Evidence Of Racial Differences Research Articles

Abstract 11605: Association of Patient Characteristics and Center on Age of Fontan Completion: A Retrospective Cohort Study Using the Pediatric Health Information Systems Database

Introduction: Little is known regarding optimal timing of the Fontan operation and whether timing affects outcomes in patients with single-ventricle heart disease. The association of patient-level factors with age at the Fontan operation and the degree of practice variation among surgical centers have not been quantified in large studies. Methods: A retrospective cohort study of patients who underwent a Fontan operation between 1/1/2007 and 12/31/2017 at Pediatric Health Information Systems Database centers was performed to evaluate associations between patient characteristics and center on timing of Fontan operation. Mixed-effects multivariable linear regression was used to adjust for patient characteristics and center-level covariance. Results: In all, 7,840 patients (41% male, 57% white) at 46 centers were included. Median age at Fontan was 3.3 years (IQR 2.5-4.3). In an adjusted model hypoplastic left heart syndrome (-16 months, 95% CI -18 to -13), heterotaxy (-9 months, 95% CI -13 to -5), and ECMO history (-11 months, 95% CI -17 to -5) were associated with younger age at Fontan. Non-cardiac diagnoses (+4 months, 95% CI 0.1-9) and technology-dependence (+21 months, 95% CI 16-25) were associated with older age at Fontan ( Figure 1A ). There was no evidence of racial differences in Fontan timing. Children with Medicaid insurance were significantly younger at Fontan than counterparts with other insurance. We observed center effects on age at Fontan (p<0.001, ICC 0.03 95% CI 0.02-0.05) with youngest median age of 0.9 years (IQR 0.6-2.8) at one center and oldest median age of 5.0 years (IQR 4.6-5.9) at another center ( Figure 1B ). Conclusion: In this study, age at Fontan was significantly associated with cardiac anatomy, non-cardiac diagnoses, ECMO history, and insurance but not race. There was practice variation between centers in Fontan timing. Future studies will examine associations between timing of Fontan and patient outcomes.

Racial Differences in Treatments and Toxicity in Patients With Non-Small-Cell Lung Cancer Treated With Thoracic Radiation Therapy.

Historical racial disparities in lung cancer surgery rates resulted in lower survival in Black patients. Our objective was to examine racial differences in thoracic radiation treatments and toxicities in patients with non-small-cell lung cancer. A large institutional review board-approved statewide patient-level database of patients with stage II-III non-small-cell lung cancer who received definitive thoracic radiation from March 2012 to November 2019 was analyzed to assess associations between race and other variables. Race (White or Black) was defined by patient self-report. Provider-reported toxicity was defined by Common Terminology Criteria for Adverse Events version 4.0. Patient-reported toxicity was determined by the Functional Assessment of Cancer Therapy-Lung quality-of-life instrument. Univariable and multivariable regression models were fitted to assess relationships between race and variables of interest. Spearman rank-correlation coefficients were calculated between provider-reported toxicity and similar patient-reported outcomes. One thousand four hundred forty-one patients from 24 institutions with mean age 68 years (range, 38-94 years) were evaluated. Race was not significantly associated with radiation or chemotherapy approach. There was significantly increased patient-reported general pain in Black patients at the preradiation and end-of-radiation time points. Black patients were significantly less likely to have provider-reported grade 2+ pneumonitis (odds ratio 0.36, P = .03), even after controlling for known patient and treatment factors. Correlation coefficients between provider- and patient-reported toxicities were generally similar across race groups except for a stronger correlation between patient- and provider-reported esophagitis in White patients. In this large multi-institutional study, we found no evidence of racial differences in radiation treatment or chemotherapy approaches. We did, however, unexpectedly find that Black race was associated with lower odds of provider-reported grade 2+ radiation pneumonitis. The stronger correlation between patient- and provider-reported esophagitis and swallowing symptoms for White patients also suggests possible under-recognition of symptoms in Black patients. Further research is needed to study the implications for Black patients.

Racial and Ethnic Disparities in Pain Management for Nursing Home Residents: A Scoping Review

Within nursing homes, residents commonly experience pain that unfortunately goes underrecognized and undertreated, having a dramatic negative impact on residents' quality of life. Nursing homes are becoming more racially and ethnically diverse, and there is concerning evidence documenting disparities in the quality of nursing home care. In other healthcare settings, people of diverse race groups often receive less optimal pain management, but the evidence regarding racial disparities has not been synthesized for nursing homes. Thus, the purpose of this review was to investigate what is known about racial disparities related to pain management (e.g. assessment, treatment, preferences) in US nursing homes. We completed a scoping literature review using PRISMA-ScR guidelines and searching PubMed, CINHAL, and Scopus for peer-reviewed, empirical studies. Most studies were older large retrospective cohort studies of administrative data documenting that White residents were more likely than residents of diverse race groups to have pain documented and treated. Only a few studies looked at possible reasons to explain the disparities; differences were not found to be related to nursing staff racial bias nor differences in pain-related diagnoses. However, there was evidence of racial differences in resident behavior and attitudes related to pain management. None of the studies examined systemic factors related to differences among nursing homes, which has been implicated in studies looking at other outcomes including COVID-19. More research is needed which examines the causal mechanisms behind the documented racial disparities in pain management so that gaps in care can be reduced.

Neuropsychiatric symptoms in Brazilians with mild cognitive impairment and dementia.

IntroductionKnowledge is limited about behavioral and psychological symptoms of mild cognitive impairment (MCI) and dementia in racial and ethnic minorities.MethodsAs part of the Pathology, Alzheimer's and Related Dementias Study (PARDoS), we interviewed knowledgeable informants of 2319 older Brazilian decedents (67% white, 11% black, 22% mixed) using the informant portion of the Clinical Dementia Rating Scale to classify MCI and dementia and the Neuropsychiatric Inventory to assess behavioral and psychological symptoms.ResultsWe identified four clusters of neuropsychiatric symptoms: agitation, affect/apathy, psychosis, and behavioral problems. On the Clinical Dementia Rating Scale, 1407 had no cognitive impairment, 180 had MCI, and 732 had dementia. Both MCI and dementia were associated with symptoms in each behavioral/psychological cluster (all P’s < .001). There was little evidence of racial differences in the association of MCI and dementia with these neuropsychiatric symptoms.ConclusionMCI and dementia are associated with elevated behavioral and psychological symptoms in older black and white Brazilians.

Abstract 3129: Investigating the importance of prostate tumor location and symmetry in a racially diverse, military cohort

Abstract Introduction and objective Prostate cancer (CaP) tumor location (TL) and symmetry (TS), may help forecast CaP outcomes in radical prostatectomy (RP) patients. The study aim was to examine associations between CaP TL and TS with disease pathology and progression, including biochemical recurrence (BCR)-free survival especially whether such associations differ across race. Methods This retrospective cohort study included 1140 patients enrolled at the Walter Reed National Military Medical Center who underwent RP between 1993 and 2008. TL and TS were recorded for index tumors (i.e, largest/highest grade) in whole-mounted RP specimen sections. TLs were divided into coronal versus axial planes. For coronal plane, TL was sub-divided into anterior (A), antero-lateral (AL), lateral (L), postero-lateral (PL), posterior (P) and diffuse (D) (includes A, AL, L, PL and P). The axial plane locations included base (B), mid (M) and apex (A). Kaplan Meier (KM) estimation curves were used to model BCR-free and DM-free survival. Results Mean age at diagnosis was 59.3 years, 27.1% were African-American (AA) and 76.7% were non-symmetric (NST). According to KM analysis patients with NST experienced significantly worse BCR-free survival (p=0.003) with no racial differences found (CA: p=0.02, AA: p=0.04). Tumor location (coronal plane) distribution by race was: A and AL tumors (CA: 9.6%, 7.5% vs. AA: 9.5%, 5.5% respectively), D tumors (CA: 6.9% vs. AA: 9.4%, respectively), L tumors (CA: 9.3% vs. AA: 6.5%, respectively), P and PL tumors (CA: 21.2%, 45.6% vs. AA: 22.7%, 46.3%, respectively) (p=0.36). In the axial plane exclusively A or B tumors are rare (CA: 3.1%, 1.3% vs. AA: 2.6%, 0%, respectively) while exclusively M tumors are more frequent (CA: 27.9% vs. AA: 23%, respectively). Tumors spanning two axial location categories MA and BM tumors were (CA: 27.6%, 15.6% vs. AA: 34%, 8.4%, respectively). Tumors spanning three axial location categories BMA were (CA: 21.8% vs. AA: 30.7%, respectively) (p&amp;lt;.0001). No racial differences in BCR-free survival were observed for D (CA: p&amp;lt;.0001, AA: p=.07) or BMA (CA p&amp;lt;.0001; AA p=0.0004) tumors. The share of tumors with nuclear grade III in D or BMA location categories was (10.5% and 7.2%, respectively; p&amp;lt;.0001) while the difference in NST and ST was (4.2% vs. 0.8%, p=.0002). Conclusions In this longitudinal, racially diverse cohort of RP patients, TL and TS were informative features in predicting BCR. However, this study did not find evidence of racial differences in these associations with the exception of axial tumor location. These findings have implications for treatment stratification at time of RP. Citation Format: William Gesztes, Grant Williams, Jennifer Cullen, Allen Burke, Denise Young, Justin Mygatt, Yongmei Chen, Huai-Ching Kuo, Shiv Srivastava, Kevin Rice, Inger Rosner, Isabell Sesterhenn. Investigating the importance of prostate tumor location and symmetry in a racially diverse, military cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3129.

Abstract WP25: Trends in the Use of Intravenous tPA and Mechanical Thrombectomy [MT] Among Elderly Medicare Beneficiaries Hospitalized for Acute Ischemic Stroke

Objective: Early treatment with intravenous tissue plasminogen activator (tPA) followed by mechanical thrombectomy [MT] is the new standard of care for stroke patients with proximal arterial occlusion. We examined trends in the use of tPA and MT among black and white Medicare beneficiaries with stroke. Methods: We used de-identified data for Humana Medicare beneficiaries age &gt;=65 to identify admissions for stroke during January 2009-March 2017 with primary diagnosis of ischemic stroke. Outcomes included IV tPA and MT identified by CPT, ICD-9, and ICD-10 procedure codes. Additional patient characteristics included demographics, comorbid conditions based on diagnosis codes prior to the stroke, and medication use from pharmacy claims. Logistic regression was used to evaluate the trends and racial differences in the use of IV tPA and MT while controlling for patient characteristics. Results: We identified 12,641 and 81,100 stroke admissions for black and white patients, respectively. Blacks were younger and more likely to have previous stroke, while white patients were more likely to have atrial fibrillation and use anticoagulants. Overall, 7558 (8.1%) received tPA during or within 1 day of stroke admission and 1533 (1.6%) underwent MT. The proportion of admissions receiving tPA increased from 5.3% in 2009-2010 to 9.9% in 2015-2016 among white patients, and from 5.7% to 9.9% among black patients. The proportion who underwent MT increased from 0.6% to 2.4% among whites, and from 0.5% to 2.5% among black patients. In multivariable logistic regression, the relative increase in tPA use over the observation period was 1.3 times greater for white compared to black patients (Odds Ratio [OR] for 2015-2016 relative to 2009-2010 = 2.01 [p&lt;.001] for white patients and 1.55 [p&lt;.001] for black patients). In contrast, the relative increase in MT use was nearly 2 times greater for black compared to white patients (OR for 2015-2016 relative to 2009-2010 = 3.90 [p&lt;.001] for black patients and 2.01 [p&lt;.001] for white patients). Conclusions: We did not find evidence of racial differences in the use of tPA or MT among black and white patients with acute ischemic stroke. Overall there was a dramatic increase in the use of recommended therapies over the 9-year observation period.

Update on epidemiologic considerations and treatment trends in testicular cancer

We aim to give an overview of the epidemiology and treatment trends of testicular germ cell tumors (TGCTs), with an emphasis on recent trends. The incidence of TGCT appears to be increasing, particularly in developed countries, although the reasons are not well understood. There is evidence of racial differences in predisposition to TGCT, with white men having highest risk and men of African or Asian descent having lower risk. In the United States, the incidence of TGCT among Hispanics appears to be rising most quickly. A recent genomic analysis indicates there is no highly penetrant major TGCT susceptibility gene. Incorporation of multidisciplinary care has led to excellent long-term cure rates; however, access to care and insurance remains barriers in young men. Recent treatment trends have centered on maximizing oncologic outcomes while minimizing long-term morbidity. Emerging population-level data provide critical insight into the evolving demographics of TGCT, which may allow for elucidation of biologic and environmental determinants of TGCT. Further, identification of socioeconomic barriers to excellent clinical outcomes will allow for targeted interventions to patients with unique demographic and socioeconomic considerations. Treatment trend analyses suggest that the field is moving toward minimizing treatment-related morbidity.

Evidence of Racial Differences in Microvascular Function Among College-Aged Women

Microvascular dysfunction contributes to the development of hypertension and insulin resistance. The black population is at an elevated risk of both conditions relative to other racial groups. Previous studies indicate that college-aged black men, compared to their white counterparts, exhibit impaired microvascular function as assessed by post- occlusion reactive hyperemia (RH). It is unknown whether this racial disparity is present in healthy, young adult black (BW) and white women (WW). Furthermore, whether nitric oxide-mediated cutaneous microvascular hyperemia during local heating (LH) is different in these populations has not been determined. PURPOSE: The purpose of this study was to test the hypothesis that college-aged BW exhibit blunted RH and attenuated LH induced cutaneous hyperemia compared to age-matched WW. METHODS: College-aged BW (n=7) and WW (n=7) were studied during the early follicular phase of the menstrual cycle. For RH, brachial artery diameter and blood velocity were measured via Doppler ultrasound before and after 5 min of forearm occlusion. For LH, a microdialysis membrane was inserted in the dermis of the forearm and perfused with Ringer’s solution. Red blood cell flux was assessed with laser Doppler after ~40 min of continuous 39°C LH. Maximal flux was established with 28 mM sodium nitroprusside infusion and 43°C LH. Brachial BP was measured throughout the protocol and cutaneous vascular conductance (CVC) was calculated as flux / MAP and reported as % of max CVC. RESULTS: WW and BW were matched for age (21 ± 3 vs 20 ± 1 y, P = 0.58) and BMI (23 ± 2 vs 23 ± 3 kg/m2, P = 0.94). There were no differences between WW and BW in baseline blood velocity (23.1 ± 5.7 vs 24.4 ± 11.6 cm/s, P = 0.79) or blood flow (98.9 ± 38.3 vs 114.5 ± 80.7 ml/min, P = 0.65). WW and BW also had similar peak blood velocity (109.2 ± 13.8 vs 109.7 ± 28 cm/s, P = 0.97), peak blood flow (453.7 ± 164.7 vs 482.5 ± 187.7 ml/min, P = 0.77), and total blood flow AUC during the 120 s after cuff release (487.4 ± 178.5 vs 486.8 ± 190.1 ml, P = 0.99). However, compared to WW, BW had a significantly blunted CVC during 39°C LH (66 ± 17 vs 45 ± 10 %max, P = 0.02). CONCLUSIONS: BW had blunted blood flow responses to LH compared to WW despite similar blood velocity and flow responses during RH. This suggests that LH is more sensitive than RH to early impairments in microvascular function.

Ethnic disparities in the dietary requirement for vitamin D during pregnancy: considerations for nutrition policy and research.

Despite the inverse association between skin colour and efficiency of cutaneous vitamin D synthesis, in addition to the widely accepted racial disparity in vitamin D status, populations of ethnic minority are understudied in terms of setting target serum 25-hydroxyvitamin D concentrations and corresponding dietary requirements for vitamin D. In minority groups, prevention of vitamin D deficiency on a population basis is challenging due to the lack of clarity surrounding the metabolism and transport of vitamin D. Authoritative agencies have been unable to define pregnancy-specific dietary recommendations for vitamin D, owing to an absence of sufficient evidence to confirm whether nutritional requirements for vitamin D are altered during pregnancy. While the question of setting race- and pregnancy-specific dietary reference values for vitamin D has not been addressed to date, endemic vitamin D deficiency has been reported among gravidae worldwide, specifically among ethnic minorities and white women resident at high latitude. In light of the increased risk of nutritional rickets among infants of ethnic minority, coupled with growing evidence for potential non-skeletal roles of vitamin D in perinatal health, determination of the dietary vitamin D requirement that will prevent deficiency during pregnancy is a research priority. However, systematic approaches to establishing dietary requirements are limited by the quality of the available evidence and the under-representation of minority groups in clinical research. This review considers the evidence for racial differences in vitamin D status and response to vitamin D supplementation, with particular application to pregnancy-specific requirements among ethnic minorities resident at high latitudes.

A limited evaluation of the association of race and anesthetic medication administration: A single-center experience with appendectomies.

Although it is known that a patient's race may influence their medical care, racial patterns of medication administration in pediatric anesthesia have not been well-studied. The aim of this study was to determine if differences exist between Black and White children with regard to administration of anesthetic and analgesic medications for a single procedure at our institution. We conducted a retrospective review of medications administered to patients for emergency appendectomies at a large academic children's hospital from 2010 to 2015. We examined the association between patient race and administration of preoperative midazolam and intraoperative ondansetron, lidocaine, ketorolac, and weight-based doses of fentanyl and morphine. During the study period, 1680 patients (1329 White, 351 Black) underwent emergency appendectomy. There were no significant racial differences in administration of intraoperative anesthetic medications between Black and White children. In unadjusted analysis, Black children were less likely to receive preoperative midazolam than White children (OR=0.74 [95% CI, 0.58-0.94], P=.012). After adjusting for confounders, there was no evidence of racial differences in administration of preoperative or intraoperative medications. We did not find a significant difference in preoperative or intraoperative medication administration based on race when we adjusted for age, gender, and attending anesthesiologist practice patterns. We encourage all institutions to monitor their own practice patterns with regard to race.

Weight gain during pregnancy and the black-white disparity in preterm birth

PurposeTo quantify the relationship between pregnancy weight gain with early and late preterm birth and evaluate whether associations differed between non-Hispanic (NH) black and NH white women. MethodsWe analyzed a retrospective cohort of all live births to NH black and NH white women in the United States 2011–2015 (n = 10,714,983). We used weight gain z-scores in multiple logistic regression models stratified by prepregnancy body mass index (BMI) and race to calculate population attributable risk (PAR) percentages for the contribution of high and low pregnancy weight gain to early and late preterm birth. ResultsPregnancy weight gain was related to early and late preterm birth, but associations varied by BMI and race. For early preterm birth, the PAR percentage for high pregnancy weight gain ranged from 8 to 10% in NH black women and from 6 to 8% in NH white women. There was little evidence of racial differences in late preterm birth: PAR percentages ranged from 2 to 7% in NH black women and from 3 to 7% in NH white women. ConclusionsModerate gestational weight gain is associated with lower rate of preterm birth, with greatest reductions for early preterm birth in NH black women.

Differences in placental telomere length suggest a link between racial disparities in birth outcomes and cellular aging

Health disparities begin early in life and persist across the life course. Despite current efforts, black women exhibit greater risk for pregnancy complications and negative perinatal outcomes compared with white women. The placenta, which is a complex multi-tissue organ, serves as the primary transducer of bidirectional information between the mother and fetus. Altered placental function is linked to multiple racially disparate pregnancy complications; however, little is known about racial differences in molecular factors within the placenta. Several pregnancy complications, which include preeclampsia and fetal growth restriction, exhibit racial disparities and are associated with shorter placental telomere length, which is an indicator of cellular stress and aging. Cellular senescence and telomere dynamics are linked to the molecular mechanisms that are associated with the onset of labor and parturition. Further, racial differences in telomere length are found in a range of different peripheral tissues. Together these factors suggest that exploration of racial differences in telomere length of the placenta may provide novel mechanistic insight into racial disparities in birth outcomes. This study examined whether telomere length measured in 4 distinct fetally derived tissues were significantly different between black and white women. The study had 2 hypotheses: (1) that telomere length that is measured in different placental tissue types would be correlated and (2) that across all sampled tissues telomere length would differ by race. In a prospective study, placental tissue samples were collected from the amnion, chorion, villus, and umbilical cord from black and white singleton pregnancies (N=46). Telomere length was determined with the use of monochrome multiplex quantitative real-time polymerase chain reaction in each placental tissue. Demographic and pregnancy-related data were also collected. Descriptive statistics characterized the sample overall and among black and white women separately. The overall impact of race was assessed by multilevel mixed-effects linear regression models that included empirically relevant covariates. Telomere length was correlated significantly across all placental tissues. Pairwise analyses of placental tissue telomere length revealed significantly longer telomere length in the amnion compared with the chorion (t=-2.06; P=.043). Overall telomere length measured in placenta samples from black mothers were significantly shorter than those from white mothers (β=-0.09; P=.04). Controlling for relevant maternal and infant characteristics strengthened the significance of the observed racial differences (β=-0.12; P=.02). Within tissue analyses revealed that the greatest difference by race was found in chorionic telomere length (t=-2.81; P=.007). These findings provide the first evidence of racial differences in placental telomere length. Telomere length was significantly shorter in placental samples from black mothers compared with white mothers. Given previous studies that have reported that telomere length, cellular senescence, and telomere dynamics are molecular factors that contribute to the rupture of the amniotic sac, onset of labor, and parturition, our findings of shorter telomere length in placentas from black mothers suggest that accelerated cellular aging across placental tissues may be relevant to the increased risk of preterm delivery in black pregnancies. Our results suggest that racial differences in cellular aging in the placenta contribute to the earliest roots of health disparities.

Characterizing Analgesic Use during Air Medical Transport of Injured Children

Background. Pain management is an important aspect of emergency care for children suffering traumatic injuries. Objectives. The objectives of this study were to characterize analgesic administration to injured children during air medical transport, to describe factors associated with analgesic use, and to examine the effects of patient race on analgesia. Methods. We used electronic records for patients transported by a regional air medical transport agency. We retrospectively examined data from 2003–2012 for patients ≤15 years old suffering traumatic injuries. We used bivariable analyses to identify associations for multivariable logistic regression models to determine factors associated with our outcomes –documentation of pain score and analgesic administration. Results. Of 5,057 patients, the median age was 8 (IQR 3–12) years. The majority of patients were male (66%, 95% CI 64–66%), were white non-Hispanic (83%, 95% CI 82–84%), and had no pain score documented (61%, 95% CI 60–62%). While only 15% of patients received analgesics overall, 70% with an initial pain score ≥5 received analgesics. In unadjusted models, non-white race was associated with lower odds of having a pain score documented (OR 0.52, 95% CI 0.44–0.62) and receiving analgesics (OR 0.64, 95% CI 0.50–0.82). After adjusting for confounders, there was no evidence of racial differences in pain management. Multivariable analysis revealed that younger age, lack of intravenous access, higher Glasgow Coma Scale, systolic blood pressure <100, transportation from the scene, initial pain score <5, and not having a pain score documented were associated with lower odds of receiving analgesics. Conclusions. Few pediatric patients had pain scores documented and fewer received analgesics during air medical transport for injuries. Racial differences in analgesia seen in unadjusted analyses did not persist after controlling for confounders. Resources, training, and appropriate pain management protocols should be made available to facilitate pain assessment in children as a strategy for increasing appropriate analgesic use during transport.

DEPRESSION AND RELATIONAL HEALTH IN ASIAN AMERICAN AND EUROPEAN AMERICAN COLLEGE WOMEN

Research consistently demonstrates elevated rates of depression among college-aged women, yet evidence of racial differences in depression among this population are poorly understood. Moreover, the correlates of depression among Asian American women are also understudied. In this exploratory analysis, we examined mean differences in depression levels in a sample of Asian American (n = 117) and European American (n = 257) students from a women's liberal arts college. We also estimated associations between depression and relational health in three types of relationships (mentor, friend, and college community) using ordinary least squares regression. Relational health was examined as a buffer (i.e., moderator) against depression. Results indicated no differences in depression levels between Asian American and European American women. Relationships with the college community were associated with lower levels of depression in both groups of women. Limited evidence suggested that relational health served as a buffer. Results are discussed in light of interventions for college campuses.

An Examination of Racial Differences in Process and Outcome of Colorectal Cancer Care Quality Among Users of the Veterans Affairs Health Care System

BackgroundVeterans Affairs (VA) manages the largest US integrated health care system. Although quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of research examining racial differences in this care. This study examines racial differences in 2 dimensions of quality of VA CRC care: processes (time to treatment) and outcomes (survival). Patients and MethodsRetrospective data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Study patients were white and African American men diagnosed with nonmetastatic CRC between 2003 and 2006 who received definitive CRC surgery. We examined 3 quality indicators: time from (1) surgery to initiation of adjuvant chemotherapy (stages II-III disease), (2) surgery to surveillance colonoscopy (stages I-III disease), and (3) surgery to death (stages I-III disease). Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models. ResultsIn unadjusted analyses, there was no evidence of racial differences across the 3 quality measures. In adjusted Cox regression, there were no racial differences in time to initiation of chemotherapy (hazard ratio [HR], 0.82; P = .61) or surgery to death (HR, 0.94; P = .49). In adjusted Cox regression, among those receiving colonoscopy within 7 to 18 months after surgery, white patients experienced slightly shorter median times to surveillance colonoscopy than did African American patients (367 vs. 383 days; HR, 0.63; P = .02). ConclusionOther than a small racial difference in timing of surveillance colonoscopy, there was little evidence of racial differences in quality of CRC care among VA health care system users.

Race and Colon Cancer Survival in an Equal-Access Health Care System

Studies have shown that Whites have a higher colorectal cancer survival rate than Blacks. However, it is unclear whether racial disparities result from unequal access to medical care or factors other than health care access or both. This study assessed whether non-Hispanic Whites (NHW) and non-Hispanic Blacks (NHB) differ in colon cancer survival in an equal-access health care system and examined whether racial differences varied by demographic and tumor characteristics. The study included 2,537 Military Health System patients diagnosed with colon cancer between 1998 and 2007. Median follow-up time was 31.4 months. Cox models estimated HRs and 95% confidence intervals (CI) for race, overall and stratified by age at diagnosis, sex, and tumor stage. No difference in overall survival (OS) between NHWs and NHBs was observed in general. However, among patients younger than 50 years old, NHBs experienced significantly worse OS than NHWs (HR: 2.03, 95% CI: 1.30-3.19). Furthermore, stratification by sex and tumor stage showed that this racial disparity was confined to women (HR: 2.87; 95% CI: 1.35-6.11) and patients with distant stage disease (HR: 2.45; 95% CI: 1.15-5.22) in this age group. When medical care is equally available to NHWs and NHBs, similar overall colon cancer survival was observed; however, evidence of racial differences in survival was apparent for patients younger than 50 years old. This study suggests that factors other than access to care may be related to racial disparities in colon cancer survival among younger, but not older, patients.

Big and beautiful? Evidence of racial differences in the perceived attractiveness of obese females

This paper investigates the relationships between body weight, race, and attractiveness in appearance and personality among adolescents. We study a sample of 5947 (non-Hispanic) white and black girls age 12 to 18 who were interviewed by a group of 338 interviewers. We find that overweight and obese white female adolescents are, respectively, 23% and 40% less likely, on average, to be perceived as physically attractive compared to normal-weight white girls. The physical appearance penalties are significantly smaller for overweight and obese black girls compared to white girls. These findings suggest that being overweight or obese is costly due to its negative impact on inner and outer perceived beauty, providing an explanation for the observed stigmatization of overweight and obesity among women in labor and relationship markets. The smaller beauty penalties for black girls above the normal-weight range suggest that the range of body sizes considered attractive may be wider for black females.

Atrial Electrical and Structural Remodeling: Implications for Racial Differences in Atrial Fibrillation

Racial Disparity in AF Electrophysiology. Racial differences in prevalence and incidence rates of atrial fibrillation (AF) are known to exist even after accounting for ascertainment bias, as well as differences in the prevalence of known risk factors. Thus, a different susceptibility to traditional risk factors in different ethnic groups that lead to AF clearly exists. Initiation and maintenance of AF are dependent on triggers, autonomic influence and atrial substrate, and progression to persistent AF occurs by electromechanical remodeling. Genetic differences among the racial group contribute to such differences. This article reviews the electrophysiologic mechanisms for AF, evidence for racial differences in susceptibility to AF, and suggests possible electromechanical reasons for the susceptibility.

Progression of Coronary Artery Calcification in Black and White Women: Do the Stresses and Rewards of Multiple Roles Matter?

Black women experience higher rates of cardiovascular disease (CVD) than white women, though evidence for racial differences in subclinical CVD is mixed. Few studies have examined multiple roles (number, perceived stress, and/or reward) in relation to subclinical CVD, or whether those effects differ by race. The aim of this study was to investigate the effects of multiple roles on 2-year progression of coronary artery calcium. Subjects were 104 black and 232 white women (mean age 50.8years). Stress and reward from four roles (spouse, parent, employee, caregiver) were assessed on five-point scales. Coronary artery calcium progression was defined as an increase of ≥10Agatston units. White women reported higher rewards from their multiple roles than black women, yet black women showed cardiovascular benefits from role rewards. Among black women only, higher role rewards were related significantly to lower progression of coronary artery calcium, adjusting for body mass index, blood pressure, and other known CVD risk factors. Blacks reported fewer roles but similar role stress as whites; role number and stress were unrelated to coronary artery calcium progression. Rewarding roles may be a novel protective psychosocial factor for progression of coronary calcium among black women.

A CRITICAL REVIEW OF RICHARD LYNN'S REPORTS ON REACTION TIME AND RACE

In the early 1990s, psychologist Richard Lynn published papers documenting average reaction times and decision times in samples of nine-year-olds taken from across the world. After summarizing these data, Lynn interpreted his results as evidence of national and racial differences in decision time and general intelligence. Others have also interpreted Lynn's data as evidence of racial differences in decision time and intelligence. However, comparing Lynn's summaries with his original reports shows that Lynn misreported and omitted some of his own data. Once these errors are fixed the rankings of nations in Lynn's datasets are unstable across different decision time measures. This instability, as well as within-race heterogeneity and between-race overlap in decision times, implies that Lynn's reaction time data do not permit generalizations about the decision times and intelligence of people of different races.