Prognostic factors for survival among Caucasian, African-American and Hispanic men with androgen-independent prostate cancer

BACKGROUND: African-American men suffer disproportionately with respect to the incidence and mortality from prostate cancer. The objective of the current study was to define if race was an independent prognostic factor among other variables assessed for survival among men treated for androgen independent prostate cancer. METHODS: Between 1988 and 1995, 379 patients with AIPC and clinical progression were referred for novel protocol therapies. Measured variables included: 1) patient age, 2) race or ethnicity, 3) hemoglobin, 4) alkaline phosphatase, 5) serum prostate-specific antigen (PSA) level, 6) time from hormonal ablation to AIPC, 7) number of metastases on bone scan, 8) osseous stage, 9) number of organ systems with metastases and 10) type of treatment for AIPC. RESULTS: Median survival for the cohort was not significantly affected by race, on uni- or multivariate analysis. Multivariate analysis demonstrated that increasing hemoglobin (HR = 0.87 per g, 95% CI [0.81-0.94]) and time to AIPC (HR = 0.994, 95% CI [0.990-0.998]) were associated with increased survival while higher osseous stage (HR = 1.49, stage I versus II, 95% CI [1.11-1.99]), treatment group (HR = 1.68, treatment group I versus II, 95% CI [1.33-2.12]), metastases to three or more organ systems (HR = 1.31 versus less than three organs, 95% CI [1.15-1.49]), and advanced age (HR = 1.51 for age > 70 versus < or = 70, 95% CI [1.18-1.94]) were associated with a decrease in survival among patients with AIPC. CONCLUSION: Independent prognostic variables for survival among patients with AIPC included patient age, serum hemoglobin level, time to androgen-independent disease, treatment group and the extent of metastatic disease. Ethnicity did not adversely affect outcome.     

Race of physician and satisfaction with care among African-American patients

The purpose of this study is to examine predictors of physician-patient race concordance and the effect of race concordance on patients'' satisfaction with their primary physicians among African American patients. The specific research question is, do African American patients express greater satisfaction with their care when they have an African American physician? Using the Commonwealth Fund, Minority Health Survey, we conduct multivariate analysis of African American respondents who have a usual source of care (n = 745). More than 21% of African American patients reported having an African American physician. Patient income and having a choice in the selection of the physician were significant predictors of race concordance. And, patients who were race concordant reported higher levels of satisfaction with care compared with African American patients that were not race concordant.     

What women want: understanding obesity and preferences for primary care weight reduction interventions among African-American and Caucasian women

PURPOSE: To explore attitudes and perceptions of obesity, and identify preferences for weight-management interventions by African-American and Caucasian women who were followed in general internal medicine clinics. PROCEDURE: Surveys exploring these issues were mailed to African-American (n=240) and Caucasian (n=240) women with a BMI of > or =30. MAIN FINDINGS: Caucasian women felt past weight-loss efforts were helped by weight-loss programs significantly more than African-American women (P<0.001); African-American women were more likely to feel that their cultural background contributed to their weight gain than did Caucasian women (P=0.001). African-American women expressed a higher need for one-on-one counseling with their physician (P<0.001) as well as group meetings with the dietician, physician and other women (P=0.004) than did Caucasian women. African-American women also felt it was more important for weight-loss programs to have information on food common to their culture than did Caucasian women (P<0.001). CONCLUSIONS: Differences in cultural background and preferences about weight loss interventions have important policy implications for how the U.S. healthcare system provides care to an ever-increasing multicultural population with a national epidemic such as obesity.     

Prostate cancer: perceptions of African-American males.

The purpose of this study was to determine black adult males'' knowledge and perceptions of prostate cancer by using the Health Belief Model. The subjects were obtained by randomly approaching males in churches, housing projects, inner-city health clinics, and inner-city shopping centers in seven major Ohio cities. A total of 290 black males responded to the survey (58% usable response rate). The mean age of respondents was 60 years (standard deviation = 13.8). Subjects often did not identify trouble urinating, pain urinating, or blood in the urine as possible signs of prostate cancer. Less than half of the subjects knew at what age one should start to have prostate examinations. Forty percent did not believe they were more likely than most men to develop prostate cancer. Almost 60% did not know black men were more likely than white men to develop prostate cancer, whereas 45% thought that if they had prostate cancer it would kill them, and another 28% were not certain. The vast majority of respondents did not perceive any barriers to having their prostate checked, yet 19% identified cost of the examination as a potential barrier. Approximately 10% to 20% of the respondents were unsure of or did not agree with the benefits of a prostate examination. Analysis of the effects of age, education level, and income levels on the Health Belief Model variables found level of education had the most significant effect followed by level of income.     

Responses to tiotropium in African-American and Caucasian patients with chronic obstructive pulmonary disease

Sparse information exists about chronic obstructive pulmonary disease (COPD) outcomes among different ethnic groups. To determine whether the effect of tiotropium on COPD exacerbation differs between African Americans and Caucasians, we performed a post hoc analysis of African-American (n = 150) and Caucasian (n = 1670) subgroups from a previously reported 6-month trial of tiotropium in patients with moderate-to-very-severe COPD. Compared with placebo, tiotropium reduced the likelihood of having at least 1 exacerbation in the entire group (RR, 0.81; 95% CI, 0.66-0.99, P = 0.037) with no statistically significant difference between African-American and Caucasian subgroups (P = 0.34). For African Americans, tiotropium significantly reduced the number of antibiotic days for COPD, hospitalizations for exacerbations, and hospitalization days for COPD. For Caucasians, tiotropium significantly reduced the number of exacerbations, exacerbation days, unscheduled clinic visits for COPD, and hospitalizations for exacerbations. Tiotropium reduced the frequencies of antibiotic days and of COPD hospital days to a significantly greater extent in African Americans compared with Caucasians (P = 0.027 and P = 0.025, respectively). No statistically significant ethnic-related differences were observed in the effect of tiotropium on the frequencies of exacerbations, exacerbation days, systemic corticosteroid days, unscheduled clinic visits, or COPD hospitalizations. Spirometry improved to a similar extent in both subgroups for the entire duration of the 6-month trial. African Americans used fewer respiratory medications than Caucasians in this study. We conclude that tiotropium reduces COPD exacerbations and associated health-care use to a similar extent in African Americans compared with Caucasians.     

Arterial stiffness variations by gender in African-American and Caucasian children

OBJECTIVE: Most arterial stiffness studies have been conducted in adult populations as a part of the aging process in the arterial system. Arterial stiffness is an important early marker of disease identification that may lead to improved cardiovascular health. The aim of this study was to assess the gender and ethnic differences in the arterial stiffness levels among children and adolescents. DESIGN: From a subgroup of schoolchildren who participated in a prospective cohort study in Minnesota, Caucasian and African-American children who completed 16 timed visits were included in this report (n=487). The participants were followed from 1978 (7.68 +/- 0.72 years) to 1987 (16.65 +/- 0.71 years). A surrogate measure of arterial stiffness-arterial pulse pressure (APP in mmHg)--was used. RESULTS: Adjusted APP differences started to appear around 12.67 years and persisted throughout the study. Boys consistently had higher APP levels than the girls. Ethnic differences in adjusted APP levels were observed at an earlier age (7.68 years) but did not persist after age 10. CONCLUSION: APP levels were different between gender and ethnic groups in youth. These early indications of arterial stiffness warrant further exploration of arterial stiffness etiology.     

Exercise intensity and oxygen uptake kinetics in African-American and Caucasian women

The effect of exercise intensity on the on- and off-transient kinetics of oxygen uptake (VO₂) was investigated in African American (AA) and Caucasian (C) women. African American (n = 7) and Caucasian (n = 6) women of similar age, body mass index and weight, performed an incremental test and bouts of square-wave exercise at moderate, heavy and very heavy intensities on a cycle ergometer. Gas exchange threshold (LT_GE) was lower in AA (13.6 ± 2.3 mL kg⁻¹ min⁻¹) than C (18.6 ± 5.6 mL kg⁻¹ min⁻¹). The dynamic exercise and recovery VO₂ responses were characterized by mathematical models. There were no significant differences in (1) peak oxygen uptake (VO_2peak) between AA (28.5 ± 5 mL kg⁻¹ min⁻¹) and C (31.1 ± 6.6 mL kg⁻¹ min⁻¹) and (2) VO₂ kinetics at any exercise intensity. At moderate exercise, the on- and off- VO₂ kinetics was described by a monoexponential function with similar time constants τ _1,on (39.4 ± 12.5; 38.8 ± 15 s) and τ _1,off (52.7 ± 10.1; 40.7 ± 4.4 s) for AA and C, respectively. At heavy and very heavy exercise, the VO₂ kinetics was described by a double-exponential function. The parameter values for heavy and very heavy exercise in the AA group were, respectively: τ _1,on (47.0 ± 10.8; 44.3 ± 10 s), τ _2,on (289 ± 63; 219 ± 90 s), τ _1,off (45.9 ± 6.2; 50.7 ± 10 s), τ _2,off (259 ± 120; 243 ± 93 s) while in the C group were, respectively: τ _1,on (41 ± 12; 43.2 ± 15 s); τ _{2, on} (277 ± 81; 215 ± 36 s), τ _1,off (40.2 ± 3.4; 42.3 ± 7.2 s), τ _2,off (215 ± 133; 228 ± 64 s). The on- and off-transients were symmetrical with respect to model order and dependent on exercise intensity regardless of race. Despite similar VO₂ kinetics, LT_GE and gain of the VO₂ on-kinetics at moderate intensity were lower in AA than C. However, generalization to the African American and Caucasian populations is constrained by the small subject numbers.     

Lower prevalence of intraventricular block in African-American patients compared with Caucasian patients: an electrocardiographic study II

BACKGROUND: Electrocardiographic (ECG) differences occur between African-American and white persons. METHODS: Intraventricular conduction abnormalities of ECGs of 2,123 African-American and white hospital patients ages 20-99 years were studied in a consecutive manner. RESULTS: Intraventricular conduction abnormalities develop later in life and are less common in African-American patients, compared with white patients. The prevalence of conduction abnormalities increases with advancing age in both races. Left- and right ventricular conduction abnormalities begin to rise at age 50 for white patients but begin to rise at age 70 for African-American patients. The prevalence of left ventricular conduction abnormalities peaks in the ninth decade of life in both races but declines in both races in the tenth decade of life. The prevalence of right ventricular conduction abnormalities gradually increases and peaks in the tenth decade of life in both races. CONCLUSIONS: The prevalence of intraventricular block is significantly less in African-American patients, compared with white patients--occurring in 8.6% of African-American patients and in 15.2% of white patients. The prevalence of intraventricular block is lowest in African-American women at 6.5% and highest in white men at 16.8%.     

Elderly African-American and Caucasian men are infrequently screened for osteoporosis

INTRODUCTION: To retrospectively examine the factors that initiated a request for dual x-ray absorptiometry (DXA) in elderly males in a rheumatology practice and to determine if there were differences between African Americans and Caucasians, MATERIALS AND METHODS: The records of 98 consecutive male patients in the rheumatology clinic were reviewed for demographic data and risk factors and treatment for osteoporosis. DXA results were noted and classified as normal, osteopenic or osteoporotic. RESULTS: There were 59 (60%) African Americans, 38 (39%) Caucasians and one (1%) Native American included for study. Fourteen patients had DXA-three (5%) among the African Americans and 11 (29%) among the Caucasians. Age was not found to be a significant predictor of obtaining DXA. Caucasians were 7.69 times more likely to have a DXA than African Americans. After adjusting for ethnicity, oral glucocorticoid use and rheumatoid arthritis were significant predictors of obtaining a DXA, although only 31% and 35% of patients on glucocorticoids or with rheumatoid arthritis, respectively, had DXA. Using a logistic regression model, ethnicity (odds ratio 4.61) remained the only significant predictor of requests for DXA. CONCLUSION: Male patients infrequently had DXA despite the presence of well-established risk factors for osteoporosis. Compared to Caucasians, fewer African Americans were screened even in the presence of similar risk factors for osteoporosis.     

Mortality and apolipoprotein E in Hispanic, African-American, and Caucasian elders

To investigate whether mortality risk is influenced by apolipoprotein E (APOE) genotype and whether the risk differs by ethnicity, we compared the mortality risk in 2,112 individuals > or = 65 years of age residing in northern Manhattan in New York. Mortality risks associated with the APOE genotype, adjusted for sex, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides, differed significantly by ethnic group. Among Caucasian and Hispanics, the E2/E3 genotype was associated with the lowest mortality risk in the multivariate Cox proportional hazards modeling, adjusted for lipid levels, whereas mortality risk did not differ substantially between the E4/E3 and E3/E3 genotypes. Among African-Americans, the E2/E3 genotype was not associated with the lowest mortality risk, but the E4/E3 genotype was. Adjustment for heart disease, diabetes, and stroke reduced mortality risk associated with each genotype by about 50% for all ethnic groups, but the patterns remained the same. Although we cannot rule out the possibility of a healthy survival bias, our analyses designed to examine healthy survival by comparing risk of mortality in groups who were younger or older at entry do not support this possibility. Our findings suggest that the APOE genotype is associated with mortality and that the genotypic risks differ by ethnic group. Nearly 50% of the mortality risk associated with the APOE genotype appears to act through major chronic diseases, but those diseases only partially explain the mechanism by which the genotypic risk acts. To better understand the observed ethnic differences in mortality risk by genotype, a detailed prospective study is needed to examine the relationships among APOE, other candidate genes, health conditions, and eventual death.     

African-American adults' perceptions of guns and violence.

This study examined African-American adults'' perceptions of guns and violence. Through a mall intercept type study, 347 adults, ages 20 to 75, responded to a 54-item questionnaire. One third of the respondents claimed they owned one or more types of guns, three fourths had personally known someone who had been shot, more than one third had actually seen someone shot, and one third had a gun pulled on them. While the vast majority (84%) believed guns are too easy to obtain, the majority (62%) also believed that having a gun at home would help protect them. There were no significant differences in perceptions of guns based on age, gender, level of education, or socioeconomic status. The results of this study tend to substantiate the concern and fear of personal harm that African Americans have to contend with on a regular basis. The results also suggest the need for some form of educational intervention and gun safety training in order to help reduce the risk of death and injury among African Americans.     

Cyclooxygenase 1 (COX1) polymorphisms in African-American and Caucasian populations

Cyclooxygenases (COXs) are the primary targets of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), and thus enzymes of major interest to pharmacology, pharmacogenetics, and epidemiology. Genetic variants that affect enzyme function, or the interaction with NSAIDs, could alter drug response. We have screened the human COX1 gene coding regions of 48 African-American and 47 Caucasian individuals using DNA sequencing. We identified 13 coding-region variants, of which seven were amino-acid substitutions, and further five intronic polymorphisms within 60bp of an exon. All nonsynonymous variants were confirmed in an independent Caucasian population (n=94 unrelated individuals). Most of the discovered polymorphisms were rare, although some variants resulting in amino-acid changes occurred at appreciable frequency in at least one population (> or =4%: R8W, P17L, L237M). We used two sequence-homology-based software programs to predict the potential impact of these polymorphisms on COX1 function. The L237M substitution was predicted as most likely to alter protein function, whereas the glycine at position 230 may be specific to COX1 function. More detailed phenotypic characterizations of these COX1 polymorphisms remain to be undertaken.     

Comparison of the prevalence of first-degree atrioventricular block in African-American and in Caucasian patients: an electrocardiographic study III

BACKGROUND: Electrocardiographic (ECG) differences occur between African-American and Caucasian patients. METHODS: The study includes ECGs of 2,123 patients, ages 20-99 years attending an urban hospital. RESULTS: First-degree atrioventricular (AV) block was more prevalent in African-American patients compared with Caucasian patients in all age groups of the study except for those patients in the eighth decade of life. The prevalence of first-degree AV block began to increase at age 50 years in both ethnic groups and gradually increased with advancing age, peaking in African-American patients in the 10th decade of life, and in Caucasian patients in the ninth decade of life. The continuing increase in first-degree AV block in African-American patients in the 10th decade of life suggests increasing impairment but greater durability of the AV conduction system in African-American compared with Caucasian patients. The dramatic decline of the prevalence of first-degree AV block in Caucasian patients in the 10th decade of life suggests more frequent failure of the AV conduction system in this group of patients at ages 90-99 years, compared with African-American patients in the same age group. In population-based surveys, first-degree AV block was more prevalent in African-American subjects compared with Caucasian subjects.     

Clinicopathological characteristics of triple-negative invasive mammary carcinomas in African-American versus Caucasian women

African-American (AA) women are more likely to have late stage, aggressive, rapidly growing, and less hormone-responsive breast tumors. An aggressive subtype of cancer, known as "Triple-Negative" (TN), that is negative for Her-2 and for estrogen and progesterone receptors (ER and PR), is reported to be more common in AA women. We examined the clinical, histopathologic, and prognostic features of TN tumors in AA and Caucasian women. Tumor size, grade, histologic type, lymphovascular invasion (LVI), lymph node status, patient survival, ploidy status, and expression of ER, PR, p53, epidermal growth factor receptor (EGFR), MIB-1, Bcl-2, Her-2, p27, and p21 were evaluated. The TN tumors (75%) were high grade, large, aneuploid tumors that occurred in younger women and were more likely to have a high rate of LVI, elevated MIB-1 score, and nodal metastases. Patients with TN tumors showed poorer overall survival. There was no difference in overall or disease-free survival (p = 0.46) in the AA versus Caucasian women. LVI was a significant predictor of overall survival in AA but not in Caucasian women. There were minor differences in histopathologic features, biomarker expressions, and survival in AA and Caucasian women with TN tumors. The absence of LVI in AA patients predicted an excellent probability of survival.     

Patient perceptions of access to care and referrals to specialists: a comparison of African-American and white older patients with knee and hip osteoarthritis

BACKGROUND: There is a marked racial difference in the use of knee and hip replacement for osteoarthritis (OA). The reasons for this disparity remain unclear. We examined how African-American and white patients with symptomatic OA of the knee and/or hip compare with respect to their perceptions of care for knee and hip OA. METHODS: Survey of 596 male patients with OA of the knee and/or hip in primary care clinics at Cleveland VAMC. RESULTS: African-American (44%) and white (56%) study participants were comparable with respect to age and clinical factors. African Americans were more likely to have VA insurance only [OR=1.93 (1.13-3.28)]. African Americans were less likely to report difficulty getting medical care when needed [OR=0.54 (0.34-0.88)]. Differences in the two groups regarding satisfaction with and confidence in the primary physician were not significant. The proportions of participants who received specialty care referrals were similar. CONCLUSION: African-American patients reported having only VA insurance more often than white patients. Other aspects of perceived system and provider-based factors were similar between groups.     

An assessment of obesity among African-American women in an inner city primary care clinic

Despite multiple patient assessments and interventions, obesity continues to cause significant morbidity and mortality nationwide. This study assesses the prevalence of obesity and weight control practices among middle-aged African-American women. In 1995, 307 women 30 years of age and older were consecutively selected in a non-random fashion from three clinic sites located within a public university hospital that served largely indigent, inner city African-American populations. Interviewers surveyed the respondents using the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS). The prevailing demographic profile of patients in the clinic was middle-aged, indigent, ill, and of low educational attainment. Over 35% of individuals were classified as being overweight (BMI 25 to 29.9 kg/m2) and 45% were classified as being obese (BMI > or = 30 kg/m2). Therefore, more than 80% of individuals in this study were either overweight or obese, with BMI exceeding 25 kg/m2. Of the overweight and obese African-American women in this study, only 40% were attempting current weight loss practices, and weight loss attempts varied directly with body mass index. Although 80% of women attempted weight loss by restricting caloric intake, only 50% were also using physical activity as part of their regime. African-American women in this population have a higher prevalence of obesity and encounter great difficulty losing weight. Counselors should emphasize the value and ease of adopting a moderate regimen of physical activity and not just reducing caloric intake when advising African-American women and their peer network.     

Challenges in making therapeutic lifestyle changes among hypercholesterolemic African-American patients and their physicians

OBJECTIVE: We explored challenges faced by hypercholesterolemic African-American primary care patients and their physicians regarding therapeutic lifestyle changes (TLC) and provide patient-influenced recommendations to physicians. METHODS: In this qualitative study, 23 urban family medicine patients and their physicians (N=12) participated in separate focus groups, where they were asked semistructured, open-ended questions about knowledge and barriers to lifestyle treatment of high cholesterol. RESULTS: During the focus groups, barriers mentioned by physicians were: lack of time for TLC counseling, inadequate knowledge about counseling patients, and patient readiness and responsibility to change. Patient-revealed barriers included difficulty adhering to a diet/exercise regimen and a lack of knowledge about high cholesterol. Patients who were successful with adopting a healthy lifestyle identified personal experiences or those of family and friends as motivating. CONCLUSION: Physicians desire training and resources to better help patients adopt diet and exercise regimens specific to their general and health literacy and their access to healthy foods, along with their readiness to change. Patients desire that physicians tailor their TLC advice to be specific to their context and they want help from physicians in setting realistic goals. Such a patient-centered counseling approach may improve adherence to lifestyle guidelines and, thus, clinical outcomes.     

Prevalence of rib anomalies in normal Caucasian children and childhood cancer patients

Purpose. – To evaluate the prevalence of abnormalities of rib development in normal Caucasian children and patients with childhood cancer.Materials And Methods. – Chest radiographs of 881 Caucasian pediatric controls and 906 childhood cancer patients were reviewed, and independently scored by four blinded observers, using strict definitions. Prevalences of 6 major rib anomaly categories in controls were compared to their prevalence in the total group of childhood cancer patients, and the 12 individual larger tumor groups using Chi-square tests.Results. – Values in the control population were generated for the occurrence of six major rib anomaly categories; cervical rib anomalies were present in 6.1% of controls, aplasia of 12^th ribs in 6.6%, lumbar ribs in 0.9%, bifurcations in 0.7%, synostosis-bridging in 0.3%, and segmentations were not found. The overall prevalence of total rib anomalies in cases and controls was equal (14.9% and 14.2%, respectively). Cervical rib anomalies were found significantly more often in cases (8.6%) compared to controls (p-value=0.047), three groups accounting for this higher prevalence: 12.1% of acute lymphoblastic leukemia patients (p=0.011), 18.2% of astrocytoma patients (p=0.023), and 14.7% of germ cell tumor patients (p=0.046) had a cervical rib anomaly.Conclusion. – Prevalence figures for the presence and type of rib anomalies in a large group of normal Caucasian children were generated. In childhood cancer patients a significantly higher prevalence of cervical rib anomalies was demonstrated in patients with acute lymphoblastic leukemia, astrocytoma, and germ cell tumors.