficiency in iron metabolism, at least within the constraints of the marker of iron stores used here (e.g. serum ferritin) and in the specific population studied (hemodialysis). Future studies with larger, more representative samples of African-Americans and Caucasians will be required to replicate such differences.

Adult↗
PubMed1992

Racial differences on the MCMI in an outpatient clinical sample.

In this study, we extended previous research on racial differences on the Millon Clinical Multiaxial Inventory (MCMI) which focused on psychiatric inpatients. Subscale scores were compared for Black and White outpatient males on the MCMI. Age, education, and employment status were controlled. Results showed that Blacks scored significantly higher than Whites on the Narcissistic, Aggressive, Paranoid, Drug, and Psychotic Delusion subscales. Results are interpreted in terms of the larger body of research on racial differences on personality instruments. Clinical implications and the need for further research are discussed.

Adult↗
PubMed1980

Racial differences in per capita income, 1960-76: the importance of household size, headship, and labor force participation.

Racial differences in average per capita income are decomposed, as are changes over time for both races. The 1960-76 decline in household size accounted for 13 percent of the per capita income improvement of both races. Whereas real increases in earnings of husbands contributed most to improvements in well-being in husband-wife households, increases in income from sources other than earnings were most important to female headed households. During a period in which a growing proportion of both races resided in female headed households and racial differences in living arrangements widened, the per capita income of female headed households relative to husband-wife households declined.

Black or African American↗
PubMed2004

Racial differences in hepatitis B and hepatitis C and associated risk behaviors in veterans with severe mental illness.

Racial differences in the seroprevalence of and risks for hepatitis B (HBV) and hepatitis C (HCV) were examined in military veterans with severe mental illnesses (SMI). Participants (376; 155 Caucasian, 221 African American) were inpatients at a Veterans Affairs (VA) psychiatric unit in Durham, N.C., from 1998 to 2000. Prevalence rates of HBV and HCV were 21.3% and 18.9%, respectively. African Americans had a higher HBV seroprevalence than did Caucasians: 27.6% versus 12.3%; odds ratio (OR) 2.73; 95% confidence interval (CI)=1.55, 4.79. Although not statistically significant, HCV seroprevalence was also higher for African Americans than it was for Caucasians: 21.3% versus 15.5%; OR=1.47; 95% CI=0.86, 2.53. No racial difference was observed for injection drug use (IDU), the strongest risk indicator for both HBV and HCV. Multivariable analyses indicated that African-American race, IDU, and multiple sex partners in the past six months were related to an increased risk of HBV, whereas IDU and smoking crack cocaine were both independently related to an increased risk of HCV. Thus, veterans with SMI--particularly African-American veterans--have high rates of HBV and HCV infection. African-American veterans have significantly higher rates of HBV than do Caucasian veterans, which persist after controlling for prominent risk behaviors.

Adult↗
PubMed2004

A cohort study found racial differences in dental insurance, utilization, and the effect of care on quality of life.

OBJECTIVE: To describe racial differences in receipt of dental services and dental insurance; and to determine the effectiveness of specific dental services in facilitating recovery in symptom-specific and race-specific subgroups. STUDY DESIGN AND SETTING: Using a restricted cohort analytic method, Florida Dental Care Study prospective cohort data were used to quantify associations between dental service use and the quality of life measure, "recovery" from oral disadvantage due to functional limitation. RESULTS: Non-Hispanic Whites (NHW) were more likely to have a dental visit [odds ratio (OR); 95% confidence interval: 3.5; 2.2-5.3], corrective treatment (OR=2.1; 1.3-3.3), caps (OR=28.8; 6.6-126.4), and dental insurance coverage for caps (OR=2.9; 1.4-5.9). After adjusting for other covariates: (1) among NHW with severe gum disease, those receiving extractions were more likely to recover (OR=7.8; 1.0-59.1), but those receiving caps were less likely to recover (OR=0.1; 0.01-0.6); (2) among Non-Hispanic Blacks (NHB) with a sensitive tooth, those receiving corrective treatment (OR=3.2; 1.2-8.8) or extractions (OR=3.8; 1.3-11.2) were more likely to recover; (3) among NHB with tooth disease, those receiving corrective treatment (OR=2.3; 1.0-5.0) and extractions (OR=2.8; 1.2-6.5) were more likely to recover. CONCLUSION: There were racial differences in dental insurance, in the receipt of dental services and in the effectiveness of dental services in improving oral health-related quality of life.

Black or African American↗