The Black–White difference in age trajectories of functional health over the life course

This study examines whether the racial disparity in functional health grows unabated over the adult life course – the cumulative disadvantage hypothesis – or shrinks among the oldest old – the age-as-leveler hypothesis. Special emphasis is placed on the role of socioeconomic status (SES), which is highly associated with race. The analysis uses latent growth-curve modeling to examine differences in age trajectories of functional health between Black and White Americans and is based on nationally representative panel data of 3497 adults. Results cautiously support the age-as-leveler hypothesis. Net of functional health at baseline, Black adults experience a growing disadvantage in functional health over time until the oldest ages, when the gap in functional health begins to shrink. Results indicate that the potential leveling mechanisms of age may be specific to women. SES including financial assets explains the divergence in functional health across young and middle-aged Black and White adults, but not the later-life convergence. This study reveals the life-course pattern of racial disparity in functional health and suggests that more theoretical development is needed in this field to explain why the age-as-leveler and cumulative disadvantage processes are different for functional health than for other outcomes.     

Neighborhood racial composition,social capital and black all-cause mortality in Philadelphia

Neighborhood characteristics such as racial composition and social capital have been widely linked to health outcomes, but the direction of the relationship between these characteristics and health of minority populations is controversial. Given this uncertainty, we examined the relationship between neighborhood racial composition, social capital, and black all-cause mortality between 1997 and 2000 in 68 Philadelphia neighborhoods. Data from the U.S. Census, the Philadelphia Health Management Corporation's 2004 Southeast Pennsylvania Community Health Survey, and city vital statistics were linked by census tract and then aggregated into neighborhoods, which served as the unit of analysis. Neighborhood social capital was measured by a summative score of respondent assessments of: the livability of their community, the likelihood of neighbors helping one another, their sense of belonging, and the trustworthiness of their neighbors. After adjustment for the sociodemographic characteristics of neighborhood residents, black age-adjusted all-cause mortality was significantly higher in neighborhoods that had lower proportion of black residents. Neighborhood social capital was also associated with lower black mortality, with the strongest relationship seen for neighborhoods in the top half of social capital scores. There was a significant interaction between racial composition and social capital, so that the effect of social capital on mortality was greatest in neighborhoods with a higher proportion of black residents and the effect of racial composition was greatest in neighborhoods with high social capital. These results demonstrate that age-adjusted all-cause black mortality is lowest in mostly black neighborhoods with high levels of social capital in Philadelphia.     

Disparate use of minimally invasive surgery in benign surgical conditions

Background  Disparities in outcome across race and ethnicity have been consistently described for medical and surgical care. Given that surgery is a rapidly evolving field, we hypothesized that racial disparities exist in access to minimally invasive surgery (MIS), which importantly influences outcome. Methods  Cohort analysis of all patients who underwent appendectomy, gastric fundoplication, and gastric bypass in the Nationwide Inpatient Sample, a 20% stratified random sample of US hospital discharge abstracts. To determine the effect of race on the use of MIS techniques and morbidity and mortality, we controlled for patient characteristics, comorbidity, and hospital characteristics including surgical volume and MIS conversion to open surgery. Results  Blacks were consistently less likely to be treated with MIS despite adjustment for socioeconomic status, comorbidity, and treatment setting. In addition, in-hospital mortality and complications such as pneumonia, heart disease, infections, and surgical misadventures were higher in black than white patients. These outcomes differences remained despite adjustment for hospital volume, the use of MIS, and MIS conversion to open surgery. Conclusions  We demonstrate evidence of racial disparities in the use of MIS for benign surgical conditions and worse outcomes for patients of black race. Although, the racial differences in outcome were attenuated with adjustment for MIS, further studies are needed to help resolve remaining differences in outcomes across race. Presented at the 2008 SAGES Annual Meeting.     

The Impact of Race on Weight Loss After Roux-en-Y Gastric Bypass Surgery

Background Gastric bypass surgery for morbid obesity has dramatically increased in volume over the past decade. Caucasian patients have been noted previously to lose more weight after bariatric surgery than African-Americans patients. Data regarding predictors of maintaining weight loss after surgery are minimal. We sought to determine predictors of long-term weight loss after bariatric surgery. Methods Retrospective analysis using a multivariate logistic regression model of all patients undergoing Roux-en-Y gastric bypass surgery at the Medical University of South Carolina from May 1993 to December 2004 for whom 2 years of follow-up data was available. Our dependent variable was the percentage of weight lost from baseline, dichotomized at ±35%. Our primary independent variable was race, defined as Caucasian, African-American, or other. Relevant covariates were added to the model to control for their potential effects on outcome. Results One hundred eleven patients (17 male/94 female; 85% Caucasian, mean age 44 years (range 18–68 years). In our model, Caucasian subjects (adjusted odds ratio [OR] = 7.60, 95% confidence intervals [95%CI] = 1.83–31.5) and late post surgical complications (adjusted OR = 2.67, 95%CI = 1.05–6.80) significantly predicted weight loss at 2 years, after controlling for relevant confounders. Other covariates did not significantly impact the model. Conclusion Race and late post surgical complications significantly impacted the percentage of weight loss at 2 years for patients undergoing Roux-en-Y gastric bypass surgery at our institution. Future research should be directed at determining potential genetic and/or social reasons for these differences.     

Profiles of tamoxifen-related side effects by race and smoking status in women with breast cancer

Background: Tamoxifen (TAM) is a selective estrogen receptor modulator (SERM) that is widely used as adjuvant therapy in breast cancer patients; however, it is also associated with undesirable side effects. The goal of this study was to investigate TAM-related side effects, and determine profiles of side effects by race and by smoking status. Methods: A secondary data analysis was conducted using cross-sectional study data from 138 African American and Caucasian women with breast cancer taking TAM 20 mg daily for at least 30 days prior to enrollment. Participants completed questionnaires that obtained information about demographic characteristics, reproductive history, health and lifestyle characteristics, TAM use and its related side effects. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals. Results: Compared to never smokers, a significantly greater percentage of current smokers reported ever experiencing TAM-related nausea (28.0% versus 5.0%, P = 0.007), depression (40.0% versus 7.1%, P = 0.001) and migraines (19.2% versus 1.7%, P = 0.02). These differences remained statistically significant after controlling for race, age, obesity, tumor stage, and duration of TAM treatment. No significant differences by race were noted in women reporting TAM side effects. Conclusion: The findings from this study suggest that current smokers with breast cancer should be informed of the increased probability of reporting TAM-related side effects such as nausea, depression and migraines, and counseled about smoking cessation which may reduce the incidence of these side effects.     

Age trends in proximal femur geometry in men: variation by race and ethnicity

Summary Data on bone architecture in diverse male populations are limited. We examined proximal femur geometry in 1,190 black, Hispanic, and white men. Cross-sectional analyses indicate greatest bone strength among black men, and greater age-related differences in bone strength among Hispanic men than other subjects at the narrow neck and intertrochanter regions of the proximal femur. Introduction Although race/ethnic differences in bone mass are well-documented, less is known about differences in bone architecture. We examined proximal femur geometry in a diverse, randomly-sampled population of 1,190 community-dwelling men (age 30–79 y). Methods Dual X-ray absorptiometry scans were obtained for 355 black, 394 Hispanic, and 441 white subjects. Measures were obtained for the narrow neck (NN), intertrochanter (IT) and shaft regions of the proximal femur via hip structural analysis. Analyses considered bone mineral density (BMD, g/cm²), outer diameter (cm), cross-sectional area (CSA, cm²), section modulus (Z, cm³), and buckling ratio (BR). Results were adjusted for height, weight and physical activity level. Results Black subjects exhibited greater age-specific BMD, CSA and Z, than their white counterparts. For instance, at age 50 y, NN BMD was approximately 11% higher among black men (p < 0.001). Hispanic men exhibited sharper age-related differences in NN and IT BMD than did others. IT BMD, for instance, decreased by 2.4% with 10 y age among Hispanic subjects, but had virtually no age trend in others (p < 0.001). Conclusions These results imply greater bone strength among black American men than among their white counterparts, and may indicate elevated fracture risk among older Hispanic American subpopulations. Grant support: The BACH/Bone study was supported by grant AG 20727 from the National Institute on Aging (NIA). The parent study (BACH) was supported by grant DK 56842 from the National Institute of Diabetes and Digestive and Kidney Diseases.     

Hand Movement Speed and Accuracy in Detoxified Alcoholics

Detoxified alcoholics (n = 192) were found to be 9.3% slower than age-matched controls (n = 112) with regard to the composite speed (movement time, MT) with which they were able to strike targets of various sizes and distances with a hand-held stylus at onset of a light stimulus (Fitts's Task). Females (n = 102) were 8% slower than males (n = 202), and blacks (n = 103) about 15.6% slower than whites (n = 201). Gender was the only significant factor with regard to errors (target misses), with women committing 28% fewer errors than men. Women, in contrast to men, appear to trade speed for accuracy in this task. Favorable socioeconomic/medical status and target misses were directly related to movement speed. Thus, when the MT data were corrected for lifestyle variables, the significance of the alcohol effects on MT disappeared, but gender differences persisted. The alcohol effect became statistically significant, the ethnic group differences remained statistically significant, and the gender effect became insignificant when MT scores were corrected for accuracy of performance (target misses). The slope of the linear function relating MT to target difficulty was similar for all subgroups. Prior knowledge of the direction of movement was found to affect MT performance more in white than in black subjects. With regard to reaction times, ethnic group and alcohol use effects remained statistically significant after corrections for lifestyle and errors were made, with values for blacks about 5% slower than values for whites, and values for alcoholics about 4.6% slower than those for controls. Prior knowledge of the direction of movement significantly improved (shortened) reaction time in all subgroups (14%-19%).