Black Hispanic Women Research Articles

Racial/ethnic and neighborhood disparities in metals exposure during pregnancy in the Northeastern United States

Despite the unequal burden of environmental exposures borne by racially minoritized communities, these groups are often underrepresented in public health research. Here, we examined racial/ethnic disparities in exposure to metals among a multi-ethnic sample of pregnant women. The sample included women enrolled in the PRogramming of Intergenerational Stress Mechanisms (PRISM) pregnancy cohort (N = 382). Urinary metal concentrations (arsenic [As], barium [Ba], cadmium [Cd], cesium [Cs], chromium [Cr], lead [Pb], antimony [Sb]) were measured during mid-pregnancy and information on individual- and neighborhood-level characteristics was ascertained during an in-person interview and from publicly available databases, respectively. Linear regression was used to examine individual and neighborhood characteristics in relation to metal concentrations.Black/Black-Hispanic women had Cd, Cr, Pb, and Sb levels that were 142.0%, 10.9%, 35.0%, and 32.1% higher than White, non-Hispanic women, respectively. Likewise, White-Hispanic women had corresponding levels that were 141.5%, 108.2%, 59.9%, and 38.3% higher. These same metals were also higher among women residing in areas with higher crime, higher diversity, lower educational attainment, lower household income, and higher poverty. Significant disparities in exposure to metals exist and may be driven by neighborhood-level factors. Exposure to metals for pregnant women can be especially harmful. Understanding exposure inequalities and identifying factors that increase risk can help inform targeted public health interventions.

921 How do birth outcomes in black hispanic women compare to other racial/ethnic groups?

There are stark racial disparities in reproductive health in the United States (US). Non-Hispanic Black women disproportionately experience adverse birth outcomes, while Hispanic women have healthier outcomes. There is limited knowledge about outcomes for Black Hispanic women. We compared birth outcomes for Black Hispanic women to those of other racial/ethnic groups. We conducted a retrospective analysis of a prospective cohort study of gravidae delivering singleton, non-anomalous infants from 2011–2020. Data were collected from an institutional perinatal database comprised of two hospitals in a large US urban center. Based on self-identified race and ethnicity, women were grouped as Black Hispanic, non-Hispanic Black (“Black”), White Hispanic, or non-Hispanic White (“White”). We performed univariable analyses and multivariable logistic regression modeling. The adverse birth outcomes of interest were preterm birth (PTB), hypertensive disease of pregnancy, small for gestational age (SGA), and large for gestational age (LGA). There were 35,505 women in our cohort, including only 300 (0.84%) Black Hispanic women. In univariable analyses, Black Hispanic women generally had fewer adverse outcomes than Black women, but more than White or White Hispanic women (Table 1). In multivariable logistic regression models, White Hispanic and Black women had increased odds for adverse birth outcomes (except for LGA), as compared to White women (Table 2). Results from regression models were not significant for altered risk among Black Hispanic women. Our cohort had lower than expected numbers of Black Hispanic women, and was underpowered to detect differences in birth outcomes in this group. Other results were consistent with prior findings, with Black women at highest risk for adverse birth outcomes, with the exception of LGA where White women were at highest risk. Further studies are needed to better understand birth outcomes in Black Hispanic women, and to combat marked disparities in US birth outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Disparities at the Intersection of Race and Ethnicity: Examining Trends and Outcomes in Hispanic Women With Breast Cancer.

We sought to examine tumor subtype, stage at diagnosis, time to surgery (TTS), and overall survival (OS) among Hispanic patients of different races and among Hispanic and non-Hispanic (NH) women of the same race. Women 18 years of age or older who had been diagnosed with stage 0-IV breast cancer and who had undergone lumpectomy or mastectomy were identified in the National Cancer Database (2004-2014). Tumor subtype and stage at diagnosis were compared by race/ethnicity. Multivariable linear regression and Cox proportional hazards modeling were used to estimate associations between race/ethnicity and adjusted TTS and OS, respectively. A total of 44,374 Hispanic (American Indian [AI]: 79 [0.2%]; Black: 1,011 [2.3%]; White: 41,126 [92.7%]; Other: 2,158 [4.9%]) and 858,634 NH women (AI: 2,319 [0.3%]; Black: 97,206 [11.3%]; White: 727,270 [84.7%]; Other: 31,839 [3.7%]) were included. Hispanic Black women had lower rates of triple-negative disease (16.2%) than did NH Black women (23.5%) but higher rates than did Hispanic White women (13.9%; P < .001). Hispanic White women had higher rates of node-positive disease (23.2%) versus NH White women (14.4%) but slightly lower rates than Hispanic (24.6%) and NH Black women (24.5%; P < .001). Hispanic White women had longer TTS versus NH White women regardless of treatment sequence (adjusted means: adjuvant chemotherapy, 42.71 v 38.60 days; neoadjuvant chemotherapy, 208.55 v 201.14 days; both P < .001), but there were no significant racial differences in TTS among Hispanic patients. After adjustment, Hispanic White women (hazard ratio, 0.77 [95% CI, 0.74 to 0.81]) and Black women (hazard ratio, 0.75 [95% CI, 0.58 to 0.96]) had improved OS versus NH White women (reference) and Black women (hazard ratio, 1.15 [95% CI, 1.12 to 1.18]; all P < .05). Hispanic women had improved OS versus NH women, but racial differences in tumor subtype and nodal stage among Hispanic women highlight the importance of disaggregating racial/ethnic data in breast cancer research.

Quality-Adjusted Life-Years Lost Due to Physical Inactivity in a US Population With Osteoarthritis.

One-half of the 14 million persons in the US with knee osteoarthritis (OA) are not physically active, despite evidence that physical activity (PA) is associated with improved health. We undertook this study to estimate both the quality-adjusted life-year (QALY) losses in a US population with knee OA due to physical inactivity and the health benefits associated with higher PA levels. We used data from the Osteoarthritis Initiative and the Centers for Disease Control and Prevention to estimate the proportions of a US population with knee OA ages ≥45 years that are inactive, insufficiently active, and active, and the likelihood of a shift in their PA level. We used the OA Policy Model, a computer simulation of knee OA, to determine QALYs lost due to inactivity and to measure potential benefits of increased PA (comorbidities averted and QALYs saved). Among 13.7 million persons with knee OA, a total of 7.5 million QALYs, or 0.55 QALYs per person, were lost due to inactivity or insufficient PA relative to activity over their remaining lifetimes. Black Hispanic women experienced the highest losses, at 0.76 QALYs per person. Women of all races/ethnicities had ~20% higher loss burdens than men. According to our model, if 20% of the inactive population were instead active, 95,920 cases of cancer, 222,413 of cardiovascular disease, and 214,725 of diabetes mellitus would potentially be averted, and 871,541 potential QALYs would be saved. Physical inactivity leads to substantial QALY losses in a US population with knee OA. Increases in the activity levels in even a fraction of this population may have considerable collateral health benefits, potentially averting cases of cancer, cardiovascular disease, and diabetes mellitus.

Abstract C091: Racial/ethnic disparities in awareness and attitudes towards the HPV vaccine among women living in the United States and Puerto Rico

Abstract Introduction In the United States (US), Human papilomavirus (HPV) is the most common sexually transmitted infection and an infectious agent related to cancer. The HPV vaccine is the most effective preventive method against cervical cancer. Studies have shown racial/ethnic disparities in knowledge and attitudes towards HPV and its vaccine. Few national studies have explored these disparities including Puerto Rican women, a group which higher rates of cervical cancer have been documented. In this study, we examined differences in awareness and attitudes toward the HPV vaccine among a sample of women 18 years of age and older from Puerto Rico (PR) and the US. Methods: We conducted a secondary analysis using data from the Health Information National Trends Survey (HINTS); conducted nationwide in 2007 (n = 4,145 HINTS U.S.) and in PR in 2009 (n = 417; PR). Multivariate logistic regression analysis assessed the association between racial/ethnic group (non-Hispanic White, non- Hispanic Black, Hispanics and PR women and HPV vaccine awareness and attitudes, whilst adjusting for age, education, marital status and health insurance. All analyses were performed using the statistical software SPSS version 23.0. Results: A total of 4,562 women participated in this survey: 72.4% non-Hispanic White, 10.2% non-Hispanic Black, 9.1% Puerto Rican women and 8.3 Hispanics. Hispanics and Puerto Rican women had a higher attitude towards the HPV vaccine (55.9% and 74.8%), respectively. Multivariate logistic regression models shown that, Hispanics women were 68% less likely to have heard that the vaccine prevents cervical cancer, compared to non-Hispanic White women (OR=0.32; 95% IC = 0.25 - 0.42, p&amp;lt;0.001). PR women are 2.4 times more likely of having a positive attitude towards the HPV vaccine compared to non- Hispanic White women in the US (OR=2.41; 95%IC=1.89 - 3.06, p&amp;lt;0.001). Non- Hispanic Black women were 25% less likely to have a positive attitude toward the vaccine when compared to non- Hispanic White women (OR=0.75; 95% IC = 0.61 - 0.93, p&amp;lt;0.001). Conclusion: The women living in PR showed a greater disposition toward the HPV vaccine. Non-Hispanic Black women in the US were least likely to be aware and have positive attitude towards the HPV vaccine. The disparities observed in the different races/ethnicities analyzed in this study, suggest racial and ethnic differences, which deserve further investigation so that health providers can better target educational across different racial/ethnic groups aiming to increase awareness and knowledge about HPV and its vaccination. Citation Format: Nelybeth Santiago Yance, Rafael E Rios McConnell, Mildred Vera Rios, Vivian Colón López. Racial/ethnic disparities in awareness and attitudes towards the HPV vaccine among women living in the United States and Puerto Rico [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C091.

Racial Disparities in Functional Limitations Among Hispanic Women in the United States.

This article assesses whether there are race differences in functional health among Hispanic women in the United States; ascertains whether the race differences in functional health vary by age; and examines the extent to which race differences in functional health are attributable to key dimensions of demographic, geographic, and socioeconomic heterogeneity. The analysis is based on 15 years of aggregated data from the National Health Interview Survey. Both U.S.- and foreign-born Black and other race Hispanic women display a higher level of functional limitations than their White Hispanic counterparts. There is little evidence that such health differences widen with age. U.S.-born Black Hispanic women, however, suffer from a high burden of functional limitations across the adult age range. This research speaks to the need for greater attention to racial differences in health among Hispanics and particularly so within the U.S.-born segment of this rapidly aging population.

Abstract B66: Breast cancer outcomes among Hispanic women by race

Abstract Introduction: Few studies have examined the distribution of breast cancer outcomes among Hispanics by race (i.e. Hispanic Black, Hispanic White). Understanding the diversity of breast cancer characteristics among Hispanic women is key to explaining the differences in breast cancer outcomes. Purpose: To assess the distribution of tumor stage, joint estrogen receptor (ER)/progesterone receptor (PR) status, and breast cancer-specific mortality with race and ethnicity, among Hispanic Black, Hispanic White, non-Hispanic Black (NHB), non-Hispanic White (NHW) women using Surveillance, Epidemiology, and End Results (SEER) Program data. Methods: We used data on 441,742 women aged 20–79 years who were diagnosed with primary invasive breast cancer between January 1992 and December 2008, with no prior history of cancer, and who were identified through the SEER 17 population-based registries. Women less than 20 and older than 79 years of age were excluded from the study. The primary outcomes of interest were: AJCC tumor stage, joint estrogen receptor (ER)/progesterone receptor (PR) status, and breast cancer-specific mortality. Our primary exposure of interest was race/ethnicity, which was categorized into four groups, based on SEER data: non-Hispanic White, non-Hispanic Black, Hispanic White, and Hispanic Black. Covariates included age at diagnosis, year of diagnosis, % population below poverty level, % population with less than a high school education, % foreign born, % non-English language, SEER registry, and treatment (surgery and/or radiation therapy). Results: Hispanic Blacks had the highest risk of being diagnosed with stage III and IV tumors compared to NHWs (RRR=2.4 [95% CI:1.9-3.1] and RRR=2.0 [95% CI:1.4-2.8], respectively; p&amp;lt;0.01). Both NHBs and Hispanic Blacks had 2.4-fold greater risk of being diagnosed with ER–/PR– breast cancer compared to NHW women (RRR=2.4 [95% CI:2.3-2.5] and RRR=2.4 [95% CI:2.0-2.9], respectively; p&amp;lt;0.01). Hispanic White women had a significantly increased risk of being diagnosed with both ER–/PR– (64% increase) and ER+/PR– (24% increase) breast cancers compared to NHW women (RRR=1.6 [95% CI:1.6-1.7] and RRR=1.2 [95% CI:1.2-1.3], respectively; p&amp;lt;0.01). Hispanic White and Hispanic Black women were at increased risk of breast cancer-specific mortality compared to NHW women (HR=1.2 [95% CI:1.2-1.3] and HR=1.5 [95%:1.2-1.80, respectively, p&amp;lt;0.01). Conclusion: Hispanic Black women have disproportionately higher rates of late stage invasive breast cancer diagnoses, ER–/PR– breast disease, and breast cancer-specific mortality compared to non-Hispanic White women. Furthermore, RRR estimates suggest that the increased risk associated with late stage and ER–/PR– may be greater than or equal to those estimates observed for non-Hispanic Black and Hispanic White women. The findings from this study will be among the first studies to present information on breast cancer characteristics and outcomes in both Hispanic Black and Hispanic White. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B66.

Racial differences in fasting lipids: low levels of triglycerides in overweight and obese non Hispanic black women

We screened 278 women with BMI ≥25 kg/m2 for entry into a study of women with metabolic syndrome (MetS) on no lipid lowering medications or supplements with entrance criteria as follows: BMI 25–45 kg/m2, age 25–75 years, LDL ≥100 mg/dL, triglyceride (TG) ≥150 mg/dL and at least 2 other MetS criteria. Fasting blood was analyzed. Distinct racial differences emerged between non Hispanic blacks (Bs) and non Hispanic whites (Ws) with respect to TG, precluding study inclusion of the large majority of Bs. In analyzing the cohort of Bs (N=116) and Ws (N=135), Bs had lower TG (81±3.3 mg/dL vs 139±5.9 mg/dL; P&lt;0.0001), total cholesterol (TC; 176±3.6 mg/dL vs 200±3.1 mg/dL; P&lt;0.0001), LDL (114±3.6 mg/dL vs 128±2.8; P&lt;0.005), and higher BMI (37±0.5 vs 35±0.5 kg/m2; P&lt;0.005) and diastolic blood pressure (BP; 82±0.8 vs 80±0.8; P&lt;0.05). HDL trended higher in Bs than Ws (48±1.4 vs 45±1.2; P=0.07). No differences were found in systolic BP, waist circumference or glucose. Only 6.9% of Bs vs 36.3% of Ws had TG ≥150 mg/dL (P&lt;0.0001). There were similar findings in those with waist circumferences &gt;88 cm (N=214), however, HDL was higher in Bs (48±1.5 vs 44±1.3 mg/dL; P&lt;0.05). Black women matched according to BMI or waist circumference have substantially lower TG than Ws; additionally, TC and LDL are lower, and HDL and diastolic BP are higher in Bs than Ws, suggesting that TG criteria for MetS should be reconsidered for Bs. Supported by MetaProteomics, LLC.

Riskier than we thought: revised estimates of noncontracepting women risking unintended pregnancy.

Risk-taking is defined as non-use of contraception among sexually active women who do not desire pregnancy. The published National Survey of Family Growth (NSFG) definition of risk of unintended pregnancy includes sterilized women and women relying on partner sterilization in the statistic. However, this inclusion skews percentages of risk-taking women to appear smaller than is realistic since sterilized women face minimal risk of pregnancy. The objective of this study was to obtain realistic estimates, of risk-taking behavior to identify groups at special need for improved services. In calculating risk-taking statistics, sterilized women and women relying on partner sterilization are removed from both the numerator and denominator. The numerator includes all non-contracepting women who believe that they are fecund. The authors calculated the proportion of risk-taking women for various age, ethnic, and marital status groups. Overall, 14.0% of sexually active, fecund women are risk-taking. Except for teenagers, who do not use sterilization, the proportions of risk takers are higher than the NSFG estimates of proportion of women at risk of unintended pregnancy in all groups. Differences in risk estimates ranged from 0.4% to 10.7%, with the greatest differences seen among formerly married and Hispanic black women. These results indicate that published NSFG percentages of adult women at risk of unintended pregnancy underestimate risk-taking behavior for groups previously thought to be at lower risk of unintended pregnancy.

Walking trends among U.S. adults: The Behavioral Risk Factor Surveillance System, 1987–2000

Objective To examine trends in walking among adults in 31 states. Methods Trends by sociodemographic strata were analyzed from respondents who participated in the Behavioral Risk Factor Surveillance System (BRFSS). Results The prevalence of walking among men increased 3.8% (95% confidence interval [CI]=2.4–5.2), from 26.2% (95% CI=25.1–25.3) in 1987 to 30.1% (95% CI=29.4–30.8) in 2000. In women, walking increased 6.6% (95% CI=5.4–7.8), from 40.4% (95% CI=–39.4–41.1) to 46.9% (95% CI=46.2–47.6) during the same time period. However, the prevalence of walking three times a week for 30 minutes duration remained constant across all years. The largest increases occurred in minority subpopulations: 8.7% (95% CI=3.2–14.2) in Hispanic women, 8.5% (95% CI=4.4–12.6) non–Hispanic black women, and 7.0% (95% CI=2.3–11.7) in non–Hispanic black men. Walking was the most frequently reported activity among adults who met the national recommendations for regular physical activity (defined as five or more times a week for ≥30 minutes per session). Conclusions Given the acceptability of walking across all sociodemographic subgroups, efforts to increase the frequency of walking could markedly increase the percentage of U.S. adults who engage in regular physical activity, a national priority identified in the Healthy People 2010 objectives for the nation.

Cancer in South Florida Hispanic Women

Cancer incidence varies among race and ethnic subgroups. Relatively little information exists on cancer among Hispanics, and none of it it stratified by race. To explore and compare cancer incidence rates of each site of cancer among white Hispanic, white non-Hispanic, black Hispanic, and black non-Hispanic women in Dade County, South Florida, we accessed 9 years of cancer incidence data. Dade County's Hispanic population is the second largest of any US county. For each site, incidence rates, rate ratios, and 95% confidence intervals are presented. Among white Hispanics, there were statistically significant lower rates of cancers of the oral cavity, esophagus, colon, pancreas, lung, breast, ovary, bladder, kidney, melanoma, Kaposi's sarcoma, and non-Hodgkin's lymphoma than among white non-Hispanics. Black Hispanics had significantly lower rates of cancers of the oral cavity, stomach, rectum, lung, cervix, and bladder than black non-Hispanics. However, white Hispanic women had significantly higher rates of cancers of the liver, gallbladder, and uterine cervix than white non-Hispanic women. No in situ breast cancer cases among blacks of either ethnic subgroup was found. Both white Hispanic and black Hispanic women generally had lower rates of cancer than their race-specific non-Hispanic counterparts. However, incidence rates among Hispanics differ substantially by race; failure to distinguish them may lead to erroneous conclusions.

Cancer in south Florida Hispanic women. A 9-year assessment

<h3>Background:</h3> Cancer incidence varies among race and ethnic subgroups. Relatively little information exists on cancer among Hispanics, and none of it is stratified by race. <h3>Methods:</h3> To explore and compare cancer incidence rates of each site of cancer among white Hispanic, white non-Hispanic, black Hispanic, and black non-Hispanic women in Dade County, South Florida, we accessed 9 years of cancer incidence data. Dade County's Hispanic population is the second largest of any US county. For each site, incidence rates, rate ratios, and 95% confidence intervals are presented. <h3>Results:</h3> Among white Hispanics, there were statistically significant lower rates of cancers of the oral cavity, esophagus, colon, pancreas, lung, breast, ovary, bladder, kidney, melanoma, Kaposi's sarcoma, and non— Hodgkin's lymphoma than among white non-Hispanics. Black Hispanics had significantly lower rates of cancers of the oral cavity, stomach, rectum, lung, cervix, and bladder than black non-Hispanics. However, white Hispanic women had significantly higher rates of cancers of the liver, gallbladder, and uterine cervix than white non-Hispanic women. No in situ breast cancer cases among blacks of either ethnic subgroup was found. <h3>Conclusion:</h3> Both white Hispanic and black Hispanic women generally had lower rates of cancer than their race-specific non-Hispanic counterparts. However, incidence rates among Hispanics differ substantially by race; failure to distinguish them may lead to erroneous conclusions. (Arch Intern Med. 1994;154:1083-1088)