Racial Differences In Risk Factors Research Articles

Racial Differences in Tendon Rupture Incidence

Despite some anecdotal evidence, the racial differences in tendon injuries have received little attention in the literature. We sought to determine the effect of race on major tendon injuries. A search was performed according to the International Classification of Diseases, Ninth Revision, Clinical Modification code 727.65 (rupture of quadriceps tendon), 727.66 (rupture of patellar tendon), and 727.67 (rupture of Achilles tendon) using the U. S. Defense Medical Epidemiology Database (DMED). Multivariate poisson regression was used to estimate the rate of major tendon rupture per 1000 person-years, while controlling for differences in gender, service, rank, and age for each code. We computed rate ratios and 95% confidence intervals using whites as the referent category. The adjusted rate ratio for black service members when compared to white service members was 2.89 (95% CI 2.42, 3.44) for quadriceps tendon tears, 4.52 (95% CI 3.94, 5.19) for patellar tendon tears, and 3.58 (95% CI 3.31, 3.88) for Achilles tendon tears. There appears to be a significant relative predisposition toward lower-extremity major tendon rupture in black U. S. service members when compared to white service members. Investigation of the racial differences in risk factors is warranted.

Association between race and hot flashes in midlife women

Objective Studies suggest that African American women may have a greater risk of hot flashes compared to Caucasian women, but the reasons for this are unknown. This study tested the hypothesis that African American women have an increased risk of hot flashes due to racial differences in risk factors for hot flashes, including high body mass index (BMI) and lower estrogen levels. Methods A population-based study was conducted among women aged 45–54 years. Participants were divided into women who reported ever experiencing hot flashes ( n = 356) and women who reported never experiencing hot flashes ( n = 257). Participants provided a blood sample for hormone assays, were weighed and measured, and completed a questionnaire. Results Among peri-menopausal women, African American women were more likely than Caucasian women to report any hot flashes (RR = 2.08), severe hot flashes (RR = 2.19), and hot flashes for more than 5 years (RR = 1.61). The risk ratios for the associations between race and the hot flash outcomes were attenuated after controlling for other important hot flash risk factors (i.e. obesity and low estrogen levels). Conclusions African American women have an increased risk of hot flashes compared to Caucasian women due to racial differences in a number of risk factors for hot flashes, including advanced age, obesity, current smoking, less than 12 drinks in the past year, and lower estrogen levels.

ETHNIC BACKGROUND HAS MINIMAL IMPACT ON THE ETIOLOGY OF NEPHROLITHIASIS

Nephrolithiasis disproportionately affects white patients. However, recent studies propose an increase in the incidence of stone disease in nonwhite populations. We compared the metabolic risk factors of ethnically disparate stone formers from the same geographic region. A retrospective review of 1,141 patients identified 98 (9%) nonwhite stone formers. Of these individuals 60 underwent a comprehensive metabolic evaluation, comprising 44 black, 8 Asian and 8 Hispanic patients. A similar sex and age matched group of 66 white stone forming patients were also identified for comparative analysis. Stone analyses were recorded when available. Urinary metabolic abnormalities were defined as low urine volume-urine volume less than 2,000 cc, gouty diathesis-pH 5.5 or less (normal level 5.5 to 6.5), hypercalciuria-calcium greater than 200 mg, hyperoxaluria-oxalate greater than 45 mg, hyperuricosuria-uric acid greater than 600 mg, hypocitraturia-citrate less than 600 mg and purine gluttony-sulfate greater than 20 mg. The incidence of metabolic abnormalities was surprisingly similar between the white and nonwhite stone formers. Whites have a higher prevalence of hypercalciuria compared with nonwhites (67% vs 25%, respectively, p <0.01). This comparison persisted when the white group was compared with individual ethnic groups (25% in each group). Whites also displayed a higher mean urinary calcium level (233 mg) than their nonwhite counterparts overall (146 mg), specifically with respect to blacks (146 mg, p <0.01). Asians had higher urine volumes with respect to whites and blacks (p <0.01) and, therefore, a decreased prevalence of low urine volumes (37.5% vs 74.2% and 79.5%, respectively). Hypocitraturia, hyperuricosuria, hyperoxaluria, gouty diathesis and high sulfate levels were equally represented among all ethnic groups. Although there appears to be a predominance of stone disease among whites, all racial groups demonstrated a remarkable similarity in the incidence of underlying metabolic abnormalities. These results suggest that dietary and environmental factors may be as important as ethnicity in the etiology of stone disease.

1383 Racial differences in risk factors and outcome in Intracranial Atherosclerotic Arterial Stenosis

1383 Racial differences in risk factors and outcome in Intracranial Atherosclerotic Arterial Stenosis

Race as a predictor of urinary incontinence and pelvic organ prolapse

Objective: The purpose of this study was to assess the effect of race on the results of a standardized evaluation of urinary incontinence and prolapse in African Americans and Caucasians. Study Design: This was an analysis of 183 African Americans and 132 Caucasians referred consecutively for symptoms associated with urinary incontinence, pelvic organ prolapse, or both. Results: Genuine stress incontinence, detrusor instability, mixed incontinence, or other condition was diagnosed in 22%, 30%, 16%, and 32% of the African-American subjects, respectively, compared with 46%, 13%, 11%, and 31% of the Caucasian subjects (P =.001). There was no significant racial difference in the presence or severity of pelvic organ prolapse. With the use of stepwise logistic regression to compare risk factors for incontinence, Caucasian race was the most significant predictor of genuine stress incontinence (odds ratio 2.21; 95% confidence interval 1.31-3.73), and African-American race was the only significant predictor of detrusor instability (odds ratio 2.6; 95% confidence interval 1.45-4.80). Conclusion: Risk factors for and conditions of urinary incontinence differed significantly between African-American and Caucasian women in this population. Racial differences in risk factors and in prevalence of incontinence subtypes may have importance for the diagnosis and prevention of urinary incontinence. (Am J Obstet Gynecol 2001;185:116-120.)

Racial differences in risk factors for delinquency and substance use among adolescents

Risk factors for delinquency and substance use were used to explore racial differences in a sample of 567 adolescents. Factors used in this study included beliefs, peer and sibling influences, school attachment and commitment, family relationships, and academic and social skills. Data from surveys administered at ages 12 and 13 were used to predict delinquent and substance-using behaviors reported at ages 15 and 16. Multiple-group longitudinal analyses were conducted to test models in explaining race differences. Patterns and paths of the risk factors demonstrated a similarity across both substance use and delinquency for both groups. Some different paths were detected in the substance-use model across groups. Intervention implications of these findings are discussed. Key words: adolescents; delinquency; racial differences; risk factors; substance use Research has identified interpersonal and contextual risk factors that are predictive of increased probabilities of adolescent delinquency and substance use (Farrington & West, 1993; Hawkins, Catalano, & Miller, 1992; Resnicow, Ross-Gaddy, & Vaughan, 1995; Stouthamer-Loeber, Loeber, & Farrington, 1993; Williams, 1994). The level and amount of exposure to risk factors are hypothesized to lead youths on a pathway for involvement in problem behaviors (Barnes & Welte, 1986; Carpenter, Lyons, & Miller, 1985; Maddahian, Newcomb, & Bentler, 1986). Interpersonal risk factors that are influential in shaping behavior and setting values often are found in an adolescent's environment (Hawkins, Catalano, & Miller, 1992; Newcomb, Maddahian, & Bentler, 1986). Such risk factors include favorable attitudes toward problem behaviors, association with antisocial peers and siblings, low bonding and low commitment to school, and academic failure (Brook, Brook, Gordon, Whiteman, & Cohen, 1990; Catalano & Hawkins, 1996; Hawkins, Catalano, & Miller, 1992). Researchers also have investigated the effects of positive influences that inhibit the onset of or modify problem behaviors (Farrington & West, 1993; Rutter, 1985, 1990; Stouthamer-Loeber et al., 1993; Werner, 1989). Protective factors, or buffers, are hypothesized to reduce the influence of risk factors on behavior, thus helping reduce involvement in delinquency and substance use (Hawkins, Catalano, & Miller, 1992). Intervention and prevention strategies can seek to address risk by enhancing positive influences. Few studies have explored racial differences in risk factors either cross-sectionally or longitudinally. However, earlier research has shown that the constructs of peer influence, school, and family have components that distinguish African American youths from white youths (Maguin & Loeber, 1996; Peterson, Hawkins, Abbott, & Catalano, 1995; Wallace & Bachman, 1991; Williams, 1994). For example, earlier studies have found that peer relationships are more important for white youths in influencing alcohol and or drug use and delinquent behavior (Brannock, Schandler, & Oncley, 1990; Matsueda & Heimer, 1987), that racial differences in academic performance predict delinquency (Maguin & Loeber, 1996), and that the number of siblings involved in problem behaviors and parental norms regarding problem behaviors differ across racial groups (Brook, Gordon, Whiteman, & Brook, 1988; Peterson et al., 1995). The study discussed in this article investigated racial differences in risk Factors of delinquency and substance use, incorporating theoretical concepts from social bonding, social learning, and differential association theories. Social bonding theory states that lack of bonding to prosocial individuals predicts deviant behavior. Social bonding theory proposes four constructs of bonding to others: attachment, commitment, involvement, and beliefs that control the individual in the direction of conformity. This theory postulates that the stronger the bonds the more control, the weaker the bonds the higher probability of antisocial behavior (Agnew, 1985, 1993; Hirschi, 1969). …

Racial Disparities in CHD Mortality from 1968–1992 in the State Economic Areas Surrounding the ARIC Study Communities

PURPOSE: This study examined racial variations in CHD (coronary heart disease) mortality rates (1968–1992) of residents aged 35–84 in the state economic areas (SEAs) surrounding the ARIC (Atherosclerosis Risk in Communities) study. The quarter century of CHD mortality rates are discussed in relation to racial and gender differences in baseline risk factors measured in the ARIC cohort and to the incidence of hospitalized myocardial infarction and case fatality rates obtained from the community surveillance component of the ARIC study between 1987 and 1994, inclusive. METHODS: Five-year average annual, gender- and age-specific CHD mortality rates were compared across race groups, based on National Vital Statistics data for state economic areas. RESULTS: Five-year average annual CHD mortality declined 2.6% for white men and women and 1.6% and 2.2% for black men and women, respectively. The black-white mortality rate ratio increased over time for men and women. The black-white mortality age crossover (higher black than white mortality in young men, lower black than white mortality at older ages) had disappeared by the end of the observation. CHD mortality was markedly greater in black than white women at all ages and time periods. The black disadvantage in CHD mortality was increasingly greater in the ARIC SEAs than in the United States as a whole. CONCLUSIONS: Persistent and increasing racial disparities in CHD mortality occurred in the ARIC SEAs concurrently with racial differences in risk factors, the incidence of myocardial infarction, and case fatality rates.