Comorbidity Disparities Research Articles

Rising Incidence and Comorbidities of Endogenous Hypothyroidism in Republic of Korea from 2004 to 2018: A Nationwide Population Study.

Hypothyroidism, a prevalent endocrine disorder, results from insufficient thyroid hormone production or release, affecting metabolism. However, disparities in comorbidities and treatment trajectories may exist between endogenous and exogenous hypothyroidism. Data from the Korean National Health Insurance Service from 2004 to 2018. Endogenous hypothyroidism was defined as cases with two or more diagnostic codes for hypothyroidism coupled with a history of thyroid hormone intake exceeding 60 days. To eliminate iatrogenic hypothyroidism, individuals with diagnosis codes for thyroid cancer, treatment codes for thyroid surgery, or radiotherapy were excluded. Hypothyroidism-related comorbidities were defined as new occurrences of the corresponding diagnosis code after the diagnosis of hypothyroidism during the entire study period. The age-standardized incidence of endogenous hypothyroidism among men was 0.2 per 1,000 person-years in 2004, increasing to 0.8 in 2018. Among women, the incidence increased from 1.6 per 1,000 person-years in 2004 to 3.7 in 2018. When comparing age groups of 20s-50s and 60s-90s, both sexes in the 60s-90s demonstrated a more rapid increase in incidence than those in the 20s-50s age range. Patients with endogenous hypothyroidism demonstrated a higher incidence of mood disorders across all age groups and cerebrovascular disease in individuals ≥60 years old, regardless of sex. In Republic of Korea, endogenous hypothyroidism incidence has been increased in recent years. The incidence of endogenous hypothyroidism is increasing more rapidly in men than in women, especially in the elderly. Patients with endogenous hypothyroidism seem to have a heightened risk for cerebrovascular disease and mood disorders.

Racioethnic disparities in comorbidities and outcomes following head and neck oncologic surgery

AbstractObjectivesRacial disparities persist despite attempts to establish an egalitarian framework for surgical care. This study aimed to investigate racioethnic disparities in comorbidities and outcomes following surgery for head and neck tumors.MethodsThis retrospective study included adult patients who underwent head and neck oncologic surgery between 2008 and 2020 from the National Surgical Quality Improvement Program. Multivariable regression analyses were conducted to explore the association of the following racioethnic categories with postoperative outcomes: White, Black, Hispanic, and Asian.ResultsA total of 113,234 patients were included in the study, comprising 78.3% White, 8.7% Black, 6.9% Hispanic, and 6.0% Asian patients. Black patients had higher rates of pre‐existing comorbidities compared to White patients. Specifically, the rates of comorbidities such as diabetes mellitus (19.8% vs. 12.4%), hypertension (57.5% vs. 41.5%), smoking history (18.8% vs. 15.0%), dyspnea (7.4% vs. 5.7%), and preoperative anemia (43.6% vs. 36.5%) were higher among Black patients. On regression analyses, Black race was not associated with major morbidity following head and neck oncologic surgeries (odds ratio, 1.098, 95% confidence interval, 0.935–1.289) when compared to White patients. However, there were significant associations between the comorbidities associated with the Black race and an increased risk of major morbidity.ConclusionsBlack patients undergoing head and neck oncologic surgery face a significant challenge due to a higher burden of comorbidities. These comorbidities, in turn, have been found to be associated with postoperative major morbidity.

Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA)

BackgroundSexual and gender minority (SGM) older adults and their care partners, compared to the general population, face unique vulnerabilities that exacerbate living with dementia, including elevated disparities in comorbidities, social isolation, and structural inequities, such as discrimination and lack of access to supports. MethodsThis paper describes the virtual adaptation process of the first-ever randomized controlled clinical trial intervention, Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA), that was designed for SGM older adults living with dementia and their care partners and built upon the foundation of RDAD and NHAS. ResultsThe virtual adaptation of IDEA was guided by the goals of accessibility, quality, ease of delivery, sustainability, and cultural relevance. The implementation required the development of a HIPPA-compliant online virtual platform, coach and participant virtual training, and modification of necessary intervention elements and materials, as needed. Based on the preliminary findings, the participants and intervention coaches responded well to the virtual adaptation of IDEA. When comparing to in-person delivery, the virtual delivery decreased attrition among both intervention participants and coaches. DiscussionThe virtual adaptation of the IDEA intervention resulted in preliminary, unexpected, yet potentially important benefits, including the ability to expand the reach of the intervention and decreased attrition. Virtual interventions are an emerging field for people living with dementia and their care partners and additional systematic research is needed to fully assess the benefits and limitations as well as to evaluate if specific subgroups are better served by differing delivery modalities.

Racial disparities in comorbidities of patients with psoriatic arthritis.

There have been significant advances in the treatment of psoriatic arthritis (PsA). Despite these advances, racial and ethnic disparities in clinical outcomes may still exist in patients with PsA. We aimed to examine the racial differences in clinical characteristics, medication usage and comorbidities in PsA patients. This retrospective study was conducted using the IBM Explorys platform. Search criteria included ICD diagnosis code for PsA and at least two visits with a rheumatologist, between 1999 and 2019. We further stratified by adding the following variables to the search: race, sex, laboratory data, and clinical characteristics, medication use, and comorbidities. Data sets were recorded as proportions and compared using chi-squared tests (p < 0.05). We identified 28,360 patients with PsA. AAs had a higher prevalence of hypertension (59% vs 52%, p < 0.0001), diabetes (31% vs 23% p < 0.0001), obesity (47% vs 30%, p < 0.0001), and gout (12% vs 8%, p < 0.0001). Caucasian patients were more likely to have cancer (20% vs 16%, p = 0.002), anxiety (28% vs 23%, p < 0.0001), and osteoporosis (14% vs 12%, p = 0.001). NSAIDs were used in 80% of Caucasians and 78% of AAs (p < 0.009), TNFs in 51% of Caucasians and 41% of AAs, and DMARDs in 72% of Caucasians and 98% of AAs (p < 0.0001). Our findings from a large US real-world database revealed that certain comorbidities were more frequent in AA patients with PsA, which warrants increased risk stratification. There was increased biologic use in Caucasians with PsA compared to AA who were more commonly on DMARDs.

Racial disparities in the development of comorbid conditions after preterm birth: A narrative review

Despite recognition and attempts to reduce racial disparities in perinatal outcomes, Black infants are still disproportionately represented among those who are born preterm. Postnatal investigations of racial disparities in comorbidities and outcomes after preterm birth are increasing, although their results and interpretations are conflicting. In the present review, we 1.) identify important methodological limitations of that literature 2.) summarize the conflicting literature investigating racial disparities, specifically Black-white differences, in postnatal comorbidities and outcomes after preterm birth 3.) describe mechanisms by which racism operates to contextualize our understanding to inform future work to actively reduce disparities in preterm birth and subsequently, its complications.

Comorbidities and ethnic health disparities in the UK biobank.

The goal of this study was to investigate the relationship between comorbidities and ethnic health disparities in a diverse, cosmopolitan population. We used the UK Biobank (UKB), a large progressive cohort study of the UK population. Study participants self-identified with 1 of 5 ethnic groups and participant comorbidities were characterized using the 31 disease categories captured by the Elixhauser Comorbidity Index. Ethnic disparities in comorbidities were quantified as the extent to which disease prevalence within categories varies across ethnic groups and the extent to which pairs of comorbidities co-occur within ethnic groups. Disease-risk factor comorbidity pairs were identified where one comorbidity is known to be a risk factor for a co-occurring comorbidity. The Asian ethnic group shows the greatest average number of comorbidities, followed by the Black and then White groups. The Chinese group shows the lowest average number of comorbidities. Comorbidity prevalence varies significantly among the ethnic groups for almost all disease categories, with diabetes and hypertension showing the largest differences across groups. Diabetes and hypertension both show ethnic-specific comorbidities that may contribute to the observed disease prevalence disparities. These results underscore the extent to which comorbidities vary among ethnic groups and reveal group-specific disease comorbidities that may underlie ethnic health disparities. The study of comorbidity distributions across ethnic groups can be used to inform targeted group-specific interventions to reduce ethnic health disparities.

Disparities in Comorbidities in Lung Cancer: Findings From the Behavioral Risk Factor Surveillance System.

In persons with lung cancer, sex and race are independent predictors of comorbidities and are associated survival. It is unclear how comorbidity profiles differ across sex and race. The objective was to examine comorbidity differences between men and women and Blacks and Whites. Data from the 2014, 2016, 2017, and 2018 Behavioral Risk Factor Surveillance System were analyzed using descriptive statistics, χ2 test of independence, and multiple logistic regression. Variables included sociodemographics and comorbidities. Among individuals with lung cancer (N = 594), men were more likely to experience a heart attack (odds ratio [OR], 3.59; 95% confidence interval [CI], 1.62-7.96) and diabetes (OR, 2.83; 95% CI, 1.57-5.10) and less likely to experience depressive disorder (OR, 0.360; 95% CI, 0203-0.637). Black men (OR, 28.57; 95% CI, 9.22-88.55) and women (OR, 2.48; 95% CI, 1.02-6.05) were more likely to have a history of stroke. Findings show that there may be differences in patterns of comorbidities among individuals with lung cancer. As we continue to move toward individualized medicine in cancer care, future work in this area should examine social determinants of health and how they may influence the patterns of comorbidities. Although nurses may be aware that certain groups have an increased risk for certain comorbid conditions, this study highlights what groups with lung cancer may be more likely to have certain comorbidities. Nurses can assess individuals for comorbidities and provide education on how to manage comorbidities during cancer treatment.

Racialized economic segregation and health outcomes: A systematic review of studies that use the Index of Concentration at the Extremes for race, income, and their interaction.

Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.

Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC).

Type 2 diabetes in the U.S. is more prevalent in youth of minority racial-ethnic background, but disparities in health outcomes have not been examined in this population. We examined racial-ethnic differences in the initial presentation and subsequent comorbidities in 1,217 youth with type 2 diabetes (63% girls) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report. Overall, the mean age at presentation was 13.4 ± 2.4 years, and BMI was 35.0 ± 9.4 kg/m2. HbA1c was higher and C-peptide was lower in non-Hispanic Black (NHB) and Hispanic (H) youth compared with non-Hispanic White (NHW) youth. NHB were three times as likely to present in diabetic ketoacidosis (19%) versus NHW (6.3%) and H (7.5%), and NHB and H both had a worse HbA1c trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34%, and dyslipidemia in 42% of Registry participants, with no significant difference among racial-ethnic groups. Nonalcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively, versus 2% in NHB. NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1c trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.

COVID-19 Inequities Across Multiple Racial and Ethnic Groups: Results From an Integrated Health Care Organization.

COVID-19 Inequities Across Multiple Racial and Ethnic Groups: Results From an Integrated Health Care Organization.

Trends in Comorbidities Among Human Immunodeficiency Virus-Infected Hospital Admissions in New York City from 2006-2016.

Due to the advent and success of antiretroviral therapy, the number of people living and aging with human immunodeficiency virus (HIV) has grown substantially. Although people living with HIV (PLHIV) are experiencing longer life expectancies, this achievement may be undermined by increasing and disproportionate chronic disease burden among PLHIV. This study is a retrospective analysis of adult (≥18 years) inpatient hospital discharges from a large hospital system in the New York City, New York metropolitan area, between 1 January 2006 and 31 December 2016. We aimed to investigate (1) changes in the prevalence of Charlson-defined comorbidities among PLHIV hospitalized between 2006 and 2016 and (2) changes in the unadjusted prevalence ratio (PR) of comorbidities in HIV-positive versus HIV-negative admissions over time. Of 898 139 hospital admissions from 2006-2016, 19 039 (2.1%) were HIV positive. Across all admissions during the study period, the greatest comorbidity disparities between HIV-positive and HIV-negative admissions were mild liver disease (PR, 4.9 [95% confidence interval, 4.8-5.1]), moderate or severe liver disease (PR, 2.2 [2.0-2.4]), and chronic pulmonary disease (PR, 1.8 [1.8-1.8]). The prevalence and relative burden of comorbidities among hospitalized PLHIV are changing over time. Careful monitoring and intensive discharge planning may be effective strategies for addressing the evolving health needs of PLHIV.

Racial disparities in obesity and comorbidities among women with early breast cancer.

e19061 Background: Both comorbidities and obesity (body mass index/BMI 30 or higher) are observed in women at the time of early breast cancer (EBC) diagnosis. This study investigates age and obesity and their association with disparities in comorbidities between black and white women at EBC diagnosis. Methods: This is a retrospective chart review of women with EBC (Stage I-III) treated at a single institution. Relative risk (RR) with 95% Confidence Interval (CI) for individual comorbidities are calculated for black compared to white patients, adjusted for age and BMI. Results: In a sample of 548 women, 26% are black and 74% are white. 18% of black patients vs 28% of white patients were age 65 or older (p = .01). 62% of black vs 33% of white patients had obesity (p &lt; .0001). 63% of black vs 47% of white patients had 2 or more total comorbidities at diagnosis (p = .003). 33% of black vs 10% of white patients had 2 or more obesity-related comorbidities (p &lt; .0001). 60% of black vs 32% of white patients had hypertension (p &lt; .0001); 23% of black vs 6% of white patients had diabetes (p &lt; .0001); and 28% of black vs 18% of white patients had high cholesterol (p = .02). In multivariable (MV) analysis adjusted for age and BMI, black women had 45% higher risk for hypertension [RR 1.45 (1.19-1.75), p = .0002)] and 44% higher risk for diabetes [RR 1.44 (1.02-5.86), p &lt; .0001)] at EBC diagnosis. However, after adjustment, differences by race were no longer seen for &gt; = 2 total comorbidities, &gt; = 2 obesity-related comorbidities, heart disease, or thyroid disease. Conclusions: This study documents significant disparities between black and white women with EBC with regard to high rates of obesity, overall comorbidities and obesity-related comorbidities. Future research should assess the potential impact of weight management (avoiding weight gain) interventions in the first 2 years post diagnosis on improving OS and BCSS among patients with obesity and in reducing OS and BCSS disparities between black and white women.

Racial Disparities in Comorbidity and Severe Maternal Morbidity/Mortality in the United States: An Analysis of Temporal Trends

(Acta Obstet Gynecol Scand. 2018;97:89–96) In the United States, there has been a temporal increase in the incidence of severe maternal morbidity and mortality (MMM) over the past several years. In fact, between 1998 and 2009 severe maternal morbidity occurring during hospitalization for delivery increased by 75%. However, this increase has not been consistent across all racial groups. The current population-based study aimed to demonstrate the racial disparities in maternal comorbidities and severe maternal morbidity/mortality.

Sexual dimorphism in developmental and diet-dependent circulating retinol binding protein 4.

SummaryObjectiveRetinol binding protein 4 (RBP4) transports vitamin A (Retinol) in the blood and contributes mechanistically to the linkage between obesity, insulin resistance and associated comorbidities including type 2 diabetes mellitus, coronary artery and neoplastic diseases. Circulating RBP4 levels have variably been associated with body mass and gender differences. Many of these differences have been demonstrated after limited dietary interventions, and/or at single unique time points. This study investigated the impact of sex and age as biologic variables as well as high versus low fat diets on development of obesity, RBP4 levels and insulin resistance in C57BL/6J mice.MethodsMale and female C57BL/6J mice were fed for 400 days with either low or high fat diets. Female mice were also evaluated on same diets after ovariectomy or sham ovariectomy. Mice were monitored for changes in weight, circulating levels RBP4, glucose and insulin at 100‐day intervals and also by 2‐hour glucose tolerance tests.ResultsAll mice on low or high fat diets gained weight. Mice on high fat diets showed significantly greater weight gain than those on low fat. Male mice showed significantly greater weight gain compared with females on corresponding diet. Male mice compared with females already showed significantly higher RBP4 levels even before starting diets. Sex differences were maintained for more than 1 year. Gender differences in RBP4 were associated with significant differences in development of glucose intolerance and insulin resistance.ConclusionsMale compared with female C57BL/6J mice show significant gender differences in circulating RBP4 levels from 6 weeks of age, extending more than 1 year. Gender differences in RBP4 may be mechanistically associated with protection against glucose intolerance and insulin resistance. Targeting RBP4 pathways could be useful to disrupt gender differences in insulin resistance and disparities in comorbidities.

Abstract C37: Racial and ethnic disparities in comorbidities and behavioral risk factors among prostate cancer survivors, NHIS 2015

Abstract Background: Despite the growing number of prostate cancer survivors, little is known about the health status and health behaviors of this population. Prostate cancer survivors are at increased risk for recurrence and second primary cancers. Improved health behaviors and health status could lower the risk of recurrence and second primary cancers, as well as provide opportunities for better quality of life and physical health outcomes in survivorship. Furthermore, an understanding of the racial/ethnic differences in health status and behavioral risk factors is necessary to enhance health outcomes and quality of life of diverse survivors. Purpose: To examine health status, comorbidity status, and health behaviors among prostate cancer survivors and explore any racial/ethnic disparities among these survivors. Methods: Analysis was conducted using cross-sectional data from the 2015 National Health Interview Survey. Demographic frequencies and percentages were calculated among White, African American, and Hispanic men 50 years of age and older diagnosed with prostate cancer (n=398) with no report of other cancer diagnoses. Self-rated health, comorbidities, and selected health behaviors (physical activity, smoking, and alcohol use) were stratified by race/ethnicity. Results: The average age of survivors was 73 years (range 50-85 years). Survivors were more likely to be married, college graduates, and be publicly insured. Twenty-five percent of respondents reported a family history of prostate cancer. Sixty percent of survivors reported “good/very good” self-rated health. Overall, 40% of prostate cancer survivors reported no physical activity. Fifty-seven percent of respondents reported being current drinkers, of whom 25% characterized their drinking as heavy/moderate. Forty-nine percent reported being former smokers, although only 6% were current smokers. Thirty-one percent of survivors were obese (BMI ≥ 30) and 20% had 3+ comorbidities. There were no significant differences for physical activity, self-rated health, or obesity by race/ethnicity. More White survivors (29%) were moderate/heavy drinkers compared to African American (11%) and Hispanic (14%) survivors (p=0.04). African Americans (17%) were more likely to be current smokers than White (5%) or Hispanic (6%) survivors (p=0.04). African American (30%) and Hispanic (22%) survivors were more likely to report having 3 or more comorbidities compared to White (18%) survivors (p=0.03). Conclusions: The overall health status of prostate cancer survivors is suboptimal. Many health behaviors need to be improved in this higher-risk group. There are significant racial/ethnic differences in health behaviors including alcohol use, smoking status, and comorbidity status among prostate cancer survivors. The findings present opportunities to improve health behaviors among prostate cancer survivors. As many prostate cancer survivors are living longer, public health efforts to improve health behaviors are imperative to prevent a recurrence or second cancer diagnosis and improve quality of life. Evidence-based interventions are needed to promote healthy behaviors among prostate cancer survivors. Citation Format: Joelle Atere-Roberts, Ingrid J. Hall, Judith Lee Smith. Racial and ethnic disparities in comorbidities and behavioral risk factors among prostate cancer survivors, NHIS 2015 [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C37.

Abstract 4245: Racial disparities in comorbidities, income levels, and surgical procedures observed in hispanic patients with pancreatic cancer compared to non-hispanic patients results from the national inpatient sample database

Abstract Background: Higher incidence and lower survival rates have been linked to racial/ethnic and socioeconomic (SES) disparities in patients with pancreatic cancer. However, systematic evaluation of the interaction between race/ethnicity, SES, comorbidities and type of surgical procedures to predict outcomes associated with pancreatic cancer are missing. Hence, we conducted this study to investigate these risk factors and outcomes of pancreatic cancer discharges, with a focus on Hispanic population. Methods: We surveyed Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database for year 2014 to identify patients with pancreatic cancer (ICD9: 230.9, 157.1-157.4, 157.8, 157.9). To identify racial disparities, we examined age, median household income at zipcode level, various comorbidities (e.g. alcohol abuse, diabetes, obesity, liver disease, hypertension, chronic pulmonary disease, etc.), types of surgical treatments (surgical vs non-surgical options; Whipple vs. others) as a treatment choice, and death during hospitalization. Results: From approximately 7 million records, we identified 18,069 pancreatic cancer-related discharges. The median age of patients was 68 years (range: 0 to 90 years). Compared to NHW, Hispanics had a significantly higher prevalence of diabetes (40% vs. 30%, p&amp;lt;0.001) and liver disease (8% vs. 5%, p&amp;lt;0.001), whereas no significant differences were observed for obesity, hypertension, congestive heart failure, or alcohol abuse. Majority of Hispanic patients (39%) with pancreatic cancer belonged to lowest income quartile ($1 - $39,999 per year) compared to NHW (20%), P value &amp;lt;0.001. The only two factors associated with the difference in receiving Whipple procedure were having underlying liver disease and the income level, stratified by race/ethnicity. We did not identify any factors associated with differences in mortality rates. Conclusions: We identified significant racial disparities such as higher prevalence of comorbidities, lower income levels, and different types of surgical procedures in Hispanic versus NHW patients hospitalized for pancreatic cancer. Future studies quantifying the impact of stage of illness at presentation, multiple comorbidities including smoking, rural/urban care setting, SES, insurance coverage on treatment choices and outcomes associated with pancreatic cancer in different racial/ethnic groups are needed. Citation Format: Miren Peña, Jswanth Raj Kintada, Sheetal Hegde, Sammira Rouhani, Edgar Munoz, Joel Michalek, Ali Seifi, Amelie Ramirez, Pratap A. Kumar, Dimpy Shah. Racial disparities in comorbidities, income levels, and surgical procedures observed in hispanic patients with pancreatic cancer compared to non-hispanic patients results from the national inpatient sample database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4245.

Racial Disparities in Comorbidity and Severe Maternal Morbidity/Mortality in the United States: An Analysis of Temporal Trends

(Acta Obstet Gynecol Scand. 2018;97:89–96) In the United States, there has been a temporal increase in the incidence of severe maternal morbidity and mortality (MMM) over the past several years. In fact, between 1998 and 2009 severe maternal morbidity occurring during hospitalization for delivery increased by 75%. However, this increase has not been consistent across all racial groups. The current population-based study aimed to demonstrate the racial disparities in maternal comorbidities and severe maternal morbidity/mortality.

Population-level differences in revascularization treatment and outcomes among various United States subpopulations.

Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.

Racial Disparities in Comorbidities, Complications, and Maternal and Fetal Outcomes in Women With Preeclampsia/eclampsia

Objective: The mechanisms leading to worse outcomes in African-American (AA) women with preeclampsia/eclampsia remain unclear. Our objective was to identify racial differences in maternal comorbidities, peripartum characteristics, and maternal and fetal outcomes. Methods/Results: When compared to white women with preeclampsia/eclampsia, AA women had an increased unadjusted risk of inpatient maternal mortality (OR 3.70, 95% CI: 2.19–6.24). After adjustment for covariates, in-hospital mortality for AA women remained higher than that for white women (OR 2.85, 95% CI: 1.38–5.53), while the adjusted risk of death among Hispanic women did not differ from that for white women. We also found an increased risk of intrauterine fetal death (IUFD) among AA women. When compared to white women with preeclampsia, AA women had an increased unadjusted odds of IUFD (OR 2.78, 95% CI: 2.49–3.11), which remained significant after adjustment for covariates (adjusted OR 2.45, 95% CI: 2.14–2.82). In contrast, IUFD among Hispanic women did not differ from that for white women after adjusting for covariates. Conclusions and Relevance: Our data suggest that African-American women are more likely to have risk factors for preeclampsia and more likely to suffer an adverse outcome during peripartum care. Future research should examine whether controlling co-morbidities and other risk factors will help to alleviate racial disparities in outcomes in this cohort of women.

Impact of Comorbidities on Racial/Ethnic Disparities in Hypertension in the United States

Background. Racial/ethnic disparities in hypertension (HTN) prevalence continue to persist in United States. We aimed in this study to examine the racial/ethnic disparities in hypertension prevalence and to determine whether or not health disparities may be explained by racial/ethnic disparities in co-morbidities. Materials and Methods. A cross-sectional design was used to examine the prevalence of hypertension among African Americans (AAs), Caucasians, and Hispanics in the National Health Interview Survey, 2003. The overall sample comprised 30, 852 adults. Results. There was a statistically significant racial/ethnic variability in hypertension prevalence, with AA/Blacks with the highest prevalence, χ2=393.0 (3), P&lt;0.01. Hypertension was associated with co-morbidities, age, education, physical inactivity, marital status, income, sex, alcohol, and cigarette consumption, but not insurance. Relative to Caucasians, AAA/Blacks were 43% more likely while Hispanics were 40% less likely to report being diagnosed with high blood pressure, prevalence odds ratio (POR) = 1.43, 99% CI, 1.25–1.64, P=0.002, and POR = 0.60, 99% CI, 0.55–0.66, P&lt;0.001, respectively. After adjustment for the relevant covariates including co-morbidities, racial/ethnic disparities in hypertension persisted; thus compared to Caucasians, African Americans were 61% more likely to be told by their health care providers that they were hypertensive, adjusted prevalence odds ratio (APOR) = 1.61, 99% CI, 1.39–1.86, P&lt;0.001. In contrast, Hispanics were 27% less likely to be diagnosed with hypertension compared to Caucasians, APOR = 0.73, 99% CI, 0.68–0.79, P&lt;0.001. Conclusions. There was racial/ethnic variability in hypertension prevalence in this large sample of non-institutionalized US residents, with the highest prevalence of hypertension observed among African Americans. These disparities were not removed after controlling for relevant covariates including co-morbidities.