Temporal Trends in Racial and Ethnic Disparities in Multimorbidity Prevalence in the United States, 1999-2018

BackgroundDisparities in multimorbidity prevalence indicate health inequalities, as the risk of morbidity does not intrinsically differ by race/ethnicity. This study aimed to determine if multimorbidity differences by race/ethnicity are decreasing over time.MethodsSerial cross-sectional analysis of the National Health Interview Survey, 1999-2018. Included individuals were ≥18 years old and categorized by self-reported race, ethnicity, age, and income. The main outcomes were temporal trends in multimorbidity prevalence based on the self-reported presence of ≥2 of 9 common chronic conditions.FindingsThe study sample included 596,355 individuals (4.7% Asian, 11.8% Black, 13.8% Latino/Hispanic, and 69.7% White). In 1999, the estimated prevalence of multimorbidity was 5.9% among Asian, 17.4% among Black, 10.7% among Latino/Hispanic, and 13.5% among White individuals. Prevalence increased for all racial/ethnic groups during the study period (P ≤ .001 for each), with no significant change in the differences between them. In 2018, compared with White individuals, multimorbidity was more prevalent among Black individuals (+2.5 percentage points) and less prevalent among Asian and Latino/Hispanic individuals (?6.6 and ?2.1 percentage points, respectively). Among those aged ≥30 years, Black individuals had multimorbidity prevalence equivalent to that of Latino/Hispanic and White individuals aged 5 years older, and Asian individuals aged 10 years older.ConclusionsFrom 1999 to 2018, a period of increasing multimorbidity prevalence for all the groups studied, there was no significant progress in eliminating disparities between Black individuals and White individuals. Public health interventions that prevent the onset of chronic conditions in early life may be needed to eliminate these disparities.     

Racial and Ethnic Differences in the Management of Childhood Asthma in the United States

Objectives. We examined racial and ethnic differences in the management of childhood asthma in the United States and the extent that care conformed to clinical best practices. Methods. Two years of pooled data from the National Health Interview Survey were analyzed using logistic regression. The sample included all children between ages 2 and 17 years who had asthma currently and had been diagnosed with asthma by a doctor or health professional (n = 1757; 465 African-American, 212 Mexican-American, 190 Puerto Rican and other Hispanic, 806 white, non-Hispanic, and 84 children of other and multiple races and ethnicities). Results. African-American children with asthma were significantly less likely than white, non-Hispanic children to have taken preventive asthma medication, but more likely to have had an asthma management plan. Mexican-American and Puerto Rican and other Hispanic children did not differ significantly from white, non-Hispanic children in either receiving preventive asthma medication or having an asthma management plan. Caregivers of African-American and Puerto Rican and other Hispanic children were more likely to report that they or their child had taken a course or class on how to manage their child’s asthma. We did not find racial or ethnic differences in the extent children used quick-relief asthma medication or received advice about reducing asthma triggers in their home, school, or work environments. Conclusions. This work highlights a need for more research on racial and ethnic differences in asthma management. Implications for public health responses and racial and ethnic disparities in asthma morbidity are discussed.     

Racial and Ethnic Differences in Acute Coronary Syndrome and Myocardial Infarction Within the United States: From Demographics to Outcomes

In the United States, different races, ethnicities, and their subgroups experience disparities regarding acute coronary syndrome (ACS) and myocardial infarction (MI). This review highlights these differences across 4 stages that comprise the ACS/MI narrative: (1) patient demographics, (2) patient comorbidities and health risks, (3) treatments and their delays, and (4) outcomes. Overall, black and Hispanic ACS/MI patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non‐Hispanic white patients. More specifically, across the studies analyzed, black and Hispanic ACS/MI patients were consistently more likely to be younger or female, or to have hypertension or diabetes, than non‐Hispanic white patients. ACS/MI disparities also exist among Asian populations, and these are briefly outlined. However, black, Hispanic, and non‐Hispanic white ACS/MI patients were the 3 most‐studied racial and ethnic groups, indicating that additional studies of other minority groups, such as Native Americans, Asian populations, and black and Hispanic subgroups, are needed for their utility in reducing disparities. Despite notable improvement in ACS/MI treatment quality measures over recent decades, disparities persist. Causes are complex and extend beyond the healthcare system to culture and patients' personal characteristics; sophisticated solutions will be required. Continued research has the potential to further reduce or eliminate disparities in the comorbidities, delays, and treatments surrounding ACS and MI, extending healthy lifespans of many underserved and minority populations, while reducing healthcare costs.     

云南省不同民族高血压患病率及血压平均水平分布特征分析

目的:了解云南省部分民族的高血压患病、血压平均水平情况。方法:应用2007年中国成人慢性病危险因素监测第二次调查云南省资料,分析不同民族高血压患病率及其收缩压、舒张压平均水平。结果:按2000年人口年龄构成标化后,男性高血压患病率最高的民族为白族(30.4%),最低的民族为壮族(19.3%),女性高血压患病率最高的为回族(24.7%),最低的为傈僳族(12.9%);收缩压男性以白族最高(133.21±21.05)mmHg、以哈尼族最低(125.25±15.78)mmHg,女性以回族最高(132.26±27.02)mmHg、哈尼族最低(118.65±16.65)mmHg;舒张压男性以白族最高(81.92±11.69)mmHg、哈尼族最低(77.38±11.37)mmHg,女性以回族最高(81.45±13.12)mmHg、哈尼族最低(72.95±11.03)mmHg。结论:高血压的患病及血压均值在所调查的民族间各不相同;与全国不同时期同类调查结果比较,高血压患病率及人群血压均值呈现大幅度上升。     

Racial and Ethnic Disparities in Characteristics and Care Patterns of Chronic Hepatitis B Patients in the United States

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高血压患者静息心率与代谢综合征

目的 探讨原发性高血压患者静息心率(RHR)与代谢综合征(MS)的关系及临床意义.方法 对323例符合原发性高血压的患者进行调查.每位患者均测RHR、血压、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素浓度(FINS)、胰岛素抵抗指数(IR).按RHR频率分RHR 1组＜75次/min(76例),RHR 2组75～79次/min(131例),RHR 3组80～85次/min(91例),RHR 4组＞85次/min(25例).结果 高血压患者不同RHR与FBG、TC、TG、LDL-C、FINS、IR正相关(r分别为0.61,0.28,0.45,0.41,0.36,0.54,P＜0.01),并随着RHR逐渐增加而升高.HDL-C随着RHR增加而下降(呈负相关,r=-0.41,P＜0.01);RHR 2与RHR3组之间腰围、血压无统计学意义(P＞0.05),但与RHR 1、RHR 4组有统计学意义(P＜0.0D.相关因素分析,高血压患者不同RHR与MS所聚集危险因素有关.结论 RHR可能与原发性高血压患者代谢紊乱有关.     

高血压患者静息心率与代谢综合征

目的探讨原发性高血压患者静息心率(RHR)与代谢综合征(MS)的关系及临床意义。方法对323例符合原发性高血压的患者进行调查。每位患者均测RHR、血压、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹胰岛素浓度(FINS)、胰岛素抵抗指数(IR)。按RHR频率分RHR1组<75次/min(76例),RHR2组75~79次/min(131例),RHR3组80~85次/min(91例),RHR4组>85次/min(25例)。结果高血压患者不同RHR与FBG、TC、TG、LDL-C、FINS、IR正相关(r分别为0.61,0.28,0.45,0.41,0.36,0.54,P<0.01),并随着RHR逐渐增加而升高。HDL-C随着RHR增加而下降(呈负相关,r=-0.41,P<0.01);RHR2与RHR3组之间腰围、血压无统计学意义(P>0.05),但与RHR1、RHR4组有统计学意义(P<0.01)。相关因素分析,高血压患者不同RHR与MS所聚集危险因素有关。结论RHR可能与原发性高血压患者代谢紊乱有关。     

Prevalence of obesity in the United States

Obesity is a major public health problem in the United States. Data on measured heights and weights indicates that the prevalence of obesity has significantly increased among the US population over the past 30 years. Data collected from 1999 to 2002 estimates that nearly 1/3 of adults are obese (27.6% of men and 33.2% of women) and one in six children and adolescents is overweight. Increased prevalence of excessive weight is noted among all age, gender and racial/ethnic groups; however, disparities exist. There is a need for further research to better understand why these increases have occurred, why the observed disparities exist and how to reverse these trends.     

Metabolic Syndrome,Androgens, and Hypertension

Obesity is one of the constellation of factors that make up the definition of the metabolic syndrome. Metabolic syndrome is also associated with insulin resistance, dyslipidemia, hypertriglyceridemia, and type 2 diabetes mellitus. The presence of obesity and metabolic syndrome in men and women is also associated with increased risk of cardiovascular disease and hypertension. In men, obesity and metabolic syndrome are associated with reductions in testosterone levels. In women, obesity and metabolic syndrome are associated with increases in androgen levels. In men, reductions in androgen levels are associated with inflammation, and androgen supplements reduce inflammation. In women, increases in androgens are associated with increases in inflammatory cytokines, and reducing androgens reduces inflammation. This review discusses the possibility that the effects of androgens on metabolic syndrome and its sequelae may differ between males and females.     

高血压前期人群中代谢综合征发生情况

目的研究高血压前期人群中代谢综合征(MS)的发生情况。方法依据2006-2007年开滦集团公司职工体检数据库,选取符合美国预防、检测、评估与治疗高血压全国联合委员会第7次报告(JNC7)高血压前期诊断标准的患者33 913例作为高血压前期组,其中男27 213例,女6700例,年龄19～95岁。以数据库中血压<120/80 mm Hg且不符合排除标准者17 961例作为理想血压组,其中男12 218例,女5743例,年龄18～96(46.6±12.8)岁。MS采用国际糖尿病联盟诊断标准。结果①高血压前期组中,男性MS的发生率为14.1%,女性为19.7%。理想血压组MS的发生率男性为4.5%,女性为5.6%。②高血压前期组中无论男女,MS的发生率随年龄的增长而升高,≤29岁组及30～39岁组男性发生率高于女性,40～49岁及其≥49组女性高于男性。结论高血压前期人群中MS的发生率男性为14.1%、女性为19.7%,高于理想血压人群。     

HIV/AIDS in Women and Racial/Ethnic Minorities in the U.S.

The clinical issues affecting women with HIV/AIDS differ little from those affecting men. However, current research shows that treatment and outcome disparities affect many women with HIV, hypothesized to result from a complex interplay of socioeconomic and gender role influences. These disparities are also a reflection of racial/ethnic differences in treatment and outcome, since 80% of women with HIV/AIDS are black or Hispanic. Women have unique needs for HIV prevention — both prevention of sexual transmission to or from sexual partners and prevention of perinatal transmission. Racial/ethnic minorities continue to be disproportionately affected by the HIV/AIDS epidemic in the U.S. Minorities are less likely to be in care and on HAART than others with HIV/AIDS. These disparities result in poorer outcomes for minorities, especially blacks, with HIV/AIDS. New strategies for optimizing engagement and retention in care, and for prevention hold great promise for women and minorities with HIV in the U.S.     

Prevalence and Predictors of Giardia in the United States

Background

Infection with Giardia lamblia is a common cause of diarrheal disease in the developing and industrialized world.

Aims

We aimed to assess the prevalence of giardiasis in the United States (US) among patients with duodenal biopsies, investigating demographic and clinical factors associated with this condition.

Methods

We conducted a cross-sectional study of patients with duodenal biopsies submitted to a national pathology laboratory between January 2, 2008, and December 31, 2015. The prevalence of giardiasis was calculated and categorized by the following patient sociodemographic and clinical data: age, sex, ethnicity, endoscopy indication, season, year, urban–rural setting, region, and presence of H. pylori and atrophic gastritis.

Results

Among all patients (n = 432,813), the mean age was 52.2 years. The prevalence of giardiasis was 0.11%. Patients with giardiasis were more likely to be male (57.8 vs. 34.1%, p < 0.0001). Among patients who had a gastric biopsy (n = 363,788), those with giardiasis were more likely to be colonized with H. pylori (25.7 vs. 9.4%, p < 0.0001). There was no statistically significant association with age, endoscopy indication, urban–rural setting, ethnicity, season, or the presence of atrophic gastritis. On multivariate analysis, male sex, Southern region, and the presence of H. pylori were independently associated with giardiasis.

Conclusions

To our knowledge, this is the largest study to date to assess predictors of giardiasis in the US. We found that male sex, being colonized with H. pylori, and residing in the Southern US are independently associated with giardiasis infection.

     

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.