Ethnic Differences In Risk Factors Research Articles

Racial/ethnic differences in colorectal cancer risk: The multiethnic cohort study

Incidence rates in the United States show clear racial/ethnic disparities for colorectal cancer. We examined the extent to which ethnic differences in risk factors could explain the age-adjusted variation in the risk of colorectal cancer, overall and by stage at diagnosis, among 165,711 African Americans, Japanese Americans, Latinos, Native Hawaiians and whites participating in the Multiethnic Cohort Study. Over a median follow-up period of 10.7 years, 2,564 incident cases of colorectal cancer were identified through surveillance, epidemiology and end result tumor registry linkages in Hawaii and California. Multivariable-adjusted Cox proportional hazard models were used to estimate relative risks (RR) and 95% confidence intervals (CI) for each ethnic group compared to whites. After accounting for known/suspected risk factors, Japanese Americans (men, RR = 1.27, 95% CI = 1.09-1.48; women, RR = 1.49, 95% CI = 1.24-1.78) and African American women (RR = 1.48, 95% CI = 1.23-1.79) remained at increased risk of colorectal cancer relative to whites; African American and Japanese American women were also at increased risk of advanced disease compared to whites. In site-specific analyses, after multivariable adjustment, African Americans (both sexes) and Japanese American women remained at increased risk for colon cancer, and Japanese Americans (both sexes) and Native Hawaiian men for rectal cancer compared to whites. The results of our study suggest that differences in the distribution of known/suspected risk factors account for only a modest proportion of the ethnic variation in colorectal cancer risk and that other factors, possibly including genetic susceptibility, are important contributors to the observed disparities in incidence.

3D-6 Ethnic differences in risk factors for chronic disease have their origins in early life: evidence from the CHASE study

3D-6 Ethnic differences in risk factors for chronic disease have their origins in early life: evidence from the CHASE study

Ethnic differences in risk factors for subarachnoid hemorrhage

Studies on risk factors for subarachnoid hemorrhage (SAH) show heterogeneity. For example, hypertension has been found to be a significant risk factor in some studies but not in others. The authors hypothesized that differences in the ethnicity of the populations studied could account for these findings. A metaanalysis was performed using 17 case-control and 10 cohort studies that met specified inclusion criteria. The authors used a random-effect model to calculate the pooled effect estimates for current smoking, hypertension, and alcohol consumption. A meta-regression analysis was performed using the ethnic composition of the study populations as a covariate. Studies were classified as multiethnic or monoethnic, and the pooled effect estimates were compared. Analysis of the cohort studies yielded a pooled effect estimate or risk ratio of 3.18 (95% confidence interval [CI] 2.37-4.26) for current smoking, 3.05 (95% CI 2.09-4.44) for hypertension, and 2.46 (95% CI 1.42-4.24) for alcohol consumption at a rate of 150 g/week or more. The results were similar for the case-control studies. For current smoking, the ethnic composition of the study population was a statistically significant predictor of heterogeneity among case-control studies (p < 0.001, even after application of the Bonferroni correction). The risk for SAH among current smokers was higher in multiethnic populations (odds ratio 3.832) than in monoethnic populations (odds ratio 2.487). The results of this metaanalysis suggest that differences in susceptibility to the harmful health effects of smoking may be one cause of the observed differences in SAH incidence for different ethnic groups. The role of ethnicity in risk factors for SAH should be considered in future studies.

Ethnic differences in risk factors for neonatal mortality and morbidity in the neonatal intensive care unit

Although our knowledge about how to care for high-risk neonates who require intensive care is continually improving, disparities in health outcomes among various ethnic groups living in developed countries are becoming more evident. The purpose of this study was to identify the risk factors for neonatal intensive care unit (NICU) mortality among Canadian-born minority infants and, furthermore, to determine whether ethnicity was in itself an independent predictor of mortality or major morbidity in the NICU. Data were prospectively gathered on 6528 infants admitted to nine regionally located NICUs across Canada. Multiple logistic regressions were used to develop risk-adjusted models for NICU mortality and major morbidity. Despite adjusting for differences in small for gestational age (SGA), outborn status and gestational age less than or equal to 28 weeks, South Asian infants still had significantly greater odds of mortality in the NICU. Neonatal sepsis was the strongest predictor of mortality among African infants, even greater than birth at 28 weeks or less. At significantly greater odds of survival with major morbidity were Aboriginal males and East Asian females. There are ethnic disparities in the risks of neonatal mortality and morbidity in the NICU. Understanding these differences is important to be able to determine specific areas to target in improving healthcare delivery and reducing disparities in health outcomes among Canada's diverse population.

Premarital cohabitation and marital disruption among white, black, and Mexican American women

We use data from the 1995 National Survey of Family Growth (N = 4,547) to investigate racial and ethnic differences in risk factors for marital disruption, with a particular emphasis on premarital cohabitation. We find that the nature and strength of the estimated effects of several risk factors for disruption differ across groups. In particular, premarital cohabitation is positively associated with subsequent marital disruption among non‐Hispanic White women but not among non‐Hispanic Black or Mexican American women. Little of the observed gaps between groups in levels of disruption, however, appears to be attributable to differences in premarital cohabitation. In addition to improving our understanding of marital disruption, this research contributes to a growing literature emphasizing heterogeneity across groups in the meaning and function of cohabitation.

Ethnic differences in risk factors for ischemic stroke: a European case-control study.

The aim is to estimate the relative risk and population attributable risk (PAR) of risk factors for ischemic stroke by ethnic group. In this case-control study, cases of first ischemic stroke were taken from the South London Stroke Register and controls from a cross-sectional prevalence survey covering the same area. PAR was determined for each risk factor by ethnic group. Multivariable analysis was used to examine the association between risk factors and ischemic stroke across all ethnic groups. 664 cases and 716 controls aged 45 to 74 years were included, with ethnicity of white 78%:42%, black Caribbean 16%:43%, and black African 6%:15%, respectively. For the white group, high PAR was found for ischemic heart disease (IHD) on ECG (56% [95% CI, 49% to 62%]), obesity (49% [95% CI, 40% to 56%]), hypertension (HT) (38% [95% CI, 29% to 46%]), smoking (31% [95% CI, 19% to 41%]), transient ischemic attack (TIA) (23% [95% CI, 19% to 27%]), and atrial fibrillation (AF) (16% [95% CI, 10% to 21%]). In the black Caribbean compared with the white group, PAR was higher for HT (46% [95% CI, 21% to 63%]) and diabetes mellitus (DM) (29% [95% CI, 14% to 42%]), and lower for current smoking (18% [95% CI, 1% to 32%]) and AF (10% [95% CI, 0% to 18%]). In the black African group HT had a higher PAR (59% [95% CI, 91% to 82%]) than the other groups. PAR for AF (11% [95% CI, -11% to 29%]), obesity (30% [95% CI, -20% to 60%]), and DM (4% [95% CI, -25% to 26%]) was low compared with the other groups. In multivariable analysis, risk factors associated with ischemic stroke included TIA, AF, IHD on ECG, smoking, excess alcohol, obesity, HT, and DM. In the first European case-control study examining risk factors for ischemic stroke in black Caribbean and African populations, some differences were demonstrated in the impact of risk factors between these groups. It may be important to address such differences when developing stroke preventative strategies.

Ethnic differences in atherosclerosis, cardiovascular disease and lipid metabolism.

Comparison of risk factors and cardiovascular disease among racial and ethnic groups is a powerful approach to study genetics and lifestyle, or environmental interactions. Most, mean or median, cardiovascular risk factor levels are similar among black and white people. There are much greater differences in the distribution of risk factor level within a specific race and ethnic group than between US populations. There are also very large differences in levels of risk factors for coronary heart disease between specific ethnic migrant populations such as comparing black people in Africa with those in the US, or Japanese people in Japan with those in Hawaii and California. Differences in distribution of risk factors and disease between race and ethnic group are a function of the frequency of specific genotypes and interaction with environmental factors. Several of the most important differences between racial groups are higher blood pressure, lower triglycerides and higher HDL cholesterol among blacks, higher prevalence of diabetes and insulin resistance among Mexican Americans and American Indians, and higher triglyceride levels among the Japanese. Further studies of racial and ethnic differences should focus on unique phenotypes and genotypic differences, international and migrant studies and large enough sample sizes to provide robust results. The sprinkling of a percentage of minority participants in each study is worthless. The study of racial and ethnic differences in disease and detection of risk factor levels must be based on solid hypotheses that can evaluate the interaction of lifestyle and possible genetic attributes. Many of the reported ethnic differences in risk factors and disease in US populations are primarily a function of differences in education, socioeconomic variations, and utilization of preventive and clinical treatments.

Ethnic Differences in Risk Factors for Cervical Incompetence

Ethnic Differences in Risk Factors for Cervical Incompetence

Ethnic differences in risk factors for cervical incompetence

Objective: African-American women (AA) have a higher premature birth rate than Caucasian women (Ca). We studied risk factors for cervical incompetence (CI) to determine if there are ethnic differences. Study design: We did a retrospective review of 199 pregnancies in 48 women with CI diagnoses over 5 years. Maternal demographics and outcomes were evaluated. Univariate and multivariate analyses were performed. Results: Eighteen AA (93 pregnancies) and 30 Ca (103 pregnancies) were studied. No significant differences in gravidity, previous preterm (PT) delivery, or presenting symptoms were found. Longitudinal analysis detected an overall successful pregnancy rate of 92%, with 42% PT. No significant differences were detected in hospitalizations, infections, PT labor interventions, gestational age at delivery, delivery mode, or mean cervical lengths (10–29 weeks). African-American women were more likely to: 1) be diagnosed in later pregnancies ( P = 0.004), 2) be younger at diagnosis ( P = 0.001), 3) have more second- and third-trimester losses ( P = 0.004), 4) not have had cervical conization ( P = 0.04), and 5) have more dilation and curettage procedures before diagnosis of CI ( P = 0.003). Conclusion: We have demonstrated significant ethnic differences in risk factors for CI. Knowledge of ethnic-specific risk factors may improve detection of this treatable cause of PT birth.

Ethnic differences in risk factors associated with genital human papillomavirus infections.

This study was a cross-sectional analysis of different risk and cofactors for genital human papillomavirus (HPV) infection among 302 women in four ethnic groups at 10 clinic sites. Ethnicity, rather than HPV status, accounted for most of the differences among the groups on five risk factors: age at first sex, number of lifetime sexual partners, number of partners' sex partners, number of 'once only' sex partners, and number of 'long-term' sexual relationships. There were also ethnic differences in three of four cofactors, which may contribute to progression of HPV infections, namely, age when women began taking oral contraceptives and duration of use, number of years smoked cigarettes, and number of other sexually transmitted diseases. Women with more than four lifetime sex partners, more than two 'once only' sex partners, and/or women who took oral contraceptives for more than 4 years had a higher prevalence of HPV infection. Major risk and cofactors for HPV infection of each ethnic group are described and compared with other HPV studies.

Ethnic Differences in Risk Factors Associated with the Prevalence of Non-insulin-dependent Diabetes Mellitus

Non-insulin-dependent diabetes mellitus is 2-5 times more common in Hispanics than in non-Hispanic whites in the United States. The authors conducted this case-control study in two Colorado counties from 1984 to 1986 to determine whether known risk factors for non-insulin-dependent diabetes mellitus explained the excess incidence in Hispanics. There were 279 subjects with prevalent diabetes and 488 subjects with normal glucose tolerance who were eligible for this analysis. After adjustment for age and sex, results showed that Hispanics were 3.5 times more likely than non-Hispanic whites to have non-insulin-dependent diabetes mellitus (95% confidence interval 2.4-4.9). The excess risks of diabetes associated with body mass index, subscapular and triceps skinfold thickness, family history of diabetes, and income were similar in Hispanics and non-Hispanic whites, after adjustment for age and sex. However, 1-unit increases in subscapular/triceps skinfold ratio and waist/hip ratio were associated with greater increases in risk among non-Hispanic whites than among Hispanics. When risk factors were entered into logistic regression models simultaneously, higher subscapular skinfolds, a higher waist/hip ratio, family history of diabetes, older age, male sex, and lower income were independently associated with non-insulin-dependent diabetes mellitus in both ethnic groups. No association was found with skin reflectance, a marker for Amerindian admixture. While the excess risk of diabetes in Hispanics was reduced, a significant 1.9-fold excess risk in Hispanics remained. Further studies are needed to understand factors contributing to the excess prevalence of diabetes in Hispanic Americans.

Cardiovascular risk factors among Asian Americans living in northern California.

Recent substantial immigration has created large population subsets of Asian Americans in the United States. Available data about cardiovascular risk factors in these persons are sparse. This study examined data among 13,031 persons self-classified as 5951 Chinese, 4211 Filipinos, 1703 Japanese, and 1166 other Asians. Covariates in regression analyses were age, smoking, alcohol, education, and marital status. Chinese men and women had the lowest adjusted mean body mass index. Filipino men and women had the highest prevalence of hypertension. There were no major differences in blood glucose levels. Total cholesterol levels were highest in Japanese men and women. Comparisons of US-born persons and those born in respective countries of origin showed no major cholesterol or glucose differences; more hypertension only in Chinese and other Asian men; higher body mass index in men, but not in women of most ethnicities; and a lower smoking prevalence in men, but a substantially higher one in women. These data show important ethnic differences in risk factors among Asian Americans and indicate groups that should be targeted for public health efforts concerned with obesity (Asian-American men), hypertension (Filipino-American men and women), hypercholesteremia (all Asian Americans), and smoking cessation (Asian-American women).