General Black Population Research Articles

Kidney Disease Progression in Membranous Nephropathy among Black Participants with High-Risk APOL1 Genotype.

Disparity in CKD progression among Black individuals persists in glomerular diseases. Genetic variants in the apolipoprotein L1 ( APOL1 ) gene in the Black population contribute to kidney disease, but the influence in membranous nephropathy remains unknown. Longitudinally followed participants enrolled in the Glomerular Disease Collaborative Network or Cure Glomerulonephropathy Network were included if they had DNA or genotyping available for APOL1 (Black participants with membranous nephropathy) or had membranous nephropathy but were not Black. eGFR slopes were estimated using linear mixed-effects models with random effects and adjusting for covariates and interaction terms of covariates. Fisher exact test, Kruskal-Wallis test, and Kaplan-Meier curves with log-rank tests were used to compare groups. Among 118 Black membranous nephropathy participants, 16 (14%) had high-risk APOL1 genotype (two risk alleles) and 102 (86%) had low-risk APOL1 genotype (zero or one risk alleles, n =53 and n =49, respectively). High-risk APOL1 membranous nephropathy participants were notably younger at disease onset than low-risk APOL1 and membranous nephropathy participants that were not Black ( n =572). eGFR at disease onset was not different between groups, although eGFR decline (slope) was steeper in participants with high-risk APOL1 genotype (-16±2 [±SE] ml/min per 1.73 m 2 per year) compared with low-risk APOL1 genotype (-4±0.8 ml/min per 1.73 m 2 per year) or membranous nephropathy participants that did not identify themselves as Black (-2.0±0.4 ml/min per 1.73 m 2 per year) ( P <0.0001). Time to kidney failure was faster in the high-risk APOL1 genotype than low-risk APOL1 genotype or membranous nephropathy participants that were not Black. The prevalence of high-risk APOL1 variant among Black membranous nephropathy participants is comparable with the general Black population (10%-15%), yet the high-risk genotype was associated with worse eGFR decline and faster time to kidney failure compared with low-risk genotype and participants that were not Black.

Perceptions of white UOF students with regard to the general black population

A central leque ini Intercultural interaction is the phenomenon of per ception. Perception Influences the understanding and Interpretation of events. In order to succeed in Inter cultural Interaction it is necessary to develop an understanding and ap preciation of perceptual differences. The purpose of this study was to examine the perceptions that a sec tion of white UOFS students have of the general black population. To reach this objective, a literature study was undertaken in order to es tablish a clear understanding of per ception and the related concepts. Such concepts included race, cul ture, attitude, prejudice and stereo type. The study concentrated on the Interrelations between these con cepts as well as on the effects of these concepts on the formation of an Individual's perceptions. Through statistical analysis the following considerations were also ad dressed: Whether or not any correlations exist between the perceptions of the respondents. Whether male and female re spondents differ with regard to their political orientations. Whether there are any differences and/or similarities in the perceptions of male and female respondents. • The Identification of specific fac tors in order to determine their contribution toward specific perceptions

An Introduction to Structural Competency for Haitian-Identified Patients: History, Culture, and Access to Care.

IntroductionThe Haitian population within the US represents the largest diaspora outside of Haiti, with most Haitians residing in major urban communities. Despite clear differences in health outcomes specific to Haitians, the community has traditionally been aggregated into the general Black population. To address specific health disparities, this workshop was designed to distinguish and elaborate on the health care problems affecting Haitians.MethodsWe created an interactive 60-minute workshop including a PowerPoint presentation, two case presentations, and a 5-minute informational video to bring awareness of the historical perspectives impacting Haitian/Haitian American health, access to care, and health care disparities to providers. Knowledge was assessed by pre- and postworkshop evaluation forms. The module was aimed at health care professional learners.ResultsSeventy-four people with diverse ethnoracial identities, including medical students, residents, academic faculty, physicians, nonmedical graduate students, and health care staff and administrators, attended three workshops. All learning objectives were met, with pre- and postworkshop data indicating a statistically significant increase in participants’ reported confidence. Workshop attendees commented positively on the group discussion component, the workshop's interactive nature, the opportunity to apply taught knowledge to case presentations, and the historical context provided.DiscussionAs the number of Haitian immigrants continues to rise throughout US urban communities, providers must increase their culture competency in training and delivery to improve care for a major population. This module can help better prepare health care providers and trainees to offer competent care to Haitian/Haitian American patients.

Risk of Pregnancy-Related Venous Thromboembolism in Black Women with Sickle Cell Trait

Background: Select inherited thrombophilias have been shown to potentiate the risk of venous thromboembolism (VTE) during pregnancy and the post-partum period. Sickle cell trait (SCT) is associated with an increased risk of VTE in the general Black population; however, prior studies investigating the risk of pregnancy-related VTE among women with SCT have been limited by an overall low number of VTE events. We, therefore, designed a retrospective cohort enriched for pregnancy-related VTE events among Black women at Johns Hopkins Hospital to address this question.Methods: We generated a cohort enriched for pregnancy-related VTE at Johns Hopkins or affiliate hospitals from 2009-2019 by using EPIC and an internal ObGyn database to identify Black women ≥18 years with at least 1 pregnancy encounter in addition to at least 1 VTE-related ICD-10 diagnosis code or comprehensive VTE-related search term. All charts were manually reviewed to confirm hemoglobinopathy status and to verify the presence or absence of a VTE event during pregnancy or 6 weeks post-partum. Individuals with sickle cell disease, history of VTE prior to index pregnancy, catheter-related or superficial vein thrombosis only, or unknown pregnancy VTE outcome were excluded.Results: A total of 418 women were included for analysis. The mean age at pregnancy was 30 years (range 18-48), and the prevalence of SCT was 6.7%, which is similar to the prevalence in the general Black American population. Thirty-seven women (8.9%) were confirmed to have a pregnancy-related VTE event. Among those with VTE, SCT carriers demonstrated a higher proportion of pulmonary embolism (PE), unusual vein thrombosis, and antepartum VTE events compared to women with HbAA (Table 1), though numbers were small. After adjusting for age, the risk of VTE was 2.9-fold (95% CI 1.1-7.9) higher among pregnant Black women with SCT compared to those without.Conclusions: In this enriched cohort, SCT was associated with an increased risk of pregnancy-related VTE among Black women. The pattern of pregnancy-related VTE was different in individuals with SCT compared to those with HbAA, with SCT demonstrating a higher proportion of PE and antepartum events. The higher risk of PE compared to isolated DVT is similar to the pattern observed in prior population-based studies of SCT. Because the prevalence of SCT is high and the overall risk of VTE in pregnancy is low, future studies are needed to determine whether routine thromboprophylaxis is warranted for select high-risk pregnant women with SCT. [Display omitted] DisclosuresLanzkron: Novartis: Research Funding; CSL Behring: Research Funding; Shire: Research Funding; Novo Nordisk: Consultancy; Imara: Research Funding; Bluebird Bio: Consultancy; Pfizer: Current holder of individual stocks in a privately-held company; Teva: Current holder of individual stocks in a privately-held company; GBT: Research Funding. Naik: Rigel: Research Funding.

Hospitalization and Case Fatality in Individuals with Sickle Cell Disease and COVID-19 Infection

Sickle cell disease (SCD) is an inherited hemoglobinopathy that can affect nearly every organ system. Individuals living with SCD are at high risk of developing serious infections which can further trigger disease related complications and attribute additional morbidity and mortality. In light of the evolving pandemic caused by SARS-CoV-2, the causative agent of COVID-19 disease, and the potential for future infectious disease epidemics, it is important to understand the impact that COVID-19 has on hospitalization rates and mortality in this medically vulnerable population. The objective of this study was to describe hospitalization and case fatality rates secondary to COVID-19 among individuals living with SCD in different age groups and compare these to the general population.The Medical College of Wisconsin established the international SECURE-SCD Registry to collect data on pediatric and adult COVID-19 infections in individuals living with SCD. Providers are instructed to report confirmed COVID-19 cases to the registry after sufficient time has passed to observe the disease course through resolution of acute illness and/or death. For each case, providers complete a short form that includes the following data: patient demographics, COVID-19 related hospitalization, COVID-19 severity/management strategies, if the patient died due to COVID, and other information about SCD complications. Data are de-identified and without protected health information to facilitate rapid and increased reporting. We calculated the hospitalization rate and case fatality rate for individuals with SCD by specific age group and contrasted it with the rates publicly available for the general Black population. We utilized data from California Department of Public Health for case fatality rate comparison in Blacks and data from COVID-NET for hospitalization rate comparison. We used indirect age adjustment to calculate standardized mortality ratios using COVID-19 data from California state as the reference population.As of July 17th 2020, 218 cases of COVID-19 in Blacks with SCD in the US were reported to the registry. There was a slight predominance of females (52.8%) and 32.1% of reported cases were patients 18 years and under. There were 15 deaths reported with overall mortality rate of 6.9%. Figure 1 shows the distribution of cases and deaths by age group and gender. Mortality rate in SCD patients was highest in the 50-64 years age group (23.1%) in contrast to mortality rate peaks seen in the general population in patients older than 80 years (Table 1). Young adult SCD patients aged 18-34 years had a case fatality rate of 3.3% and those aged 34-50 years had a rate of 14.9%. California Department of Public Health report case fatality rates for Blacks are less than 1% in both of these comparative age groups. Age-standardized mortality ratio shows that individuals with SCD are 7.7 times more likely to die due to COVID-19 infection compared to the general population. The overall hospitalization rate in individuals with SCD was 72.5% and 18.8% of reported hospitalized cases were children. Among hospitalized adults with SCD, stratification by age showed that 85% were aged 18-49, whereas only 25.7% of people 18-49 years in the general Black population were hospitalized (Table 2).Our findings show that individuals with SCD who have COVID-19 infection have higher rates of death due to COVID-19 than the general Black population. Also, a large proportion of COVID hospitalization for the SCD population occurs among the younger age group. Further analysis is planned to examine effects of underlying comorbidities and prior SCD-associated complications on the severity of COVID-19 in individuals with SCD.DisclosuresMucalo:NIH/NHLBI: Research Funding; NIH/NINDS: Research Funding. Brandow:Greater Milwaukee Foundation: Research Funding; NIH / NHLBI: Research Funding. Panepinto:HRSA: Research Funding; NINDS: Research Funding; NINDS: Research Funding; NHLBI: Research Funding.

Coinheritance of sickle cell anemia and α‐thalassemia delays disease onset and could improve survival in cameroonian's patients (Sub‐Saharan Africa)

Coinheritance of sickle cell anemia and α‐thalassemia delays disease onset and could improve survival in cameroonian's patients (Sub‐Saharan Africa)

The Paradox of Risk: Historically Black College/University Students and Sexual Health

Objective: This literature review provides an analysis of the current state of the empirical research on sexual health among students attending historically black colleges and universities (HBCUs). Methods: Several electronic databases were used to identify 24 empirical studies that met criteria for inclusion in this review. Results: The results indicated that perceived human immunodeficiency virus (HIV) risk, religiosity, HIV testing, condom use, and substance use were as high or higher for black HBCU students in comparison with students of other racial/ethnic groups. Comment: Consistent with past findings, sexually transmitted infections continue to be of concern among HBCU students, as seen in the general black population. Limitations: This review only examined cross-sectional studies published between 2000 and 2013. Conclusions: The findings in this review suggest the importance of moving beyond individual risk models to examining structural barriers and assets related to promoting sexual health on HBCU campuses.

Seeking Help from Clergy Among Black Caribbeans in the United States

This study examined use of clergy for serious personal problems within a representative sample of US black Caribbean adults from the National Survey of American Life. Logistic regression analysis was used and confirmed the importance of problem type, church involvement, and nativity as correlates of clergy use. Findings for black Caribbeans indicate similarities, as well as important departures from prior research on the correlates of clergy assistance among African Americans. These and other findings confirm the position of black Caribbeans as a distinctive ethnic subgroup within the general black population in the United States.

Carotid artery calcification in the black population: a retrospective study on panoramic radiographs.

To determine the prevalence of carotid artery calcification on panoramic radiographs in the Black population. Panoramic radiographs of 700 adult male and female Black dental outpatients from the Medical Center of Louisiana Charity Hospital were examined for any unusual radiopacity adjacent to or just below the intervertebral space between C3 and C4. Three (0.43%) of the 700 patients, with ages ranging from 46 - 77-years-old, had one or more unusual radiopacities in the region of interest. All three were female. It is uncommon to find radiopacities adjacent to or just below the intervertebral space between C3 and C4 in the general Black population.

HLA-A, -B, -C, -DRB1, DRB3, DRB4, DRB5 and DQB1 Polymorphism Detected by PCR-SSP in a Semi-Urban HIV-Positive Ugandan Population

PCR-SSP was used to HLA-type a cohort of Ugandan HIV-positive individuals. The results represent a more comprehensive description of HLA in an African population than previously described and are in concordance with data from a general Black population. Substantial differences exist between this population and Caucasoid populations in which immunological responses to HIV have been investigated; this emphasises that the main HLA-restrictive elements for HIV-specific cytotoxic T lymphocytes will most likely be different for each population.

Anorexia nervosa and bulimia nervosa in British blacks.

Thirteen black patients were referred over 5 years to the eating-disorders unit at the Maudsley Hospital. Two suffered from anorexia nervosa and 11 from bulimia nervosa. This group was compared with a matched white control group from the total clinic population during that period. The Blacks had more commonly experienced parental divorce or separation, and premorbid obesity, and were more likely to be referred by the emergency services. Their lower educational achievements, and fathers of lower socio-economic status, reflected variation among the general black and white populations in this country, but their educational levels and social statuses were higher than in the general black population.

Dense cells in sickle cell anemia: the effects of gene interaction

In an attempt to uncover potential genetic sources of the clinical diversity of sickle cell anemia, we have characterized homozygous SS patients in the following ways: percentage of dense red blood cells (% F4) as determined from Percoll-Stractan continuous density gradients, alpha gene deletion, average percentage of hemoglobin F (% HbF), hemoglobin in g/dL, age, and sex. We find that alpha 4 individuals have a higher % F4 (mean 24% +/- 15%) than alpha 3 individuals (mean 12% +/- 8%) (P less than .005). Multivariate analysis demonstrated a significant correlation among % F4 levels and alpha-gene number and % HbF, and an interaction between the last two variables. The other variables considered did not significantly alter this model. As reported before, with fewer samples, we find that in the first ten years of life of SS individuals, the frequency of alpha gene deletion is 17%, which is comparable to that in the general black population, while in the group over 20 years of age, the frequency rises to 49%, implying that alpha thalassemia is associated with longer survival. These results indicate that it is necessary to consider sickle cell anemia not only as a single gene defect, but also as a disease whose clinical expression is the result of a group of genes capable of interacting at the phenotypic level.

Dense Cells in Sickle Cell Anemia: The Effects of Gene Interaction

In an attempt to uncover potential genetic sources of the clinical diversity of sickle cell anemia, we have characterized homozygous SS patients in the following ways: percentage of dense red blood cells (% F4) as determined from Percoll-Stractan continuous density gradients, alpha gene deletion, average percentage of hemoglobin F (% HbF), hemoglobin in g/dL, age, and sex. We find that alpha 4 individuals have a higher % F4 (mean 24% +/- 15%) than alpha 3 individuals (mean 12% +/- 8%) (P less than .005). Multivariate analysis demonstrated a significant correlation among % F4 levels and alpha-gene number and % HbF, and an interaction between the last two variables. The other variables considered did not significantly alter this model. As reported before, with fewer samples, we find that in the first ten years of life of SS individuals, the frequency of alpha gene deletion is 17%, which is comparable to that in the general black population, while in the group over 20 years of age, the frequency rises to 49%, implying that alpha thalassemia is associated with longer survival. These results indicate that it is necessary to consider sickle cell anemia not only as a single gene defect, but also as a disease whose clinical expression is the result of a group of genes capable of interacting at the phenotypic level.

Brain infarction risk factors in Black New York city stroke patients

Of 527 consecutive stroke patients at Harlem Hospital, 22 per cent had had a previous stroke; 57 per cent had hypertension; 28 per cent had diabetes mellitus; 24 per cent had advanced heart disease; 18 per cent had none of these conditions identified. These proportions match those from white series, except for the low prevalence of heart disease, which was recorded only in clinically symptomatic stages. When the series was divided in half by age, diabetes, heart disease and previous stroke were each more common in patients 65 and older. Hypertension was significantly ( p < 0.02) less frequent. The Health Examination Survey estimated that 52 per cent of Blacks aged 65–74 and 60 per cent of those aged 75–79 are hypertensive. In Harlem stroke patients, by contrast, the prevalence of hypertension at ages 65–74 was 48 per cent. It fell to 37 per cent for ages 75 and over. In more aged patients, hypertension seemed to be less common than estimates for the general black population would predict. In this population, hypertension beyond age 65 may not be associated with the increased risk of stroke it carries earlier.