Outcomes In African Americans Research Articles

The relation of digital vascular function to cardiovascular risk factors in African-Americans using digital tonometry: the Jackson Heart Study

Digital vascular tone and function, as measured by peripheral arterial tonometry (PAT), are associated with cardiovascular risk and events in non-Hispanic whites. There are limited data on relations between PAT and cardiovascular risk in African-Americans. PAT was performed on a subset of Jackson Heart Study participants using a fingertip tonometry device. Resting digital vascular tone was assessed as baseline pulse amplitude. Hyperemic vascular response to 5 minutes of ischemia was expressed as the PAT ratio (hyperemic/baseline amplitude ratio). Peripheral augmentation index (AI), a measure of relative wave reflection, also was estimated. The association of baseline pulse amplitude (PA), PAT ratio, and AI to risk factors was assessed using stepwise multivariable models. The study sample consisted of 837 participants from the Jackson Heart Study (mean age, 54 ± 11 years; 61% women). In stepwise multivariable regression models, baseline pulse amplitude was related to male sex, body mass index, and diastolic blood pressure (BP), accounting for 16% of the total variability of the baseline pulse amplitude. Age, male sex, systolic BP, diastolic BP, antihypertensive medication, and prevalent cardiovascular disease contributed to 11% of the total variability of the PAT ratio. Risk factors (primarily age, sex, and heart rate) explained 47% of the total variability of the AI. We confirmed in our cohort of African-Americans, a significant relation between digital vascular tone and function measured by PAT and multiple traditional cardiovascular risk factors. Further studies are warranted to investigate the utility of these measurements in predicting clinical outcomes in African-Americans.

Perceived Discrimination and Cardiovascular Outcomes in Older African Americans: Insights From the Jackson Heart Study

ObjectiveTo assess the associations of perceived discrimination and cardiovascular (CV) outcomes in African Americans (AAs) in the Jackson Heart Study. Patients and MethodsIn 5085 AAs free of clinical CV disease at baseline enrolled in the Jackson Heart Study from September 26, 2000, through March 31, 2004, and followed through 2012, associations of everyday discrimination (frequency of occurrences of perceived unfair treatment) and lifetime discrimination (perceived unfair treatment in 9 life domains) with CV outcomes (all-cause mortality, incident coronary heart disease [CHD], incident stroke, and heart failure [HF] hospitalization) were examined using Cox proportional hazards regression models. ResultsHigher levels of everyday and lifetime discrimination were more common in participants who were younger and male and had higher education and income, lower perceived standing in the community, worse perceived health care access, and fewer comorbidities. Before adjustment, higher levels of everyday and lifetime discrimination were associated with a lower risk of all-cause mortality, incident CHD, stroke, and HF hospitalization. After adjustment for potential confounders, we found no association of everyday and lifetime discrimination with incident CHD, incident stroke, or HF hospitalization; however, a decrease in all-cause mortality with progressively higher levels of everyday discrimination persisted (hazard ratio per point increase in discrimination measure, 0.90; 95% CI, 0.82-0.99; P=.02). The unexpected association of everyday discrimination and all-cause mortality was partially mediated by perceived stress. ConclusionWe found no independent association of perceived discrimination with risk of incident CV disease or HF hospitalization in this AA population. An observed paradoxical negative association of everyday discrimination and all-cause mortality was partially mediated by perceived stress.

Abstract P5-10-02: African Americans have more aggressive invasive lobular carcinoma subtypes and inferior early outcomes: SEER 2010-2013

Abstract Introduction: African Americans (AA) present more frequently with triple negative breast cancer (TN) and other aggressive breast cancer subtypes. Invasive lobular (ILC) breast cancer most commonly presents as estrogen receptor (ER)+, progesterone receptor (PR)+ and HER2-, though less frequently the more aggressive ER- or PR- luminal, TN or HER2+ subtypes occur. For women presenting with ILC 2010-2013, we report by race, differences in disease subtype, grade and stage at presentation and 2-year outcomes. Methods: We conducted a retrospective cohort analysis using Surveillance, Epidemiology and End Results Program. Women diagnosed with first primary malignant lobular breast cancer from 2010-2013 were included. Subtypes were categorized into four exclusive groups: ER+ and PR+ HER2-, ER+ or PR+ HER2-, TN and HER2+. Two-year survival was compared across race, and a multivariate cox model assessed overall survival. Results: ILC occurred less frequently in non-whites (Table 1). AA and other non-whites were younger at diagnosis than whites (p<0.001). AAs and other non-whites were less likely to have ER+ and PR+ HER2- disease (OR 0.85, p= 0.019 and OR 0.79, p=0.003 respectively). AAs had ILC of significantly higher grade and presented with more advanced stage disease than other race categories (p<0.001 for both). On multivariate analysis, survival was inferior for AA relative to whites (HR 1.32, p<0.010). Other non-whites had better survival than whites (HR 0.58, p=0.008). For AAs 2-year survival by disease subtype was: ER+ and PR+ HER2- (91.3%), ER+ or PR+ HER2- (90.5%), TN (59.5%), HER2+ (84.0%). For these subtypes, the proportion of women presenting with Stage IV ILC was 8.1%, 10.8%, 22.6% and 15.9% respectively. Conclusion: In this large, recent ILC cohort there were significant racial disparities in disease biology at presentation, with non-whites having more aggressive ILC subtypes, but only AAs having higher grade ILC. Short-term survival outcomes were inferior for AAs. Whether AAs presenting with advanced stage disease more frequently is due to biology or access to care is unknown. Further study of disease biology and healthcare delivery disparities could offer improved outcomes for AAs with ILC. Table 1: ILC Characteristics by Race WhiteAA Other non-white N13,5571,445 957 ILC - % diagnoses per race category9.67.2 5.8 Rate of ILC (per 100,000 women of that race)10.56.4 4.4 Median Age6461 60 %%OR*p%OR*pSubtype ER+ and PR+ HER2-80.978.30.850.01977.00.790.003ER+ or PR+ HER2-12.914.41.140.10615.31.220.036TN1.52.11.440.0642.11.400.158HER2+4.75.11.090.4735.61.210.186Stage I40.536.4 39.0 <0.001II36.534.5 40.4 III17.019.9 14.9 IV6.09.2 5.6 Grade (Differentiation) Well or Moderate91.287.5 89.5 <0.001Poor or Undifferentiated8.812.5 10.5 2-year survival93.9%90.0% 96.3% *compared to white (reference group) Table 2: Multivariate Cox Model for 2-year Survival HRp95% CIRace Whiteref AA1.320.0101.071.64Other non-white0.580.0080.380.87Subtype ER+ and PR+ HER2-ref ER+ or PR+ HER2-1.80<0.0011.512.16TN2.89<0.0012.074.03HER2+0.970.8670.691.37Stage Iref II1.91<0.0011.512.42III3.44<0.0012.714.37IV22.34<0.00117.7828.07Grade (Differentiation) Well or Moderateref Poor or Undifferentiated1.400.0011.141.71 Citation Format: Thomas A, Altekruse S, Avery TP, Melin SA, Howard-McNatt MM, Schroeder MC. African Americans have more aggressive invasive lobular carcinoma subtypes and inferior early outcomes: SEER 2010-2013 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-02.

Cultural adaptations to augment health and mental health services: a systematic review

BackgroundMembership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery.MethodsMEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients.ResultsThirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider’s behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group.ConclusionsConceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others.

A decade of improved access to screening is associated with fewer colorectal cancer deaths in African Americans: a single-center retrospective study.

BackgroundControversy exists as to whether disparities in colorectal cancer (CRC) outcomes in African Americans (AAs) are best resolved by screening at age 45 or by proper use of existing guidelines. In 2004, an aggressive colonoscopy-based CRC screening program was implemented throughout New York City. Our goal was to determine the effect of that program on CRC outcomes in our mostly AA population.MethodsCRC cases entered into Harlem Hospital’s tumor registry from January 1992 to December 2011 were divided into two cohorts: 1992-2003, the pre-intensive screening era (PSE), and 2004-2011, the intensive screening era (ISE). Each cohort was reviewed for demographics, indication for colonoscopy, tumor location, tumor stage, and mortality. Multivariate analysis was applied to the pooled cohorts to determine factors associated with survival.ResultsInclusion criteria were met by 379 patients: 207 PSE and 172 ISE. Racial distribution, gender, age at presentation, and tumor location were not different during the two eras. Over 75% of patients were AA. During the ISE, 84% were insured compared to 34% in the PSE (P<0.0001). Fewer patients died during the ISE (21%) than during the PSE (67%) (P<0.0001). The ISE patients were diagnosed with earlier stages of CRC compared to the PSE. Increased survival was associated with being insured (hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.30-2.81), distal tumors (HR 1.43, 95%CI 1.05-1.95), and being female (HR 1.36, 95%CI 1.01-1.850).ConclusionsA multifaceted program reduced CRC outcome disparities in a poor AA community. Aggressive implementation of current colonoscopy screening guidelines still has unrealized potential to reduce CRC mortality disparities in AAs.

Pain coping skills training for African Americans with osteoarthritis (STAART): study protocol of a randomized controlled trial.

BackgroundAfrican Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Americans in the development and evaluation of behavioral interventions for management of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA.Methods/DesignThis is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models will be used to compare the pain CST group to the WL control group and explore whether participant characteristics are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System.DiscussionThis culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities.Trial registrationClinicalTrials.gov, NCT02560922, registered 9/22/2015.

Why We Must Continue to Investigate Menthol's Role in the African American Smoking Paradox.

The disproportionate burden of tobacco use among African Americans is largely unexplained. The unexplained disparities, referred to as the African American smoking paradox, includes several phenomena. Despite their social disadvantage, African American youth have lower smoking prevalence rates, initiate smoking at older ages, and during adulthood, smoking rates are comparable to whites. Smoking frequency and intensity among African American youth and adults are lower compared to whites and American Indian and Alaska Natives, but tobacco-caused morbidity and mortality rates are disproportionately higher. Disease prediction models have not explained disease causal pathways in African Americans. It has been hypothesized that menthol cigarette smoking, which is disproportionately high among African Americans, may help to explain several components of the African American smoking paradox. This article provides an overview of the potential role that menthol plays in the African American smoking paradox. We also discuss the research needed to better understand this unresolved puzzle. We examined prior synthesis reports and reviewed the literature in PubMed on the menthol compound and menthol cigarette smoking in African Americans. The pharmacological and physiological effects of menthol and their interaction with biological and genetic factors may indirectly contribute to the disproportionate burden of cigarette use and diseases among African Americans. Future studies that examine taste sensitivity, the menthol compound, and their effects on smoking and chronic disease would provide valuable information on how to reduce the tobacco burden among African Americans. Our study highlights four counterintuitive observations related to the smoking risk profiles and chronic disease outcomes among African Americans. The extant literature provides strong evidence of their existence and shows that long-standing paradoxes have been largely unaffected by changes in the social environment. African Americans smoke menthols disproportionately, and menthol's role in the African American smoking paradox has not been thoroughly explored. We propose discrete hypotheses that will help to explain the phenomena and encourage researchers to empirically test menthol's role in smoking initiation, transitions to regular smoking and chronic disease outcomes in African Americans.

Racial Differences in Outcomes of an Advance Care Planning Intervention for Dialysis Patients and Their Surrogates.

African Americans' beliefs about end-of-life care may differ from those of whites, but racial differences in advance care planning (ACP) outcomes are unknown. The aim of this study was to compare the efficacy of an ACP intervention on preparation for end-of-life decision making and post-bereavement outcomes for African Americans and whites on dialysis. A secondary analysis of data from a randomized trial comparing an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) with usual care was conducted. There were 420 participants, 210 patient-surrogate dyads (67.4% African Americans), recruited from 20 dialysis centers in North Carolina. The outcomes of preparation for end-of-life decision making included dyad congruence on goals of care, surrogate decision-making confidence, a composite of the two, and patient decisional conflict assessed at 2, 6, and 12 months post-intervention. Surrogate bereavement outcomes included anxiety, depression, and post-traumatic distress symptoms assessed at 2 weeks, and at 3 and 6 months after the patient's death. SPIRIT was superior to usual care in improving dyad congruence (odds ration [OR] = 2.31, p = 0.018), surrogate decision-making confidence (β = 0.18, p = 0.021), and the composite (OR = 2.19, p = 0.028) 2 months post-intervention, but only for African Americans. SPIRIT reduced patient decisional conflict at 6 months for whites and at 12 months for African Americans. Finally, SPIRIT was superior to usual care in reducing surrogates' bereavement depressive symptoms for African Americans but not for whites (β = -3.49, p = 0.003). SPIRIT was effective in improving preparation for end-of-life decision-making and post-bereavement outcomes in African Americans.

Disparities in Outcomes for African Americans and Whites Undergoing Total Knee Arthroplasty: A Systematic Literature Review.

African Americans in the United States undergo total knee arthroplasty (TKA) less often than whites, in part because of lower expectations among African Americans for successful surgery. Whether this lower expectation is justified is unknown. Our objective is to compare health-related quality of life (HRQOL) and satisfaction after TKA between African Americans and whites. A systematic review of English language articles using Medline, the Cochrane register, Embase (April 21, 2015), and a hand search of unlisted disparities journals was performed. Search terms included total knee replacement, quality of life, outcomes, and satisfaction. High-quality cohort studies that examined HRQOL in African Americans and white adults 6 months or more after TKA were included. Of the 4781 studies screened by title, and 346 by abstract, 7 studies included race in their analysis. Results included 5570 TKA patients, 4077 whites (89%), and 482 (11%) blacks. Because studies used different outcome measures and were inconsistent in their adjustment for confounders, we could not perform a quantitative synthesis of results. In 5 studies, US blacks had worse pain, in 5 worse function, and in 1 less satisfaction 6 months to 2 years after TKA. US blacks may derive less benefit from TKA than whites as measured by HRQOL, pain, function, and satisfaction. Many studies assessing predictors of patient-related TKA outcomes fail to analyze race as a variable, which limited our study. More studies assessing the effect of race and socioeconomic factors on TKA outcome are needed.

Abstract TP353: Glucose on Admission Associated With Post-stroke Outcome

Introduction: Studies suggest that an elevated inflammatory profile is associated with increased stroke incidence and worse post-stroke outcome. It is unclear if an elevated inflammatory profile on admission is a useful prognostic marker of poor outcome after stroke, a reflection of a more severe stroke, or a marker of infection or the comorbidities that caused the stroke. Hypothesis: We hypothesized that elevated acute phase reactants (APRs) are associated with poor outcome post-stroke, independent of stroke severity and infection. Methods: The study used a prospectively collected clinical database of 755 patients admitted for ischemic or hemorrhagic stroke. APRs studied included erythrocyte sedimentation rate (ESR), glucose, platelets, and white blood cell count. Outcome was assessed at discharge using a dichotomous modified Rankin Scale (mRS) score of 3-6 (poor outcome) vs. 0-2 (good outcome), and was evaluated in multivariate logistic regression. Analyses were adjusted for NIHSS, age, sex, race, hypertension, diabetes, and use of antithrombotic medication, and were further stratified by presence/ absence of diabetes, infection (via urinalysis), and by race. Results: Elevated ESR (OR: 1.16, 95% CI: 1.00-1.33) and glucose (OR: 1.04 per 10 mg/dL, 95% CI: 1.00-1.09), were each associated with poor outcome, independent of stroke severity (NIHSS). Even in non-diabetics, elevated glucose was associated with 15% non-significantly higher odds of poor outcome per 10 mg/dL (95% CI: 0.998-1.34). However, subgroup analysis of those without infection showed no association between APRs and poor outcome. In race-stratified models, glucose level was significantly associated with poor outcome in African Americans (OR: 1.13, 95% CI: 1.01-1.26), but not in other races. Conclusion: Our study shows that ESR is associated with poor outcome after stroke, independently of stroke severity, and that elevated glucose may be associated with increased odds of poor outcome in non-diabetic or African American ischemic stroke patients. Glucose and ESR may play a role in determining prognosis of stroke patients, and therefore point to a potential target for improving outcome of stroke patients.

Socioeconomic factors and self-reported health outcomes in African Americans with rheumatoid arthritis from the Southeastern United States: the contribution of childhood socioeconomic status.

BackgroundThere is abundant evidence that low socioeconomic status (SES) is associated with worse health outcomes among people with Rheumatoid Arthritis (RA); however, the influence of socioeconomic disadvantage in early life has yet to be studied within that population.MethodsData originated from the cross-sectional arm of the Consortium Evaluation of African-Americans with Rheumatoid Arthritis (CLEAR II), which recruited African-Americans with RA from six sites in the Southeastern United States. We used linear regression models to evaluate associations of parental homeownership status and educational level at participant time of birth with participant-reported fatigue (Visual Analog scale, cm), pain (Visual Analog scale, cm), disability (Health Assessment Questionnaire) and helplessness (Rheumatology Attitudes Index), independently of participant homeownership status and educational level. Models included random effects to account for intra-site correlations, and were adjusted for variables identified using backward selection, from: age, disease-duration, sex, medication use, body-mass index, smoking history.ResultsOur sample included 516 CLEAR II participants with full data on demographics and covariates. 89 % of participants were women, the mean age was 54.7 years and mean disease duration was 10.8 years. In age adjusted models, parental non-homeownership was associated with greater fatigue (β = 0.75, 95 % CI = 0.36–1.14), disability (β = 0.12, 95 % CI = 0.04–0.19) and helplessness (β = 0.12, 95 % CI = 0.03–0.21), independently of participant homeownership and education; parental education had a further small influence on self-reported fatigue (β = 0.20, 95 % CI = 0.15–0.24).ConclusionsParental homeownership, and to a small extent parental education, had modest but meaningful relationships with self-reported health among CLEAR II participants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0882-5) contains supplementary material, which is available to authorized users.

Socioeconomic factors and self-reported health outcomes in African Americans with rheumatoid arthritis from the Southeastern United States: the contribution of childhood socioeconomic status

Socioeconomic factors and self-reported health outcomes in African Americans with rheumatoid arthritis from the Southeastern United States: the contribution of childhood socioeconomic status

Evaluating the Measurement Structure of the Abbreviated HIV Stigma Scale in a Sample of African Americans Living With HIV/AIDS

Purpose: The purpose of this study was to validate the 10-item version of the HIV Stigma Scale (HSS-10) in a sample of African Americans with HIV/AIDS.Method: One hundred and ten African Americans living with HIV/AIDS were recruited from 3 case management agencies in Baton Rouge, Louisiana. Measurement structure of the HSS-10 was evaluated using exploratory and confirmatory factor analysis.Results: Factor analysis results support a 2-factor factorial structure for the HSS-10 (social stigma and self-stigma). The HSS-10 demonstrates good reliability and factorial validity, and it correlates moderately with related constructs in the expected directions.Conclusion: HSS-10 is a brief, reliable, and valid instrument for assessing HIV stigma and can be used as a clinical rehabilitation and research tool to assess the contribution of stigma as a major cause of health disparities and outcomes in African Americans living with HIV/AIDS.

Circulating Procollagen Type III N-Terminal Peptide and Mortality Risk in African Americans With Heart Failure

BackgroundProcollagen type III N-terminal peptide (PIIINP) is a biomarker of cardiac fibrosis that is associated with heart failure prognosis in whites. Its prognostic significance in African Americans is unknown. We sought to determine whether PIIINP is associated with outcomes in African Americans with heart failure. Methods and ResultsBlood was collected from 138 African Americans with heart failure for determining PIIINP and genetic ancestry, and patients were followed prospectively for death or hospitalization for heart failure. PIIINP was inversely correlated with West African ancestry (R2 = 0.061; P = .010). PIIINP > 4.88 ng/mL was associated with all-cause mortality on univariate (hazard ratio [HR] 4.9, 95% confidence interval [CI] 2.2–11.0; P < .001) and multivariate (HR 5.8; 95% CI 1.9–17.3; P = .002) analyses over a median follow-up period of 3 years. We also observed an increased risk for the combined outcome of all-cause mortality or hospitalization for heart failure with PIIINP > 4.88 ng/mL on univariate (HR 2.6, 95% CI 1.6–5.0; P < .001) and multivariate (HR 2.4, 95% CI 1.2–4.7; P = .016) analyses. ConclusionsHigh circulating PIIINP is associated with poor outcomes in African Americans with chronic heart failure, suggesting that PIIINP may be useful in identifying African Americans who may benefit from additional therapy to combat fibrosis as a means of improving prognosis.

Comparison of Characteristics of Colorectal Cancer Patients and Outcomes in African Americans Versus Caucasians in a Veteranʼs Affairs Medical Center

Introduction: Colorectal cancer (CRC) is the third leading cause of mortality due to cancer in the United States. Compared to Caucasians, African American men have incidence and mortality rates 25% and 50% higher respectively from CRC as well as lower CRC screening uptake. Poverty and health insurance status remains a key determinant of CRC screening uptake. In this study, we compared the characteristics of CRC patients as well as their outcomes in African Americans vs. Caucasians in a health care system that affords similar access to health care among the Veterans. Methods: We updated the records of male patients diagnosed with colorectal cancer between 2003 and 2012 at a VA medical center for demographics including race, stage, reason for colonoscopy, treatment modalities and survival. Statistical analysis was performed using SPSS v22. Results: We analyzed 263 men. 108 (39.0%) patients were African Americans (AA) and 155 (61.0%) were Caucasians in this study. Median age was 69 (43-89) years among African Americans and 70 (44-92) in Caucasians. 29 (26.9%) AA patients were diagnosed by screening colonoscopy, 26 (24.1%) diagnosed by asymptomatic anemia and 53 (49.1%) diagnosed by symptoms. 40 (25.5%) were diagnosed by screening colonoscopy, 32 (20.6%) by asymptomatic anemia and 83 (53.5%) by symptoms. On univariate analysis, there was no statistically significant difference in the distribution by stage of colorectal cancer presentation between the two racial groups (p=0.126). There was also no significant difference in patterns of treatment with chemotherapy and surgery at different stages in African Americans vs. Caucasians. The 5 year overall survival rate in African Americans was 52.6% compared to 54.5% in Caucasians, 10 year overall survival rate was 33.2% vs. 34.3% in African American and Caucasians respectively. Conclusion: Racial disparities are well known to exist in the diagnosis and management of colorectal cancer. In our VA health care system, the 5 and 10 year survival among AA compared with Caucasians were found to be similar. This suggests eliminating financial barriers to health care might be a key target in addressing colorectal cancer racial disparities. Further studies are needed.Table 1: Characteristics of Colorectal Cancer Patients in African Americans vs. Caucasians in a Veteran's Affairs Medical CenterTable 2: Outcomes of Colorectal Cancer Patients in African Americans vs. Caucasians in a Veteran's Affairs Medical Center

Improving breast cancer services for African-American women living in St. Louis.

A mixed methods, community-based research study was conducted to understand how provider-level factors contribute to the African-American and white disparity in breast cancer mortality in a lower socioeconomic status area of North St. Louis. This study used mixed methods including: (1) secondary analysis of Missouri Cancer Registry data on all 885 African-American women diagnosed with breast cancer from 2000 to 2008 while living in the geographic area of focus; (2) qualitative interviews with a subset of these women; (3) analysis of data from electronic medical records of the women interviewed; and (4) focus group interviews with community residents, patient navigators, and other health care professionals. 565 women diagnosed with breast cancer from 2000 to 2008 in the geographic area were alive at the time of secondary data analysis; we interviewed (n = 96; 17 %) of these women. Provider-level obstacles to completion of prescribed treatment included fragmented navigation (separate navigators at Federally Qualified Health Centers, surgical oncology, and medical oncology, and no navigation services in surgical oncology). Perhaps related to the latter, women described radiation as optional, often in the same words as they described breast reconstruction. Discontinuous and fragmented patient navigation leads to failure to associate radiation therapy with vital treatment recommendations. Better integrated navigation that continues throughout treatment will increase treatment completion with the potential to improve outcomes in African Americans and decrease the disparity in mortality.

Ethnic group differences in racial identity attitudes, perceived discrimination and mental health outcomes in African American, Black Caribbean and Latino Caribbean college students

The increasing presence of Black Caribbean and Latino Caribbean college students in higher education settings requires helping professionals to more clearly understand their unique racial identity developmental needs and experiences with discrimination in order to fortify their academic endeavors and contribute to their success. A series of 3 × 2 ANOVAs and MANOVAS were conducted to examine ethnic group differences in racial identity attitudes, perceived racial discrimination and mental health outcomes in 159 African American, Black Caribbean and Latino Caribbean college students in an urban college setting in the Northeast USA. Results indicated that dissonance and immersion racial identity status attitudes were significantly linked to perceived racial discrimination and depression for all participants. Findings also showed a main interaction effect between ethnicity and racial identity conformity attitudes and mental health outcomes with high conformity linked to increased perceived stress for Latino Ca...

Comparative Efficacy of Cardiac Resynchronization Therapy in Africans Americans Compared With European Americans

Race has seldomly been reported in the major clinical trials of cardiac resynchronization therapy (CRT). When described, African Americans (AAs) were substantially under-represented. This study sought to compare reverse ventricular remodeling and long-term outcomes in AAs versus European Americans (EAs) with advanced heart failure who underwent CRT. We extracted demographic (including race), clinical, and echocardiographic data on patients with advanced heart failure who underwent CRT with a left ventricular ejection fraction (LVEF) ≤35% and a QRS duration ≥120ms. Long-term outcomes were compared between AAs and EAs. In patients in whom follow-up echocardiograms were available, improvement in LVEF (defined as an absolute improvement ≥5%) was compared between races. From a cohort of 662 patients, there were 88 AAs and 574 EAs. At a mean follow-up of 5.0 ± 2.5years, survival rate free of left ventricular assist device (LVAD) and heart transplant was 54.5% for AAs and 53.8% for EAs (log-rank p= 0.997). Inmultivariate analysis, there was no difference in survival free of heart transplant or LVAD based on race (hazard ratio 1.1 [0.74 to 1.56], p= 0.72, EAs race as referent); 424 patients had a follow-up echocardiogram (55.4% EAs and 64.7% AAs). In multivariate analysis, there was no difference in the incidence of response based on race (1.1 [0.6 to 2.1, p= 0.80], EAs as referent). AAs derive similar benefits with CRT compared with EAs in terms of improvement in LVEF and long-term survival free of LVAD and heart transplant.

Intervention to reduce racial treatment disparities in early stage non-small cell lung cancer (NSCLC).

e17597 Background: Racial differences in the treatment of non-small lung cancer (NSCLC) continue to exist leading to poorer outcomes in African-Americans (AA) compared to Caucasians (C). Our previo...

Lasting Effects? Hiring Through Referrals and the Post-Entry Career Outcomes of African Americans and Women

The authors examine the effects of referral-based hiring on the number of promotions employees receive after entering organizations and the differences in this effect across demographic groups using a two-study multi-method approach. The first study uses data collected from a single organization on approximately 16,000 employees hired over an eleven-year period, while a second study uses data collected from two experiments. The authors theorize that referral-based hiring will disproportionately increase African American’s and women’s number of promotions because it legitimates otherwise traditionally illegitimate employees within organizations. Consistent with this expectation, the authors find evidence that referral-based hiring has a positive effect on promotions for African Americans compared to Caucasians but no disparate effect on the promotions of women compared to men in the first study. In the second study, and in line with their theorizing, they find evidence that the positive benefits of referrals that accrue to African Americans stem from legitimation benefits that affect careers.