Ethnic Disparities In Risk Research Articles

Racial and Ethnic Disparities in Risk and Survival in Children With Neuroblastoma: A Children's Oncology Group Study

Although health disparities are well-described for many cancers, little is known about racial and ethnic disparities in neuroblastoma. To evaluate differences in disease presentation and survival by race and ethnicity, data from the Children's Oncology Group (COG) were analyzed. The racial/ethnic differences in clinical and biologic risk factors, and outcome of patients with neuroblastoma enrolled on COG ANBL00B1 between 2001 and 2009 were investigated. A total of 3,539 patients (white, 72%; black, 12%; Hispanic, 12%; Asian, 4%; and Native American, < 1%) with neuroblastoma were included. The 5-year event-free survival (EFS) rates were 67% for whites (95% CI, 65% to 69%), 69% for Hispanics (95% CI, 63% to 74%), 62% for Asians (95% CI, 51% to 71%), 56% for blacks (95% CI, 50% to 62%), and 37% for Native American (95% CI, 17% to 58%). Blacks (P < .001) and Native Americans (P = .04) had a higher prevalence of high-risk disease than whites, and significantly worse EFS (P = .01 and P = .002, respectively). Adjustment for risk group abrogated these differences. However, closer examination of the EFS among high-risk patients who remained event free for 2 years or longer, revealed a higher prevalence of late-occurring events among blacks compared with whites (hazard ratio, 1.5; 95% CI, 1.0 to 2.3; P = .04). Black and Native American patients with neuroblastoma have a higher prevalence of high-risk disease, accounting for their worse EFS when compared with whites. The higher prevalence of late-occurring events among blacks with high-risk disease suggests that this population may be more resistant to chemotherapy. Studies focused on delineating the genetic basis for the racial disparities observed in this study are planned.

Circumventing Communication Barriers With Spanish-speaking Patients Regarding Pediatric Obesity

In 2005, the Journal of Pediatric Health Care published an article citing the importance of educational material in the treatment and prevention of pediatric obesity, including handouts that could be copied for use (Ward-Begnoche & Gance-Cleveland, 2005). With the increased clinical use of these educational handouts, the need for Hispanic versions of the handouts to use with Spanishspeaking patients and families has become clear. This article reviews the need for language-specific educational material, and includes the Spanish versions of the handouts on Metabolism, Nutrition for Kids, Healthy Snacks, Portion Sizes, Fitness for Children and Adolescents, Behavioral Recommendations for Overweight Children and Adolescents, and Exercise Activities for Kids. Concerns for culturally appropriate treatment approaches also are reviewed. In addition, a list of online resources and books is provided to assist in behavioral change for overweight Hispanic youth. Research suggests that there is an ethnic disparity in risk for pediatric obesity, with Hispanic youth being at highest risk (Ogden et al., 2006), suggesting the need to target this population with prevention and intervention efforts. Yet youth (including Hispanic youth) report rarely receiving preventive counseling regarding specific recommendations for nutritional intake or physical activity changes during routine primary care visits (Taveras et al., 2007). Taveras and colleagues suggest that social class disparities should be included in the design of prevention counseling and treatment. Most of the literature on pediatric obesity has focused on White, middle-class samples, thus telling us little about how best to deliver chronic disease self-management interventions to low-income, Wendy L. Ward-Begnoche, Associate Professor of Pediatrics, Department of Pediatrics,UniversityofArkansas forMedical Sciences,CollegeofMedicine,andArkansas Children’s Hospital, Little Rock, AR.

Are there ethnic disparities in risk of preterm birth among infants born with congenital heart defects?

Birth defects and preterm birth (PTB) are leading causes of infant morbidity and mortality in the United States. Infants with birth defects are more likely to be born preterm (<37 weeks), yet the roles of maternal ethnicity and fetal growth in this relationship are unclear. This study aimed to assess the risk of PTB among non-Hispanic (NH) Black, NH-White, and Hispanic infants with congenital heart defects (CHD), adjusting for fetal growth. Florida Birth Defects Registry data were used to conduct a retrospective cohort study on 14,319 live-born infants with CHDs born January 1, 1998 to December 31, 2002. ORs and 95% CIs were computed for each growth category (small-for-gestational age [SGA], appropriate-for-gestational-age [AGA], and large-for-gestational-age [LGA]) by ethnicity and adjusted for maternal and infant covariates using logistic regression. After adjusting for potential confounders, SGA and AGA NH-Black infants with CHDs had increased risk of PTB compared to NH-White infants with CHDs (OR 1.79; 95% CI: 1.40, 2.30 and OR 1.89; 95% CI: 1.68, 2.13, respectively). Hispanic SGA, AGA, and infants with CHDs had no increased risk of PTB compared to NH-White infants. The increased risk of PTB among SGA and AGA NH-Black infants with CHDs is not explained by the overall disparities in risk of PTB between NH-Blacks and NH-Whites. Additional studies are needed to determine the specific subtypes of CHD for which these relationships are present and if these findings are seen among infants with other birth defects.

Are There Ethnic Disparities in Risk of Preterm Birth for Infants With Congenital Heart Defects?

Are There Ethnic Disparities in Risk of Preterm Birth for Infants With Congenital Heart Defects?