Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception cohort epidemiology study

BACKGROUND The current epidemiology of inflammatory bowel disease(IBD) in the multiethnic United Kingdom is unknown. The last incidence study in the United Kingdom was carried out over 20 years ago.AIM To describe the incidence and phenotype of IBD and distribution within ethnic groups.METHODS Adult patients( 16 years) with newly diagnosed IBD(fulfilling Copenhagen diagnostic criteria) were prospectively recruited over one year in 5 urban catchment areas with high South Asian population. Patient demographics, ethnic codes, disease phenotype(Montreal classification), disease activity and treatment within 3 months of diagnosis were recorded onto the Epicom database.RESULTS Across a population of 2271406 adults, 339 adult patients were diagnosed with IBD over one year: 218 with ulcerative colitis(UC, 64.3%), 115 with Crohn's disease(CD, 33.9%) and 6 with IBD unclassified(1.8%). The crude incidence of IBD, UC and CD was 17.0/100000, 11.3/100000 and 5.3/100000 respectively. The age adjusted incidence of IBD and UC were significantly higher in the Indian group(25.2/100000 and 20.5/100000) compared to White European(14.9/100000,P = 0.009 and 8.2/100000, P 0.001) and Pakistani groups(14.9/100000, P = 0.001 and 11.2/100000, P = 0.007). The Indian group were significantly more likely to have extensive disease than White Europeans(52.7% vs 41.7%, P = 0.031). There was no significant difference in time to diagnosis, disease activity and treatment.CONCLUSION This is the only prospective study to report the incidence of IBD in an ethnically diverse United Kingdom population. The Indian ethnic group showed the highest age-adjusted incidence of UC(20.5/100000). Further studies on dietary,microbial and metabolic factors that might explain these findings in UC are underway.     

Osteologic analysis of ethnic differences in supernumerary ethmoidal foramina: implications for endoscopic sinus and orbit surgery

Background

Knowledge of the position of the ethmoidal arteries is critical to enable safe endoscopic sinus and orbital surgery. The presence of a third or “middle” ethmoid variant has recently become more relevant as endoscopic intraconal surgery continues to advance. The purpose of this study was to quantify the presence of supernumerary (ie, over 2) ethmoid foramina in different ethnicities and genders.

Methods

Morphometric osteologic measurements were performed in 273 orbits. Prevalence of supernumerary ethmoid foramina and orbital length data were obtained from human skulls of Asian (n = 54), Caucasian (n = 70), African (n = 39), Hispanic (n = 49), and Middle Eastern (n = 61) derivation. Correlations between gender, ethnicity, symmetry, orbital floor, and lamina papyracea length were assessed by analysis of variance, paired t test, and χ² test.

Results

Supernumerary foramina were identified in 95 of 273 orbits (34.79%). A significantly higher prevalence was seen in Asian (42.59%), African (41.02%), and Hispanic (41.00%) skulls as compared with Caucasian (25.71%) and Middle Eastern (22.95%) skulls (p < 0.05 for all). The length of the orbital floor was significantly shorter in the Asian (3.35 ± 1.52 cm) specimens (p < 0.01). Asians were found to have the highest risk of ethmoid artery injury compared with the other ethnic groups (ratio of number of supernumerary foramina to orbital floor length = 0.72).

Conclusion

Supernumerary ethmoidal foramina were common among all orbits studied. Orbits of Asian and African derivation had significantly greater numbers of ethmoidal foramina, both unilaterally and symmetrically and within a shorter orbital length, suggesting a greater proximity between the ethmoidal vessels. Surgeons should be alert to the possible presence of middle ethmoidal vessels during endoscopic sinus and orbital approaches.

     

Racial and Ethnic Disparities Persist in the Current Era of Pediatric Heart Transplantation

BackgroundPrevious studies have demonstrated that children in the United States who were of racial and ethnic minorities have inferior waitlist and post-heart transplant (HT) outcomes. Whether these disparities still exist in the contemporary era of increased ventricular assist device use remains unknown.MethodsAll children (age <18 years) in the Scientific Registry of Transplant Recipients database listed for HT from December 2011 to February 2019 were included and were separated into 5 races/ethnicities: Caucasian, African American, Hispanic, Asian, and Other. Differences in clinical characteristics and survival among children of different racial/ethnic groups were compared at listing and at HT.ResultsThe waitlist cohort consisted of 2134 (52.2%) Caucasian, 840 (20.5%) African American, 808 (19.8%) Hispanic, 161 (3.9%) Asian, and 146 children of Other races (3.6%). At listing, Asian children mostly had cardiomyopathy (70.8%), whereas Caucasian children had congenital heart disease (58.7%). African American children were most likely to be listed as Status 1A and to have renal dysfunction and hypoalbuminemia at listing. African American and Hispanic children were most likely to be on Medicaid. After multivariable analysis, it was found that only African American children were at increased risk for waitlist mortality as compared to Caucasian children (adjusted hazard ratio = 1.25; P = 0.029). Post-HT, there were no disparities in early and midterm graft survival among groups, but African American children had increased numbers of rejection episodes compared to Caucasian and Hispanic children.ConclusionAfrican American children continue to experience increased waitlist mortality and have increased rejection episodes post-HT. Studies exploring barriers to health care access and implicit bias as reasons for these disparities need to be conducted.     

A novel isoform of platelet glycoprotein Ibα is prevalent in African Americans

The heavy chain of platelet glycoprotein Ib (GPIb) contains two prevalent sequence polymorphisms. The first, Thr/Met¹⁴⁵ is responsible for the human platelet alloantigen system, human platelet antigen (HPA)-2. The second is a tandem repeat polymorphism that consists of four variants, A, B, C, and D. Previous linkage studies in Caucasian and Eastern Asian populations have demonstrated that HPA-2a (Thr¹⁴⁵) is associated with variants C and D, while HPA-2b (Met¹⁴⁵) is associated with variants A and B. We have determined HPA-2 and variable number of tandem repeats (VNTR) genotypes in three different North American ethnic groups. The gene frequency of HPA-2b in the North American Indians was intermediate between African Americans and Caucasians, and similar to the frequency previously reported in Japanese. Furthermore, the VNTR-A allele, which previously has been reported only in Eastern Asian populations, was present in two of 101 North American Indian individuals. These data are consistent with the hypothesis that the first Native Americans migrated to North America from Eastern Asia. Analysis of HPA-2 and VNTR haplotypes demonstrated an unexpected linkage pattern in the African American population. A rare GPIbα isoform, HPA-2b/VNTR-C, was present in 2.2% of African American haplotypes. Furthermore, a novel GPIbα isoform, HPA-2a/VNTR-B, was present in 6.5% of African American haplotypes. These data suggest a more complex evolutionary pattern of GPIbα isoforms than previously proposed. Am. J. Hematol. 60:77–79, 1999. © 1999 Wiley-Liss, Inc.     

Ethnic differences in the number of miscarriages, number of children, perceived family support and the impact of the disease on daily living in patients with systemic lupus erythematosus

Our aim was to test for ethnic differences in the number of children, number of miscarriages, family support and the impact of the disease on daily living among patients with systemic lupus erythematosus (SLE). Patients with SLE (n?=?54) who attended two hospitals in Essex, UK, were asked to complete a semi-structured, validated questionnaire. The number of children and the number of miscarriages were reported numerically. The level of family support and the impact of the disease on daily living were reported using 10 cm visual analogue scales (VAS) in which 10 cm represented the maximum support and worst effect on daily living, respectively. There were 20 Caucasian, 22 Asian and 12 African/Afro-Caribbean patients. There were 50 females and four males. The mean ± standard deviation (SD) age was 45.9?±?12.2 years, and the mean ± SD age at disease onset was 35.6?±?11.1 years. Overall, 34/50 female patients (68 %) reported having children of their own, while 17/50 female patients (34 %) reported one or more miscarriages. The miscarriages were mostly reported by Caucasian patients (45 % versus 18.1 % for Asian and 33.3 % for African/Afro-Caribbean patients; P?<?0.05). All of the groups received support from their families (90.7 % overall), but the level of support was greater for Caucasian (mean ± SD VAS, 6.6?±?3.4 cm) than for Asian (5.4?±?3.9 cm) and African/Afro-Caribbean (5.4?±?4.9 cm) patients (P?=?0.06). More than half of the patients (53.7 %) reported a severe impact of SLE on daily living, while 13 % reported a moderate impact, 22.2 % reported a mild impact and 11.1 % reported no impact. The impact of SLE on daily living was significantly worse for African/Afro-Caribbean patients compared with Asian patients (P?<?0.05). Overall, one in two patients with SLE reported having children of their own, while one in three patients reported having at least one miscarriage. Ninety percent of the patients received family support for their disease. Miscarriages and family support were more frequently reported by Caucasian patients. Asian patients had more children and experienced fewer miscarriages, while African/Afro-Caribbean patients reported a worse impact of the disease on daily living compared with the other ethnic groups.     

Inflammatory bowel disease in Tuzla Canton,Bosnia-Herzegovina: A prospective 10-year follow-up

BACKGROUNDThe incidence and prevalence of inflammatory bowel disease (IBD) vary between regions but have risen globally in recent decades. A lack of data from developing nations limits the understanding of IBD epidemiology.AIMTo perform a follow-up review of IBD epidemiology in the Tuzla Canton of Bosnia-Herzegovina during a 10-year period (2009-2019).METHODSWe prospectively evaluated the hospital records of both IBD inpatients and outpatients residing in Tuzla Canton for the specified period of time between January 1, 2009 and December 31, 2019. Since all our patients had undergone proximal and distal endoscopic evaluations at the hospital endoscopy unit, we used the hospital’s database as a primary data source, alongside an additional cross-relational search of the database. Both adult and pediatric patients were included in the study. Patients were grouped by IBD type, phenotype, age, and gender. Incidence rates were calculated with age standardization using the European standard population. Trends in incidence and prevalence were evaluated as a 3-year moving average and average annual percentage change rates.RESULTSDuring the 10-year follow-up period, 651 patients diagnosed with IBD were monitored (of whom 334, or 51.3%, were males, and 317, or 48.7%, were females). Of all the patients, 346 (53.1%) had been diagnosed with ulcerative colitis (UC), 292 (44.9%) with Crohn’s disease (CD), and 13 (2%) with indeterminate colitis (IC). We observed 440 newly diagnosed patients with IBD: 240 (54.5%) with UC, 190 (43.2%) with CD, and 10 (2.3%) with IC. The mean annual crude incidence rates were found to be 9.01/100000 population for IBD [95% confidence interval (CI): 8.17-9.85], with 4.91/100000 (95%CI: 4.29-5.54) for UC and 3.89/100000 (95%CI: 3.34-4.44) for CD. Calculated IBD prevalence in 2019 was 146.64/100000 (95%CI: 128.09-165.19), with 77.94/100000 (95%CI: 68.08-87.70) for UC and 65.77/100000 (95%CI: 54.45-74.1) for CD. The average annual IBD percentage change was 0.79% (95%CI: 0.60-0.88), with -2.82% (95%CI: -2.67 to -2.97) for UC and 6.92% (95%CI: 6.64-7.20) for CD. During the study period, 24,509 distal endoscopic procedures were performed. The incidence of IBD was 3.16/100 examinations (95%CI: 2.86-3.45) or 1.72/100 examinations (95%CI: 1.5-1.94) for UC and 1.36/100 examinations (95%CI: 1.17-1.56) for CD.CONCLUSIONTrends in the incidence and prevalence of IBD in Tuzla Canton are similar to Eastern European averages, although there are significant epidemiological differences within geographically close and demographically similar areas.     

Impact of race and ethnicity on inflammatory bowel disease

INTRODUCTION: Inflammatory bowel disease (IBD) is now increasingly recognized in diverse ethnic populations. In the United States, IBD among the minority populations, especially Mexican Americans, has not been extensively studied. Apart from the known genetic influences that differ among the IBD subtypes [ulcerative colitis (UC) vs. Crohn's disease (CD)], serologic markers may differentiate UC and CD, including perinuclear antineutrophilic cytoplasmic antibody (p-ANCA) and anti-Saccharomyces cerevisiae antibody (ASCA) in UC and CD. METHODS: One hundred forty-eight patients with IBD seen in a university gastroenterology practice in Houston, Texas, between June 1999 and November 2003 were analyzed to determine whether there were significant differences among racial/ethnic groups. Whites comprised 40%, African Americans 37%, Mexican Americans 20%, and Asians 3% of the total IBD patients. RESULTS: We found that African Americans and whites predominantly had CD, whereas Mexican Americans predominantly had UC. There was no difference between African Americans and Mexican Americans when separately compared to whites in terms of intestinal manifestations of CD and UC, respectively. However, African Americans with CD had a significantly higher incidence of IBD-associated arthritis (p= 0.004) and ophthalmological manifestations, notably uveitis (p= 0.028), compared to whites with CD. Among UC patients, in comparison to the Mexican Americans, whites had significantly higher incidences of joint symptoms (p < 0.0001) and osteoporosis (p= 0.001). Whites had a stronger family history of IBD and colorectal carcinoma compared to the other ethnic groups. p-ANCA served as a sensitive marker for UC among Mexican Americans. All the Mexican Americans with UC tested had positive p-ANCA compared to only 40% of whites (p= 0.033). CONCLUSION: There are significant differences in IBD subtypes and serologic markers among racial/ ethnic groups with IBD in the United States.     

Exploring racial/ethnic disparities in hypertension care among patients served by health centers in the United States

Some racial/ethnic minorities are more likely to have hypertension and experience increased hypertension‐related morbidity and mortality compared to whites. Health Resources and Services Administration‐funded health centers care for over 27 million patients, 62 percent of whom are racial/ethnic minorities. We assessed the presence of racial/ethnic disparities in (a) hypertension management and (b) hypertension outcomes among health center patients. We used data from the 2014 Health Center Patient Survey and performed multilevel logistic regression models to predict hypertension management counseling, patient adherence to counseling and medication regimen, management plan receipt, high blood pressure at last clinical visit, confidence in hypertension self‐management, and hypertension‐related emergency department (ED) episodes or hospitalizations in the past year. We controlled for patient characteristics including age, sex, education, nativity, health behaviors, health care access, and comorbidities. We found significantly higher odds of diet counseling (African Americans, OR: 1.87; Asian Americans, OR: 3.02, AIAN, OR: 2.01), reduced sodium intake (African American, OR: 2.42), and adherence to exercise counseling (African American, OR: 3.52; Asian Americans, OR: 2.93). We also found lower odds of taking hypertension control medication (AIAN, OR: 0.50) and higher odds of hypertension‐related ED visits (African Americans, OR: 3.61, AIAN, OR: 5.31). These results highlight the success of health centers in managing hypertension by race/ethnicity but found adverse hypertension outcomes for some groups. Racial/ethnically tailored efforts might be required to manage hypertension and improve outcomes.     

A prospective comparative study of ASCA and pANCA in Chinese and Caucasian IBD patients

BACKGROUND: Inflammatory bowel disease manifests throughout all ethnic groups. Antisaccharomyces cerevisiae (ASCA) and antineutrophil cytoplasmic antibodies (pANCA) can aid in the differentiation between Crohn's disease (CD) and ulcerative colitis (UC), but their sensitivity may vary between races. OBJECTIVES: This study compared the sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of pANCA and ASCA between Chinese and Caucasian IBD populations and identified disease subtype associations. RESULTS: Three hundred patients were prospectively recruited from Caucasian and Chinese populations (CD, n = 50, UC, n = 50, controls, n = 50 each). pANCA detection was greater in Caucasian than Chinese UC patients (p= 0.046). ASCA IgG detection was similar, but IgA was lower in Chinese CD patients (p < 0.001). Differentiation between UC and CD (+ve pANCA/-ve ASCA) demonstrated a PPV of 92% in isolated colonic disease. Logistic regression in CD identified positive pANCA had a lower association with ileal (OR = 6.8, p= 0.0067) and complicated disease (OR = 5.5, p= 0.015). Caucasian CD patients with positive ASCA IgA/IgG had a greater association with ileal (OR = 6.7, p= 0.022) or complicated disease (OR = 9.4, p= 0.0073) and in Chinese CD patients positive ASCA IgA/IgG was associated with isolated ileal disease (OR = 16.8, p= 0.032). Linear regression demonstrated that higher ASCA titers predicted complicated CD and isolated ileal disease. CONCLUSIONS: This study identified that pANCA is more sensitive in Caucasian than Chinese UC and that ASCA IgA has a low yield in Chinese CD. pANCA and ASCA are useful for differentiating between UC and CD in both populations, and ASCA IgG and IgA titers have potential use in determining the risk of developing complicated CD.     

Race/Ethnicity-Specific Disparities in the Severity of Disease at Presentation in Adults with Ulcerative Colitis: A Cross-Sectional Study

Background

While ulcerative colitis (UC) is well studied in Caucasian populations, less data are available on UC patients of racial/ethnic minorities, including variations in disease severity at presentation.

Aim

To evaluate race/ethnicity-specific disparities in UC disease presentation among an ethnically diverse underserved population.

Methods

We performed a cross-sectional study of all consecutive UC adults among a large ethnically diverse safety-net hospital from July 2014 to May 2016 to compare race/ethnicity-specific disparities in severity of disease at presentation. Severity was evaluated using the clinician-based simple clinical colitis activity index (SCCAI) and the Mayo score at time of presentation. Multivariate ordered logistic regression models were used to evaluate associations with SCCAI and Mayo scores.

Results

Among 98 UC patients (56.1% male, mean age 40.1 (SD 14.2), 32.0% were African-American, 26.7% Hispanic, 16.0% Asian, and 20.0% Caucasian. Mean Mayo score was 6.6 and mean SCCAI score was 6.5. When stratified by race/ethnicity, SCCAI scores were significantly higher in non-Caucasians compared to Caucasians (7.0 vs 4.6, p = 0.03) and in Asians compared to Caucasians (8.0 vs 4.6, p = 0.02). There was a trend toward higher mean SCCAI in Hispanics compared to Caucasians (6.9 vs 4.6, p = 0.07). Mayo scores at presentation demonstrated similar trends. On multivariate logistic regression, Asians (OR 5.26, 95% CI 1.24–22.42) and Hispanics (OR 3.74; 95% CI 1.02–13.66) had more severe disease at presentation than Caucasians based on SCCAI.

Conclusions

Among a diverse underserved cohort of UC patients, racial/ethnic minority patients with UC, specifically Asians and Hispanics, had more severe disease at presentation compared to Caucasians. The differences may reflect disparities in timely access to specialty care and treatment and deserves greater attention and research.

     

Colon pathology detected after a positive screening flexible sigmoidoscopy: a prospective study in an ethnically diverse cohort

OBJECTIVES: Although the association between distal neoplasia on sigmoidoscopy and proximal colonic pathology on follow-up colonoscopy has been well-described, it is not known if these findings are consistent across ethnic groups. The aim of this study was to evaluate ethnic variations in the prevalence of proximal neoplasia on follow-up colonoscopy after a neoplastic lesion is found on sigmoidoscopy. METHODS: Consecutive asymptomatic patients at average-risk for colorectal cancer who were referred for screening flexible sigmoidoscopy were prospectively enrolled. Colonoscopy was recommended for all patients with a polyp on flexible sigmoidoscopy, regardless of size. Advanced neoplasms were defined as adenomas > or = 10 mm in diameter or any adenoma, regardless of size, with villous histology, high-grade dysplasia, or cancer. RESULTS: Among the 2,207 patients who had sigmoidoscopy, 970 were Caucasian, 765 were African American, 395 were Hispanic, and 77 were Asian. The prevalence of neoplasia in the distal colon was 12.6% in Caucasians, 11.2% in African Americans, 15.9% in Hispanics, and 24.7% in Asians (p = 0.002). Of the 290 patients with neoplastic lesions on sigmoidoscopy, follow-up colonoscopy identified neoplasms in the proximal colon in 63.9% of Caucasians, 59.3% of African Americans, 66.7% of Hispanics, and 26.3% of Asians (p = 0.01). Advanced neoplasms in the proximal colon were highest in African Americans (34.9%) and lowest in Asians (10.5%). CONCLUSIONS: In our study population, Asians demonstrated a higher prevalence of distal colonic neoplasia and a lower prevalence of proximal colonic neoplasia compared to non-Asians. Future studies should explore ethnic variation in colonic neoplasia prevalence and location since ethnic variation could lead to tailored colorectal cancer screening strategies.     

Epidemiology of inflammatory bowel disease in South America: A systematic review

BACKGROUND The worldwide epidemiology of inflammatory bowel disease(IBD) is rapidly changing. Increasing Crohn's disease(CD) and ulcerative colitis(UC) incidence and prevalence have been recorded in developing regions such as Asia, Africa and Eastern Europe where it was previously thought to be uncommon. Whether this is also the case in South America is not well known. Demonstration that developing regions worldwide have increasing IBD incidence would indicate that environmental change plays a significant role in the development of IBD.AIM To report the incidence, prevalence and disease characteristics of CD and UC within the South American continent.METHODS A systematic review was conducted by searching published studies in major international and regional databases(MEDLINE, EMBASE and Scopus) between January 1990 and December 2018. Outcomes considered were incidence,prevalence, phenotype, environmental and genetic factors, ethnicity and gender.A pair of independent reviewers screened and reviewed all identified articles.RESULTS One hundred and sixty two citations were initially retrieved with 18 studies included in this systematic review. The majority of included studies were from Brazil(n =13, 72%). The incidence of UC ranged from 4.3-5.3/100000 personyears whilst the incidence of CD ranged from 0.74-3.5/100000 person-years.Prevalence ranged from 15.0-24.1/100000 inhabitants for UC and from 2.4-14.1/100000 inhabitants for CD. The incidence and prevalence of both UC and CD has increased significantly in Brazil over the past 21 years. Pancolitis was the most common disease distribution in patients with UC whilst colonic involvement was the most common distribution in CD. People residing in urbanareas were at higher risk of developing both CD and UC.CONCLUSION The IBD burden in South America is increasing at a rate possibly even greater than other developing regions around the world. There is a paucity of highquality epidemiological studies and further robust and representative data are required to further explore modifiable risk factors and disease phenotypes.     

2008—2017年新疆维吾尔自治区菌阳肺结核流行病学特征分析

目的 分析2008—2017年新疆维吾尔自治区(简称“新疆”)14个地(州、市)报告的菌阳肺结核患者的流行病学特征,以了解新疆肺结核疫情。方法 对2008年1月至2017年12月《传染病报告信息管理系统》报告的新疆菌阳肺结核患者104306例,采用描述性统计分析方法,分析10年来全区14个地(州、市)报告的菌阳肺结核患者的平均报告发病率、性别、年龄、职业等流行病学特征。结果 2008—2017年菌阳肺结核平均发病率为46.71/10万,年报告发病率在35.40/10万和60.85/10万之间, 各年报告发病率差异有统计学意义( {\chi }_{\mathit{趋势}}^2 =3675.41,P<0.01)。2008—2017年报告的菌阳肺结核中,男57437例,女46869例,男∶女=1.23∶1;男性报告发病率为50.26/10万,女性报告发病率为43.00/10万,差异有统计学意义(χ ²=629.18,P<0.01)。各地(州、市)发病率比较,喀什地区为69.64/10万(28232/40540543),和田地区为68.80/10万(14096/20488832),阿勒泰地区为58.37/10万(3711/6357778),阿克苏地区为58.05/10万(14200/24462693),克孜勒苏柯尔克孜自治州(简称“克州”)为49.34/10万(2693/5458469),伊犁州为48.82/10万(13058/26746349),塔城地区为47.41/10万(5703/12029999),以上7个地区高于全疆平均水平(46.71/10万)。南疆四地州(喀什地区、阿克苏地区、和田地区、克州)的菌阳肺结核患者例数占全疆总数的56.78%(59221/104306)。患者的职业分布以农牧民最多,占70.14%(73157/104306);其次是家务及待业人员,占9.61%(10024/104306)。结论 2008—2017年新疆报告的菌阳肺结核患者平均发病率呈下降趋势,南疆四地州患者例数占全疆的1/2,老年人、男性、农牧民发病率较高。     

Ethnic differences in Rotterdam criteria and metabolic risk factors in a multiethnic group of women with PCOS studied in Denmark

Objective Clinical manifestations and metabolic risk factors may differ in ethnic subgroups of patients with polycystic ovary syndrome (PCOS). Design Retrospective trans‐sectional study. Patients One thousand and two premenopausal women with the diagnoses hirsutism or PCOS were divided according to ethnicity: Caucasian (CA, n = 784), Middle East (ME, n = 190), Asian (n = 14) and others (n = 14). Measurements Clinical evaluation (hirsutism, BMI, waist, blood pressure), hormone analyses (testosterone, sex hormone–binding globulin, prolactin, lipids, insulin, glucose) and transvaginal ultrasound were performed. Oral glucose tolerance tests (OGTT) (n = 499) and ACTH tests (n = 434) were performed in a subgroup of patients. Results (CA vs ME women) CA women were older [32(25–37) vs 25(18–32) years, median (quartiles)] and had increased BMI compared to ME women. After correcting for age and BMI, CA women were less hirsute, but had increased testosterone levels compared to ME women. The Rotterdam criteria were fulfilled in 56% of both populations, but PCO was diagnosed in 47% CA vs 29% ME women, P < 0·01. CA women had increased blood pressure and smoked at a higher frequency (40 vs 23%), whereas area under the curve for insulin during OGTT was decreased, all P < 0·001. Prolactin levels were significantly lower in CA women compared to ME women [7(5–10) vs 9(6–12) μg/l] and were inversely associated with smoking status. Conclusion CA women had a more adverse cardiovascular profile than ME women, whereas insulin sensitivity was higher. The prevalence of the individual Rotterdam criteria differed significantly in the two study populations.     

Glycaemic control and hypoglycaemia in the PRESENT study

The PRESENT study was a 6-month multinational observational study in patients with type 2 diabetes receiving biphasic insulin aspart 30 (BIAsp 30). Data from PRESENT were analysed according to predefined subgroups stratified by age, body mass index (BMI) and ethnic origin. Achieved HbA1c levels were similar in each of: four age subgroups (<40 years 7.82%, 40-50 years 7.70%, 50-60 years 7.75%, >or=65 years 7.75%); five BMI subgroups (<25 kg/m(2): 7.78%, 25-30 kg/m(2): 7.58%, 30-35 kg/m(2): 7.57%, 35-40 kg/m(2): 7.74%, >or=40 kg/m(2): 7.93%); and Asian/Pacific Islander, Middle Eastern/Asian, White ethnic-origin subgroups (7.78%, 7.40%, 7.59%, respectively). The Black ethnic-origin subgroup had a higher baseline HbA1c of 11.61% (other groups 9.29-9.63%) and achieved a final HbA1c of 8.59%. Major hypoglycaemia was reported by fewer than 1% of subjects in any subgroup at end of study; overall end of study hypoglycaemia rates were less than four events/subject year (all subgroups). In conclusion, data from subgroups in the PRESENT study indicate that BIAsp 30 can be initiated and titrated effectively to help patients of all ages, of all degrees of obesity, and from a variety of ethnic origins, to achieve clinically relevant improvements in glycaemic control with low rates of hypoglycaemia.     

Longitudinal study of changes in hip bone mineral density in Caucasian and African-American women

OBJECTIVES: To determine whether changes in hip bone mineral density (BMD) differ in Caucasian and African American women. DESIGN: Longitudinal study of changes in hip BMD. SETTING: Four U.S. clinical centers. PARTICIPANTS: Six thousand seven Caucasian (mean age 73) and 482 African-American (mean age 75) women enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Total hip and femoral neck BMD were measured an average of 3.5 years apart (Caucasian) and 2.0 years apart (African American). Annual absolute and percentage changes in BMD and bone mineral apparent density (BMAD) were calculated. RESULTS: The multivariate adjusted annual percentage change in BMD was greater in Caucasian than African-American women at the total hip (-0.574%/y vs -0.334%/y) and femoral neck (-0.515%/y vs -0.203%/y) (both, P<.001). Similar findings were observed for BMAD. The average annualized rate of BMD loss was twice as high in women aged 75 and older as in women younger than 75 in both ethnic groups. The annual percentage loss in femoral neck BMD in nonusers versus hormone therapy users was (-0.57% vs -0.22%) in Caucasians and (-0.35% vs 0.64%) in African Americans (interaction P=.03). CONCLUSION: The average rate of hip BMD loss is approximately twice as great in Caucasian as African-American women and increases with age in both groups. The hormonal and biochemical factors that contribute to ethnic differences and the increase in bone loss with advancing age need to be identified.     

The variation in anti-ENA characteristics between different ethnic populations with systemic lupus erythematosus over a 10-year period

OBJECTIVE: To assess how anti-ENA characteristics change in patients with systemic lupus erythematosus from different ethnic backgrounds over a 10-year period follow-up study. RESULTS: There were 61 patients, of whom 37 were Caucasian, 12 were Asian and 12 were Afro-Caribbean. At the first available bleed 12/37 (32%) Caucasians were anti-ENA positive compared to 6/12 (50%) Asians and 9/12 (75%) of Afro-Caribbeans (Chi-squared P=0.01 for Caucasian vs Afro-Caribbean) and these proportions remained essentially unchanged after 10 y of follow-up. However, over the 10 y of follow-up anti-ENA patterns did change, with anti-Ro being the commonest antibody pattern to emerge and anti-Ro/La the commonest antibody pattern to disappear. There were 20/37(54%) Caucasians, 1/12(8%) Afro-Caribbeans and 5/12(42%) Asians who remained negative for anti-ENA throughout the 10-year follow-up (Chi-squared P=0.03 for Caucasian vs Afro-Caribbean). CONCLUSION: Anti-ENA were more commonly found in the Afro-Caribbean than the Caucasian population. The commonest patterns of anti-ENA differ between ethnic groups and, over a 10-year period, anti-ENA patterns in individual patients changed in a significant number of individuals. However, Caucasians were more likely to remain anti-ENA negative over 10 y of follow-up than Afro-Caribbeans.     

Characteristics of contemporary patients with hypertension and coronary artery disease

BACKGROUND: Despite a high prevalence of hypertension in the population with CAD, there are limited data describing the clinical characteristics and treatments, as well as their interrelations in these patients. This is particularly true for black and Hispanic patients who have been underrepresented in randomized CAD trials. HYPOTHESIS: There exist racial and ethnic differences that define the characteristics of patients with both coronary artery disease (CAD) and hypertension. METHODS: This report describes the characteristics of Caucasian, Hispanic, and black patients enrolled in the International Verapamil SR/trandolapril Study (INVEST), a prospective trial undertaken exclusively in patients with CAD and hypertension. RESULTS: In all, 10,925 Caucasian, 8,045 Hispanic, and 3,029 black patients are described. An abnormal angiogram or documented myocardial infarction was observed more frequently in Caucasian patients (73%), while angina pectoris was more prevalent in Hispanic patients (87%). Diabetes and left ventricular hypertrophy were most common in black patients (33 and 29%, respectively), while hypercholesterolemia and prior revascularization (coronary artery bypass graft or angioplasty) were most common in Caucasian patients (64 and 41%, respectively). More than 60% of Hispanic and black patients were women--a unique characteristic for randomized CAD trials. Comparing race/ethnic cohorts, there were significant differences for all characteristics. More than 80% of patients in all race/ethnic groups were receiving antihypertensive therapy; however, only fewer than 25% had controlled blood pressure according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. CONCLUSIONS: This high-risk population of hypertensive patients with CAD has been undertreated and does not have well-controlled BP. Race/ethnic differences were observed for clinical characteristics and medication use.