Ethnic differences in health preferences: analysis using willingness-to-pay

OBJECTIVE: Racial and ethnic differences in health services utilization are well recognized, but the explicit contribution of access to care, physician bias, and patient preferences to these disparities remains unclear. We investigated whether preferences for improvements in health vary among ethnic groups. We chose to assess preferences for osteoarthritis (OA) of the knee because significant differences have been observed in the utilization of total knee arthroplasty among ethnic groups, and because it is an elective procedure, where individual preferences have a major role in decision-making. METHODS: A survey using willingness-to-pay (WTP) methodology was conducted to elicit preferences for improvement in severe and mild OA and for 5 non-health items; data were collected from 193 white, African American, and Hispanic individuals over the age of 20 years. Multivariate regression analyses were used to determine whether WTP varied across racial/ethnic groups. RESULTS: WTP as a percentage of income for each of the 3 scenarios was highest for whites, intermediate for Hispanics, and lowest for African Americans (e.g., 32.9%, 26.4%, and 16.7% for mild OA). Controlling for income, differences in log WTP between African Americans and whites were significant in multivariate regression analyses, whereas values for Hispanics and whites did not differ significantly. Race/ethnic group variables explained a relatively large (21-30%) part of the variation in log WTP. CONCLUSION: The findings suggest that ethnic differences in health valuation and preferences contribute to the observed disparities in health services utilization of elective procedures such as total knee arthroplasty.     

Racial similarities and differences in predictors of mobility change over eighteen months

OBJECTIVES: To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change. DESIGN: Prospective, observational, cohort study. PARTICIPANTS: Nine hundred and five community-dwelling older adults. MEASURES: Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up. RESULTS: African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 +/- standard deviation [SD] 24.5 vs. 72.7 +/- SD 22.6; P < .001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson's disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites. CONCLUSIONS: There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility.     

Racial differences in prevalence of coronary obstructions among men with positive nuclear imaging studies.

OBJECTIVES: The purpose of this research was to compare coronary obstruction between clinically similar African Americans (AA) and white persons undergoing coronary angiography. BACKGROUND: African Americans have higher rates of coronary death than whites, but are less likely to undergo coronary revascularization. Although differences in coronary anatomy do not explain racial difference in revascularization rates, several studies of clinically diverse persons undergoing coronary angiography have found less obstructive coronary disease in AA than clinically similar whites. METHODS: We studied 52 AA and 259 white male veterans who had both a positive nuclear perfusion imaging study and coronary angiography within 90 days of that study in five Department of Veterans Affairs hospitals. We used chart review and patient interview to collect demographics, clinical characteristics, and coronary anatomy results. Before angiography, we asked physicians to estimate the likelihood of coronary obstruction. RESULTS: The treating physicians' estimates of coronary disease likelihood were similar for AA (79.5%) and whites (83.0%); AA were less likely to have any coronary obstruction (63.5% vs. 76.5%, p = 0.05) and had significantly less severe coronary disease (p = 0.01) than whites. African Americans continued to be less likely to have coronary obstruction in analyses controlling for clinical features, including the physician's estimate of the likelihood of coronary obstruction. CONCLUSIONS: These results suggest that AA have less coronary obstruction than apparently clinically similar whites. Further studies are required to confirm our findings and better understand the paradox that AA are less likely to have obstructive coronary disease and more likely to suffer mortality from coronary disease.     

Clinical appropriateness and not race predicted referral for joint arthroplasty

Objective

To understand the reasons behind racial disparities in the use of total joint arthroplasty (TJA), we sought to examine the predictors of time to referral to orthopedic surgery for consideration of joint replacement.

Methods

In this prospective, longitudinal study of 676 primary care clinic patients with at least a moderately severe degree of hip or knee osteoarthritis (OA), we examined the effects of race, health beliefs (i.e., perceived benefits and risks) of TJA, and clinical appropriateness of TJA on referral to orthopedic surgery.

Results

The sample included 255 African Americans (38%) and 421 whites (62%); 523 patients had knee OA (78%) and 153 had hip OA (22%). Subjects were 60% male, with a mean ± SD age of 64 ± 9 years, a mean ± SD body mass index of 33.6 ± 8 kg/m², and a mean ± SD summary Western Ontario and McMaster Universities Osteoarthritis Index score of 56 ± 14, suggesting moderately severe OA. At baseline, African Americans perceived fewer benefits and greater risk from TJA than whites. There were no significant racial group differences in the proportions of cases deemed clinically appropriate for TJA. After controlling for potential confounders, clinical appropriateness (hazard ratio [HR] 1.95, 95% confidence interval [95% CI] 1.15–3.32; P = 0.01) predicted referral to orthopedic surgery. Neither race (HR 1.30, 95% CI 0.94–2.05; P = 0.1) nor health beliefs (HR 1.0, P = 0.5) were associated with referral status.

Conclusion

In this sample of primary care clinic patients, African Americans and whites were equally likely to be referred by their physicians to orthopedic surgery. Clinical appropriateness predicted future referral to orthopedic surgery, and not race or TJA‐specific health beliefs.     

Health care disparities in critical illness

Disparities in critical illness are evident in a variety of racial and ethnic groups. Most data available in the literature reflect variations in the incidence, presentation, diagnosis,treatment, and outcomes between African Americans and whites. Most research in critical care concerning disparities relates to cardiovascular illnesses. Significantly less in-formation is available regarding disparities in common ICU diagnoses. Data are significantly lacking delineating the reasons for disparities in the critically ill. Further re-search is required to elucidate the root causes for racial or ethnic differences, provide adequate education for health care providers, and develop and implement evidence-based interventions targeted for specific patient groups.     

Racial disparity in liver disease: Biological, cultural, or socioeconomic factors

Chronic liver diseases are a major public health issue in the United States, and there are substantial racial disparities in liver cirrhosis-related mortality. Hepatitis C virus (HCV) is the most significant contributing factor in the development of chronic liver disease, complications such as hepatocellular carcinoma, and the need for liver transplantation. In the United States, African Americans have twice the prevalence of HCV seropositivity and develop hepatocellular carcinoma at more than twice the rate as whites. African Americans are, however, less likely to respond to interferon therapy for HCV than are whites and have considerably lower likelihood of receiving liver transplantation, the only definitive therapy for end-stage liver disease. Even among those who undergo transplantation, African Americans have lower 2-year and 5-year graft and patient survival compared to whites. We will review these racial disparities in chronic liver diseases and discuss potential biological, socioeconomic, and cultural contributions. An understanding of their underlying mechanisms is an essential step in implementing measures to mollify racially based inequities in the burden and management of liver disease in an increasingly racially and ethnically diverse population.     

The epidemiology of end-stage renal disease among African Americans

Although disparities in outcomes among African Americans compared with whites with respect to cardiovascular disease, cancer, diabetes, infant mortality, and other health standards have been well-described, these disparities are most dramatic with respect to kidney diseases. End-stage renal disease (ESRD) occurs almost 4 times more commonly in African Americans than in their white counterparts. These disparate rates of kidney disease may be caused by the complex interplay of genetic, environmental, cultural, and socioeconomic factors. African Americans are particularly vulnerable to the deleterious renal effects of hypertension and may require more aggressive blood pressure control than whites to accrue benefit with respect to preservation of renal function. Diabetes, the leading cause of ESRD in the United States, is another important factor in the excess renal morbidity and mortality of African Americans because of its prevalence in this population. Other renal diseases, especially those associated with HIV/AIDS, are also much more likely to affect African Americans than other American population subgroups. A more thorough understanding of the epidemiology of renal diseases in African Americans and the cultural, social, and biological differences that underlie racial disparities in prevalence of renal disease will be essential to the design of effective public health strategies for prevention and treatment of this burdensome problem.     

Hyperinsulinemia, Insulin Resistance, Vitamin D, and Colorectal Cancer Among Whites and African Americans

African Americans have the highest incidence and mortality rates of colorectal cancer among all US racial and ethnic groups. Dietary factors, lifestyle factors, obesity, variability in screening rates, socioeconomic differences, barriers to screening, and differences in access to health care may be contributory factors to racial and ethnic disparities. African Americans are more likely to demonstrate microsatellite instability in their colorectal tumors leading to malignancy. However, these differences do not completely explain all the variances. Ample evidence implicates insulin resistance and its associated conditions, including elevated insulin and insulin-like growth factor-1 (IGF-1), in colorectal carcinogenesis. African Americans have a high risk for and a high prevalence of insulin resistance and subsequent overt type 2 diabetes. Recent clinical studies revealed that ethnic differences between whites and African Americans in early diabetes-related conditions including hyperinsulinemia already exist during childhood. African Americans have a much higher prevalence of vitamin D deficiency than whites throughout their life spans. Vitamin D deficiency has been associated with higher rates of diabetes and colorectal cancer, particularly in individuals with high serum insulin and IGF-1 levels. Moreover, African Americans have lower insulin sensitivity in tissues, independent of obesity, fat distribution, and inflammation. Further development of measures of biomarkers of tumor biology and host susceptibility may provide further insight on risk stratification in African Americans.     

Disparities in cardiac care: rising to the challenge of Healthy People 2010

Eliminating health disparities is one of two overarching goals of Healthy People 2010. Although the causes of health disparities are complex, they appear to be related, in part, to disparities in the quality of medical care. Two recent reviews of peer-reviewed research investigated the evidence on racial/ethnic differences in medical care. An Institute of Medicine summary of the literature concluded that in most studies, racial and ethnic disparities in health care remained even after adjustment for potentially confounding factors. A review focused specifically on cardiac care, conducted jointly by the Kaiser Family Foundation and the American College of Cardiology Foundation, reached a similar conclusion after examining the most rigorous studies investigating racial/ethnic differences in angiography, angioplasty, coronary artery bypass graft (CABG) surgery, and thrombolytic therapy. For example, African Americans were statistically less likely than whites to undergo CABG surgery in 21 of the 23 most rigorous studies that calculated odds ratios to compare CABG use. Although there is a convincing body of evidence that race continues to matter in the health system, a nationally representative survey of physicians revealed that the majority of physicians do not view a patient's race/ethnicity as a factor in obtaining care, but do believe insurance coverage matters. Increasing physicians' awareness of the evidence for the role that race/ethnicity plays in health care is important because they are in a good position to directly and indirectly affect changes in clinical practice or patient behavior that could reduce disparities in care.     

Racial and ethnic disparities in the use of health services: bias,preferences, or poor communication?

African Americans and Latinos use services that require a doctor's order at lower rates than do whites. Racial bias and patient preferences contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviors. Research has shown that doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.     

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.     

Ethnic and socioeconomic disparities in health among patients with rheumatic disease

PURPOSE OF REVIEW: To describe recent studies of differences in the occurrence and outcomes of rheumatic diseases and differences in treatment by ethnic group or socioeconomic status. RECENT FINDINGS: African Americans and Hispanics in the United States have consistently been found to have higher prevalences of arthritis and other rheumatic conditions than whites, and also generally have more activity limitations in the setting of rheumatic disease. Variations in disease occurrence by socioeconomic status have not been studied extensively. African Americans with osteoarthritis were less likely than whites to be treated with narcotic analgesics. Rates of total knee or hip arthroplasty were found to be substantially lower among African Americans and Hispanics than among whites in the United States, and lower among those of low socioeconomic status in the United Kingdom. Ethnic differences in use of arthroplasty have been associated with less willingness of African Americans to have surgery, which has been related to perceptions of uncertain benefits of surgery. Poverty and ethnicity had important associations with the activity of systemic lupus erythematosus, whereas socioeconomic status was a more important predictor of mortality in these patients. Treatment adherence was similar in African American and white patients with systemic lupus erythematosus, but barriers to adherence differed by ethnic group. SUMMARY: Ethnic disparities in health have been more extensively studied than socioeconomic disparities. Most studies only describe the disparities, but several studies have begun to investigate potential reasons for the disparities.     

COPD: racial disparities in susceptibility, treatment, and outcomes

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States and mortality continues to increase particularly among African Americans. Although this increase may be caused by changing smoking habits, some studies suggest that African Americans may be more susceptible to tobacco smoke than whites.Unlike other respiratory diseases for which there are significant published data on racial and ethnic disparities in disease outcomes, such information is notably lacking in the COPD literature. This article examines the available data concerning racial disparities in COPD susceptibility and care.     

Racial differences in resting end-tidal CO2 and circulating sodium pump inhibitor

Previous studies have shown that high end-tidal CO₂ (PetCO₂) is a marker for sodium sensitivity of blood pressure (BP) in White Americans, and that the BP of African Americans is more sensitive to high sodium intake than that of whites. The present study tested the hypothesis that resting PetCO₂ is higher in normotensive African Americans than in whites. Resting end-tidal CO₂ of 395 white and 125 African American participants in the Baltimore Longitudinal Study on Aging was monitored for 20 min with a respiratory gas monitor, and BP and heart rate were recorded every 5 min by oscillometric methodology. Twenty-four-hour urinary excretion of a circulating sodium pump inhibitor marinobufagenin-like compound (MBG), which increases when plasma volume is expanded, was also analyzed by fluoroimmunoassay in racial groups. Mean resting PetCO₂ of African American men was higher than that of white men (38.1 ± 0.5 v 36.4 ± 0.3 mm Hg), and resting PetCO₂ of African American women was higher than that of white women (37.7 ± 0.3 v 36.2 ± 0.3 mm Hg). The differences were not significant in either men or women less than 50 years old, but were substantial in both men and women more than 50 years. Twenty-four-hour urinary excretion of MBG was higher in white (2.7 ± 0.2 pmol) than in African American (2.1 ± 0.2 pmol) participants, and high PetCO₂ was a significant independent predictor of high MBG excretion in African Americans. These data are consistent with the hypothesis that the higher resting PetCO₂ in African Americans plays a role in slower urinary excretion of sodium, greater BP sensitivity to high sodium intake, and increased prevalence of chronic hypertension.     

Effect of race and ethnicity on perceptions of inflammatory bowel disease

BACKGROUND AND AIMS: Historically, inflammatory bowel disease (IBD) was thought to predominantly affect whites. However, IBD is now increasingly recognized in diverse ethnic populations. There is a paucity of studies of IBD in nonwhite populations, especially in Mexican Americans. The aims of this study were to compare the impact of IBD on the quality of life of whites, African Americans, and Mexican Americans and to evaluate differing patient understanding and beliefs regarding IBD. MATERIALS AND METHODS: A questionnaire was administered to 148 patients between June 1999 and November 2003 at a university gastroenterology practice in Houston, Tex. RESULTS: Caucasians (W) comprised 40%, African Americans (AA) 37%, and Mexican Americans (MA) 20% of the respondents. AA and W had predominantly Crohn's disease (CD), whereas MA had predominantly ulcerative colitis (UC; P<0.05). We therefore compared W and AA with CD and W and MA with UC. W were more likely to tell their employers (57% vs 27.5%, P=0.02), fellow employees (68% vs 43.8%, P=0.02) and friends (100% vs 79%, P=0.034) that they had CD. W and AA were equally as likely to have regular checkups by a physician, and there was no difference in the access to gastroenterologists or surveillance colonoscopy. There were fewer differences between MA and W with UC. MA were more likely to believe that UC was caused by stress (70% vs 37%, p=0.044) and cigarette smoking. CONCLUSIONS: Significant differences appear among racial and ethnic groups with IBD regarding attitudes toward disease and impact on daily life. Appreciation of varying ethnic and racial perceptions, attitudes, and beliefs among patients with IBD may be critical to more effective management.     

Genetic variants in platelet factor 4 modulate inflammatory and platelet activation biomarkers

Background- African Americans suffer from higher prevalence and severity of atherosclerosis compared with whites, highlighting racial and ethnic disparities in cardiovascular disease. Previous studies have pointed to the role of vascular inflammation and platelet activation in the formation of atherosclerotic lesions. Methods and Results- We explored the role of genetic variation in 4 chemokine/chemokine receptor genes (CX3CR1, CX3CL1, CXCR3, and PF4) on systemic inflammation and platelet activation serum biomarkers (fractalkine, platelet P-selectin, platelet factor 4 [PF4], and tumor necrosis factor-α). In total, 110 single nucleotide polymorphisms were tested among 1042 African Americans and 763 whites. The strongest association with serum PF4 levels was observed for rs168449, which was significant in both racial groups (P value: African Americans=0.0017, whites=0.014, combined=1.2 × 10(-4)), and remained significant after permutation-based multiple corrections (P(c) value: combined=0.0013). After accounting for the effect of rs168449, we identified another significant single nucleotide polymorphism (rs1435520), suggesting a second independent signal regulating serum PF4 levels (conditional P value: African Americans=0.02, whites=0.02). Together, these single nucleotide polymorphisms explained 0.98% and 1.23% of serum PF4 variance in African Americans and whites, respectively. Additionally, in African Americans, we found an additional PF4 variant (rs8180167), uncorrelated with rs168449 and rs1435520, associated with serum tumor necrosis factor-α levels (P=0.008, P(c)=0.048). Conclusions- Our study highlights the importance of PF4 variants in the regulation of platelet activation (PF4) and systemic inflammation (tumor necrosis factor-α) serum biomarkers.     

Peripheral arterial disease in African Americans: clinical characteristics, leg symptoms, and lower extremity functioning

OBJECTIVES: The describe peripheral arterial disease (PAD) in African Americans, and compare findings in African Americans and whites with PAD. DESIGN: Cross-sectional. SETTING: Three academic medical centers. PARTICIPANTS: Three hundred sixty-six whites and 76 African Americans with PAD (as defined by an ankle brachial index (ABI) <0.90) aged 55 and older identified from lower extremity arterial studies performed between 1996 and the fall of 1999. MEASUREMENTS: Comprehensive medical interview, body mass index, and neuropathy score. Functional measurements included the 6-minute walk distance, 4-m walking velocity, and the summary performance score. RESULTS: Age- and sex-adjusted results showed that African Americans had a lower mean ABI than whites (0.60 vs 0.66, P=.001), were less likely to be college graduates (13.7% vs 44.4%, P<.001), and had nearly twice the prevalence of diabetes mellitus (46.8% vs 28.0%, P=.001). After adjusting for age, sex, education level, and ABI, African Americans had a higher prevalence of no exertional leg pain (28.0% vs 18.2%, P=.044) and leg pain with exertion and rest (30.0% vs 17.3%, P=.023). African Americans had a shorter 6-minute walk distance (989 vs 1,156 ft, P<.001), a slower normal-pace 4-m walking velocity (0.79 vs 0.89 m/s, P<.001), a slower fast-pace 4-m walking velocity (1.12 vs 1.20 m/s, P=.012), and a lower summary performance score (8.8 vs 9.6, P=.018) than whites. These differences in functioning were attenuated after adjusting for age, sex, ABI, education, and leg symptoms. CONCLUSION: Poorer lower extremity functioning in African Americans was largely explained by differences in leg symptoms and, to a somewhat lesser degree, lower ABI levels and poorer education in African Americans than in whites. Further study is needed to determine whether these findings affect racial treatment disparities and poorer outcomes previously reported in African Americans than in whites with PAD.     

Racial/ethnic differences in activities of daily living disability in older adults with arthritis: a longitudinal study

OBJECTIVE: To investigate racial/ethnic differences in disability onset among older Americans with arthritis. Factors amenable to clinical and public health intervention that may explain racial/ethnic differences in incident disability were examined. METHODS: We analyzed longitudinal data (1998-2004) from a national representative sample of 5,818 non-Hispanic whites, 1,001 African Americans, 228 Hispanics interviewed in Spanish (Hispanic/Spanish), and 210 Hispanics interviewed in English (Hispanic/English), with arthritis and age >or=51 years who did not have baseline disability. Disability in activities of daily living (ADL) was identified from report of inability, avoidance, or needing assistance to perform >or=1 ADL task. RESULTS: Over the period of 6 years, 28.0% of African Americans, 28.5% of Hispanic/Spanish, 19.1% of Hispanic/English, and 16.2% of whites developed disability. The demographic-adjusted disability hazard ratios (AHR) were significantly greater among African Americans (AHR 1.94, 95% confidence interval [95% CI] 1.51-2.38) and Hispanic/Spanish (AHR 2.03, 95% CI 1.35-2.71), but not significantly increased for Hispanic/English (AHR 1.41, 95% CI 0.82-2.00) compared with whites. Differences in health factors (comorbid conditions, functional limitations, and behaviors) explained over half the excess risk among African Americans and Hispanic/Spanish. Medical access factors (education, income, wealth, and health insurance) were substantial mediators of racial/ethnic differences in all minority groups. CONCLUSION: Racial/ethnic differences in the development of disability among older adults with arthritis were largely attenuated by health and medical access factors. Lack of health insurance was particularly problematic. At the clinical level, treatment of comorbid conditions, functional limitations, and promotion of physical activity and weight maintenance should be a priority to prevent the development of disability, especially in minority populations.     

Racial and geographic variations in colectomy rates among hospitalized ulcerative colitis patients.

BACKGROUND & AIMS: Ulcerative colitis is a debilitating disease for which colectomy is curative. Racial disparities have been described for a wide spectrum of surgical procedures. The goal of this study was to characterize racial and geographic differences in colectomy rates among hospitalized ulcerative colitis (UC) patients. METHODS: We analyzed discharge records from the Nationwide Inpatient Sample, the largest representative sample of acute care hospitals throughout the United States. A total of 23,389 discharges with UC from 1998-2003 were included for analysis. Colectomy rates, in-hospital mortality, and length of stay were calculated for non-Hispanic whites, African Americans, and Hispanics. RESULTS: After adjustment for age, gender, health insurance, comorbidity, and hospital characteristics, the colectomy rate ratios for African Americans and Hispanics compared with whites were 0.46 (95% confidence interval, 0.35-0.60) and 0.74 (95% confidence interval, 0.59-0.93), respectively. African Americans experienced a longer interval between admission and colectomy than whites (8.8 vs 5.6 days, P=.02). There were also significant geographic variations in colectomy, with the West and Midwest regions yielding rates 3-fold higher than the Northeast. Although adjusted in-hospital mortality did not differ by race, Medicaid patients had 3.3-fold higher mortality than those with private insurance. Between 1998 and 2003, the colectomy rate decreased among whites but not African Americans and Hispanics. A temporal narrowing of geographic variation in colectomy was also observed. CONCLUSIONS: The rate of colectomy among hospitalized UC patients varies significantly by race and geographic location. Further studies are needed to elucidate the social and biologic underpinnings of these variations.     

Racial and ethnic differences in physical activity guidelines attainment among people at high risk of or having knee osteoarthritis

Objective

This cross‐sectional study examined racial/ethnic differences in meeting the 2008 United States Department of Health and Human Services Physical Activity Guidelines aerobic component (≥150 moderate‐to‐vigorous minutes/week in bouts of ≥10 minutes) among persons with or at risk of radiographic knee osteoarthritis (RKOA).

Methods

We evaluated African American versus white differences in guideline attainment using multiple logistic regression, adjusting for sociodemographic (age, sex, site, income, and education) and health factors (comorbidity, depressive symptoms, overweight/obesity, and knee pain). Our analyses included adults ages 49–84 years who participated in accelerometer monitoring at the Osteoarthritis Initiative 48‐month visit (n = 1,142 with RKOA and n = 747 at risk of RKOA).

Results

Two percent of African Americans and 13.0% of whites met the guidelines. For adults with and at risk of RKOA, significantly lower rates of guidelines attainment among African Americans compared to whites were partially attenuated by health factor differences, particularly overweight/obesity and knee pain (with RKOA: adjusted odds ratio [OR] 0.24, 95% confidence interval [95% CI] 0.08–0.72; at risk of RKOA: OR 0.28, 95% CI 0.07–1.05).

Conclusion

Despite known benefits from physical activity, attainment of the physical activity guidelines among persons with and at risk of RKOA was low. African Americans were 72–76% less likely than whites to meet the guidelines. Culturally relevant interventions and environmental strategies in the African American community targeting overweight/obesity and knee pain may reduce future racial/ethnic differences in physical activity and improve health outcomes.