Racial disparities in risk factors for thrombosis

PURPOSE OF REVIEW: Until recently, the paucity of characterization of the epidemiology of venous thromboembolism among non-Caucasians has contributed to the misconception that race or ethnicity does not modify disease presentation. This review will describe the previously poorly documented magnitude of venous thromboembolism disease burden among four racial cohorts, by defining disease incidence and associated morbidity/mortality from available literature data. RECENT FINDINGS: Emerging data suggest that African-Americans possess the highest burden of venous thromboembolism, and Asians the lowest, compared with the Caucasian population. In both racial groups, however, the inheritable thrombophilic risk factors prevalent in Caucasians (factor V Leiden, Prothrombin G20210A) are distinctly rare. The presence of yet undetermined modifiers of disease, conferring susceptibility or resistance to venous thromboembolism among these racial groups, is suspected and requires further investigation. SUMMARY: Racial disparity in thrombotic disorders exists in the divergent patterns of disease incidence among different racial/ethnic cohorts, yet the genetic determinants of disease and modifiers of risk remain obscure. Further research focused on delineating the underlying etiologies of venous thromboembolism across different racial/ethnic groups promises to be a productive and much needed area of exploration.     

Racial and ethnic disparities in sarcoidosis: from genetics to socioeconomics

Sarcoidosis is a multisystem granulomatous disease of unknown cause that occurs worldwide. The clinical expression of sarcoidosis varies by race. These racial differences may be the result of genetic and socioeconomic factors. Many of these genetic associations are race-specific in that they are found in either African Americans or whites but not both. Socioeconomic differences may also explain the racial disparities between African American and white patients with sarcoidosis. Finally, the phenotypic differences be-tween races may relate to an interaction between genetics and socioeconomic factors.The influences of genetics and socioeconomic status on the development and phenotypic expression of sarcoidosis will be better understood as the mechanisms of disease development are uncovered.     

Cardiovascular disease disparities: Racial/ethnic factors and potential solutions

Disparities persist in cardiovascular disease, and it is difficult to separate socioeconomic status from race/ethnicity or genetic factors. Blacks have more hypertension, with higher cardiovascular morbidity and mortality. Despite high rates of type 2 diabetes and obesity, Hispanics do not appear to have higher cardiovascular mortality than non-Hispanic whites or blacks. South Asians have premature coronary heart disease, with more metabolic syndrome and diabetes. Racial/ethnic pharmacogenetics does not justify withholding appropriate medications. However, pharmacogenetics demonstrates the importance of using starting doses of medications that are ethnic specific. The Agency for Healthcare Research and Quality reports that the uninsured have difficulty accessing care, which may lead to delayed diagnosis and longer hospitalizations. Minority providers may positively affect the health of an increasingly diverse population.     

Educational disparities in the prevalence and consequence of physical vulnerability

OBJECTIVES: The purpose of this study was to estimate educational differences in the prevalence and mortality consequence of physical vulnerability among older adults in the United States. METHODS: Data came from the 1998 and 2000 waves of the Health and Retirement Study, a nationally representative cross-sectional and prospective cohort study of community-based adults aged 65 and older. We created a physical vulnerability score from age, gender, and self-reported disability measures and measured socioeconomic status via educational attainment. Mortality data came from the National Death Index. RESULTS: In the 1998 cohort, high physical vulnerability was more than 3 times more prevalent in individuals with less than 12 years of education compared to those with 16 or more years of education. Although less educated older adults had a higher probability of death overall, evidence of educational differences in the mortality consequence of high physical vulnerability was limited. In 2000, 2.16 million older adults had high physical vulnerability, and more than one half (53%) of these adults had less than 12 years of education. DISCUSSION: In persons 65 years of age or older, educational differences are more apparent in the prevalence of physical vulnerability than in the mortality consequence of that vulnerability.     

Racial disparities in preferences and perceptions regarding organ donation

OBJECTIVES: To identify reasons for lower organ donation rates by African Americans, we examined knowledge and attitudes about brain death, donation, and transplantation and trust in the health care system. METHODS: Data were collected from 1,283 subjects in Ohio using a random digit dial telephone survey. Items were developed based on focus group results. Willingness-to-donate indicators included a signed donor card and willingness to donate one’s own and a loved one’s organs. RESULTS: Compared with whites, African-Americans had lower rates of signing a donor card (39.1% vs 64.9%,P<.001), and willingness to donate their own organs (72.6% vs 88.3%,P<.001) or a loved one’s organs (53.0% vs 66.2%,P<.001). African Americans had lower scores on the Trust in the Health Care System scale (mean scores ± SD, 9.43 ± 3.05 vs 9.93 ± 2.88,P<.01) and were more likely to agree that “if doctors know I am an organ donor, they won’t try to save my life” (38.6% vs 25.9%,P<.001), the rich or famous are more likely to get a transplant (81.9% vs 75.7%,P<.05), and less likely to agree that doctors can be trusted to pronounce death (68.2% vs 82.9,P<.001). African Americans were also more likely to agree that families should receive money for donating organs (45.6% vs 28.0%,P<.001) and funeral expenses (63.1% vs 46.6%,P<.001). CONCLUSIONS: African Americans reported greater mistrust in the equity of the donation system and were more favorable about providing tangible benefits to donor families than white respondents. None of the authors have any conflicts of interest to declare. This project was funded by a grant R01-HS10047 from the Agency for Healthcare Research and Quality. Dr. Ibrahim is a recipient of a career development award from the VA Health Services Research and Development Office and the Robert Wood Johnson Foundation’s Harold Amos Faculty Development Award.     

Racial disparities in hematopoietic cell transplantation in the United States

Hematopoietic cell transplantation (HCT) is a highly specialized, expensive and resource-intense medical procedure that can be associated with racial disparities. We review the prevailing literature on racial disparities in HCT in the United States and describe areas for future research and interventions. We discuss the complexity of interpreting race as a biological and social determinant of disease in biomedical research, especially as it relates to HCT. In the United States, race is often a surrogate for socioeconomic, education and health insurance status. We also discuss some of the nuances to consider while reviewing the literature on racial disparities. Disparities by race exist in three areas related to HCT: donor availability, access to HCT and outcomes of HCT. African-Americans/Blacks have a lower likelihood of finding an unrelated donor. Race and ethnicity definitions are country-specific and reconciling race data can represent significant challenges to unrelated donor registries worldwide. African-Americans/Blacks do not have the same access to autologous and allogeneic HCT as Whites. Racial disparities in outcomes of HCT are more prevalent among allogeneic HCT than autologous HCT recipients. More research is required to understand the biological, social, cultural, medical and financial aspects of race that may influence access to HCT and survival after transplantation. Better understanding of racial disparities will minimize inequities, inform health policy, guide development of interventions targeted to eliminate disparities and ensure equitable access to HCT for all populations.     

Racial disparities in hypertension prevalence, awareness, and management

BACKGROUND: Effectively reducing cardiovascular disease disparities requires identifying and reducing disparities in risk factors. Improved understanding of hypertension disparities is critical. METHODS: Cross-sectional analysis of nationally representative samples of black and white adults 20 years and older who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2002 (white, n = 4624; black, n = 1837) and NHANES III conducted in 1988-1994 (white, n = 7121; black, n = 4709). We examined differences in hypertension prevalence, awareness, treatment, and blood pressure (BP) control among both treated and prevalent cases across the 2 periods. RESULTS: Hypertension prevalence increased significantly from 35.8% to 41.4% among blacks and from 24.3% to 28.1% among whites and remains significantly higher among blacks. Awareness is higher among blacks (77.7% vs 70.4%; P<.001), as is treatment (68.2% vs 60.4%; P<.001). These results are driven by higher rates in black women. Blood pressure control rates among those treated have increased in both races, primarily as a result of increased BP control in black and white men (27.3% and 44.7%, respectively; P相似文献