Culture,Ethnicity, and Level of Education in Alzheimer’s Disease

Alzheimer’s disease (AD) is the most frequent cause of dementia, where the abnormal accumulation of beta-amyloid (Aβ) and tau lead to neurodegeneration as well as loss of cognitive, behavioral, and functional abilities. The present review analyzes AD from a cross-cultural neuropsychological perspective, looking at differences in culture-associated variables, neuropsychological test performance and biomarkers across ethnic and racial groups. Studies have found significant effects of culture, preferred language, country of origin, race, and ethnicity on cognitive test performance, although the definition of those grouping terms varies across studies. Together, with the substantial underrepresentation of minority groups in research, the inconsistent classification might conduce to an inaccuratte diagnosis that often results from biases in testing procedures that favor the group to which test developers belong. These biases persist even after adjusting for variables related to disadvantageous societal conditions, such as low level of education, unfavorable socioeconomic status, health care access, or psychological stressors. All too frequently, educational level is confounded with culture. Minorities often have lower educational attainment and lower quality of education, causing differences in test results that are then attributed to culture. Higher levels of education are also associated with increased cognitive reserve, a protective factor against cognitive decline in the presence of neurodegeneration. Biomarker research suggests there might be significant differences in specific biomarker profiles for each ethnicity/race in need of accurate cultural definitions to adequately predict risk and disease progression across ethnic/racial groups. Overall, this review highlights the need for diversity in all domains of AD research that lack inclusion and the collection of relevant information from these groups.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-022-01193-z.     

Racial aspects of comorbidity in systemic lupus erythematosus

Objective. To investigate racial differences in the expression of systemic lupus erythematosus (SLE) by comparing comorbidity at death among individuals with SLE. Methods. Proportional mortality rates were estimated for common contributing causes of death among white and black females in the United States, 1989–1991, whose death certificates listed SLE as an underlying or contributing cause. Logistic regression analysis was used to assess the effects of SLE and race on variation in proportional mortality using rates from non SLE deaths as a comparison baseline. Results. Common contributing causes of death listed with SLE included conditions that are known sequelae of the disease. Proportional mortality rates for these conditions varied with race and age. However, among black deaths that listed SLE, the rates of renal disease surpassed those of all other conditions regardless of age. When rates of renal disease among black SLE deaths or among white SLE deaths in any age group were compared to those among white non-SLE deaths, proportional mortality ratios were significantly greater than 1. This also held when rates of renal disease among black non-SLE deaths were compared to rates among white non-SLE deaths. However, across all ages, the proportional mortality ratios for renal disease in black SLE deaths significantly exceeded corresponding ratios for white SLE deaths and for black non-SLE deaths. Conclusion. Black females who die with SLE appear to experience a combination of the excess renal disease reported for persons with SLE and for all blacks. This combination may be a source of the elevated SLE mortality rates observed among US blacks.     

Intergenerational transmission of socio-economic status: The role of neighborhood effects

IntroductionLittle attention has been paid to the role of neighborhoods as a predictor of intergenerational transmission of socio-economic status. This study uses a nationally representative, longitudinal sample from the United States to examine how neighborhoods impact racial/ethnic disparities in the intergenerational transmission of socio-economic status.MethodsThe study sample is derived from Waves 1 and 4 of the National Longitudinal Study of Adolescent to Adult Health. The sample size comprises 13,738 participants (aged 15 at Wave 1; 51% female). Multilevel regression is used to predict racial/ethnic disparities in intergenerational transmission of socio-economic status. Six neighborhood-level indicators are regressed on the indicators of intergenerational transmission of education, income and occupational prestige, while controlling for a range of individual socio-demographic variables.ResultsResults reveal that: (1) African-American and Hispanic children are less likely to surpass their parents’ levels of education, income and occupational prestige than Asian-Pacific Islander and non-Hispanic white children; (2) these racial/ethnic differences in intergenerational transmission of socio-economic status are attenuated but not fully explained by neighborhood-level indicators; (3) all but one of the neighborhood-level factors examined were significant in predicting the pace of intergenerational transmission of socio-economic status.ConclusionsThe implication of these results is that policies aimed at reducing inequalities between residential neighborhoods are likely to beneficially affect all racial/ethnic groups but are not sufficient in reducing racial/ethnic disparities in intergenerational transmission of socio-economic status.     

Disparities in Stage at Diagnosis in an Equal-access Integrated Delivery System: A Retrospective Cohort Study of 7244 Patients With Bladder Cancer

BackgroundDisparities in bladder cancer survival by race/ethnicity and gender are likely related to differences in diagnosis. We assessed disparities in stage at diagnosis and potential contributing factors within a large, integrated delivery system.Patients and MethodsWe conducted a retrospective cohort study of 7244 patients with bladder cancer age ≥ 21 years diagnosed from January 2001 to June 2015 within Kaiser Permanente Southern California. Bivariate analyses compared stage at diagnosis – as well as comorbidities, health plan membership length, and health care utilization prior to diagnosis – by race/ethnicity, gender, and age. Multivariable generalized linear mixed models with urologist as a random effect were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for diagnosis of muscle-invasive bladder cancer (MIBC) versus non–muscle-invasive bladder cancer.ResultsIn multivariable analyses, stage at diagnosis varied significantly by race/ethnicity (P < .001). Non-Hispanic black patients had significantly higher odds of being diagnosed with MIBC than non-Hispanic white patients (OR, 1.33; 95% CI, 1.05-1.67), whereas Asian patients had significantly lower odds (OR, 0.67; 95% CI, 0.49-0.91). Women were significantly more likely to be diagnosed with MIBC than men (OR, 1.40; 95% CI, 1.22-1.61). Non-Hispanic black women had the highest proportion (39%) of MIBC diagnoses. Among Hispanic and Asian patients, a greater proportion of diagnoses occurred at younger ages.ConclusionsHealth care coverage within an equal-access system did not eliminate disparities in stage at diagnosis by race/ethnicity or gender. Studies are needed to identify etiologic factors and aspects of care delivery (eg, patient-physician interactions) that may affect the diagnostic process to inform efforts to improve health equity.     

Outcomes for Young Men With Localized Intermediate-Risk Prostate Cancer: An Analysis of the NCDB

BackgroundPrimary management of localized, intermediate-risk prostate cancer consists of radical prostatectomy (RP), radiotherapy (RT) with short-course androgen deprivation therapy (ADT), or RT alone. The purpose of this study was to determine if these treatment strategies have equivalent overall survival (OS) in patients < 55 years old with intermediate-risk prostate cancer.Patients and MethodsWe identified 35,134 patients in the National Cancer Data Base with localized intermediate-risk prostate cancer treated with RP, RT + ADT, or RT from 2004 to 2013. Ten-year OS rates were estimated by the Kaplan-Meier method. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed by multivariate Cox regression.ResultsA total of 29,920 patients (85.2%) underwent RP, 1393 (4.0%) RT + ADT, and 3821 (10.9%) RT. Median patient age was 51 years old, and median follow-up was 59.9 months. Ten-year OS was estimated to be 94.2% for RP, 80.7% for RT + ADT, and 85.2% for RT (P < .0001). On multivariate analysis, treatment with RT + ADT or RT was associated with significantly worse OS compared to treatment with RP (RT + ADT HR = 2.06, 95% CI 1.67-2.54, P < .0001; RT HR = 2.0, 95% CI 1.71-2.33, P < .0001). Patients who met all 3 of the intermediate-risk criteria showed worse OS compared to patients who met only one criterion (HR = 1.80; 95% CI, 1.32-2.44; P = .0002).ConclusionRP is significantly more likely than RT + ADT or RT to be used as a primary treatment for young men with localized intermediate prostate cancer. RP was also associated with improved OS compared to RT + ADT and RT.     

Validity of electrocardiographic classification of left ventricular hypertrophy across adult ethnic groups with echocardiography as a standard

Aims

To assess the validity of the electrocardiogram (ECG) as a diagnostic tool for left ventricular hypertrophy (LVH) for different ethnic groups with echocardiography as a standard.

Methods

Systematic review of the literature using the Cornell and Sokolow-Lyon voltage criteria for LVH.

Results

Five studies were identified. Pooled data from these studies demonstrated low sensitivity using both types of ECG criteria for white and African-origin groups, but with slightly higher sensitivity values for the African-origin group (Cornell, 31.2%; 95% confidence interval [CI], 28%-34.8%; Sokolow-Lyon, 32.9%; 95% CI, 29.5%-36.4%) compared with the white group (Cornell, 26.5%; 95% CI, 25.2%-27.8%; Sokolow-Lyon, 18.2%; 95% CI, 17.2%-19.3%). Specificity was high using both types of criteria in the white group (Cornell, 87.4%; 95% CI, 86.4%-88.4%; Sokolow-Lyon, 88.9%; 95% CI, 88%-90%) but was much lower in the African-origin group using the Sokolow-Lyon criteria (72.1%; 95% CI, 68.7%-75.3%). Specificity was high however for the African-origin group using the Cornell criteria (86.2%, 95% CI, 83.4%-88.5%).

Conclusions

Both types of criteria are more sensitive in African-origin populations. The Sokolow-Lyon criteria are less specific for LVH in people of African origin. The evidence favors the Cornell criteria in research and service contexts involving African-origin and white populations. Further research is needed to adapt ECG criteria to take into account ethnicity to a greater degree. The issue needs to be studied in a broader range of ethnic groups.     

Carotid intima–media thickness value distributions in The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Objective

Carotid intima–media thickness (IMT) is a noninvasive measurement of early atherosclerosis. Most IMT studies have involved populations with low rates of racial blending. The aim of the present article is to describe IMT value distributions and analyze the influence of sex and race on IMT values in a large Brazilian sample, a setting with a high rate of racial admixture.

Methods

The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort of 15,105 adult (aged 35–74 years) civil servants in six Brazilian cities. Baseline assessment included IMT measurements in both common carotid arteries. Race was self-reported. We studied the association between sex and race with IMT values using multiple linear regression models. We conducted analyses in all and low-risk individuals, defined as those without classical cardiovascular risk factors.

Results

We analyzed complete IMT data from 10,405 ELSA-Brasil participants. We present nomograms by age for all and low-risk individuals, stratified by sex and race. We found that men had significantly higher maximal IMT values compared with women (β = 0.058; P < 0.001). This association remained for low-risk individuals (β = 0.027; P = 0.001). In addition, Brown and White individuals had lower maximal IMT values compared with Black individuals for all (β = −0.034 and β = −0.054, respectively; P < 0.001) and low-risk individuals (β = −0.027; P = 0.013 and β = −0.035; P < 0.001, respectively).

Conclusion

We found significantly higher IMT values in men. We found significantly higher IMT values in Black individuals than White and Brown individuals. These results persisted when analyses were restricted to low-risk individuals.     

种属差异对实验性高脂血症的影响

目的观察动物种属差异对实验性高脂血症的影响.方法分别用老年小鼠、正常大鼠和正常家兔建立动物高脂血症模型,以动物血清胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)和高密度脂蛋白(HDL)为指标,研究不同动物种属建立的高脂模型中,上述指标变化是否存在差异.结果实验发现老年小鼠血清LDL和TC升高,HDL变化不明显,而TG则下降;大鼠血清TC和LDL显著升高,HDL明显下降,而TG未见显著升高;家兔血清TG、TC和LDL显著升高,而HDL也明显升高.结论动物种属差异对实验性高脂血症存在显著影响.     

人种间体质差异对拔罐疗法的影响

以人种间体质差异为基础,探讨该差异对中医疗法理论的影响,提出不同人种对拔罐的耐受性和适应性差异,以及拔罐疗法对不同人种予以运用过程中的差别处理原则,并举在英国行医期间所录黑色、白色和黄色人种医案各1例进行讨论,以期有益于中医关于人种间体质理论的研究和临床应用,促进中医走向世界。