Cause of deep venous thrombosis and pulmonary embolism in young patients from India as compared with other ethnic groups

Venous thromboembolism (VTE), which consists of deep vein thrombosis (DVT) and pulmonary embolism, is a potentially fatal disease. The existing Asian literature has shown a wide variation in the prevalence of VTE, with very limited data from India. In the present study, the risk factors for VTE in Indian patients were compared with Caucasians and Blacks. We used data prospectively collected from total of 1396 Indian patients (716 males, 680 females) enrolled over a decade and compared with White (n = 2002) and Black (n = 395) patients objectively diagnosed with VTE. When compared with females, males had significantly higher episodes of pulmonary embolism and VTE (P = 0.0001). Amongst the known thrombophilia markers, only homocysteine was found to be significantly higher in males as compared with females (P = 0.006). Males had a higher proportion of rheumatic heart disease (RHD) and ischaemic heart disease (IHD) as compared with females. The prevalence of DVT amongst Indians was significantly higher as compared with Whites and Blacks. However, the rate of pulmonary embolism and VTE was lower in Indians as compared with both the races. Amongst the baseline characteristics identified as risk factors for VTE, Indians had a higher prevalence of infection as compared to both Whites and Blacks, but lower HIV infection as compared to Blacks. As compared to Whites, Indians had lower prevalence of idiopathic VTE (but similar to blacks) and had higher prevalence of idiopathic pulmonary embolism (P < 0.0001). This can be explained by different inherited and environment risk factors between these three populations.     

Noninsulin-dependent diabetes mellitus in black and white Americans

This report presents an overview of the prevalence, characteristics, morbidity, mortality, and risk factors for noninsulin-dependent diabetes (NIDDM) in Blacks and Whites in the United States. Data are drawn primarily from national surveys, but the report also includes the few clinical studies that have differentiated the two races. NIDDM constitutes 90-95% of all diabetes in the United States and is more prevalent in Black Americans than in Whites. Diabetes prevalence increases with age for both races and reaches 26% among Blacks aged 65-74 years compared with 18% among Whites. Rates of diabetes among persons aged 20-74 years are 30% higher in White women, 70% higher in Black men, and 100% higher in Black women, compared with White men. Approximately half of diabetes is undiagnosed in both races. White and Black diabetics are similar with regard to age, duration of diabetes, and diabetes therapies, although Blacks of both sexes are more obese than their White counterparts. Rates of vision loss, amputations, and renal disease are 1.5-4 times higher in Blacks than in Whites, although prevalence of hypertension is about equal in the two races. Blacks and Whites see the same physician specialists for their diabetes, but Whites have approximately 40% more visits to office-based physicians each year. Diabetes-specific mortality has declined significantly in the past decade and may now be lower in Black than in White diabetics. Risk factors for diabetes, including age, sex, obesity, and family history of diabetes, all operate within both race groups and probably interact with each other. The effect of gender and family history on rates of diabetes is similar in Blacks and Whites. Blacks have higher rates of diabetes at each obesity level, indicating that obesity alone cannot explain the differential in prevalence between the races. Impaired glucose tolerance (IGT), a strong risk factor for development of diabetes, increases with age in all race/sex groups except for Black women older than 54 years in whom rates of IGT, decline, possibly because of conversion of IGT to diabetes.     

Sociodemographic Predictors of Pattern and Volume of Alcohol Consumption Across Hispanics,Blacks, and Whites: 10‐Year Trend (1992–2002)

Background: There have been limited trend studies examining variations on the patterns of alcohol consumption among Whites, Blacks, and Hispanics in the United States. The current paper reports national trends in drinking patterns, volume of drinking (number of drinks per month), binge drinking, and drinking to intoxication among Blacks, Whites, and Hispanics over a period of 10 years and identifies sociodemographic predictors of these behaviors across the 3 ethnic groups. Methods: Data are from the 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES; n = 42,862) and the 2001 to 2002 National Epidemiologic Study on Alcohol and Related Conditions (NESARC; n = 43,093). Both surveys used multistage cluster sample procedures to select respondents 18 years of age and older from the U.S. household population. Results: Trends varied across different dimensions of drinking and ethnic groups. There were no statistically significant differences in the mean number of drinks consumed per month among men and women in any of the 3 ethnic groups between 1992 and 2002, but there was a significant rise in the proportion of current drinkers in both genders and in all 3 ethnic groups. Multivariate analysis indicated that, compared to Whites in 1992, Blacks and Hispanics did not increase their volume of drinking, but Whites did. Drinking 5 or more drinks in day at all did not increase between 1992 and 2002, but drinking 5 or more drinks at least once a month was more likely for all groups in 2002 compared to Whites in 1992. Drinking to intoxication at all was more likely among Whites in 2002 than 1992, but drinking to intoxication at least once a month was more likely among Whites and Blacks in 2002 than 1992. Conclusion: The only common trend between 1992 and 2002 across both genders and 3 ethnic groups was a rise in the proportion of drinkers. There was also a rise in drinking 5 or more drinks in a day (Whites, Blacks, and Hispanics) and drinking to intoxication (Whites and Blacks), but this was limited to those reporting such drinking at least once a month. The reasons for these changes are many and may involve complex sociodemographic changes in the population. It is important for the field to closely monitor these cross‐ethnic trends in alcohol consumption.     

Racial disparity in all‐cause mortality among hepatitis C virus‐infected individuals in a general US population,NHANES III

There are few long‐term nationally representative studies of all‐cause mortality among those infected with hepatitis C virus (HCV). When an additional 5 years of data were made publicly available in 2015, the Third National Health and Nutrition Examination Survey Linked Mortality File became the longest nationally representative study in the United States. Our objective was to update the estimated HCV‐associated all‐cause mortality in the general US population and determine any differences by sex, age and race/ethnicity. HCV status was assessed in 9117 nationally representative adults aged 18‐59 years from 1988 to 1994, and mortality follow‐up of the same individuals was completed through 2011 and made publicly available in 2015. There were 930 deaths over a median follow‐up of 19.8 years. After adjusting for all covariate risk factors, chronic HCV had 2.63 times (95% CI: 1.59‐4.37; P=.0002) higher all‐cause mortality rate ratio (MRR) compared with being HCV negative. All‐cause MRR was stratified by sex, age and race/ethnicity. Only race/ethnicity was a significant effect modifier of MRR (P<.0001) as the highest MRR of chronic HCV compared to HCV negative was 7.48 (95% CI: 2.15‐26.10, P=.001) among Mexican Americans, 2.67 (95% CI: 2.67‐5.56, P=.009) among non‐Hispanic Whites and 2.02 (95% CI: 1.20‐3.40, P=.007) among non‐Hispanic Blacks. Racial disparity was seen in the all‐cause mortality as Mexican Americans with chronic HCV had approximately seven times higher mortality rate than HCV‐negative individuals. This suggests that these at‐risk individuals should be targeted for HCV screening and treatment, given the availability of new highly effective HCV therapies.     

The prevalence of hypovitaminosis D and secondary hyperparathyroidism in obese Black Americans

CONTEXT: Both obesity (body mass index, BMI > or = 30 kg/m2) and Black race are associated with a higher risk of vitamin D deficiency and secondary hyperparathyroidism. We hypothesized the risk of hypovitaminosis D would therefore be extraordinarily high in obese Black adults. OBJECTIVE: To study the effects of race and adiposity on 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (iPTH). DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study of 379 Black and White adults from the Washington D.C. area. BMI ranged from 19.9 to 58.2 kg/m2. MAIN OUTCOME MEASURES: Prevalence of hypovitaminosis D [25(OH)D < 37.5 nmol/l] and secondary hyperparathyroidism [25(OH)D < 37.5 nmol/l with iPTH > 4.2 pmol/l]. RESULTS: Obese Black subjects had lower mean 25(OH)D, 40.3 (SD, 20.3) nmol/l, compared with obese Whites, 64.5 (29.7), P < 0.001, nonobese Blacks, 53.3 (26.0), P = 0.0025 and nonobese Whites, 78.0 (33.5), P < 0.001. The prevalence of hypovitaminosis D increased with increasing BMI, and was greater (P < 0.001) in Blacks than Whites within all BMI categories examined. Among subjects with BMI > or = 35 kg/m2, 59% of Blacks vs 18% of Whites had hypovitaminosis D (odds ratio 6.5, 95% confidence interval 3.0-14.2). iPTH was negatively correlated with 25(OH)D (r = -0.31, P < 0.0001), suggesting those with hypovitaminosis D had clinically important vitamin D deficiency with secondary hyperparathyroidism. For secondary hyperparathyroidism 35.2% of Blacks met the criteria, compared to 9.7% of Whites (OR 3.6, CI 1.5-98.8). CONCLUSIONS: Obese Black Americans are at particularly high risk for vitamin D deficiency and secondary hyperparathyroidism. Physicians should consider routinely supplementing such patients with vitamin D or screening them for hypovitaminosis D.     

Subclinical myocardial injury and cardiovascular mortality: Racial differences in prevalence and risk (from the third National Health and Nutrition Examination survey)

BackgroundSubclinical myocardial injury (SCMI) determined from the Electrocardiographic Cardiac Infarction/Injury Score (CIIS) is associated with increased risk of cardiovascular disease and mortality. We hypothesized that SCMI prevalence and association with mortality would differ by race, categorized as non‐Hispanic White (White), non‐Hispanic Black (Black), and Mexican American.MethodsOur analysis included 5,852 participants (age 58.5 ± 13.2 years; 54% women, 52% Whites, 23% Blacks, and 25% Mexican American participants) from the National Health and Nutrition Examination Survey (NHANES III, 1988–94) who were free of cardiovascular disease at the time of enrollment. SCMI was defined as the presence of CIIS ≥ 10 score points on the 12‐lead ECG. Prevalence of SCMI and its association with cardiovascular mortality were examined in each race/ethnic group in models adjusted for sociodemographics and common cardiovascular risk factors.ResultsSCMI prevalence was 23.4% in Whites, 21.8% in Blacks, and 18.0% in Mexican Americans. Compared to Whites, Blacks were as likely to have SCMI (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.80–1.13), while Mexican Americans were less likely (OR 0.74, 95% CI 0.62–0.88). SCMI was not associated with increased risk of cardiovascular mortality in either Whites (hazard ratio [HR] 1.18, 95% CI 0.95–1.48) or Blacks (HR 1.19, 95% CI 0.79–1.80). In contrast, SCMI in Mexican Americans was associated with increased risk of cardiovascular mortality (HR 1.74, 95% CI 1.13–2.67, p < .05).ConclusionMexican Americans had a lower prevalence of SCMI, but increased risk of cardiovascular mortality. Screening for SCMI may identify individuals at increased risk and improve targeted prevention efforts.     

Commentary on why national epidemiological estimates of substance abuse by race should not be used to estimate prevalence and need for substance abuse services at community and local levels

Large-scale epidemiological studies suggest substantially lower prevalence rates of substance abuse disorders in Black Americans than in White Americans. This is counterintuitive since indicators of socioeconomic status, which on an average are lower in Blacks than Whites, are inversely associated with the prevalence of psychiatric disorders. Herein, we recommend against the use of race-specific national epidemiological data to estimate prevalence of substance abuse disorders and need for services at community/local levels. This is important so that catchment areas with high proportions of minorities receive equitable levels of substance abuse prevention and treatment resources. We illustrate our recommendation through observations and potential biases (e.g., reporting bias) identified from large-scale epidemiological studies of the prevalence of substance use disorders between Black and White Americans.     

COMMENTARY ON WHY NATIONAL EPIDEMIOLOGICAL ESTIMATES OF SUBSTANCE ABUSE BY RACE SHOULD NOT BE USED TO ESTIMATE PREVALENCE AND NEED FOR SUBSTANCE ABUSE SERVICES AT COMMUNITY AND LOCAL LEVELS

Large-scale epidemiological studies suggest substantially lower prevalence rates of substance abuse disorders in Black Americans than in White Americans. This is counterintuitive since indicators of socioeconomic status, which on an average are lower in Blacks than Whites, are inversely associated with the prevalence of psychiatric disorders. Herein, we recommend against the use of race-specific national epidemiological data to estimate prevalence of substance abuse disorders and need for services at community/local levels. This is important so that catchment areas with high proportions of minorities receive equitable levels of substance abuse prevention and treatment resources. We illustrate our recommendation through observations and potential biases (e.g., reporting bias) identified from large-scale epidemiological studies of the prevalence of substance use disorders between Black and White Americans.     

Exploring pregnancy-related changes in alcohol consumption between black and white women

Background: Although epidemiological data indicate that White women are more likely to drink and binge drink before pregnancy, fetal alcohol syndrome (FAS) is more common in the Black population than among Whites in the United States. Differences in drinking cessation between Black and White women who become pregnant may help explain the disparity in FAS rates. Methods: The study sample was comprised of 280,126 non‐Hispanic Black and White women, ages 18 to 44, from the Behavioral Risk Factor Surveillance System (BRFSS) 2001 to 2005 data sets. Predictors of reduction in alcohol consumption (in drinks per month) and binge drinking (>4 drinks on one occasion) by pregnant and non‐pregnant women were identified with logistic regression. The effect of interactions of pregnancy status with age, education, and Black or White race on drinks per month and binge occasions were explored using analysis of variance (ANOVA). Results: Pregnant White women averaged 79.5% fewer drinks per month than non‐pregnant White women (F = 1250.1, p < 0.001), and 85.4% fewer binge drinking occasions (F = 376, p < 0.001). Pregnant Black women averaged 58.2% fewer drinks per month than non‐pregnant Black women (F = 31.8, p < 0.001) and 64.0% fewer binge occasions (F = 13.8, p < 0.001). Compared to Black women, White women appear to make a 38% greater reduction in drinks per month, and a 33% greater reduction in binge occasions. Conclusions: Non‐Hispanic White women appear more likely to reduce drinks per month and binge drinking occasions than non‐Hispanic Black women during pregnancy. These findings may help explain disparities in FAS in the United States, though this cross‐sectional sample does not permit claims of causation. To better describe the impact of differential drinking reduction on FAS rates, future studies of longitudinal data should be done.     

Elder disability as an explanation for racial differences in informal home care

PURPOSE: Adjusting for sociodemographic characteristics and disability levels, this study examines whether differences exist in the structure and function of community-dwelling Black and White frail elders' informal care networks. DESIGN AND METHODS: Data from in-person assessments of Michigan's Home and Community-Based Medicaid Waiver applicants were analyzed by using logistic and ordinary least squares regression. The sample consisted of 936 Black and 3,182 White frail elderly persons. RESULTS: When sociodemographic characteristics were controlled for, racial differences were found in all informal care components except out-of-home chores. Differences in functional components (amount of care, scope of assistance, and personal care) were largely accounted for by disability, whereas racial differences in the structural components (source of care, living arrangement, and sole caregiver) and in-home chores were not. IMPLICATIONS: Findings suggest that Blacks are not better off than Whites in the receipt of informal care. Although Black elders receive more informal help, this difference is primarily because Blacks are more disabled. This study calls for heightened awareness of disability among low-income Blacks and the potential burden experienced by their caregivers.     

Characteristics of hip fractures among hospitalized elder Mexican American Black and White Medicare beneficiaries in the Southwestern United States

BACKGROUND AND AIMS: Hip fractures are a major cause of morbidity and mortality in the older adult population. The evidence of the incidence of morbidity and mortality in Mexican Americans compared to other ethnic groups is mixed. This study aims to examine characteristics and utilization patterns of older Mexican Americans compared to Whites and Blacks, hospitalized for hip fracture in the Southwestern United States. METHODS: Retrospective analysis of the Medicare and Medicaid claims data for the southwestern states of California, Arizona, Colorado, New Mexico and Texas. All Medicare beneficiaries aged 65 and above, hospitalized for non-pathologic hip fractures, participated in the study. Mexican Americans were directly identified from the H-EPESE database. The primary outcome measures were length of stay, total charges and number of diagnoses. RESULTS: The total proportion of hospital encounters related to hip fractures within each ethnic group was 3.7% for Whites, 2.0% for Mexican Americans and 1.2% for Blacks. The mean patient age for the hip fracture was 82.5 years while the non-hip fractures encounters had a mean age of 76.6 years. A higher percentage of Mexican Americans who suffered fracture were female. Although length of stay for Mexican Americans was equivalent to Whites, comparative total charges for Mexican Americans were lower. Mexican Americans also have lower mean number of diagnoses at admission than the other groups (MA=5.5, B=6.2, W=5.9: p<0.001). CONCLUSIONS: Mexican American elders in the southwestern United States who are hospitalized for hip fractures are more likely to be female, relatively healthier, and have lower health care costs when compared to Whites and especially to Blacks in the same region.     

Racial/ethnic differences in prehypertension in American adults: population and relative attributable risks of abdominal obesity

To estimate the risk and population attributable risk of prehypertension that is due to abdominal obesity in White, Black and Hispanic American adults. To determine how much of the relative difference in the risk of prehypertension between high-risk Blacks and Hispanics and the low-risk group Whites that is attributable to their differences in abdominal obesity. Data (n=4016) from the 1999 to 2000 US National Health and Nutrition Examination Surveys were used in this study. Abdominal obesity was defined as waist circumference >/=102 and >/=88 cm in men and women, respectively. Prehypertension was defined as not being on antihypertensive medication and having systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg. Odds ratio from the logistic regression analysis was used to estimate the risk of prehypertension that was due to abdominal obesity. To estimate prehypertension risk differences between low-risk Whites and high-risk Blacks and Hispanics that was due to abdominal obesity, we estimated relative attributable risk. Statistical adjustments were made for age, blood glucose, total cholesterol, current smoking and exercise. Abdominal obesity was associated with increased odds of prehypertension in Whites, Blacks and Hispanics. In men, abdominal obesity was associated with 44, 90 and 98% increased odds of prehypertension in Whites, Blacks and Hispanics, respectively. The corresponding values in women were 112, 198 and 104%. Proportions of risk of prehypertension explained by abdominal obesity were 15.2, 22 and 25.8% in White men, Black men and Hispanic men, respectively. The corresponding values in women were 38.8, 58.6 and 32.5%. Approximately, 7% of the differences in the risk of developing prehypertension between White and Black men and between White and Hispanic men may be attributable to differences in rates of abdominal obesity. The analogous values for women were approximately 39.7 and approximately 16.5%, respectively. In conclusion, despite having lower rates of abdominal obesity than their counterparts, Black men, Hispanic men and Hispanic women had high population attributable risks, indicating that factors other than abdominal obesity may have important explanatory power for racial differences in prehypertension in these groups. However, in Black women reduction in risk of prehypertension could be possible by instituting public health measures to reduce abdominal obesity to the levels seen in White women. Intervention programmes designed to reduce overall obesity may also lead to reduction of abdominal obesity, and consequently may curb prehypertension in these population groups. Life-style modification, including diet and exercise, may have public health significance in reducing the incidence of prehypertension in these populations.     

Ethnic differences in the relationship of carotid atherosclerosis to coronary calcification: the Multi-Ethnic Study of Atherosclerosis

Ethnic differences in non-invasive measures of atherosclerosis are increasingly being reported, but the relationship of these measures to each other has not been widely explored. Carotid ultrasonographic and computed cardiac tomographic findings were compared in 6814 participants of White, Black, Hispanic, and Chinese ethnicities free of overt cardiovascular disease. Coronary calcium and carotid atherosclerosis were strongly related to each other in all ethnic groups. Associations of coronary calcium prevalence and common carotid intimal-medial thickness (IMT) differed by ethnicity in women, being weakest among Black women (0.07 mm IMT difference between those with and without coronary calcium) compared to the other three groups (0.10-0.12 mm difference, p=0.007). Estimated percent increments in internal carotid IMT per 10% increment in coronary calcium score were highest in Hispanics (18.5%) and lowest in Blacks (6.1%, p<0.01). Coronary calcium may be less strongly associated with carotid atherosclerosis in Blacks, particularly Black women, than in other ethnic groups. These differences should be pursued for relationships to coronary events to determine whether coronary calcium carries the same risk information in other ethnic groups as it does in Whites.     

Racial and ethnic differences in asthma and mental health among US adults: results from the national survey on drug use and health

Objective: Evaluate the racial and ethnic differences in asthma and mental health comorbidity. Methods: A secondary analysis of 2008–2013 National Survey on Drug Use and Health was conducted, resulting in a total of 206?993 civilian adult respondents to evaluate the association between asthma and mental health (past year serious psychological distress [SPD] and doctor diagnosis of depression). Both survey weighted bivariate (chi-square) and multivariable (binary logistic) regression analyses, after accounting for control variables, were conducted to evaluate the asthma/mental health nexus. A p value of less than 0.05 was used to denote significance. Results: Current asthma was significantly associated with past year SPD for non-Hispanic Whites (adjusted odds ratio [aOR] = 1.45), Hispanics (aOR?=?1.68), and Black/African Americans (aOR?=?1.47). A similar association was noted for current asthma and past year doctor diagnosis of depression (non-Hispanic White aOR?=?1.74; Hispanics aOR?=?1.77; Black/African American aOR?=?1.62). Among those with lifetime asthma, higher odds of SPD were reported for non-Hispanic Whites (aOR?=?1.42), Hispanics (aOR?=?1.64), and Black/African Americans (aOR?=?1.50). Lifetime asthma also significantly associated with past year doctor diagnosis of depression for non-Hispanic Whites (aOR?=?1.42), Hispanics (aOR?=?1.41), and Black/African Americans (aOR?=?1.46). Conclusion: Our results demonstrate the significant burden of asthma and mental health comorbidity among diverse racial and ethnic groups. Improved public health efforts through promotion of integrated care for early screening and preventive measures are needed to alleviate the burden for at-risk groups.     

Does nocturnal blood pressure fall in people of African and South Asian descent differ from that in European white populations? A systematic review and meta-analysis

OBJECTIVE: To assess whether nocturnal blood pressure fall in people of African (Black) and South Asian descent differs from that of the European origin white populations (White). METHODS: A systematic literature review was carried out using Medline 1966-2003 and Embase 1980-2003, and citations from references. The meta-analysis was performed using Cochrane review manager software (RevMan version 4.2; The Cochrane Collaboration, Oxford, UK). RESULTS: Seventeen studies were identified; 11 studies from the USA, one from the USA and Canada, and six studies from the United Kingdom. The mean percentage systolic blood pressure (SBP) nocturnal fall was below 10% (non-dipping) in 10 of 17 studies (59%) and the diastolic blood pressure (DBP) nocturnal fall was below 10% in four of 16 studies (25%) in Blacks compared with four of 17 studies (24%) in SBP and none in DBP nocturnal falls in Whites. Compared with Whites, Blacks had a significantly lower mean percentage nocturnal fall; the overall weighted mean difference in SBP was -3.07 (95% confidence interval, -3.81, -2.33; P < 0.00001) and in DBP was -2.98 (95% confidence interval, -3.97, -2.00; P < 0.00001). Two studies on South Asians showed a higher SBP but a similar mean DBP nocturnal fall compared with Whites. CONCLUSION: Smaller nocturnal blood pressure falls and a higher prevalence of non-dipping may contribute to the higher levels of hypertension complications seen in Black people. No such phenomenon was seen in South Asians but more research is needed to explore their higher stroke mortality.     

Race, gender, and health care service utilization and costs among Medicare elderly with psychiatric diagnoses

OBJECTIVE. To investigate race and gender differences in health care service utilization and costs among the Medicare elderly with psychiatric diagnoses. METHODS. The authors employ a 5% sample of Medicare beneficiaries from Tennessee (N = 33,680), and among those with a psychiatric diagnosis (n = 5,339), they examine health care service utilization and costs by race and gender. RESULTS. African Americans had significantly higher rates of diagnosis for dementia, organic psychosis, and schizophrenia, whereas Whites had significantly higher rates for mood and anxiety disorders. White and African American men have higher rates of utilization of emergency and inpatient services and lower rates of outpatient utilization compared to White women and African American women. African American men have significantly higher health care costs. DISCUSSION. The findings suggest that race and gender interact to influence service utilization and preventive care, thereby driving up costs of care, for elderly persons with psychiatric diagnoses.     

National estimates of the burden of inflammatory bowel disease among racial and ethnic groups in the United States

BackgroundThe epidemiology of inflammatory bowel disease (IBD) is poorly characterized in minorities in the U.S. We sought to enumerate the burden of IBD among racial and ethnic groups using national-level data.MethodsData from the National Health Interview Survey was used to calculate prevalence and incidence of IBD among adults (≥ 18 years) in 1999. The Nationwide Inpatient Sample was queried to ascertain rates of IBD-related hospitalizations and the Underlying Cause of Death Database was accessed to quantify IBD-related mortality.ResultsAn estimated 1,810,773 adult Americans were affected by IBD yielding a prevalence of 908/100,000, which was higher in Non-Hispanic Whites (1099/100,000) compared with Non-Hispanic Blacks (324/100,000), Hispanics (383/100,000), and non-Hispanic Other (314/100,000). Relative to Non-Hispanic Whites, the odds ratios for having a diagnosis of IBD associated with being Non-Hispanic Black, Hispanic, and Other Non-Hispanic race after adjusting for age, sex, and geographic region were 0.33 (95% CI: 0.19 – 0.57), 0.45 (95% CI: 0.26 – 0.77), and 0.34 (95% CI: 0.12 – 0.93), respectively. IBD incidence was similarly lower in Non-Hispanic Blacks (24.9/100,000) and Hispanics (9.9/100,000) compared to Non-Hispanic Whites (70.2/100,000). The ratio of IBD hospitalizations to prevalence was disproportionately higher among Non-Hispanic Blacks (7.3%) compared with Non-Hispanic Whites (3.0%) and Hispanics (2.7%). Similarly, the ratio of IBD-related mortality was greater in Non-Hispanic Blacks (0.061%) compared to Non-Hispanic Whites (0.036%) and Hispanics (0.026%).ConclusionsIBD disease burden is lower in ethnic minorities compared to Non-Hispanic Whites. However, IBD-related hospitalizations and deaths seem disproportionately high in Non-Hispanic Blacks.     

Racial Differences in Long‐Term Outcomes after Percutaneous Coronary Intervention with Paclitaxel‐Eluting Coronary Stents

Objectives

To assess the influence of race on long‐term outcomes following percutaneous coronary intervention (PCI) with paclitaxel‐eluting stents (PES).

Background

Data on the influence of race on long‐term outcomes following PCI with drug‐eluting stents are limited because of severe underrepresentation of minority populations in randomized trials.

Methods

We compared 5‐year outcomes of 2,301 Whites, 127 Blacks, and 169 Asians treated with PES in the TAXUS IV, V, and ATLAS trials. Outcomes were adjusted using a propensity score logistic regression model with 1:4 matching.

Results

Blacks were more likely than Whites to be female, have a history of hypertension, diabetes mellitus, congestive heart failure, and stroke, but were less likely to have prior coronary artery disease. Compared with Whites, Asians were younger, more likely to be male, have stable angina, and left anterior descending disease, and less likely to have silent ischemia, previous coronary artery bypass surgery, prior coronary artery disease, diabetes mellitus, peripheral vascular disease, and to receive glycoprotein IIb/IIIa inhibitors. Despite higher antiplatelet compliance, the adjusted 5‐year rates of myocardial infarction (15.4% vs. 5.4%, P < 0.001) and stent thrombosis (5.6% vs. 1.1%, P = 0.002) were higher in Blacks than Whites. Despite lower antiplatelet compliance, Asians had no differences in myocardial infarction and stent thrombosis compared with Whites. Mortality and revascularization rates were similar between the three groups.

Conclusions

The long‐term risk of major thrombotic events after PCI with PES was higher in Blacks, but not Asians, compared with Whites. The mechanisms underlying these racial differences warrant further investigation. (J Interven Cardiol 2013;26:49–57)

     

Gender and Racial/Ethnic Disparities in the Impact of HIV Prevention Programming in Substance Abuse Treatment

Objective: The objective of the study was to evaluate the capacity of HIV prevention programs offered in substance abuse treatment to reduce HIV-related risk behavior for women and men and for Black, Latino, and White groups. Methods: Prospective data was collected at intake, discharage, and 12 months post-treatment from 1992 to 1997 for the National Treatment Improvement Evaluation Study with a sample consisting of 3,142 clients from 59 service delivery units: 972 females, 1,870 males, 1,812 Blacks, 486 Latinos, and 844 Whites. Results: Study findings show that receipt of HIV prevention programming as part of substance abuse treatment services resulted in reductions in HIV-related risk behavior for the sample overall and for women as well as men. However, although Blacks received more prevention services than Latinos and Whites, the significant positive effect of HIV services on reduced HIVrisk behavior held only for Whites. Conclusions: Racial/ethnic disparities exist in the capacity for HIV prevention programming offered as part of substance abuse treatment to reduce HIV-risk behavior. The findings highlight the need for the development of culturally competent service delivery strategies to enhance the impact of these services for all groups.